45
Daily frequency Comments
2 or 3 ese are associated with sodium and water retention and reflex
tachycardia and should be used with a diuretic and beta blocker.
Hydralazine is associated with a drug-induced lupus-like syndrome
at higher doses.
Minoxidil is associated with hirsutism and requires a loop diuretic.
Minoxidil can induce pericardial effusion.
1–2
1 Associated with mild-to-moderate fluid retention usually occurring
within the first 4 to 6 weeks of therapy.
Indicated as add-on therapy for patients whose BP is not adequately
controlled on other antihypertensive medications.
Avoid use in pregnancy.
5.2.4. Choice of Initial Monotherapy Versus Initial
Combination Drug Therapy
COR LOE
Recommendations
1 B-R
1. In adults with stage 2 hypertension (SBP ≥140 mm Hg
and DBP ≥90 mm Hg ), initiation of antihypertensive drug
therapy with 2 first-line agents of different classes, ideally in
a single-pill combination (SPC), is recommended to improve
BP control and adherence.
2a C-EO
2. In adults with stage 1 hypertension (SBP 130 to 139 mm Hg
and DBP 80 to 89 mm Hg ), initiation of antihypertensive
drug therapy with a single first-line antihypertensive drug is
reasonable, with dosage titration and sequential addition of
other agents as needed to achieve BP control.
3: Harm A
3. In adults with hypertension, simultaneous use of an
ACEi, ARB, and/or renin inhibitor in combination is not
recommended due to the potential for harm.
