Professional Documents
Culture Documents
Moreover, quitting smoking, eating oily fish and adopting a diet that is
low in saturated fat may produce further reductions in cardiovascular
risk.
Antihypertensive drugs
Diuretics
Thiazide :
The mechanism of action of these drugs is incompletely understood and it may take up to a
month for the maximum effect to be observed.
Loop diuretics: used as antihypertensive in cases with CRF, GFR less than 30 ml/kg/min
Angiotensin converting enzyme inhibitors:
Angiotensin l converted via ACE to angiotensin ll which cause
vasoconstriction and Stimulate the release of aldosterone from adrenals.
Blocking this pathway result in hypotensive effect.
ACE inhibitors should be used with particular care in patients with impaired
renal function or renal artery stenosis because they can reduce the filtration
pressure in the glomeruli and precipitate renal failure.
Electrolyte should be checked 1 to 2 weeks after initiation of therapy up to 30
% woresning in renal function is accepted, more woresning indicate stopping
ACE inhibitors.
e.g Captopril , enalopril, lisinporil, ramipril, perindopril.
S.E: Dry cough 15 %, angioedema 1 %, hyperkalemia, rash, renal
dysfunction, Neutropenia(captopril)
• Bradykinin is inflammatory mediators which promote vasodilatation,
degraded by ACE, ACE inhibitors result in accumulation of bradykinin
which give additional antihypetensive effect.
• Bradykinin is the cause of ACE inhibitors dry cough.
• ACE inhibtors induced dry cough is indication to stop ACE I hibitors and
to swich to ARB
ARB: angiotensin receptor blockers
e.g: Losartan, Valsartan, telmisartan, candesartan, irbesartan.
Block angiotensin 2 receptor.