ARBs Azilsartan 40 80 1 Do not use in combination with ACE inhibitors or direct renin inhibitor. There is an increased risk of hyperkalemia in CKD or in those on K+ supplements or K+ -sparing drugs. There is a risk of acute renal failure in patients with severe bilateral renal artery stenosis. Do not use if patient has history of angioedema with ARBs. Patients with a history of angioedema with an ACE inhibitor can receive an ARB beginning 6 weeks after ACE inhibitor is discontinued. Avoid in pregnancy. CCB dihydropyridines Amlodipine 2.5 10 1 Avoid use in patients with HFrEF; amlodipine or felodipine may be used if required. They are associated with dose-related pedal edema, which is more common in women than men. CCB nondihydropyridines Diltiazem ER 120 360 1 Avoid routine use with beta blockers because of increased risk of bradycardia and heart block. Do not use in patients with HFrEF. There are drug interactions with diltiazem and verapamil (CYP3A4 major substrate and moderate inhibitor). Verapamil-delayed onset ER evening) Secondary agents Diuretics loop Bumetanide 0.5 2 2 These are preferred diuretics in patients with symptomatic HF. They are preferred over thiazides in patients with moderate-to-severe CKD (eg, GFR <30 mL/min). Diuretics potassium sparing Amiloride 5 10 1 or 2 These are monotherapy agents and minimally effective antihypertensive agents. Combination therapy of potassium-sparing diuretic with a thiazide can be considered in patients with hypokalemia on thiazide monotherapy. Avoid in patients with significant CKD (eg, GFR <45 mL/min). (Continued) Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e45 Diuretics aldosterone antagonists Eplerenone 50 100 1 or 2 These are preferred agents in primary aldosteronism and resistant hypertension. Spironolactone is associated with greater risk of gynecomastia and impotence as compared with eplerenone. This is common add-on therapy in resistant hypertension. 