Table 3.

Cautions, contraindications, and compelling considerations for major classes of antihypertensive drugs^*

Class of drug	Cancer-specific cautions or reasons to avoid	Basis for preferred selection	General cautions and contraindications
Angiotensin-converting enzyme inhibitors	Coadministration/titration with renal clearance–dependent agents (eg, cisplatin and pemetrexed); hyperkalemia	Left ventricular systolic dysfunction; diabetic nephropathy	Renovascular disease; peripheral vascular disease; renal impairment
Angiotensin II receptor blockers	Coadministration/titration with renal clearance–dependent agents (eg, cisplatin and pemetrexed); hyperkalemia	Intolerance of other agents, especially ACE inhibitors; left ventricular systolic dysfunction; diabetic nephropathy	Renovascular disease; peripheral vascular disease; renal impairment
Beta blockers	Asthenia; malaise; fatigue; QT interval prolonging drugs	Angina; history of myocardial infarction; anxiety	Bradycardia/heart block; diabetes (risk for hypoglycemia); asthma/chronic obstructive pulmonary disease (wheezing); decompensated heart failure
Calcium channel blockers (eg, dihydropyridines)	Lower extremity swelling	Elderly patients; isolated systolic hypertension	Preexisting edema; slow onset of action
Thiazide diuretics	Gout; hypercalcemia; hypokalemia; young patients (age ≤45 y); QT interval prolonging drugs	Elderly patients; isolated systolic hypertension; secondary stroke prevention; typically least expensive	Gout; documented sulfa allergy

^*Adapted, with permission, from Mancia et al. (33). Diltiazem and verapamil are inhibitors of CYP3A4, an important enzyme in the metabolism of sunitinib and sorafenib. Although specific drug–drug interactions are undocumented, as general guidance, the other agent classes might be used with a greater potential safety margin.