Q: Describe at least three paired groups of antihypertensives that should be avoided simultaneously?
Answer: Antihypertensives are the lifelines of hemodynamics, but care should be taken when more than two antihypertensives are indicated. Following are the three classic paired groups, which should not be prescribed together.
1. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) should not simultaneously be prescribed.
2. Beta-blockers should not be combined with nondihydropyridine calcium channel blockers (i.e., diltiazem, verapamil) due to their similar negative inotropic and chronotropic effects.
3. Alpha-blockers and central adrenergic inhibitors (e.g., clonidine) should not be prescribed together. They can cause life-threatening hypotension.
#cardiology
#hemodynamic
#pharmacology
References:
1. Guerrero-García C, Rubio-Guerra AF. Combination therapy in the treatment of hypertension. Drugs Context. 2018 Jun 6;7:212531. doi: 10.7573/dic.212531. PMID: 29899755; PMCID: PMC5992964.
2. Mancia G, Rea F, Corrao G, Grassi G. Two-Drug Combinations as First-Step Antihypertensive Treatment. Circ Res. 2019 Mar 29;124(7):1113-1123. doi: 10.1161/CIRCRESAHA.118.313294. PMID: 30920930.
3. Flack JM, Sica DA, Bakris G, et al. Management of high blood pressure in Blacks: an update of the International Society on Hypertension in Blacks consensus statement. Hypertension 2010; 56:780.
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