Disease Management-

Hypertension
By
Anam Fatima
Lecturer (Pharmacy)
University of Lahore, Lahore
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Etiology of hypertension

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Blood Pressure Regulation

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Sympathetic nervous system

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Clinical Presentation

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Diagnosis of hypertension

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Treatment of hypertension
• Pharmacological therapy
• Non-pharmacological

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Recommendation for choice of initial
medication
For initiation of anti-hypertensive therapy, first line agent include:
 Thiazide diuretics
Ca channel blockers
ACE Inhibitors or ARBs

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Mechanism of action
• Angiotensin-converting enzyme is part of the renin-angiotensin-
aldosterone system.
• Specifically, ACE is involved in converting angiotensin I into
angiotensin II, which is the active hormone used to increase blood
pressure through several mechanisms.
• First, angiotensin II binds to angiotensin II receptors located on blood
vessels. This causes vasoconstriction and an increase in blood
pressure.
• Angiotensin II also increases sodium and water reabsorption in the
kidneys, and augments the release of aldosterone from the adrenal
cortex.
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ACE MOA:
• ACE is also involved in the breakdown of bradykinin, a vasodilator.
ACE inhibitors block the breakdown of bradykinin, causing levels of
this protein to rise and blood vessels to widen (vasodilation).

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Side effects/Adverse effects
• Dry cough
• Skin rash
• Fever
• Hyperkalemia
• Angioedema
• Hypotension

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Contraindication
• ACE inhibitors are fetotoxic so should not be used in women who are
pregnant

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ARBs

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ARB drugs:

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ARBs Side effects/Adverse effects
• Skin rash
• Fever
• Dizziness
• Hyperkalemia
• Angioedema
• Hypotension
• Teratogenic

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Side effects of Calcium channel blockers
• Constipation
• Dizziness
• Fast heartbeat (palpitations)
• Fatigue
• Flushing
• Headache
• Nausea
• Rash
• Swelling in the feet and lower legs
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• Calcium channel blockers should not be prescribed to congestive
heart failure patients.

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Beta Blockers

Beta-adrenergic blocking agents, commonly known as beta blockers,

are medications used to reduce blood pressure and are often
prescribed to treat cardiac problems.
They work by blocking the effects of adrenaline, also called
epinephrine. Beta blockers may affect the heart and blood vessels.
They reduce the blood pressure by slowing down the heart rate and
contractility, as well as by improving blood flow by dilating veins and
arteries.

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Drugs
• atenolol
• bisoprolol
• carvedilol.
• labetalol
• metoprolol
• propranolol

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Beta blockers indications
 A β-blocker can be used in patients who have any of the
following: coronary artery disease,
 postmyocardial infarction,
 dysrhythmia, and
 heart failure.
• Those older than 60 years, however, should not use a β-blocker
as the initial agent.

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Drugs to treat hypertension in pregnancy

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Drugs to treat hypertension in pregnancy
• According to WHO recent guidelines:

The pharmacological treatment of HTN in pregnancy, preferred

medications include:
 methyldopa,
 beta-blockers (particularly labetalol),
 CCBs (particularly nifedipine and, as an alternative, verapamil),
 and the direct-acting vasodilators (particularly hydralazine

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Drugs contraindicated in pregnancy
• ACE inhibitors
• ARBs
• Direct acting renin inhibitors
• Spironolactone
• Beta blocker (atenolol)

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Hypertensive Crises

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Drugs to treat hypertensive crises
• Na-nitroprusside
• Hydralazine (safe in pregnancy)
• Beta blockers

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Hypertension treatment in compelling
indication

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Hypertension treatment in diabetic patients

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