Table 7. Indications and contra-indications for the major classes of antihypertensive drugs. Adapted from the ESC/ESH guidelines⁹.

		Contra-indications
Class	Conditions favouring the use	Compelling	Possible
Diuretics (thiazide; thiazide-like)	• Heart failure( HF)	• Gout	• Pregnancy
	• Elderly hypertensives		• β-blockers (especially atenolol)
	• Isolated systolic HTN (ISH)
	• Hypertensives of African origin
Diuretics (loop)	• Renal insufficiency		• Pregnancy
	• HF
Diuretics (anti-aldosterone)	• HF	• Renal failure
	• Post-myocardial infarction	• Hyperkalaemia
	• Resistant hypertension
CCB (dihydropyridine)	• Elderly patients		• Tachyarrhythmias
	• ISH		• HF especially with reduced ejection fraction
	• Angina pectoris
	• Peripheral vascular disease
	• Carotid atherosclerosis
	• Pregnancy
CCB non-dihydropyridine (verapamil, diltiazem)	• Angina pectoris	• AV block (grade 2 or 3)	• Constipation (verapamil)
	• Carotid atherosclerosis	• HF
	• Supraventricular tachycardia
ACEI	• HF	• Pregnancy
	• LV dysfunction	• Hyperkalaemia
	• Post-myocardial infarction	• Bilateral renal artery stenosis
	• Non-diabetic nephropathy	• Angioneurotic oedema (more common in blacks than in Caucasians)
	• Type 1 diabetic nephropathy
	• Prevention of diabetic microalbuminuria
	• Proteinuria
ARB	• Type 2 diabetic nephropathy	• Pregnancy
	• Type 2 diabetic microalbuminuria	• Hyperkalaemia
	• Proteinuria	• Bilateral renal artery stenosis
	• LVH
	• ACEI cough or intolerance
β-blockers	• Angina pectoris	• Asthma	• Peripheral vascular disease
	• Post-myocardial infarction	• Chronic obstructive pulmonary disease	• Bradycardia
	• HF (carvedilol, metoprololol, bisoprolol, nebivolol only)	• AV block (grade 2 or 3)	• Glucose intolerance
	• Tachyarrhythmias	• Pregnancy (atenolol)	• Metabolic syndrome
			• Athletes and physically active patients
			• Non-dihydropyridine CCBs (verapamil, diltiazem)