Antihypertensives

Dr.U.P.Rathnakar MD.DIH.PGDHM
Assistant Professor
Dept of Pharmacology
KMC, Mangalore
 BLOOD PRESSURE
•Systolic blood pressure (SBP): is
Maximum pressure recorded during
ventricular systole.
•Diastolic blood pressure (DBP):
Minimum pressure recorded during
ventricular diastole.
 JNC VII
Classification
Category Blood Pressure (mmHg)
Systolic Diastolic
Normal
<120 <80
Prehypertension
120-139 80-89
Hypertension

Stage 1 (mild)
140-159 90-99
Stage 2 (moderate)
160-179 100-109
Stage 3 (severe)
≥ 180 ≥110
 CLASS IFIC 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
 α-Adrenergic blockers: Prazocin
 β-Adrenergic blockers: Propranolol, atenolol,
• Vasodilators
• Hydralazine, Na Nitroprusside
Normal Regulation of
Blood Pressure
 •↓TOTAL PERIPHERAL RESISTANCE
ACE Inhibitors, Angiotensin Receptor
Blockers (ARB’S),
Vasodilators, α-Adrenergic Blockers,

•↓ Cardiac output
•Centrally acting •β adrenergic receptor blocker
Clonidine
•↓ Blood volume and body sodium stores
Diuretics

•Renin Angiotensin System

ACE-I, ARB’s
 Why treat HTN?

• Multiple organ
damage – heart,
kidney, brain (CVA),
eyes
Diuretics in
Hypertension
•Thiazides-Usually
used
•First-line therapy
•Mild to moderate HT
•Combined with
Amiloride
•ADE?
•Other uses?
 β-Blockers –
Mechanism of action

ADE:
•Impotence, loss of libido
•Precipitation of asthma
•LV dysfunction,
•Caution inDM
Beta Blockers
 CALCIUM CHANNEL BLOCKERS
Amlodipine, Nifedipine (extended release),
felodipine verapamil, diltiazem

• Block Ca2+ channels→arterial smooth

muscle relaxant action
• Dilate coronary, cerebral and peripheral
arteries → reduce total arterial resistance
• ADE:
• Nifedipine immediate release:Reflex
tachycardia, Headache, Flushing, Peripheral
edema
• Verapamil and Diltiazem: Bradycardia
ACE inhibitors
Captopril, enalapril, lisinopril, ramipril
ACE
 ACE inhibitors
Captopril, enalapril, lisinopril, ramipril

ACE-I

ARB

Angiotensin receptors
 Adverse effects and Uses
Of ACE-I
ADE

Dry cough

USES
•CHF
Hyper K+

Rashes

Post.Hypo •HTN
Fever
 Sodium nitroprusside

• Use – severe HTN, CHF as IV infusion

• Nursing implication

• Infusion should be protected from light and discarded after

24 hrs
• Discarded if colour changes to pale orange or dark brown
 Treatment strategies

• Lifestyle modification
- Weight reduction (BMI-18.5-24.9)
- Consume diet rich in fruits, vegetables
and low fat dietary product with a reduced
content of saturated and total fat
- Restricted sodium intake (< 6g NaCl)
- Regular physical activity (30 min/day)
- Limit alcohol consumption