Antihypertensive Drugs for NEET PG: Classification and Drug-of-Choice Questions

Antihypertensive questions in NEET PG rarely ask you to just list a drug class — they hand you a clinical scenario (pregnancy, post-MI, a diabetic with proteinuria) and ask which class is the right call. The classification is the easy part; matching class to scenario is where marks are actually won or lost.

Classification at a Glance

Class	Examples
Thiazide diuretics	Hydrochlorothiazide
Loop diuretics	Furosemide
Potassium-sparing diuretics	Spironolactone
ACE inhibitors	Enalapril, Ramipril, Captopril
ARBs	Losartan, Telmisartan
Calcium channel blockers (dihydropyridine)	Amlodipine, Nifedipine
Calcium channel blockers (non-dihydropyridine)	Verapamil, Diltiazem
Beta blockers (cardioselective)	Atenolol, Metoprolol
Beta blockers (non-selective)	Propranolol
Combined alpha/beta blockers	Carvedilol, Labetalol
Centrally acting agents	Clonidine, Methyldopa
Direct vasodilators	Hydralazine, Minoxidil
Alpha blockers	Prazosin, Doxazosin

Drug-of-Choice Scenarios Examiners Actually Ask

• Hypertension in pregnancy: Methyldopa is the classic drug of choice, alongside Labetalol and Nifedipine in many protocols. ACE inhibitors and ARBs are contraindicated in pregnancy due to fetotoxic effects, particularly in the second and third trimesters.
• Post-myocardial infarction: Beta blockers are first-line, both for their anti-ischemic effect and their mortality benefit.
• Diabetic with proteinuria: ACE inhibitors or ARBs are preferred for their renoprotective effect, independent of their blood-pressure-lowering action.
• Hypertensive emergency: Fast-acting IV agents (such as sodium nitroprusside or labetalol) are used, distinct from the oral agents used for chronic management.

Side Effects Worth Knowing Cold

• ACE inhibitors: dry cough (from bradykinin accumulation), hyperkalemia, angioedema.
• ARBs: similar to ACE inhibitors but without the cough, since they don’t affect bradykinin metabolism the same way.
• Non-dihydropyridine CCBs (Verapamil, Diltiazem): avoid combining with beta blockers — the combination risks severe bradycardia and heart block, since both depress AV conduction.
• Thiazides: hypokalemia, hyperglycemia, hyperuricemia (can precipitate gout).

Drug-of-choice questions are exactly the kind of applied pharmacology Reflex’s daily TROCAR quiz drills, subject by subject.