Hypertension is a medical condition in which there is an increase in blood pressure

exceeds normal.Hipertensi is an increase in blood pressure so that the systolic pressure

over 140 mmHg and diastolic pressure greater than 90 mmHg (Priyanto, 2010).
Efficacy and Its use
The goal of treatment of hypertension is to prevent morbidity and mortality due to high
BP. This means that TD must be lowered as low as possible that does not interfere with the
function of kidney, brain, heart, and quality of life, while to control the risk factors for
cardio vascular others.
The benefits of hypertension therapy that lowers BP with antihypertensive (AH) has been
shown to reduce morbidity and mortality cardio vascular, namely stroke, cardiac ischemia,
congestive heart failure, and hypertension memberatnya.
Types of Drugs and classification
1. Diuretics
Working through various mechanisms to reduce cardiac output and causes the
kidneys to increase the excretion of salt and water.
2. Beta receptors antagonists Work on Beta receptors to decrease the heart rate and
cardiac output.
3. Receptor Antagonist-Alfa Alpha receptors inhibit vascular smooth diotot which
normally responds to sympathetic stimulation with vasoconstriction.
4. Calcium Antagonist
Lowering the contraction of smooth muscles of the heart and arteries to intervene
or calcium influx is required for contraction. Calcium inhibitors have different
abilities in lowering heart rate. Stroke volume and peripheral resistance.
5. ACE inhibitor
Serves to reduce the angiotensin II by inhibiting the enzyme required to convert
angiotensin I to angiotensin II. It lowers blood pressure both directly lowering
peripheral resisitensi. And angiotensin II is required for the synthesis of
aldosterone, as well as by increased spending netrium through urine so that the
plasma volume and cardiac output decreased.
6. Vasodilators
These drugs work directly on the blood vessels by relaxing the smooth muscle
(muscle of blood vessels). Included in this group are: Prasosin, Hidralasin. The side
effects that might occur from this drug is: headache and dizziness.

Antihypertensive Drugs
1. Diuretics
a. furosemide
Name of the patent: Cetasix, farsix, furostic, impungsn, kutrix, Lasix, salurix,
uresix.
Dosage: Tablets, capsules, injection.
The working mechanism: reducing active NaCl reabsorption in the tubule lumen
into intersitium on the ascending limb of Henle.
Indications: Acute pulmonary edema, edema due to congestive heart disease,
cirrhosis, nephrotic syndrome, hypertension.
Contraindications: pregnant and lactating women
Side effects: dizziness. Lethargy, muscle rigidity, hypotension, nausea, diarrhea.
Drug interactions: effects of indomethacin lowers diuretiknya, ototoksit effect
increases when administered together with aminoglycosides. Should not be given
together etakrinat acid. Silisilat increased toxicity when administered concurrently.
Dosage: Adult 40 mg / hr
Son of 2-6 mg / kg / hr
b. HCT (Hydrochlorothiaside)
Dosage: Tablets
The working mechanism: mendeplesi (emptying) of sodium deposits so that blood
volume, cardiac output and peripheral vascular resistance decreased.
Pharmacokinetics: well absorbed by the digestive tract. Distributed throughout the
extracellular space and just dumped in the kidney tissues.
Indications: used to reduce edema due to heart failure, liver cirrhosis, chronic renal
failure, hypertension.
Contraindications: hypokalemia, hypomagnesemia, hyponatremia, hypertension in
pregnancy.
Dose: Adults 25-50 mg / hr
Kids from 0.5 to 1.0 mg / kg / 12-24 hours
2. Beta receptors antagonists
a. Asebutol (Beta-blockers)
Patent Name: sacral, corbutol, sectrazide.
Dosage: tablets, capsules.

The working mechanism: inhibiting effect of isoproterenol, decrease the activity of

renin, menurunka peripheral sympathetic outflow.
Indications: hypertension, angina pectoris, arrhythmias, pheochromocytoma,
obtruktif hypertrophic cardiomyopathy, tirotoksitosis.
Contraindications: cardiac failure, cardiogenic shock, asthma, diabetes mellitus,
bradycardia, depression.
Side effects: nausea, cold hands feet, insomnia, nightmares, lethargy
Drug interactions: extended a state of hypoglycemia when given with insulin.
Thiazide diuretics trigleserid and increase levels of uric acid when given bersaa
ergot alkaloids. Depression AV node and SA increased when given together with
calcium inhibitors
Dosage: 2 x 200 mg / day (maximum 800 mg / hr).
b. Atenolol (beta-blockers)
Name of the patent: Betablok, Farnomin, Tenoret, Tenoretic, Tenormin, internolol.
Dosage: Tablets
The working mechanism: pengurahan cardiac output accompanied by peripheral
vasodilation, effects on adrenergic receptors in the CNS, inhibition of renin
secretion in the kidney due adrenoceptor activation.
Indications: hypertension mild - moderate, arrhythmia
Contraindications: AV conduction disorders, heart failure hidden, bradycardia,
cardiogenic shock, anuria, asthma, diabetes.
Side effects: muscle pain, cold limbs, lethargy, sleep disturbances, skin redness,
impotence.
Drug interactions: effects of prolonged hypoglycemia when administered with
insulin. Thiazide diuretics increase the levels of triglycerides and uric acid. Severe
peripheral ischemia when given together with ergot alkaloids.
Dosage: 2 x 40-80 mg / hr
c. Metoprolol (Beta-blockers)
Name of the patent: Cardiocel, Lopresor, Seloken, Selozok
Dosage: Tablets
The working mechanism: the reduction of cardiac output followed by peripheral
vasodilation, effects on adrenergic receptors in the CNS, inhibition of renin
secretion due to activation of beta-adrenoceptor 1 in the kidney.

Pharmacokinetics: well absorbed by the digestive tract. Short half-life, and can be
given several times a day.
Pharmacodynamics: beta adrenergic inhibitors inhibit the sympathetic stimulation,
thus lowering heart rate and blood pressure. Beta blockers can penetrate the
placenta barrier and can get into breast milk.
Indications: hypertension, myocardial infard, angina pectoris
Contraindications: sinus bradycardia, heart block II and III level, cardiogenic
shock, heart failure hidden.
Side effects: lethargy, cold hands and feet, insomnia, nightmares, diarrhea
Drug interactions: reserpine enhances the effect antihipertensinya
Dosage: 50-100 mg / kg.
d. Propranolol (beta blockers)
Name of the patent: Blokard, Inderal, Prestoral
Dosage: Tablets
The working mechanism: not so obvious, allegedly due to decrease cardiac output,
inhibit the release of renin in the kidneys, inhibiting the sympathetic tone in the
vasomotor center of the brain.
Pharmacokinetics: well absorbed by the digestive tract. Short half-life, and can be
given several times a day. It is easy to bind to the protein and will compete with
drugs - other drugs that are also very easy to bind to the protein.
Pharmacodynamics: beta adrenergic inhibitors inhibit the sympathetic stimulation,
thus lowering heart rate and blood pressure. Beta blockers can penetrate the
placenta barrier and can get into breast milk.
Indications: hypertension, angina pectoris, cardiac arrhythmia, migraine, hepertrofi
subaortik stenosis, myocardial infarction, pheochromocytoma
Contraindications: cardiogenic shock, bronchial asthma, heart block brikadikardia
and level II and III, congestive heart failure. Heart - heart administering to the
patient biabetes mellitus, haminl and lactating women.
Side

effects:

bradycardia,

insomnia,

nausea,

vomiting,

bronchospasm,

agranulocytosis, depression.
Drug interactions: liver - liver when administered in conjunction with reserpine
because it adds weight hypotension and calcium antagonists for causing
suppression of myocardial contractility. Cardiac arrest can occur when
administered together with haloperidol. Phenytoin, phenobarbital, rifampin

increase the cleanliness of this drug. Cimetidine propranolol lowered metabolism.

Etanolol menurukan absorbsinya.
Dosage: a starting dose of 2 x 40 mg / hr, forwarded the maintenance dose.
3. Receptors antagonists alfa
Clonidine (alpha antagonist)
Patent name: Catapres, dixarit
Dosage: Tablets, injection.
The working mechanism: inhibiting stimulation of adrenergic nerves in the CNS.
Indications: hypertension, migraine
Contraindications: pregnant women, people who do not comply.
Side effects: dry mouth, dizziness, nausea, vomiting, constipation.
Drug interactions: enhance the effects of antihistamines, andidepresan, antipsychotics,
alcohol. Betabloker increase antihipertensinya effect.
Dosage: 150-300 mg / hr.
4. Calcium antagonists
a. Diltiazem (calcium antagonist)
Name of the patent: Farmabes, Herbeser, Diltikor.
Dosage: Tablets, capsules
The working mechanism: inhibiting the intake, discharge, or work through the slow
calcium calcium cannel.
Indications: hypertension, angina pectoris, MCI, peripheral vascular disease.
Contraindications: pregnant and lactating women, heart failure.
Side effects: bradycardia, dizziness, fatigue, leg edema, gastrointestinal disorders.
Drug interactions: decreases heart rate when given together with beta-blockers. The
effects on cardiac conduction are affected when administered together with
amiodarone and digoxin. Simotidin increase its effect.
Dosage: 3 x 30 mg / day before meals
b. Nifedipine (calcium antagonists)
Patent name: Adalat, Carvas, Cordalat, Coronipin, Farmalat, Nifecard, Vasdalat.
Dosage: tablet, caplet
The working mechanism: reducing peripheral vascular resistance, decrease
Coronary Artery spasm.
Indications: hypertension, angina due to coronary vasospasm, refractory heart
failure.

Contraindications: severe heart failure, severe stenosis, pregnant and lactating

women.
Side effects: headache,tachycardia,hypotension, leg edema.
Drug interactions: Award along with beta blockers cause severe hypotension or
Exacerbation
angina. Increase digitalis in the blood. Increase the time if given protombin
together with anticoagulants. Cimetidine increase the levels in plasma.
Dosage: 3 X 10 Mg /Hr
c. Verapamil (calcium antagonists)
Name Of The patent:Isoptil
Dosage: Tablets, InjectionThe working mechanism: inhibiting the entry of Ca ions
into heart muscle cells and systemic vascular coronary arteries, causing relaxation,
and

lowers

Indications:

peripheral

resistance

hypertension,

angina

resulting
pectoris,

in

lower

cardiac

use

of

arrhythmia,

oxygen.
migraine

Contraindications: severe ventricular disorder, cardiogenic shock, fibrillation, heart

block II and III level, hypersensitivity.
Side effects: constipation, nausea, hypotension, headache, edema, lethargy,
dipsnea,bradycardia,skin redness.
Drug interactions: Award along with beta blockers could lead to negative effects on
the pulse, kondiksi and cardiac contractility. Increasing levels of digoxin in the
blood. Award along with other antihypertensive effects severe hypotension
Increasing levels of carbamazepine, lithium, cyclosporine. Rifampin decrease its
effectiveness. Repair kontraklitas heart when given together flekaind and berate
decrease in blood pressure when given together with Quinidine. Phenobarbital
nemingkatkan Cleanliness Of This drug.
Dosage: 3X 80Mg /Hr
5.

ACE

Inhibitors

(angiotensin

Converting

Enzyme

inhibitors)

Kaptopril

a. Patent name:Capoten
Dosage:Tablets
The working mechanism: inhibiting the angiotensin converting enzyme thereby
lowering angiotensin II result in decreased release of renin and aldosterone.
Indications: hypertension, heart failure.
Contraindications: hypersensitivity, liver - liver in patients with a history of
angioedema and Lactating women.
Side effects: cough, skin flushing, constipation, hypotension, dyspepsia, blurry
vision, myalgia.
Drug interactions: hypotension increased when given together with diuretics.
Should not be given together with vasodilators such as nitroglycerin or other nitrate
preparations. Indomethacin and other NSAIDs reduce the effects of this drug.

Increases lithium toxicity.

Dosage: 2-3X25 Mg /hr.
b. Lisinopril
Name Of The patent: Zestril
Dosage: Tablets
The working mechanism: inhibiting the angiotensin converting enzyme so that the
changes of angiotensin I to angiotensin II disrupted, resulting in decreased
vasopressor activity and aldosterone secretion.
Indications: Hypertension
Contraindications: patients with a history of angioedema, pregnant women,
hypersensitivity.
Side effects: cough, dizziness, fatigue, joint pain, confusion, insomnia, dizziness.
Drug interactions: increased hypotensive effect when given together with diuretics.
Indomitasin increase its effectiveness. Lithium intoxication increased when given
together.
Dosage: initial 10 Mg/ Hr
c. Ramipril
Name Of The patent:Triatec
Dosage: Tablets
The working mechanism: inhibiting the angiotensin converting enzyme so that the
changes of angiotensin I to angiotensin II disrupted, resulting in decreased
vasopressor Activity And Aldosterone secretion.
Indications: Hypertension
Contraindications: patients with a history of angioedema, hypersensitivity. Heart heart

administration

to

pregnant

and

lactating

women.

Side effects: cough, dizziness, headache, fatigue, abdominal pain, confusion,

insomnia.
Drug interactions: hypotension increased when given together with diuretics.
Indomethacin

lowers

effectiveness.

Intoksitosis

litiumm

increased.

Dosage: initial 2.5 mg / hr

6. Vasodilator
1. Hydralazine
Name Of The patent: Aproseline
Dosage: Tablets
The working mechanism: relaxes smooth muscle arterioles so that the peripheral
resistance decreased, increasing the heart rate.
Indications: hypertension heart failure.
Contraindications: Renal failure, rheumatic heart disease.
Side effects: headache, tachycardia, gastrointestinal disturbances, flushing, skin
redness.

Drug interactions: severe hypotension occurs when given together diazodsid.

Dosage: 50 Mg / day, divided 2-3 doses.
SIDE EFFECTS
All antihypertensive drugs cause side effects common, such as decongestants (due
to vasodilation mucosa) and dry mouth, bradykardia (except fasodilator directly:
instead tachycardia), fatigue and lethargy, impaired vision, and gastrointestinal
(nausea, diarrhea), there are times when impotence (particularly drugs central)
.Efek-these effects are often temporary lost within 1-2 weeks. Can be reduced or
avoided by pentakaran "sneak", which means starting with a low dose that is
gradually increased.
Thus, the sudden fall in BP can be avoided. Similarly, the drug should be taken
after meals so that plasma drug levels do not suddenly reach a high peak (with
consequent strong hypotension). Discontinuation of therapy should not be too
suddenly, but gradually to prevent the danger of rising TD with Strong (rebound
effect) Special. More serious is the large number of special side effects, among
others:
1. orthostatic hypotension, namely the decline in TD stronger when the body
upright (= ortho, Lat.) Rather than in a state of lying, can occur in especially
simpatolitika.
2. Depression, especially in drug-centrally acting drugs, especially reserpine
and methyldopa, also on beta-blockers that are lipophilic, among others
3.

propra-nolol, Alprenolol And metoprolol.

Retention of salt and water, with weight gain or edema occurrence, other
anatra Ca antagonists, reserpine, methyldopa and hydralazine. These side

4.

effects can be overcome degan in combination with a deuretikum.

Decrease ratio of HDL: LDL. Some drugs affect the metabolism of lipids
poorly, which lowers plasma HDL cholesterol levels that are considered as
protective factors against heart disease vessels. Alternatively, it also
increases LDL cholesterol is considered a risk factor for PJP. These
properties have been confirmed on diuretics (group thiazida and
chlorthalidone) and on beta-blockers, especially drugs that are not
cardioselective or do not have the ISA.

A. Conclusion Hypertension is the increase in blood pressure so that the systolic

pressure> 140 mmHg and diastolic blood pressure> 90 mmHg (Kee & Hayes).

Antihypertensive drug is a drug used to lower blood pressure tingggi to achieve

normal blood pressure. All antihypertensive drugs work in one or more anatomical
point of control and these effects occur by affecting the normal regulatory
mechanisms TD. Pharmacological Treatment
1. Diuretics
2. Beta Receptors Antagonists
3. Receptor Antagonist-Alfa
4. Calcium Antagonist
5. ACE Inhibitor
6. Vasodilators
All antihypertensive drugs cause side effects common, such as decongestants (due
to vasodilation mucosa) and dry mouth, bradykardia (except fasodilator directly:
instead tachycardia), fatigue and lethargy, impaired vision, and gastrointestinal
(nausea, diarrhea), there are times when impotence (particularly drugs central)
.Efek-these effects are often temporary lost within 1-2 weeks. Can be reduced or
avoided by pentakaran "sneak", which means starting with a low dose that is
gradually increased.
With Accordingly, TD sudden decline can be avoided. Similarly, the drug should be
taken after meals so that plasma drug levels do not suddenly reach a high peak
(with consequent strong hypotension). Discontinuation of therapy should not be too
suddenly, but gradually to prevent the danger of increased TD with strong (rebound
effect) Special.