Table 2.

Summary of Pharmacological Treatment of Hypertension in the Management of Ischemic Heart Disease.

	ACEI or ARB	Diuretic	ß-Blocker	Non-DHP CCB	DHP CCB	Nitrates	Aldosterone Antagonist	Hydralazine/ Isosorbide Dinitrate
Stable angina	1*	1†	1	2‡	2	1	2
ACS	1*	1†	1§	2‡	2	2	2‖
HF	1	1†	1¶			2	1‖	2

ACEI indicates angiotensin-converting enzyme inhibitor; ACS, acute coronary syndrome; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; DHP, dihydropyridine; HF, heart failure; 1, drug of choice; and 2, “add-on,” alternative drug, or special indications.

^*Especially if prior myocardial infarction, left ventricular systolic dysfunction, diabetes mellitus, or proteinuric chronic kidney disease is present.

^†Chlorthalidone is preferred. Loop diuretic should be used in the presence of HF (New York Heart Association class III or IV) or chronic kidney disease with glomerular filtration rate <30 mL·min⁻¹·1.73 m⁻². Caution should be exercised in HF with preserved ejection fraction.

^‡If β-blocker is contraindicated, a non-DHP CCB can be substituted, but not if left ventricular dysfunction or HF is present. Caution should be exercised if combining a non-DHP CCB with a β-blocker.

^§Esmolol (intravenous) or metoprolol or bisoprolol (oral).

^‖Spironolactone or eplerenone if left ventricular dysfunction, HF, or diabetes mellitus is present.

^¶Carvedilol, metoprolol succinate, or bisoprolol.