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Antihypertensives

Dr.U.P.Rathnakar MD.DIH.PGDHM

Assistant Professor

Dept of Pharmacology

KMC, Mangalore

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Systolic blood pressure (SBP): isMaximum pressure recorded during

ventricular systole.Diastolic blood pressure (DBP):

Minimum pressure recorded duringventricular diastole.

BLOOD PRESSURE

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Category Blood Pressure (mmHg)Systolic Diastolic

Normal

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CLASSIFIC ATION ACE Inhibitors:

Captopril, enalapril, lisinopril,

Angiotensin-II-receptor antagonists:

Losartan, candesartan,

Calcium channel blockers:

Nifedipine SR, amlodipine, Diuretics

Hydrochlorothiazide, Furosemide, Amiloride, triamterene, spironolactone.

Sympatholytics

-Adrenergic blockers: Prazocin

-Adrenergic blockers: Propranolol, atenolol,

Vasodilators

Hydralazine, Na Nitroprusside

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Normal Regulation of

Blood Pressure

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TOTAL PERIPHERAL RESISTANCE

ACE Inhibitors, Angiotensin Receptor

Blockers (ARBS),

Vasodilators, -Adrenergic Blockers,

Cardiac output adrenergic receptor blocker

Blood volume and body sodium stores

Diuretics

Centrally acting

Clonidine

Renin Angiotensin System

ACE-I, ARBs

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Why treat HTN?

Multiple organ

damage heart,kidney, brain (CVA),

eyes

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Diuretics in

Hypertension

Thiazides-UsuallyusedFirst-line therapy

Mild to moderate HTCombined with

Amiloride

ADE?Other uses?

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-Blockers

Mechanism of action

ADE:Impotence, loss of libidoPrecipitation of asthmaLV dysfunction,Caution inDM

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Beta Blockers

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CALCIUM CHANNEL BLOCKERS

Amlodipine, Nifedipine (extended release),

felodipine verapamil, diltiazem

Block Ca2+

channels

arterial smoothmuscle relaxant action

Dilate coronary, cerebral and peripheral

arteries reduce total arterial resistance ADE:

Nifedipine immediate release:Reflextachycardia, Headache, Flushing, Peripheraledema

Verapamil and Diltiazem: Bradycardia

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ACE inhibitorsCaptopril, enalapril, lisinopril, ramipril

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ACE

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ACE inhibitorsCaptopril, enalapril, lisinopril, ramipril

Angiotensin receptors

ARB

ACE-I

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Dry cough

Hyper K+

Rashes

Post.Hypo

Fever

Adverse effects and Uses

Of ACE-IADE

USES

CHF

HTN

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Sodium nitroprusside

Use severe HTN, CHF as IV infusion

Nursing implication

Infusion should be protected from light and discarded after24 hrs

Discarded if colour changes to pale orange or dark brown

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Treatment strategies

Lifestyle modification- Weight reduction (BMI-18.5-24.9)

- Consume diet rich in fruits, vegetables

and low fat dietary product with a reducedcontent of saturated and total fat

- Restricted sodium intake (< 6g NaCl)

- Regular physical activity (30 min/day)

- Limit alcohol consumption