Presented by: Sara Khalid Memon – Group B3 3 rd year, MBBS, LUMHS

HYPERTENSIONHYPERTENSION

> Centrally acting sympatholytic drugs > Ganglionic Blockers > Sympathetic Nerve Ending Blockers > Adrenergic Receptor Blockers a) Alpha 1 blockers b) Beta blockers c) Mixed blockers > Direct Vasodilators > Calcium Channel Blockers > Angiotensin Converting Enzyme Inhibitors >Angiotensin Receptor Blockers >Renin Inhibitor > Diuretics

C) Mixed blockers: Acting on Alpha as well as on Beta receptors. Labetolol, Carvidolol, Bucindolol Adverse Effects: Drowsiness, Fatigue, Insomnia, Orthostatic Hypotension NOTE: Nebivolol is a newer beta blocker with some direct vasodilator action Relatively very less adverse effects and is highly cardioselective !!!

Verapamil: Acts on both cardiac and smooth muscles(more action on heart) Advantage: Additional used in treatment of angina, supraventricular tachyarrythmias, migraine headache Disadvantage: Facial flushing, dizziness, constipation Diltiazem: Acts on both cardiac and smooth muscles equally. Advantage: Used for hypertension, Angina Disadvantage: Hypotension, bradycardia

Nifedipine: Acts more on arterial smooth muscles than on heart Advantage: Vasoselective Disadvantage: Lethargy, Bradycardia, Hypotension

Captopril, Enapril, Lisinopril, Prindropril, Ramipril Advantage: Effective in CCF and Diabetic Nephropathy too Losartan, Cadesartan, Valsartan, Telmisartan Advantage: Do not increase the bradycardia level. Aliskiren, Pepstatin Advantage: Acts directly on the required substrate.

Cough (dry Cough) Angioedema Proteinuria Taste changes Hypotension Contraindicated in Pregnancy Rashes Increased K+ Levels Low Ang II and Aldosterone levels

> Diuretics are very effective in Elderly patients, Blacks, Inexpensive and can be used for Prolonged maintenance. > Beta Blockers are wonderful if the patient also has supraventricular tachycardia and/ Angina and/ MI and/Migraine. > Beta blockers and ACE inhibitors are very effective in white and young hypertensives. > Vasodilating drugs cause salt and water retention and cardiostimulatory effects. > Hydralazine should be used with diuretics and beta blockers. > Alpha Blockers always cause postural hypotension.

New Antihypertensive Drugs >Monatepil, a dual alpha-receptor and calcium channel blocker, has potent antihypertensive effect, lowers serum cholesterol and also has antiatherosclerotic effect. >Dual ACE and endopeptidase inhibitor, such as alatriopril, has a "broad spectrum" antihypertensive effect and may be effective in majority of hypertensive patients. Many other are under clinical testing and not yet approved.. !

> Physical Exercise > Weight loss > Salt Restriction > Avoid Smoking > Reducing Alcohol Consumption > Relaxation techniques > K+ rich diets > Red meat should be avoided