1. 2017 ACC/AHA High Blood Pressure Clinical Practice Guideline에서 권고하는 initial medications은 thiazide diuretics, CCBs, ACE/ARB가 있습니다. 캐나다 가이드라인에서는 compelling indications이 없는 diastolic HTN의 경우 thiazide/thiazide-like diuretics (with longer-acting diuretics preferred), b-blockers, ACE inhibitors, ARBs, long-acting CCBs를 권고하듯이 b-blockers가 포함되어 있습니다. 다만 60세 이상에서는 권고되지 않으며(Not recommended : b-blockers in those 60 years of age or older) isolated systolic hypertension에서는 thiazide/thiazide-like diuretics, ARBs, long-acting dihydropyridine CCBs처럼 b-blockers가 포함되어 있지 않습니다.
2. Diabetes mellitus not included in the above category
(microalbuminuria, renal disease, cardiovascular disease, additional cardiovascular risk factors가 없는 경우)
: ACE inhibitors, ARBs, dihydropyridine CCBs, thiazide/ thiazide-like diuretics 모두 ok
위 질환들이 있는 DM의 경우는 ACE 또는 ARB
3. Left ventricular hypertrophy
: ACE inhibitor, ARB, long-acting CCB, thiazide/thiazide-like diuretics
4. Past stroke or TIA
: ACE inhibitor and a thiazide/thiazidelike diuretic combination
5. Recent myocardial infarction과 heart failure
: 여기서는 ARB보다는 ACEI가 선호되고 ARB는 ACE inhibitor-intolerant한 경우에 사용
* ACEI 또는 ARB를 권고하는 것과 ACEI를 우선 권고하되 ACEI에 intolerant한 경우에 ARB를 권고하는 것은 다릅니다.
6. Nondiabetic chronic kidney disease with proteinuria
: ACE inhibitors (ARBs if ACE inhibitor-intolerant) if there is proteinuria.
Diuretics as additive therapy
7. Renovascular disease
: Does not affect initial treatment recommendations.
8. Peripheral arterial disease
: Does not affect initial treatment recommendations.
: Avoid b-blockers with severe disease.
