| Thiazide and thiazide-like diuretics |
Hydrochlorothiazide |
25-50 |
1 |
Higher doses of thiazides and thiazide-like medications increase the diuretic effect without increasing antihypertensive action. |
| Chlorthalidone |
12.5-25 |
1 |
| Indapamide |
1.5 |
1 |
| Loop diuretics |
Furosemide |
20-240 |
1-3 |
Used in chronic renal failure (CRF), congestive heart failure (CHF), and fluid retention conditions (edema). |
| Bumetanide |
1-4 |
1-3 |
| Potassium-sparing diuretics |
Spironolactone |
25-100 |
1-2 |
May cause hyperpotassemia, particularly in CRF and when associated with ARBs or ACE inhibitors. |
| Amiloride |
2.5-5 |
1 |
Available only in combination with hydrochlorothiazide or chlorthalidone |
| Dihydropyridine calcium channel blockers (CCBs) |
Amlodipine |
2.5-10 |
1 |
Avoid use in patients with heart failure and reduced ejection fraction. May cause lower limb edema depending on dose. |
| Felodipine |
2.5-10 |
1 |
| Nifedipine |
10-60 |
1-3 |
| Nitrendipine |
10-30 |
1 |
| Manidipine |
10-30 |
1 |
| Lacidipine |
2-6 |
1 |
| Lercanidipine |
10-20 |
1 |
| Levamlodipine |
2.5-5 |
1 |
| Nondihydropyridine calcium channel blockers (CCBs) |
Verapamil |
120-360 |
1-2 |
Avoid use in patients with heart failure and reduced ejection fraction. Avoid association with beta-blockers and in patients with bradycardia. |
| Diltiazem |
80-240 |
1-2 |
| Angiotensin-converting enzyme inhibitors (ACEIs) |
Captopril |
25-150 |
2-3 |
Avoid use in women of childbearing age due to the high risk of fetal malformations and other gestational complications. Contraindicated in combination with other renin-angiotensin-aldosterone system inhibitors, except spironolactone for CHF. Risk of hyperpotassemia for patients suffering from renal failure or receiving potassium supplementation. |
| Enalapril |
5-40 |
1-2 |
| Benazepril |
10-40 |
1-2 |
| Lisinopril |
10-40 |
1 |
| Fosinopril |
10-40 |
1 |
| Ramipril |
2.5-20 |
1-2 |
| Perindopril |
2,5-10 |
1 |
|
Angiotensin II AT
1
receptor blockers (ARBs)
|
Losartan |
50-100 |
1-2 |
Same recommendations as ACEIs. |
| Valsartan |
80-320 |
1 |
| Irbesartan |
150-300 |
1 |
| Candesartan |
8-32 |
1 |
| Olmesartan |
20-40 |
1 |
| Telmisartan |
20-80 |
1 |
| Noncardioselective beta-blockers (BBs) |
Propranolol |
80-320 |
2-3 |
Avoid sudden withdraw of BBs, as it may cause reflex tachycardia and discomfort. |
| Nadolol |
40-160 |
1 |
|
| Pindolol |
10-60 |
1 |
Has intrinsic sympathomimetic activity, leading to less bradycardia. |
| Cardioselective beta-blockers |
Atenolol |
50-100 |
1-2 |
|
| Metoprolol |
50-200 |
1 |
|
| Bisoprolol |
5-20 |
1 |
|
| Nebivolol |
2.5-10 |
1 |
Vasodilatory action via nitric oxide. |
| Carvedilol |
12.5-50 |
1-2 |
Alpha-blocker effect produces less bradycardia. |
| Centrally acting sympatholytics |
Methyldopa |
500-2.000 |
2 |
|
| Clonidine |
0.2-0.9 |
2 |
Abrupt clonidine withdraw may cause rebound hypertension (hypertensive crisis) via catecholamine release at synaptic endings. |
| Rilmenidine |
1-2 |
1-2 |
|
| Alpha-blockers |
Prazosine |
1-20 |
2-3 |
Initiate with low dose before lying down since it may trigger orthostatic hypotension. Progressively increase every 2 days. Other alpha-blockers are exclusively available for benign prostate hyperplasia (tamsulosin, alfuzosin, silodosin). |
| Doxazosin |
1-16 |
1 |
| Direct-acting vasodilators |
Hydralazine |
50-200 |
2-3 |
May cause sodium and fluid retention, hypervolemia, and reflex tachycardia. Must be used in combination with loop diuretic. Lupus-like syndrome at high dose. |
| Direct renin inhibitors |
Aliskiren |
150-300 |
1 |
Same recommendations as ACEIs and ARBs. |
