1. ANTIHYPERTENSIVE DRUGS

3. Definition
Elevation of arterial blood pressure above 140/90 mm Hg. Can be caused by:
- idiopathic process (primary or essential hypertension)
an underlying disease process (secondary hypertension)
Renal artery stenosis
Hyperaldosteronism
pheochromocytoma

4. Stages of Hypertension
Diastolic Range (mm Hg)
Systolic Range (mm Hg)
High Normal
85-89
Stage 1
90-99
Stage 2
Stage 3
> 109
>179

5. Treatment Rationale Stroke Congestive heart failure
Long-term goal of antihypertensive therapy:
Reduce mortality due to hypertension-induced disease
Stroke
Congestive heart failure
Coronary artery disease
Nephropathy
Peripheral artery disease
Retinopathy

6. Ways of Lowering Blood Pressure
MAP = CO X TPR
Reduce cardiac output (ß-blockers, Ca2+ channel blockers)
Reduce plasma volume (diuretics)
Reduce peripheral vascular resistance (vasodilators)

7. ANTI-HYPERTENSIVE DRUG CLASSES
Diuretics
Beta blockers
Vasodilators
Calcium Channel Blockers
Angiotensin Converting Enzyme (ACE) Inhibitor
Alpha blockers

8. Beta Blockers Atenolol Propranolol Metoprolol Labetalol Timolol
Nadolol

9. Types of ß-blockers:
Non selective
Prototype: Propranolol (others: nadolol, timolol, pindolol, labetolol)
Cardioselective
Prototype: Metoprolol (others: atenolol, esmolol, betaxolol)
Non selective and cardioselective ß-blockers are EQUALLY effective in reducing blood pressure

10. BETA - BLOCKERS ACTIONS : DECREASES CARDIAC OUTPUT BLOOD PRESSURE
SYMPATHETIC OUTFLOW
RENIN RELEASE
ALDOSTERONE RELEASE
PERIPHERAL RESISTANCE

12. THERAPEUTIC USES SUPRAVENTRICULAR TACHYCARDIA PREVIOUS MI ANGINA
For HTN( first line agents chosen to treat patients with mild to moderate HTN)
HTN+ other diseases
SUPRAVENTRICULAR TACHYCARDIA
PREVIOUS MI
ANGINA
GLAUCOMA

13. SIDE EFFECTS CNS: fatigue, lethargy, insomnia, hallucinations
Drug induced sexual dysfunction
Lipid profile : decrease HDL,

14. Contraindications Asthma (Beta 1 specific drugs can be used )
PERIPHERAL VASCULAR DISORDERS
Heart blocks
CHF

15. DIURETICS LOOP DIURETICS FUROSEMIDE TORSEMIDE BUMETANIDE
THIAZIDE DIURETICS
HYDROCHLORTHIAZIDE
CHLOROTHIAZIDE
CHLORTHALIDONE
INDAPAMIDE
METOLAZONE
LOOP DIURETICS
FUROSEMIDE
TORSEMIDE
BUMETANIDE
ETHACRYNIC ACID

16. ACTIONS MAINLY ACT BY Increasing the Na & water excretion, Lower CO
Decrease extracellular volume
Decrease renal blood flow
Decrease B.P.

17. USES:
HTN
CONGESTIVE CARDIAC FAILURE

18. THIAZIDE SE: ( THIAZIDE ) HYPOKALEMIA arrhythmias
HYPERURICEMIA precipitate gout
HYPERGLYCEMIA impair glucose tolerance and increase insulin resistance.
NOT USED IN HYPERTENSIVE DIABETICS.

19. DIURETICS K SPARING DIURETICS AMILORIDE SPIRONOLACTONE TRIAMTERENE
They may be useful in combination with other diuretics to prevent hypokalaemia.
Spironolactone is a specific aldosterone antagonist, with a particular role in primary hyperaldosteronism or Conn’s syndrome.

20. No risk of hypokalemia
With spironolactone
breast enlargement in men (gynecomastia) and menstrual irregularities in women

21. OTHER SYMPATHOLYTICS Alpha 1 blockers Prazosin Terazosin Doxazosin
Central alpha 2 agonists
Clonidine
Guan Benz
Guanfacine
Alpha methyl dopa

22. Clonidine Alpha Methyldopa
Does not decrease GLOMERULAR FILTRATION RATE AND RENAL BLOOD FLOW RATE
Use : HTN + renal disease
These drugs decrease total peripheral resistance without changing CO.
This drugs has no direct effect on the kidney and can be used in patients with renal disease
Side effect ; sedation, sodium retention dry mouth
**Rebound hypertension**

23. Alpha 1 blockers - side effects
Fainting (syncope) with the first dose, palpitations,
dizziness, low blood pressure when the person stands (orthostatic hypotension), and fluid retention (edema)

24. ACE - INHIBITORS Fall in B.P. DECREASES ANGIOTENSIN II
DECREASES INACTIVATION OF BRADYKININ.
Final effect : VASODILATION
Fall in B.P.

25. ACE INHIBITORS ENALAPRIL CAPTOPRIL LISINOPRIL QUINAPRIL FOSINOPRIL
BENAZEPRIL
MOEXIPRIL

26. USES
HTN
CHF
POST MI
Considered best drugs for HTN with DM.

27. MC SIDE EFFECTS DRY COUGH due to decrease bradykinin metabolism
ALLERGY LIKE SYMPTOMS rash, angioedema
RHINORRHOEA
HYPERKALEMIA
low blood pressure

28. CONTRAINDICATIONS PREGNANCY RENOVASCULAR STENOSIS
MAY PRECIPITATE ACUTE RENAL FAILURE

29. ANGIOTENSIN II RECEPTOR ANTAGONISTS
LOSARTAN
Valsartan
Candesartan
Eprosartan
Irbesartan
Telmisartan

30. LESS SEVERE SIDE EFFECTS
Bradykinin is not produced
Angioedema rare
CI ::::: PREGNANCY

31. CALCIUM CHANNEL BLOCKERS
VERAPAMIL
DILTIAZEM
NIFEDIPINE
AMLODIPINE
FELODIPINE
NICARDIPINE
NISOLDIPINE

32. ACTION
BLOCKS CALCIUM CHANNELS IN HEART AND CORONARY AND PERIPHERAL VESSELS
DECREASES CYTOPLASMIC CALCIUM LEVELS
SMOOTH MUSCLE RELAXES
DILATES ARTERIOLES

33. NIFIDIPINE , - MORE EFFECT ON PERIPHERAL VESSELS
MINIMAL EFFECT ON HEART CONDUCTION AND HR

34. VERAPAMIL – MORE EFFECT ON HEART
DECREASES CONDUCTION, HR,OXYGEN DEMAND
MORE - VE IONOTROPISM

35. USES HTN ANGINA PERIPHERAL VASCULAR DISEASE ARRHYTHMIA
CAN BE USED IN PT’S WITH HTN ALONG WITH ASTHMA OR DM

36. SIDE EFFECTS DIZZINESS HEADACHE REFLEX TACHYCARDIA CARDIAC DEPRESSION
FLUSHING

37. VASODILATORS
HYDRALAZINE
MINOXIDIL

38. ACTIONS Cardiovascular Effects:
Greater effect on diastolic blood pressure
Reduce systemic vascular resistance
Increased: (baroreceptor reflex-mediated; some direct cardiac effect also likely)
heart rate
stroke volume
cardiac output
Limited orthostatic hypotension --secondary to greater effect on arterioles than veins

39. HYDRALAZINE USES HTN, CHF.
SE: whose main side effect is a lupus-like syndrome SLE
NAUSEA
VOMITING
HEADACHE
FLUID RETENTION
ARRHYTHMIA
ANGINA

41. MINOXIDIL For baldness HYPERTRICHOSIS SE: SODIUM AND WATER RETENTION
VOLUME OVERLOAD
LEADING TO EDEMA & CHF
USED FOR TREATING REFRACTORY HTN
HYPERTRICHOSIS
For baldness

44. SODIUM NITROPRUSSIDE
Direct-acting, nonselective peripheral vasodilator
Relaxation of arterial and venous vascular smooth muscle

45. EFFECTS CVS BOTH ARTERIES AND VEINS ARE AFFECTED (dilated)
FALL IN B.P.
Reduces preload and afterload

46. ACTIONS NITROPRUSSIDE BINDS WITH OXY Hb FORMING METH Hb
AND RELEASES NO
ALSO CYANIDE IONS

47. USES ***HTN EMERGENCIES*** IV ROUTE DURING SURGERIES
TOXICITY – CYANIDE TOXICITY
RX SODIUM THIOSULFATE

48. DIAZOXIDE ***HTN EMERGENCIES*** DIRECT ACTING ARTERIOLAR VASODILATOR.
IV ROUTE
***HTN EMERGENCIES***
SE; EXCESSIVE HYPOTENSION