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● If available, use drugs with proven clinical benefits, i.e. angiotensin converting enzyme inhibitors (if not tolerated replace with an angiotensin receptor blocker), calcium channel blockers (usually dihydropyridine type), beta blockers, and thiazide diuretics.
● The reduction of blood pressure and of cardiovascular morbidity and mortality is similar for these so called 1st line antihypertensives. Therefore in most cases you decide based on the patient's preference in conjunction with his/her co-morbidities.
Angiotensin converting enzyme inhibitors are drugs of choice in patients with diabetes mellitus, with diabetic nephropaty, post-myocardial infarction patients, and in those with a congestive heart failure. On the other hand, they are contra-indicated in cases of renal failure, renal artery stenosis, and pregnancy. Due to a diabetogenic effect, thiazide diuretics and beta blockers should be avoided in obese, pre- or manifest diabetic patients. Such "pros" Table 15 and "contras" Table 14 exist for all other 1st line antihypertensives and they are sometimes substance-specific.