NAME ZEESHAN ALI

REG 70092862

Blood pressure is defined as the force exerted by the blood against the walls of blood vessels after one
complete cycle of the heart

➢Hypertension: is defined as the systolic blood pressure greater than 130 mm of Hg or a diastolic blood
pressure greater than 80 mm of Hg

Classification:

Classification: Systolic BP Diastolic BP

Normal <120 <80
Pre-hypertension 120-139 80-89
Stage 1 HTN 140-159 90-99
Stage2 HTN >160 >100

Classes of Antihypertensive Agents

Diuretics

Reduce blood volume and cardiac output

Mechanism of action

Cardiac output return to normal But peripheral vascular resistance declines

Sodium Contribute to vascular resistance=increase vessel
stiffness
Venodilation Alter sodium-sodium calcium exchange

Uses of diuretics

Lower BP by 10-15 mmHg in most patients

Thiazide diuretic –mild to moderate HTN

Loop diuretic – severe HTN and hypertensive emergencies

Adverse Effects (Thiazide Diuretics):

Potassium depletion – hypokalemia Magnesium depletion Hyperuricemia- gouty attacks Glucose

intolerance. Increase serum lipid concentration
Thiazide diuretics Loop diuretic K+sparing diuretics
MOA MOA MOA
Inhibits reabsorption of Na, K, Cl Loss of fluid by inhibition of Na Blocks reabsorption of Na and
resulting is osmotic water loss and Cl reabsorption water, potassium retained
Relaxes arterioles (decrease Reduced BP
afterload) Reduced SVR (afterload),
reduced CVP (preload)
Indication Indication Indication
HTN (first line) Edema
Edematous state d/t HF, liver Fluid accumulation d/t liver/-
cirrhosis kidney disease
Adverse effect Adverse effect Adverse effect
Electrolyte disturbances Electrolye loss/dehydration Spironolactone- gynecomastia,
(decrease K, elevated Ca, lipids, Furosemide- amenorrhea, irregular menses,
glucose, uric acid) ototoxicity/photosensitivity Triamterene- kidney stone d/t
Dizziness Orthostatis hypotension reduced folic acid
GI disturb Hyperglycemia, hyperuricemia

B- blocker

atenolol, metoprolol, bisoprolol, timolol (eye drops), labetalol (IV)

MOA

o blocks SNS stimulation of Beta 1

o Reduced renin and aldosterone release and fluid balance
o Vasodilation of aterioles= Decreased PVR and BP
o Decreased myocardial stimulation
o Decreased HR
o Decreased conduction through AV node
o Prolonged SA node recovery
o Decreases myocardial O2 demand and contractility

*reduces the work of the heart

Indications

• HTN, angina, dysrhythmias

Adverse Effects

- Can worsen angina or cause MI if stopped quickly

- Symptoms of HF (coughing, SOB, Edema, fatigue)
- Can mask signs of hypoglycemia
- CV: AV block, bradycardia, HF, PV insufficiency, hypotension
- Resp: bronchospasm, bronchoconstriction dazziness
ARB [Angiotensin receptor blockers]

losartan, eprosartan, valsartan, irbesartan, telmisartan

MOA

blocks binding of angiotensin II to receptors

Affects smooth muscle and adrenal gland

Blocks vasoconstriction and secretion of Aldosterone

Indications

HTN, HF (decrease preload/after load), decreased mortality after MI

Adverse Effects

URI, headache, hypotension, tachycardia, S/S of toxicity

CALCIUM CHANNEL BLOKER

Amlodipine (dihydropyridines), Diltiazem (benzothiazepines), Verapamil (phenylakylamines)

MOA

- Blocks Ca access to cells causing:

- decreased contractility
- decreased conductivity of the heart
- decreased demand for O2
- dilation of coronary arteries (decreased afterload, increased oxygen supply)
decrease work of heart

IndicationS

- Angina
- HTN
- Migraines

Adverse Effects

- Hypotension
- Palpitations
- Tachycardia or bradycardia
- HF
- Constipation
 - Nausea
- Dermatitis
- Dyspnea
- Rash/flushing
- Peripheral edema

Interactions

- beta blocker, digoxin, h2 blockers, cyclosporin

ACE inhibitors
i.e. ramipril, fosinopril sodium, lisinopril, enalapril, perindopril, captopril
MOA
✓ Suppresses formation of angiotensin II from the RAAS system - Reduces PVR
✓ Increases CO
Indications
➢ HTN (decreased afterload, prevents formation of ACE II)
➢ HF (prevents Na and water resorption, causes diuresis, decreases preload) -
Protective effects on kidney (decreases GFR)
AdverseEffects
➢ Hyperkalemia
➢ Fatigue, mood changes, dizziness, headache
➢ Dry, non-productive cough**
➢ Hypotension
➢ Angioedema
➢ Rash, thrombocytosis, loss of taste, proteinuria, pruritis, anemia,
neutropenia
Interactions
o NSAIDS
o Potassium sparing diuretics - Lithium and ACE inhibitors