Dear Dr. Roach: With all the different medications available for high blood pressure, what factors determine the medicine a doctor will prescribe?
The first consideration is whether the person has any other medical conditions that would make a particular medication more advantageous. Someone with diabetes and protein in the urine would benefit greatly from an ACE inhibitor; a person with blockages in the arteries to the heart should be on a beta blocker; someone with migraines might benefit from a calcium channel blocker or beta blocker. When a practitioner can treat two conditions with one medication, it is usually the first choice. Similarly, if there is a condition that would make a particular antihypertensive inappropriate, the clinician avoids prescribing it. Examples include thiazide diuretics in people with gout, and beta blockers in a person with depression.
If there is no particular reason to pick a class of drug based