Hypertensive therapies recommended for treating coexisting conditions:
| Uncomplicated hypertension (any race) | Two-drug start (stage 2): ACEI/ARB + dihydropyridine CCB, ideally one pill; one-drug start: ACEI, ARB, or dihydropyridine CCB (thiazide-like diuretic is a reasonable alternative) |
| Angina | β-blockers, CCB |
| Recent myocardial infarction | β-blockers + ACEI/ARB |
| Heart failure with reduced EF | ARNI (or ACEI/ARB), β-blockers, MRA, SGLT2 inhibitor, diuretics for volume |
| Chronic kidney disease with albuminuria (including diabetic kidney disease) | ACEI/ARB |
| Diabetes mellitus without albuminuria | Same as anyone else — ACEI, ARB, dihydropyridine CCB, or thiazide-like diuretic |
| Isolated systolic HTN in older adults | Same first-line classes; start low and titrate slowly if frail |
| Osteoporosis, edema, or calcium kidney stones | Thiazide-like diuretics (chlorthalidone, indapamide) |
| BPH | α1 blockers (add-on — not first-line for hypertension alone) |
| Gout | CCB; losartan (the only ARB that lowers uric acid); avoid thiazide and loop diuretics if possible |
| Atrial fibrillation (rate control) | β-blockers or non-dihydropyridine CCB (diltiazem, verapamil) |
| Orthostatic hypotension | ACEI, ARB, or dihydropyridine CCB; avoid diuretics and α-blockers |
| Could become pregnant | Dihydropyridine CCB (nifedipine ER, amlodipine); avoid ACEI, ARB, and MRA |
Note: current guidelines no longer choose antihypertensives by race — the same approach is used for every patient.
*Adapted from the wonderful review book PANCE PREP PEARLS
