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• Avoid use in patients with heart failure with reduced ejection fraction (HFrEF);
amlodipine or felodipine may be used if required.
• They are associated with dose-related pedal edema, which is more common in women
than men.
• Avoid routine use with beta blockers because of increased risk of bradycardia and
heart block.
• Do not use in patients with HFrEF.
• There are drug interactions with diltiazem and verapamil (CYP3A4 major substrate
and moderate inhibitor).
• These are preferred diuretics in patients with symptomatic HF. They are preferred
over thiazides in patients with moderate-to-severe CKD (e.g., GFR <30 mL/min).
• These are monotherapy agents and minimally effective antihypertensive agents.
• Combination therapy of potassium-sparing diuretic with a thiazide can be considered
in patients with hypokalemia on thiazide monotherapy.
• Avoid in patients with significant CKD (e.g., GFR <45 mL/min).
• These are preferred agents in primary aldosteronism and resistant hypertension.
• Spironolactone is associated with greater risk of g ynecomastia and impotence as
compared with eplerenone.
• This is common add-on therapy in resistant hypertension.
• Avoid use with K
+
supplements, other K
+
-sparing diuretics, or significant renal
dysfunction.
• Eplerenone often requires twice-daily dosing for adequate BP lowering.
• Beta blockers are not recommended as first-line agents unless the patient has IHD or
HF.
• These are preferred in patients with bronchospastic airway disease requiring a beta
blocker.
• Bisoprolol and metoprolol succinate are preferred in patients with HFrEF.
• Avoid abrupt cessation.
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