Potential advantages, disadvantages, and special clinical considerations in the older hypertensive related to the major antihypertensive classes recommended for initial treatment

Table 40.3. Potential advantages, disadvantages, and special clinical considerations in the older hypertensive related to the major antihypertensive classes recommended for initial treatment.

Antihypertensive class	Potential advantages	Potential disadvantages	Clinical situations to recommend use	Clinical situations to recommend against use, or that require monitoring
Diuretics	Benefit documented in clinical trials Produce greater reduction in SBP than DBP Inexpensive	Metabolic abnormalities Urinary incontinence	Systolic hypertension	Glucose intolerance, gout, hyperlipidemia
Calcium antagonists	Benefit documented in clinical trials Absence of CNS or metabolic effects	Peripheral edema, constipation, heart block	Systolic hypertension Coronary artery disease	Left ventricular dysfunction
β-Antagonists	Benefit documented in clinical trials	May increase peripheral vascular resistance Metabolic abnormalities CNS effects	Coronary artery disease and postmyocardial infarction	COPD, peripheral vascular disease, heart block, glucose intolerance, type 2 DM, hyperlipidemia, depression
ACE inhibitors	Absence of CNS or metabolic effects	Hyperkalemia, renal insufficiency, cough	Congestive heart failure, type 2 DM	Renal insufficiency or renal artery stenosis

SBP, systolic blood pressure; DBP, diastolic blood pressure; ACE, angiotensin-converting enzyme; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; CNS, central nervous system.