Evidence-based Drugs for Hypertensive Adults with Specific Compelling Indications

JNC 7 made specific recommendations for blood pressure treatment for a wide range of other specific comorbid, compelling indications (see below).With the exception of diabetes and renal disease mentioned earlier, JNC 8 did not comment on any of these other conditions specifically and they were not part of the review. “Clinicians often provide care for patients with numerous comorbidities or other important issues related to hypertension, but the decision was made to focus on…questions considered to be relevant to most physicians and patients.” (JNC 8, 2013).

Despite not being part of the JNC 8 recommendations, most providers may continue to choose antihypertensive therapy carefully for these other specific compelling indications, either as initial or add-on therapy, as listed below:

Compelling Indications for Individual Drug Classes
Compelling Indication Initial Therapy Options
Clinical Trial Basis
Heart failure
THIAZ, BB, ACEI, ARB, ALDO ANT
ACC/AHA Heart Failure Guideline, MERIT-HF, COPERNICUS, CIBIS, SOLVD, AIRE, TRACE, ValHEFT, RALES
Postmyocardial infarction
BB, ACEI, ALDO ANT
ACC/AHA Post-MI Guideline, BHAT, SAVE, Capricorn, EPHESUS
High CAD risk
THIAZ, ACE, CCB
ALLHAT, HOPE, ANBP2, LIFE, CONVINCE
Recurrent stroke prevention/stroke prevention THIAZ, ACEI PROGRESS

CHF

Diuretics reduce heart failure; beta blockers reduce cardiac work demand; and ACE inhibitors and ARBs reduce afterload. Low dose aldosterone antagonists reduce morbidity and mortality in CHF but these agents should not be titrated to higher levels (as other BP medications) as they may be associated with negative outcomes.

<< Drug Therapy for Adults With Compelling Indications

Anti-hypertensive Medication Class Considerations >>