p.37 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

September 16, 2025 Circulation. 2025;152:e114–e218. DOI: 10.1161/CIR.0000000000001356 e150

Table 13.  FDA-Approved Drugs for Treatment of Hypertension

Class Drug Usual Dose, Range (mg/d)∗ Daily Frequency Comments Agents recommended for initial therapy Thiazide-type diuretics Chlorthalidone 12.5-25 1 Chlorthalidone has a longer half-life and is more potent than hydrochlorothiazide on a mg-to-mg basis.

Monitor for hyponatremia and hypokalemia, increased glucose, uric acid, and calcium levels. Monitor patients with history of acute gout unless patient is on uric acid-lowering therapy.

Hydrochlorothiazide 25-50 1 Indapamide 1.25-2.5 1

ACEi Benazepril 10-40 1 or 2 Do not use in combination with ARB or direct renin inhibitor.

There is an increased risk of hyperkalemia, especially in patients with 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 ACEi. Avoid use in pregnancy.

Captopril 12.5-150 2 or 3 Enalapril 5-40 1 or 2 Fosinopril 10-40 1 Lisinopril 10-40 1 Moexipril 7.5-30 1 or 2 Perindopril 4-16 1 Quinapril 10-80 1 or 2 Ramipril 2.5-20 1 or 2 Trandolapril 1-4 1

ARBs Azilsartan 40-80 1 Do not use in combination with ACEi 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 use in pregnancy.

Candesartan 8-32 1 Eprosartan 600-800 1 or 2 Irbesartan 150-300 1 Losartan 50-100 1 or 2 Olmesartan 20-40 1 Telmisartan 20-80 1 Valsartan 80-320 1

CCB—dihydropyridines Amlodipine 2.5-10 1 Associated with dose-related lower extremity edema, which is more common in women than men. Felodipine 2.5-10 1

Isradipine 5-10 2 Nicardipine SR 60-120 2 Nifedipine LA 30-90 1 Nisoldipine 17-34 1

Alternative agents CCB—nondihydropyridines Diltiazem ER 120-360 1 Avoid routine use with beta blockers because of in­ creased 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 IR 120-360 3 Verapamil SR 120-360 1 or 2 Verapamil-delayed onset ER 100-300 1 (in the evening)

Diuretics—loop Bumetanide 0.5-2 2 These are preferred diuretics in patients with symptom­ atic HF.

They are preferred over thiazide-type diuretics in patients with moderate-to-severe CKD (eg, GFR <30 mL/min). The longer-acting choice of torsemide is preferred for treatment of hypertension. A loop diuretic is an option for patients who develop thiazide-type diuretic associated hyponatremia.

Furosemide 20-80 2 Torsemide 5-10 1

(Continued )

Downloaded from http://ahajournals.org by on October 7, 2026