2. Hypertension Hypertension can be classified as follows: Mild :Diastolic pressure 85-90 mmHg Moderate: Diastolic pressure 90-95 mmHg Sever: Diastolic pressure 95-100

3. Hypertension If not treated and reached a late stage target-organ damage will start

4. Hypertension complications premature cardiovascular disease increases the risk of heart failure at all ages Left ventricular hypertrophy is a common problem in patients with hypertension Hypertension is the most common and most important risk factor for stroke Hypertension is the most important risk factor for the development of intracerebral hemorrhage Hypertension is a risk factor for chronic renal insufficiency and end-stage renal disease Marked elevations in blood pressure can cause an acute, life-threatening emergency

5. Anti-Hypertensive drugs Diuretics Mechanism of action Increase renal execration of sodium and water Decrease fluid volume within the intravascular compartment

6. Anti-Hypertensive drugs Diuretics Potassium wasting Chlorthalidone (hygroton), Hydrochlorothiazide (hydrodiuril, esidrix), Indapamide (lozol), Metalazone (zaroxolyn) ↑ cholesterol and TG ↑ glucose and uric acid Hypokalemia ↑ calcium conc ↑

7. Anti-Hypertensive drugs Diuretics Loops Frusamide (lasix), ethacrynic acid (edecrin), bumetanide (bumex), torsemide (demadex) Short duration of action No hypercalcemia

8. Anti-Hypertensive drugs Diuretics Potassium sparing Amiloride (midamor), spironolactone (aldactone), triameterene (dyrenium) Hyperkalemia, gynacomastia with spironolactone

9. Anti-Hypertensive drugs sympatholytic drugs Beta adrenergic blockers Alpha and beta blockers Labetalol Alpha blocker Prazosin, doxazosin, terazosin Presynaptic adrenergic inhibitors Guandrel, guanethidin, reserpine Centrally acting agents Clonidine, guanabenz, guanfacine, and methyldopa Ganglionic blockers

10. Anti-Hypertensive drugs Beta-Blockers Mechanism of action: ↓ heart rate and force of contraction ↓ cardiac output Other mechanism postulated

11. Anti-Hypertensive drugs Beta-Blockers Acebutolol (sectral) Atenolol (tenormin) Bisprolol (zebeta) Carvedilol (coreg) Metoprolol (lopressor, toprol XL) Nadolol (corgard) Pindolol (visken) Propranolol (inderal) Timolol (blocadren Bronchospasm Bradycardia Heart failure Mask hypoglycemia and delay recovery Impaired peripheral circulation ↓Exercise tolerance

12. Anti-Hypertensive drugs vasodilators Hydralazine (apresoline) Injectable for emergency Onset of action: I.V.: 5-20 minutes Minoxidil (loniten) For renal failure patient who are resistant to everything Hair growth, fluid accumulation

13. Anti-Hypertensive drugs calcium antagonists Mechanism of action Block calcium entry into vascular smooth muscle vasodilatation ↓ peripheral resistance ↓ heart rate ↓ Myocardial contractile force

14. Anti-Hypertensive drugs calcium antagonists Nondihydropyridines Diltiazim (cardizem) Verapamil (isoptin) Dihydropyridines Amlodipine (norvasc) Felodipine (plendil) Isradaoine (dynacirc) Nifedipine (procardia, adalat) Nisoldipne (sular) Nondihydropyridines Conduction defects Worsening systolic dysfunction Gingival hyperplasia Constipation (verapamil) Dihydropyridines Ankle edema Flushing Headache Gingival hyperplasia

15. Anti-Hypertensive drugs Renin Angiotensin Aldosterone Inhibitors Angiotensin converting enzyme inhibitors (ACEI) Block conversion of angiotensin I to angiotensin II (angiotensin II cause vasoconstriction) Angiotensin II receptor blockers (ARBs) Block the angiotensin II receptor on the cells

16. Anti-Hypertensive drugs ACEI Benzopril (lotensin) Captopril (capoten) Enalapril (vasotec) Fosinopril (monopril) Lisinopril (zestril) Quinapril (accupril) Cough Angioedema Hyperkalemia Rash Loss of taste Leukopenia Pregnancy category C and D

17. Anti-Hypertensive drugs ARBs Candesartan (atacand) Irbesartan (avapro) Losartan (cozaar) Telmisartan (micardis) Valsartan (diovan) Hyperkalemia Very rare angioedema Pregnancy category C and D