적응증에 따른 항고혈압 약제 선택, Considerations for individualizing antihypertensive therapy

Considerations for individualizing antihypertensive therapy

Indication	Antihypertensive drugs
Compelling indications (major improvement in outcome independent of blood pressure)
Systolic heart failure	ACE inhibitor or ARB, beta blocker, diuretic, aldosterone antagonist*
Postmyocardial infarction	ACE inhibitor, beta blocker, ARB, aldosterone antagonist
Proteinuric chronic kidney disease	ACE inhibitor or ARB
Angina pectoris	Beta blocker, calcium channel blocker
Atrial fibrillation rate control	Beta blocker, nondihydropyridine calcium channel blocker
Atrial flutter rate control	Beta blocker, nondihydropyridine calcium channel blocker
Likely to have a favorable effect on symptoms in comorbid conditions
Benign prostatic hyperplasia	Alpha blocker
Essential tremor	Beta blocker (noncardioselective)
Hyperthyroidism	Beta blocker
Migraine	Beta blocker, calcium channel blocker
Osteoporosis	Thiazide diuretic
Raynaud phenomenon	Dihydropyridine calcium channel blocker
Contraindications
Angioedema	ACE inhibitor
Bronchospastic disease	Beta blocker
Depression	Reserpine
Liver disease	Methyldopa
Pregnancy (or at risk for)	ACE inhibitor, ARB, renin inhibitor
Second- or third-degree heart block	Beta blocker, nondihydropyridine calcium channel blocker
May have adverse effect on comorbid conditions
Depression	Beta blocker, central alpha-2 agonist
Gout	Diuretic
Hyperkalemia	Aldosterone antagonist, ACE inhibitor, ARB, renin inhibitor
Hyponatremia	Thiazide diuretic
Renovascular disease	ACE inhibitor, ARB, or renin inhibitor

 

ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker.

* A benefit from an aldosterone antagonist has been demonstrated in patients with NYHA class III-IV heart failure or decreased left ventricular ejection fraction after a myocardial infarction.

Adapted from: The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. JAMA 2003; 289:2560.