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• Nebivolol induces nitric oxide-induced vasodilation.
• Avoid abrupt cessation.
• Avoid in patients with reactive airways disease.
• Avoid abrupt cessation.
• Generally avoid, especially in patients with IHD or HF.
• Avoid abrupt cessation.
• Carvedilol is preferred in patients with HFrEF.
• Avoid abrupt cessation.
• Do not use in combination with ACE inhibitors or ARBs.
• Aliskiren is very long acting.
• There is an increased risk of hyperkalemia in CKD or in those on K
+
supplements or
K
+
-sparing drugs.
• Aliskiren may cause acute renal failure in patients with severe bilateral renal artery
stenosis.
• Avoid in pregnancy.
• These are associated with orthostatic hypotension, especially in older adults.
• They may be considered as second-line agent in patients with concomitant benign
prostatic hyperplasia (BPH).
• These are generally reserved as last-line because of significant CNS adverse effects,
especially in older adults.
• Avoid abrupt discontinuation of clonidine, which may induce hypertensive crisis.
Clonidine must be tapered to avoid rebound hypertension.
• These are associated with sodium and water retention and reflex tachycardia. Use with
a diuretic and beta blocker.
• Hydralazine is associated with drug-induced lupus-like syndrome at higher doses.
• Minoxidil is associated with hirsutism and requires a loop diuretic. Minoxidil can
induce pericardial effusion.
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