Hypertension and Dyslipidemia
First Line Drugs
- BENAZEPRIL (C09AA07)
- CILAZAPRIL (C09AA08)
- ACEBUTOLOL (C07AB04)
Second Line Drugs
- HYDROCHLOROTHIAZIDE (C03AA03)
- PROPRANOLOL (C07AA05)
- PRAZOSIN (C02CA01)
For Pregnant Women, Suggest
- FELODIPINE (C08CA02)
- METHYLDOPA (RACEMIC) (C02AB02)
1. ACE inhibitors
benazepril 10-40 mg, once daily $0.68-1.56/day
or cilazapril 2.5-10 mg, once daily $0.68-1.58/day
or ramipril 2.5-10 mg, once daily $0.75-0.95/day
2. Beta-blockers (with partial agonist activity)
acebutolol 100-600 mg, bid $0.35-2.39/day
or oxprenolol 20-160 mg, tid $0.43-2.35/day
or pindolol 5-30 mg, bid $0.46-2.33/day
1. Drugs that may affect lipid levels adversely, but be beneficial in terms of cardiovascular morbidity and mortality.
i. Low-dose thiazide and thiazide-like diuretics
hydrochlorothiazide 12.5-25 mg once daily in am $0.01/day
or chlorthalidone 12.5-25 mg once daily in am $0.01/day
or metolazone 2.5 mg once daily in am $0.15/day
ii. Beta-blockers without partial agonist activity
propranolol 40-160 mg, bid $0.07-0.23/day
or nadolol 20-80 mg, once daily $0.12-0.45/day
or metoprolol 25-100 mg, bid $0.12-0.45/day
2. Drugs that do not adversely affect lipid levels, but have not demonstrated positive clinical outcomes in terms of cardiovascular morbidity and mortality.
prazosin 0.5-10 mg, bid $0.16-1.21/day
or terazosin 1-20 mg, once daily $0.55-2.80/day
or doxazosin 1-16 mg, once daily $0.55-3.43/day
ii. Calcium channel blockers
felodipine 5-20 mg, once daily $0.66-1.98/day
or verapamil 80-160 mg, tid $0.82-1.64/day
or diltiazem 30-60 mg, qid $0.83-1.45/day
iii. Centrally acting
methyldopa 250-500 mg bid to tid $0.12-0.35/day
-The ACE inhibitors and beta-blockers with partial agonist activity are recommended as drugs of choice based on expert opinion. Neither group has been shown to reduce cardiovascular morbidity and mortality in patients with hypertension.
-In treating patients with hypertension and dyslipidemia, prescribers have to weigh the risks and benefits of using drugs with proven favourable clinical outcomes in terms of cardiovascular morbidity and mortality versus drugs that do not adversely affect lipid levels.
-In patients who have not had a myocardial infarction, use beta-blockers with partial agonist activity as they do not interfere with lipid metabolism. In patients who have had a myocardial infarction, use beta-blockers without partial agonist activity as health outcomes are better with this group of drugs.
-Avoid high-dose thiazides.