Antihypertensive Drugs
Introduction to Hypertension
- Hypertension: A chronic
condition characterized by elevated blood pressure.
- Importance of management:
Reduces risk of cardiovascular events such as stroke, heart attack, and
kidney damage.
- Antihypertensive drugs: Key
to controlling blood pressure and preventing complications.
Classification of Antihypertensive Drugs
- Diuretics
- Thiazide diuretics
- Loop diuretics
- Potassium-sparing diuretics
- Beta Blockers
- Atenolol
- Metoprolol
- Propranolol
- Esmolol
- Carvedilol
- Nebivolol
- Calcium Channel Blockers
(CCBs)
- Dihydropyridines (e.g.,
amlodipine)
- Non-dihydropyridines (e.g.,
verapamil)
- Renin-Angiotensin-Aldosterone
System (RAAS) Inhibitors
- ACE inhibitors (e.g.,
enalapril)
- ARBs (e.g., losartan)
- Direct renin inhibitors
(e.g., aliskiren)
- Alpha Blockers
- Terazosin
- Prazosin
- Tamsulosin
- Central Alpha Agonists
- Methyldopa
- Clonidine
- Vasodilators
- Hydralazine
- Sodium nitroprusside
Mechanism of Action (MOA)
1. Diuretics
- Increase renal excretion of
sodium and water.
- Reduce blood volume and
cardiac output.
2. Beta Blockers
- Block beta-adrenergic
receptors.
- Reduce heart rate and
cardiac output.
3. Calcium Channel Blockers
- Inhibit calcium entry into
vascular smooth muscle and myocardium.
- Cause vasodilation and
reduce cardiac workload.
4. RAAS Inhibitors
- ACE inhibitors: Block
conversion of angiotensin I to angiotensin II.
- ARBs: Block angiotensin II
receptors.
- Renin inhibitors: Directly
inhibit renin activity.
5. Alpha Blockers
- Block alpha-adrenergic
receptors, leading to vasodilation.
6. Central Alpha Agonists
- Decrease sympathetic outflow
from the CNS.
7. Vasodilators
- Relax vascular smooth muscle
to decrease peripheral resistance.
Clinical Indications
- Diuretics: First-line for
hypertension, heart failure, and edema.
- Beta Blockers: Hypertension with comorbid
angina, post-MI, or arrhythmias.
- CCBs: Hypertension, angina,
arrhythmias.
- ACE Inhibitors/ARBs: Hypertension with heart
failure, diabetic nephropathy.
- Alpha Blockers: Resistant hypertension,
BPH.
- Vasodilators: Severe or refractory
hypertension.
Adverse Effects
- Diuretics: Electrolyte imbalance,
dehydration.
- Beta Blockers: Bradycardia, fatigue,
bronchospasm.
- CCBs: Peripheral edema, headache,
dizziness.
- ACE Inhibitors: Dry cough, hyperkalemia,
angioedema.
- ARBs: Similar to ACE inhibitors
but without cough.
- Alpha Blockers: Orthostatic hypotension,
dizziness.
- Vasodilators: Reflex tachycardia,
headache.
Contraindications
- Diuretics: Severe electrolyte
disturbances, anuria.
- Beta Blockers: Asthma, severe bradycardia.
- CCBs: Severe heart failure
(non-dihydropyridines).
- ACE Inhibitors: Pregnancy, bilateral renal
artery stenosis.
- ARBs: Pregnancy.
- Alpha Blockers: Hypotension.
- Vasodilators: Hypotension, coronary
artery disease.
Drug Interactions
- Diuretics: Increased risk of lithium
toxicity.
- Beta Blockers: Enhanced effect with CCBs;
reduced effect with NSAIDs.
- CCBs: Potentiated effect with
grapefruit juice.
- ACE Inhibitors/ARBs: Risk of hyperkalemia with
potassium supplements.
- Alpha Blockers: Additive hypotensive
effects with other antihypertensives.
References
- Goodman & Gilman’s The Pharmacological Basis of Therapeutics.
- Rang & Dale’s Pharmacology.
Presentation for Antihypertension Drugs
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