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Antihypertensive Agents
Reading:
Antihypertensive Drugs
Formative Assessment
Practice question
Clinical:
e-Medicine article
Hypertension
Normal Control of BP
Essential Hypertension
With essential hypertension, mechanisms in the
previous slide function inappropriately
Hypertension Defined
Re: Table in the next slide
http://www.nhlbi.nih.gov/guideline
s/hypertension/phycard.pdf
Classification of Blood
Pressure (JNC VII)
Category
Normal
<130
<85
High normal
130-139
85-89
Hypertension
Stage 1
Stage 2
Stage 3
Stage 4
140-159
160-169
180-209
210
90-99
100-109
110-119
120
Classification of HTN
Primary Hypertension
Specific cause unknown
90% of the cases
Also known as essential or idiopathic
hypertension
Secondary Hypertension
Cause is known (such as eclampsia of
pregnancy, renal artery disease,
pheochromocytoma)
10% of the cases
Physiological Factors
Influencing Arterial Pressure
Arterial pressure is determined by a
number of interacting factors
Preload & Contractility
Heart rate
Peripheral resistance
Some antihypertensive agents decrease heart rate (adrenergic receptor antagonists, e.g.)
Heart Rate X Stroke Volume = Cardiac Output (CO)
Reduce preload
Reduce afterload
Decrease heart rate
Reduce peripheral resistance
Reduce contractility.
Anti-Hypertensive Drug
Classes
1.
2.
3.
4.
5.
Diuretics
Sympatholytics
Vasodilators
Calcium Channel Blockers
Angiotensin Converting Enzyme (ACE)
Inhibitor
14
Anti-Hypertensive Drug
Classes-1) Diuretics
Thiazides
Potassium Sparing
Loop Diuretics
Hydrochlorothiazide
(HydroDIURIL)
Chlorthalidone
(Hygroton)
Chlorothiazide
(Diuril)
Indapamide (Lozol)
Metolazone
(Zaroxolyn)
Amiloride (Midamor)
Spironolactone
(Aldactone)
Triamterene
(Dyrenium)
Furosemide (Lasix),
Bumetanide (Bumex),
Ethacrynic acid
(Edecrin)
Torsemide
(Demadex)
15
Adrenergic
Neuron Blocker
Adrenoceptor
Antagonists
Guanadrel (Hylorel)
Guanethidine
(Ismelin)
Reserpine
Labetalol
(Trandate,
Normodyne) (alpha
& beta)
Prazosin (Minipress)
(alpha), Terazosin
(Hytrin) (alpha)
16
Diazoxide
(Hyperstat)
Hydralazine
(Apresoline)
Minoxidil
(Loniten)
Nitroprusside
sodium
(Nipride)
17
Non-Dihydropyridines
Bepridil (Vascor)
Diltiazem (Cardiazem)
Verapamil (Isoptin, Calan)
18
Benazepril (Lotensin)
Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
Lisinopril (Prinvivil, Zestril)
Moexipril (Univasc)
Quinapril (Accupril)
Ramipril (Altace)
Losartin (Cozaar), Irbesartin***
***
***angiotensin receptor blocker
19
Antihypertensive Agents:
Categories Discussion
Adrenergic agents
Angiotensin-converting enzyme
inhibitors
Angiotensin II receptor blockers
Calcium channel blockers
Diuretics
Vasodilators
20
Antihypertensive Agents:
Categories
Adrenergic Agents
Alpha1 blockers
Beta blockers (cardioselective and
nonselective)
Centrally acting alpha blockers
Combined alpha-beta blockers
Peripheral-acting adrenergic agents
21
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Antihypertensive Agents:
Adrenergic Agents
Alpha1 Blockers
doxazosin (Cardura)
prazosin (Minipress)
terazosin (Hytrin)
23
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Central-Acting Adrenergics
24
Antihypertensive Agents:
Adrenergic Agents
Central-Acting Adrenergics
clonidine (Catapres)
methyldopa (Aldomet)
(drug of choice for hypertension in
pregnancy)
25
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
26
Antihypertensive Agents:
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
reserpine
guanadrel (Hylorel)
guanethidine (Ismelin)
27
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
28
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
Central-Acting Adrenergics
Treatment of hypertension, either alone or
with other agents
Usually used after other agents have
failed due to side effects
29
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
Central-Acting Adrenergics(2)
Also may be used for treatment of severe
dysmenorrhea, menopausal flushing,
glaucoma
Clonidine is useful in the management of
withdrawal symptoms in opioid- or
nicotine-dependent persons
30
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
31
Antihypertensive Agents:
Adrenergic Agents
Side Effects
Most common:
Other:
32
Antihypertensive Agents:
Categories- (ACE Inhibitors)
Angiotensin-Converting Enzyme
Inhibitors (ACE Inhibitors)
Antihypertensive Agents:
Mechanism of Action
ACE Inhibitors
RAAS: Renin Angiotensin-Aldosterone
System
Antihypertensive Agents:
Mechanism of Action(2)
ACE Inhibitors
Therefore, increased BP
35
Antihypertensive Agents:
Mechanism of Action(3)
ACE Inhibitors
36
Antihypertensive Agents:
Mechanism of Action(4)
ACE Inhibitors
38
39
Antihypertensive Agents
ACE Inhibitors
captopril (Capoten)
enalapril (Vasotec)
41
Antihypertensive Agents:
Therapeutic Uses
ACE Inhibitors
Hypertension
CHF (either alone or in combination with diuretics
or other agents)
Slows progression of left ventricular hypertrophy
after an MI
Renal protective effects in patients with diabetes
Drugs of choice in hypertensive patients with CHF
42
Antihypertensive Agents:
Side Effects
ACE Inhibitors
Fatigue
Dizziness
Headache
Mood changes
Impaired taste
Dry, nonproductive cough, reverses when therapy is
stopped
NOTE: first-dose hypotensive effect may occur!!
43
Antihypertensive Agents:
Categories
Angiotensin II Receptor Blockers
(A II Blockers or ARBs)
Newer class
Well-tolerated
Do not cause coughing
44
Antihypertensive Agents:
Mechanism of Action
Angiotensin II Receptor Blockers
45
Antihypertensive Agents:
Angiotensin II Receptor Blockers
losartan (Cozaar)
eposartan (Teveten)
valsartan (Diovan)
irbesartan (Avapro)
candesartan (Atacand)
telmisartan (Micardis)
46
Antihypertensive Agents:
Therapeutic Uses
Angiotensin II Receptor Blockers
Hypertension
Adjunctive agents for the treatment of CHF
May be used alone or with other agents such
as diuretics
47
Antihypertensive Agents:
Side Effects
Angiotensin II Receptor Blockers
48
Antihypertensive Agents:
Categories
Calcium Channel Blockers
Benzothiazepines
Dihydropyridines
Phenylalkylamines
49
Antihypertensive Agents:
Mechanism of Action
Calcium Channel Blockers
Benzothiazepines:
Phenylalkamines:
Dihydropyridines:
51
Antihypertensive Agents:
Therapeutic Uses
Calcium Channel Blockers
Angina
Hypertension
Dysrhythmias
Migraine headaches
52
Antihypertensive Agents:
Side Effects
Calcium Channel Blockers
Cardiovascular
Gastrointestinal
Other
Antihypertensive Agents:
Diuretics
Decrease the plasma and extracellular fluid volumes
Results:
decreased preload
decreased cardiac output
decreased total peripheral resistance
54
Antihypertensive Agents:
Mechanism of Action
Vasodilators
Result:
55
56
Antihypertensive Agents
Vasodilators
diazoxide (Hyperstat)
hydralazine HCl (Apresoline)
minoxidil (Loniten, Rogaine)
sodium nitroprusside (Nipride, Nitropress)
57
Antihypertensive Agents:
Therapeutic Uses
Vasodilators
Treatment of hypertension
May be used in combination with other
agents
Sodium nitroprusside and diazoxide IV are
reserved for the management of
hypertensive emergencies
58
Antihypertensive Agents:
Side Effects
Vasodilators
Hydralazine:
Sodium nitroprusside:
Stepwise Approach to Tx of
Antihypertensive
Essential HTN Medication
Sequence
Resources
JNC GUIDELINES