ANTI-HYPERTENSIVE DRUGS

DR MEHREEN MIRZA
MBBS , MPHIL
LEARNING OBJECTIVES:
 To define hypertension and its types

 To classify anti-hypertensive drugs

 To explain the mechanism of action

 To enlist the clinical uses and adverse effects

 To describe vasodilators etc

To List the nursing management of a patient with a hypertensive

emergency
DEFINITION
Hypertension is defined as a sustained increase in blood pressure of 140/90 mm Hg
or higher
WHO defines hypertension as a condition in which the blood vessels have
persistently raised pressure
 TYPES OF HTN

Essential or primary Secondary hypertension

hypertension ( < 20% )

● Pheochromocytoma
● Renal vascular disease
● Adrenal cortical
tumors
ANTI HYPERTENSIVE DRUGS
• Antihypertensives are a class of drugs that are used to treat
hypertension (high blood pressure)

• The fundamental goal of treatment should be the prevention of the

important endpoints of hypertension, such as heart attack, stroke
and heart failure

• Patient age, associated clinical conditions and end-organ damage

also play a part in determining dosage and type of medication
administered
 CLASSIFICATION OF VASODILATORS
DIRECTLY ACTING INDIRECTLY ACTING

Calcium Channel Blockers Drugs that interfere with the

sympathetic nervous system
Nifedipine
Alpha 1 blockers
Diltiazem
Phentolamine, Phenoxybenzamine
Verapamil Alpha 2 agonists

Potassium channel activators Clonidine

D1 receptor agonist
Minoxidil Fenoldopam

Diazoxide Renin Angiotensin Antagonists

 CLASSIFICATION
Diuretics

Sympathoplegics Vasodilators

Calcium RAAS
Channel
Blockers Inhibitors
CLASSIFICATION
POINT OF ACTION OF ANTIHYPERTENSIVE DRUGS
ACE INHIBITORS
BETA BLOCKERS
CALCIUM CHANNEL BLOCKERS
DIURETICS
 VASODILATORS
CLASSIFICATION OF VASODILATORS
• Arterial Vasodilators • Arterial and Venous
Vasodilators
Hydralazine
Sodium Nitroprusside
Minoxidil
Fenoldopam
Diazoxide
CENTRALLY ACTING
SYMPATHOPLEGICS
CENTRALLY ACTING SYMPATHOPLEGICS
 These agents stimulate alpha 2 receptors in brainstem resulting in
reduction in sympathetic outflow from vasopressor centers in the
brain
 Drugs included in this group are:
o Methyldopa
o Clonidine
o Guanabenz
o Guanfacine
METHYLDOPA
MECHANISM OF ACTION

 Selective alpha 2 agonist

 It’s a prodrug so it should be converted to active

metabolite

 Methyldopa is carried through blood via aromatic amino

acids transporters
 Methyldopa enters the brain via aromatic amino acid transporter
Dopa decarboxylase
Alpha methyl dopamine
Beta hydroxylase
Alpha methyl norepinephrine
(Stored in the secretory vesicles substituting for NE)

When released from the vesicles activate central alpha 2 receptors

Decrease in sympathetic output & lowers Blood Pressure

 Rapid

ABSORPTION
absorption,
half life is 2
hours and is

METABOLISM
PHARMACOKINETICS prolonged to
4-6 hours in
Metabolized
in liver AND Duration of

DOSE AND DOC

patients with excreted in action of
liver disease urine single dose is
primarily as 24 hours
the sulfate
conjugate
(50-70%) and Preferred
the parent drug in
drug (25%) hypertension
during
pregnancy,
250mg twice
daily
ADVERSE EFFECTS
Transient Sedation
Depression
Dryness of mouth
Hyperprolactinemia causing gynaecomastia and galactorrhea
Hepatotoxicity (Rare)
Medicine triggers the body immune system to attack its own RBC
Hemolytic anaemia in 1-5 % of patients (positive coombs test)
PHARMACOLOGICAL SITES OF ACTIONS

Heart Veins Arteries

1. Beta Blockers 1. Loop and 1. ACEI

2. Diltiazem Thiazide diuretics 2. ARBs
3. Verapmil 2. Aldosterone 3. Alpha Blockers
antagonist 4. CCBs
4. Clonidine (Via 3. Nitrates 5. Dihydropyridine
central mechanism) 4. ACEI 6. Vasodlators
5. ARBs 7. (Minoxidil and
Hydralazine)
HYPERTENSIVE EMERGENCY
MANAGEMENT
WHAT IS HYPERTENSIVE EMERGENCY
• Hypertensive emergency is a condition in which there is elevation of
both systolic and diastolic blood pressure with the presence of acute
target organ disease

• Patients with a hypertensive emergency need admission with continuous

blood pressure monitoring

• For adults with no organ damage, lower the blood pressure by 25% in
the first hour and then to 160/100 over the next 2-6 hours, and then
gradually to normal over 2 days
SIGN AND
SYMPTOMS
• Headache
• Visual blurring
• Dyspnea
• Chest pain
• Dizzy
• Anxiety
• Sense of doom
 MANAGEMENT

• The drugs of choice in treating a hypertensive emergency with acute

pulmonary edema are intravenous nitroglycerin, clevidipine, or nitroprusside
 NURSING MANAGEMENT
• Monitor blood pressure frequently.
• Administer antihypertensive medications as
prescribed.
• Have two large-bore IVs.
• Provide oxygen f the saturations are low
(less than 94%)
• Limit fluid intake if the patient is in heart
failure.
• Assess ECG to ensure the patient is not
having a heart attack.
• Check report of the chest x-ray to ensure
the patient is not in heart failure
• Listen to the heart for murmurs and
lungs for rales and crackles
• Check if the patient has edema
• Check renal function and electrolyte
levels
• Encourage rest and provide a quiet
room
• Educate the patient on how to lower
stress
• Educate patient on a low salt diet,
exercise, and healthy eating
• Educate the patient on the importance
of taking antihypertensive medications
THANK YOU