ANTIHYPERTENSIVES

Hypertension A sustained elevation in blood pressure Can result in damage to the body organs, secondary to vascular damage compromising the function of the heart, kidney, brain, and other body tissues Antihypertensive Drugs Treatment to lower blood pressure by: 1. Reducing vascular volume (using diuretics) 2. Relaxing blood vessels (using vasodilators) 3. Inhibiting the sympathetic nervous system that believe to be hyperactive in the disease state (using nerve ending blocking agents) 4. Inhibit the renal mechanism for blood elevation (ACE angiotensinconverting enzyme Inhibitors) Diuretics Help the kidneys eliminate excess salt and water from the body's tissues and blood. Forces sodium and water excretion, reducing body fluid. Relaxes muscle cells of small arteries. Reduced body fluid and relaxed arteries lower blood pressure. Commonly known as "water pills," help your body get rid of unneeded water and salt through the urine. Getting rid of excess salt and fluid helps lower blood pressure and can make it easier for your heart to pump May be used to treat a number of heart-related conditions, including high blood pressure, heart failure, kidney and liver problems, and glaucoma. Examples: Thiazide Diuretics: Only thiazide diuretics are used to lower blood pressure Esidrix Zaroxolyn Epitizide

Hydrochlorothia zide, a popular thiazide diuretic Chlorothiazide (Diuril) Bendroflumethia zide Metolazone (Zaroxolyn) Loop Diuretics: Bumetanide (Bumex) Ethacrynic acid (Edecrin) Furosemide (Lasix) Torsemide (Demadex) Potassium-Sparing Diuretics: Amiloride Triamterene (Dyrenium) Eplerenone (Inspra) Spironolactone (Aldactone) Side Effects: Increased urination, occurs most frequently in people taking loop diuretics; for some people, this side effect improves within a few weeks of taking a diuretic. People who take diuretics may also have too much potassium in their blood (hyperkalemia) if they take a potassium-sparing diuretic, or too little potassium in their blood (hypokalemia) if they take a thiazide diuretic. Low sodium in your blood (hyponatremia) Increased blood sugar Increased cholesterol Rash Joint disorders (gout) Impotence in men Menstrual irregularities Breast enlargement in men (gynecomastia) Beta-Adrenergic Blocking Agents Blocks certain actions of sympathetic nervous system. Lowers heart's oxygen requirements. Slows nerve impulses through heart. Reduces blood vessel contraction in heart, scalp and other body parts.

 More commonly known as Beta-Blockers Beta Blockers Although beta blockers lower blood pressure, they do not have as positive a benefit on endpoints as some other antihypertensives. In particular, Atenolol seems to be less useful in hypertension than several other agents. However, beta blockers have an important role in the prevention of heart attack in people who have already had a heart attack. Examples: Atenolol Metoprolol Nadolol Oxprenolol Pindolol Propranolol Timolol Side Effects: Less common Breathing difficulty and/or wheezing; Cold hands and feet; Mental depression; Shortness of breath; Slow heartbeat (especially less than 50 beats per minute); Swelling of ankles, feet, and/or lower legs Rare Back pain or joint pain; Chest pain; Confusion (especially in elderly patients); Dark urinefor Acebutolol, Bisoprolol, or Labetalol; Dizziness or lightheadedness when getting up from a lying or sitting position; Fever and sore throat; Hallucinations (seeing, hearing, or feeling things that are not there); Irregular heartbeat; Red, scaling, or crusted skin; Skin rash; Unusual bleeding and bruising; Yellow eyes or skinfor Acebutolol, Bisoprolol, or Labetalol

Signs and symptoms of overdose (in the order in which they may occur) Slow heartbeat; Dizziness (severe) or fainting; Fast or irregular heartbeat; Difficulty in breathing; Bluish-colored fingernails or palms of hands; Convulsions (seizures) Alpha Blockers Despite lowering blood pressure, alpha blockers have significantly poorer endpoint outcomes than other antihypertensives, and are no longer recommended as a first-line choice in the treatment of hypertension. However, they may be useful for some men with symptoms of prostate disease. Examples: Doxazosin Phentolamine Indoramin Phenoxybenzamine Prazosin Terazosin Tolazoline Vasodilators Work by relaxing the smooth muscle of blood vessels, which opens up (dilates) the blood vessels This allows blood to flow more easily, thereby lowering blood pressure. Not commonly used alone to treat ongoing high blood pressure because of the significant drop in blood pressure that they cause, which may lead to heart palpitations or rapid heartbeat. They may be used if a person is in a hypertensive crisis or when other classes of medicine are not effective in controlling high blood pressure. They also may be used if a person has certain other conditions in addition to high blood pressuresuch as heart failure, asthma, impotence, or an enlarged prostate-

that may benefit from the effects of vasodilators. Examples: Clonidine (Catapres) Doxazosin (Cardura) Guanabenz Guanadrel Guanfacine (Tenex) Hydralazine Methyldopa (Aldomet) Minoxidil Prazosin (Minipres) Terazosin (Hytrin) Side Effects: Chest pain Rapid heartbeat (tachycardia) Heart palpitations Fluid retention (edema) Nausea Vomiting Dizziness Flushing Headache Nasal congestion Excessive hair growth In addition, some vasodilators can increase your risk of developing lupus, a connective tissue disease. ACE Inhibitors Angiotensin converting enzyme (ACE) inhibitors are high blood pressure drugs that widen or dilate your blood vessels to improve the amount of blood your heart pumps and lower blood pressure. Increase blood flow, which helps to decrease the amount of work your heart has to do and can help protect your kidneys from the effects of hypertension and diabetes. Used to treat a number of heart-related conditions, including high blood pressure, heart failure, heart attack, and preventing kidney damage associated with high blood pressure and diabetes. Examples: Capoten ( captopril) Vasotec ( enalapril) Prinivil, Zestril ( lisinopril) Lotensin ( benazepril) Monopril ( fosinopril)

Altace ( ramipril) Accupril ( quinapril) Aceon (perindopril) Mavik (trandolapril) Univasc ( moexipril) Side Effects: Cough. Red, itchy skin rash. Dizziness, lightheadedness or faintness upon rising. Salty or metallic taste or a decreased ability to taste. Physical symptoms. Sore throat, fever, mouth sores, unusual bruising, fast or irregular heartbeat, chest pain, and swelling of feet, ankles and lower legs. Swelling of your neck, face, and tongue High potassium levels. Kidney Failure. Severe vomiting or diarrhea.