now that you know the key players when it comes to medications how do you decide which one to use as a first-line therapy for your patient well all the possible options are way more than what we could pack into this course but let's look at some general guidelines based on some common patient characteristics and comorbidities these guidelines are meant to help you navigate the initial management of a patient with hypertension when determining which classes or specific drugs to prescribe always consider your patient's unique situation and history for the general population your best first line agents are usually thiazides calcium channel blockers ace inhibitors or arbs thiazides are often the first choice and there's evidence that they may be better at preventing heart failure than calcium channel blockers for patients who have maintained good lifestyle choices and significantly reduce their sodium intake but still require medication there's evidence that they may respond better to ace inhibitors or arbs but ultimately your choice will depend on your patient's history and clinical situation beta blockers are no longer a first choice for the general population for patients with diabetes all your first line options will be the same as for the general population however if your patient has albuminuria you may consider starting with an ace inhibitor or arp since these drugs have been shown to slow progression of albuminuria and help preserve kidney function similarly for patients with chronic kidney disease ace inhibitors or arps are going to be your first line therapy especially if the patient has albuminuria for black patients a thiazide or a calcium channel blocker should be your first line therapy options studies have shown that ace inhibitors and arbs are less effective at preventing stroke in black patients as compared to thiazides or calcium channel blockers if you're starting two agents it's reasonable to choose an ace inhibitor or arm along with a thiazide or calcium channel blocker but if you have to choose only one best to stay away from the ras inhibitors this is true even for patients with diabetes however for black patients with diabetic nephropathy you'll still get the best response by using an ace inhibitor or arp first the treatment of hypertension during pregnancy is outside the scope of this course but for patients who plan to become pregnant your choices are more limited your best bets are usually a calcium channel blocker like nephetipine or a beta blocker such as libido lol methyl dopa as an alpha 2 agonist is also a safe first line choice you'll want to avoid ace inhibitors and arbs in patients who may become pregnant as these can harm the fetus for patients with a recent myocardial infarction or heart failure this is where the beta blocker will be our first choice followed by an ace inhibitor or arp and lastly for patients with stable coronary artery disease we may choose an ace inhibitor or arp followed by a beta blocker or calcium channel blocker what about sex differences as it turns out other than pregnancy-related considerations there's no evidence that anti-hypertensive treatments or blood pressure targets should be different between males and females that said some studies suggest that side effects of antihypertensive therapy may be more common in women than in men so that might be something to watch out for so i hope you liked this video absolutely make sure to check out the course this video was taken from and to register for free trial account which will give you access to selected chapters of the course if you want to learn how medmastery can help you become a great clinician make sure to watch the about mastery video so thanks for watching and i hope to see you again soon