Selecting a P-drug for Stage I Hypertension

Define diagnosis:

 Stage I Hypertension (Systolic blood pressure:140-159, Diastolic:90-99 mm

Hg)

Specify the therapeutic objective:

 To keep the blood pressure levels within normal limits (Systolic BP < 140,
Diastolic < 90)
 To prevent hypertension induced complications like – Heart attack, stroke,
chronic heart failure and renal disease.
 To prevent hypotension due to overdose of drugs.

Make a list of effective groups of drugs:

S.No. Drug Class Drugs and Dose Adverse effects

1 Diuretics
2 ACE Inhibitors
3 ARB
4 Beta Blockers
5 Calcium Channel
Blockers
6 Alpha Blockers
7 Vasodilators
8 Centrally acting
agents
Hydrochlorothiazide 12.5-50mg
Spironolactone 25-50mg
Furosemide 20-80mg
Enalapril 2.5-40mg
Lisinopril 10-20mg
Ramipril 5-20mg
Candesartan 8-32mg
Valsartan 80-320mg
Losartan 50-100mg
Olmesartan 20-40mg
Telmisartan 20-80mg
Metoprolol succinate 50-100mg BD
Nebivolol 5-10mg
Propranolol 40-120mg BD
Carvedilol 6.25-25mg BD
Bisoprolol 5-10mg
Labetalol 100-300mg BD
Amlodipine 5-10mg
Nifedipine ER 30-90mg
Prazosin 1-20mg
Hydralazine 25-100mg BD
Minoxidil 5-10mg
Clonidine 0.1-0.2mg BD
Methyldopa 250-500mg BD
Monitor for hypokalemia
Gynaecomastia, Hyperkalemia
Used when GFR < 40ml/min
Cough, Angioedema and
hyperkalemia
Losartan lowers uric acid levels;
Candesartan may prevent
migraine headaches
Not first line agents – reserve
for post-MI/CHF
Cause fatigue and decreased
heart rate
Adversely affect glucose; mask
hypoglycemic awareness
Cause ankle edema
Orthostatic hypotension
May cause reflex tachycardia
and fluid retention
Clonidine available as weekly
patch formulation

Select an effective group based on efficacy, safety, economy:

 ACE Inhibitors are preferred for stage I hypertension patients.

Select a drug (P-drug)

 Ramipril is the p drug