GoodRx for Healthcare Professionals5 Outdated High Blood Pressure Medications You Should Consider Upgrading

Modern treatment guidelines for hypertension continue to evolve, with some medications falling out of favor as first-line therapy. Current recommendations emphasize four primary medication classes while recognizing specific clinical scenarios where older agents may remain appropriate. Understanding these shifts helps optimize patient care and minimize adverse effects while maintaining effective blood pressure control.

Key Points:

• First-line antihypertensive medications now focus on four classes: thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers, based on demonstrated efficacy and safety profiles
• Beta blockers have been demoted from first-line therapy due to less favorable outcomes and side effects, but remain valuable for specific conditions including atrial fibrillation, CAD, heart failure, and pregnancy
• Loop diuretics, alpha blockers, vasodilators, and alpha-2 agonists are now considered suboptimal for primary hypertension management due to side effect profiles and availability of better alternatives
• Regular monitoring requirements vary by medication class – calcium channel blockers typically require less laboratory monitoring than ACE inhibitors, ARBs, or thiazide diuretics
• Medication selection should account for comorbidities, with ACE inhibitors offering particular benefit in diabetic patients and calcium channel blockers providing options during pregnancy

HCN Medical Memo
Although older antihypertensive medications may retain utility in specific clinical scenarios, current evidence supports prioritizing thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers as first-line therapy for most patients with hypertension.

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