1.  Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180 - 209 110 - 119

2. Typical Diurnal Blood Pressure Rhythm in a "Dipper"

6. Classification of antihypertensives :  ACE inhibitors : Captopril, Enalapril.  Angiotensin Antagonist : Losartan  Calcium channel blockers : Verapamil, Diltiazem, Nifedipine.  Beta adrenergic blockers : Propranolol.  Alpha adrenergic blockers : Prazosin.

7. Diuretics :  Thiazides : Hydrochlorothiazides, Metolazone, Indapamide.  High ceiling diuretics : Furesomide, Bumetanide, Ethacrynic acid  K sparing diuretics : Spironolactone, Triamterene, Amiloride Alpha -2 agonist: Clonidine, Methyldopa

8. Vasodilators:  Arteriolar : Hydralazine, Minoxidil.  Arteriolar + Venous : ACE inhibitors  Venodilator : Nitrates

9. Angiotensin Converting Enzyme (ACE) Inhibitors:  Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril  Reduction in arterial resistance (after load)  Reduction in venous tension (preload)  Reduction in aldosterone secretion

12. Indications for ACE inhibitors includes:  Congestive heart failure (CHF)  Hypertension  Left ventricular dysfunction  Prevention of nephropathy in diabetes mellitus

13. Adverse effects:  Common adverse effects includes hypotension, cough, hyperkalemia.  Rash and taste disturbances with captopril  Angioedema Cautions and contraindications:  Pregnancy  Bilateral renal artery stenosis

14. ANGIOTENSIN RECEPTOR BLOCKERS ARB (AT 1 BLOCKERS): Losartan, Erbesartan, Candesartan  Competitive antagonists of Angiotensin II  No inhibition of ACE or breakdown of bradykinin

15. Antihypertensives agents

16. Hydralazine :  Direct arteriolar vasodilator.  Release of nitric oxide cause the vasodilation of the arteries.  Reflex sympathetic system activation can cause tachycardia.  Norepinephrine release from nerve endings can increase myocardial contractility

17. Hydralazine : Adverse effects  Throbbing headache, palpitation  SLE – in slow acetylators or on prolonged use at a higher dose  Precipitation of angina and MI

18. Hydralazine : Uses  Hypertension not controlled by first line of anti hypertensives  Can be used hypertension of pregnancy  Hypertensive emergencies

19. Minoxidil :  Arteriolar vasodilator - K channel activator  Chronic therapy – excess growth of hair on face, back and arms  Used in life threatening hypertension  Used in hypertension with renal failure

20. Hypertensive emergencies :  Sodium Nitroprusside  NTG  Diazoxide  Hydralazine  Enalaprilat  Nicardipine  Esmolol  Nifedipine - Sublingual

21. THE CHOICE OF THE ANTIHYPERTENSIVE IN PATIENTS WITH CONCOMITANT DISEASES. Concomitant disease Antihypertensive drug Diuretics ß-block.Ca- block. ACE- inhibitor Diabetes C.IAVOID OK INDI CATED Gout AVOID -- Dyslipidemia C.I AVOID -- Angina pectoris -- I I Cardiac failure I judicious OK I Pregnancy C.I Cautious OKAVOID