Table 6 Classification of antihypertensive drug classes used in stepwise combination therapy

From: Key highlights of the Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025)

Group

Antihypertensive drugs

Details

G1

a

• Long-acting dihydropyridine calcium channel blockers (CCBs)

• Renin–angiotensin system inhibitors (ARBs, ACE inhibitors)

• Major antihypertensive drugs

• Select from Treatment STEP 1abased on the clinical condition

• Evidence supporting prevention of cerebrovascular and cardiovascular events in hypertension

a

• Excellent tolerability

b

• Low-dose thiazide diureticsb

• β-blockers (e.g., bisoprolol, carvedilol)

b

• Currently underutilized in conditions where they should be prescribed in Japan, active administration is recommended

G2

• Angiotensin receptor neprilysin inhibitors (ARNI)

• Mineralocorticoid receptor antagonists (MRAs)

• Select from Treatment Step 2 or Step 3abased on the clinical condition

• No evidence for preventing cerebrovascular and cardiovascular events in hypertension

G3

• α-blockers

• Hydralazine

• Central sympatholytics, etc.

• Used in treatment-resistant hypertension or specific clinical conditions

  1. Translated and adapted from ref. [2]
  2. ARBs angiotensin II receptor blockers, ARNI angiotensin receptor–neprilysin inhibitor, ACE angiotensin-converting enzyme, CCBs calcium channel blockers, MR mineralocorticoid receptor
  3. aRefer to Fig. 2 for treatment steps
  4. bEquivalent doses of thiazide diuretics: trichlormethiazide 0.5–1 mg, hydrochlorothiazide 6.25–12.5 mg, indapamide 0.5–1 mg
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