Introduction
This table presents a structured review of the main pharmacological classes used in the treatment of arterial hypertension. Each group is described according to its preferred indications, contraindications, adverse effects and specific precautions, allowing a global and comparative overview of antihypertensive therapy.
Thiazide and thiazide-like diuretics
These include chlortalidone, hydrochlorothiazide, indapamide and metolazone. They are first-line drugs in many patients with hypertension, effective as monotherapy or in combination. They should be avoided in cases of active gout and used with caution in metabolic syndrome, glucose intolerance, pregnancy and hypokalaemia.
The most frequent adverse effects include hyperglycaemia, hyperuricaemia, dyslipidaemia and electrolyte disturbances such as hyponatraemia and hypokalaemia. They may also cause postural hypotension, dizziness, photosensitivity and sexual dysfunction.
Angiotensin-converting enzyme inhibitors, ACE inhibitors
Examples include captopril, enalapril, lisinopril and perindopril.
They are contraindicated in pregnancy, previous angioedema, hyperkalaemia and bilateral renal artery stenosis.
The main adverse effects include symptomatic hypotension, particularly in dehydrated patients, irritating dry cough, altered renal function, skin rash and angioedema, which is more frequent in Black patients.
Angiotensin II receptor blockers, ARBs
These include losartan, valsartan, candesartan and telmisartan.
They share many characteristics with ACE inhibitors and are a useful alternative when ACE inhibitor-induced cough occurs. However, they retain the risk of hyperkalaemia and renal impairment, and are also contraindicated in pregnancy and in bilateral renal artery stenosis.
Calcium-channel blockers
Dihydropyridines — such as amlodipine, nifedipine and lercanidipine — rarely have absolute contraindications. They may cause peripheral oedema, flushing, headache and mild gastrointestinal symptoms.
Non-dihydropyridines — verapamil and diltiazem — should be avoided in heart failure with reduced ejection fraction and when combined with beta-blockers, due to the risk of bradycardia and conduction blocks.
Loop diuretics
The most commonly used are furosemide and torasemide.
They are more effective in patients with heart failure or renal dysfunction, but require close monitoring.
Adverse effects include hyponatraemia, hypokalaemia, dehydration, ototoxicity and metabolic abnormalities such as hyperglycaemia and hyperuricaemia.
Potassium-sparing diuretics
These include spironolactone and eplerenone, useful in heart failure with reduced ejection fraction.
Contraindications include eGFR < 30 mL/min, hyperkalaemia and Addison’s disease.
The most relevant adverse effects are hyperkalaemia, gynaecomastia, menstrual disorders, muscle weakness and pruritus.
Beta-blockers
They are divided into cardioselective agents, atenolol, bisoprolol, metoprolol and nebivolol; non-selective agents, propranolol; and agents with additional alpha-blocking action, carvedilol.
They should be avoided in marked bradycardia, second- or third-degree atrioventricular block, severe asthma and decompensated heart failure.
Adverse effects include fatigue, sleep disturbances, sexual dysfunction, cold extremities and, occasionally, worsening heart failure.
Although they are not first-line drugs in isolated hypertension, they play a key role in patients with stable angina, post-myocardial infarction and stable chronic heart failure.
Conclusion
The choice of antihypertensive drug should be individualised, taking into account comorbidities, renal function, electrolytes and potential interactions.
Periodic clinical and laboratory monitoring is essential to optimise therapeutic efficacy and prevent complications.
