There are lots of blood pressure medication option in the ambulatory setting which begs the question: How do we select the right one?  There are lots of things to think about.  Here’s a list of four really important factors you need to consider.

1. Compelling indications.  MI, BPH, Diabetes, etc. all go into which medication you should select.
2. Allergies/intolerances: It seems stupid to mention this, but often allergy lists are inaccurate or incomplete.  Another mistake I’ve seen numerous times in practice is (non knowingly) restarting medications that have been previously tried, failed, and/or not tolerated but the documentation has not been done.  Whenever you have a patient who tells you they stopped a medication, document the reason why.  It may help prevent some future pain and suffering for our patient.
3. Strategy: Are you going to try to do multiple antihypertensives at low doses, or does the patient only want to take one with the goal of maximizing the dose. This certainly needs to be weighed with compelling indications.
4. Side effects: Does the patient already have edema?  How important is the risk of sexual dysfunction?  Potential for side effects matters to our patients, so it should matter to us!

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