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BNSSG Adult Joint Formulary
2.4 Blood pressure conditions
Last edited: 19-04-2024
First line drugs |
Second line drugs |
Specialist drugs |
Secondary care drugs |
Angiotensin Converting Enzyme (ACE) Inhibitors
MHRA guidance for recommendations on use during pregnancy
Recommended: (TLS Green)
Ramipril
Lisinopril
Alternative: (TLS Blue)
Perindopril erbumine
Stroke
Recommended: (TLS Green)
Ramipril
Perindopril erbumine
Angiotensin-II Receptor Antagonists
MHRA guidance for recommendations on use during pregnancy.
Recommended: (TLS Green)
Candesartan
Losartan
Alternatives: (TLS Blue)
Irbesartan
Telmisartan
Antihypertensives (Centrally acting)
Specific indications: (TLS Blue)
Methyldopa
- Hypertension in pregnancy
- Treatment resistant cases
Alternatives: (TLS Blue)
Clonidine
Moxonidine
Alpha-adrenoceptor Blockers
Doxazosin (TLS Blue)
- Not including Doxazosin m/r preparation
Beta-adrenoceptor Blocking Drugs
Recommended: (TLS Green)
Atenolol
Bisoprolol
Specific indications:
Carvedilol (TLS Blue)
Esmolol (intravenous) (TLS Red)
Labetalol (intravenous) (TLS Red)
Labetalol (oral) (TLS Blue)
Metoprolol (TLS Blue)
- Renal patients and obstetrics only
Metoprolol (intravenous) (TLS Red)
- Cardiac rate control for CT coronary angiography
Nadolol (TLS Blue)
Nebivolol (TLS Blue)
- On recommendation of Cardiology specialist only
Propranolol (TLS Blue)
- Anxiety, portal hypertension and thyrotoxicosis
Bisoprolol, carvedilol and Nebivolol (mild/moderate heart failure in patients over 70) are the only beta-blockers licensed for use in heart failure. Use of these in heart failure should be initiated cautiously, titrated very slowly and adequately monitored.
Calcium-channel Blockers
For most Calcium channel blockers it is best to prescribe by brand. When patients are initiated they should be started on the brand with the lowest acquisition cost
Recommended: (TLS Green)
Amlodipine
Alternatives: (TLS Blue)
Nifedipine modified-release (Prescribe by brand) (TLS Blue)
Diltiazem modified-release (Prescribe by brand) (TLS Blue)
Lercanidipine (TLS Blue)
- For treatment of hypertension as a second line calcium channel blocker option when amlodipine is not tolerated or suitable
Felodipine modified-release (TLS Blue)
- For those who need low doses (2.5mg), unable to take amlodipine, existing patients
Verapamil modified-release
Specific indications:
Nimodipine (TLS Red)
- Subarachnoid haemorrhage only
Nicardipine (intravenous) (TLS Red)
- for acute hypertension in critical care/intensive care units where labetalol/GTN is not effective of contraindicated or most suitable.
Nifedipine capsules non modified-release (TLS Blue) - Raynaud's Phenomenon / ITU / Renal
Peripheral Vasodilators
- For use as an adjunct, or where other treatments have failed
Recommended:
Hydralazine (intravenous) (TLS Red)
Hydralazine (oral) (TLS Green)
Alternative: (TLS Blue)
Minoxidil
Renin Inhibitors
Specific indication: (TLS Red)
Aliskiren
- As a 4th/5th line treatment antihypertensive, but not for patients with significant comorbidities such as diabetes who were specifically excluded from the trials.
Benign Prostatic Hyperplasia - see section 7.1
Thiazides and Related Diuretics
Recommended: (TLS Green)
Indapamide 2.5mg tablets
- First line post-stroke and hypertension
- Not first line for heart failure
2.4.2 Hypertension associated with phaeochromocytoma
Specific indications: (TLS Red)
Phentolamine
- Management of phaeochromocytoma
Phenoxybenzamine
- Management of phaeochromocytoma
2.4.3 Hypertensive crises
Diazoxide
Sodium nitroprusside
- Hypertensive crisis (may be delays in obtaining unlicensed product)
2.4.4 Pulmonary hypertension
Specific indications: (TLS Red)
According to NHS England Policy A11/P/a Targeted Therapies for Pulmonary Hypertension Functional Class II
Sildenafil (oral & parenteral)
- Pulmonary Arterial Hypertension (PAH) - UHB only
Tadalafil (oral)
- Pulmonary Arterial Hypertension (PAH) - UHB only
Bosentan (oral)
Ambrisentan (oral)
Epoprostenol (intravenous)
Riociguat
Prostaglandins (Cardiovascular)
Iloprost (TLS Red)
2.4.5 Hypotension and shock
Sympathomimetics (vasoconstrictor)
Recommended:
Adrenaline (epinephrine) 1 in 1000 (1mg/mL) (TLS Green)
Adrenaline (epinephrine) 1 in 10,000 (100micrograms/mL) only in secondary care (TLS Red)
Ephedrine (TLS Red)
Metaraminol (TLS Red)
Noradrenaline (norepinephrine) (TLS Green)
Phenylephrine (TLS Red)
Specific indication:
Ephedrine hydrochloride tablets (unlicensed indication) (TLS Red)
- For use post spinal cord injuries
2.4.6 Other
Midodrine (TLS Red)
Midodrine (TLS Amber Specialist Initiated)
- For orthostatic hypotension/intradialytic hypotension
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