Table 4.

Compelling and possible indications and contraindications for the major classes of antihypertensive drugs (British Hypertension Society – Guidelines for Hypertension Management 1999)

Class of drug	Indication		Contraindications
	Compelling	Possible	Possible	Compelling
a-blockers	Prostatism	Dyslipidemia	Postural hypotension	Urinary incontinence
ACE inhibitors	Heart failure Left ventricular dysfunction Type I diabetic nephropathy	Chronic renal disease* Type II diabetic nephropathy	Renal impairment* Peripheral vascular disease†	Pregnancy Renovascular disease
Angiotensin II receptor antagonists	Cough induced by ACE inhibitor‡	Heart failure Intolerance of other antihypertensive drugs	Peripheral vascular disease†	Pregnancy Renovascular disease
ß-blockers	Myocardial infarction Angina	Heart failure§	Heart failure§ Dyslipidemia Peripheral vascular disease	Asthma or chronic obstructive pulmonary disease Heart block
Calcium antagonists (dihydropyridine)	Isolated systolic hypertension in elderly patients	Angina Elderly patients	-	-
Calcium antagonists (rate limiting)	Angina	Myocardial infraction	Combination with ß blockade	Heart block Heart failure
Thiazides	Elderly patients	-	Dyslipidemia	Gout

^*Angiotensin converting enzyme (ACE) inhibitors may be beneficial in chronic renal failure but should be used with caution. Close supervision and specialist advice are needed when there is established and significant renal impairment.

^†Caution with ACE inhibitors and angiotensin II receptor antagonists in peripheral vascular disease because of association with renovascular disease.

^‡If ACE inhibitor indicated.

^§â-blockers may worsen heart failure, but in specialist hands may be used to treat heart failure.