ANTIHYPERTENSIVE DRUGS

Hypertension is an elevation of systolic

and/ordiastolicBP above 140/90 mm of Hg
It is a common cardiovascular condition.
Hypertension may be primary (essential)
hypertension-where the cause is not
known or secondary-when it is secondary
to other conditions like renal, endocrine or
vascular disorders.
Based on the degree of severity, hyper-
tension can be graded as in Table 6.5:
Table 6.5: Grading of blood pressure

Category SBP mmHg DBP mmHg

Normal <120 and <80

Prehypertension 120-139 or 80-89

Hypertension Stage1 140-159 or 90-99

Hypertension Stage 2 2160 or 2100

Abbreviations: SBP-systolic blood pressure;

DBP-diastolic blood pressure

Blood pressure is determined by

cardiac output (CO) and total peripheral
vascular resistance (PVR),5 Blood pressure
iscontroled by baroreceptor retlexes acting
through autonomic nervous system along
with the renin-angiotensin-aldosterone
System.
 System, renin-angi0
sodium and water balancee
channels or
Chabr Sup
plasma volume). DD
Classification
Diuretics
Thiazides: Hydrochlorothiazide,
chlorthalidone, etc.
11cal
Loop diuretics: Furosemide, bume-
tanide Po
K'Sparing diuretics: Spironolactone,
amiloride, triamterene
2Drugs acting on renin angiotensin
system
A P
Angiotensin converting enzyme in-
hibitors: Captopril, enalapril, lisinoo-
Alu pril, ramipril, fosinopril, benazepril.
Angiotensinl receptor antagonist:
Losartan, candesartan, valsartan
irbesartan, olmesartan.
Renin inhibitor: Aliskiren. Agren
3. Sympathelytics
Centoa
Centrally acting drugs: Clonidine,
methyldopa
Arud Ganglion blockers: Trimethaphan
Arud

Muhr9Adrenergic receptor blockers:

B-blockers:
-

etc. Propranolol, atenolol

a-blockers: Prazosin
Mixed a- and
carvedilot.
B-blockers: Labetalol
4/ Vasodilators
(Arteriolar dilators:Hydralazine,
minoxidilkdiazOxide
Arteriolar and venular
Sodium nitroprusside dilators:
 Renin Angiotensin System
Drugs Acting on

Afgiotensin Converting Enzyme (ACE)

Kibitors
powerful vasoconstrictor.
Angiotensin II is a

Aldosterone also raises the BPby increasing

the plasma volume Fig. 6.4). ACE inhibitors
prevent the formation of angiotensin II
 Angiotensinogen
Renin
24
Angiotensin I
ACE ACE inhibitors
Vasoconstriction
Angiotensin ll
oso
BP
Angiotensin lll
Salt
Aldosterone and water t Blood volume
retention
Fig. 6.4:Renin-angiotensin system
Uses (HC M Sc)
1 Hypertension ACE inhibitors are
useful in the treatment of hypertension
ofall grades due to all causes. Addition
of a diuretic potentiates their efficacy.
They are presently the first line anti-
hypertensives. (Table 6.7). They are spe-
cially indicated as antihypertensives in:
Patients with diabetes as ACE-Tslow
the development of nephropathy)
Renal diseases-ACE inhibitors
slow the progression.
Left ventricular hypertrophy -is
gradually reversed by ACE inhi-
itos
CCEÁCE inhibitors.are the first line
drugs (Cuptop0l CMpml
3 Myocardial infarction ACE inhibitorsenala
started within 24 hours andgiven for ph
severalweeks prevent the development
of CCF and reduce mortality
4 Coronary artery disease: In patients
who are at a high-risk of ischemic
cardiovascular conditions like MI and
stroke, ACEinhibitors afford significant
benefit by reducing the risk of MI
strokeand sudden death
5. Chronic renal failure: In patients with
diabetic nephropathyand chronicrenal
failure, ACE inhibitors delay the pro
gression of renal disease
6.Scleroderma renal crisis: ACE inhi-
bitors may be life-saving in these
patients.
Adverse effects:/ ACE inhibitors are well-
tolerated. Adverse effects include
dry cough (due to raised bradykininpersistent
levels)
hyperkalemia, alteration of taste sensation,
skin rashes, hypotension,
headache, nausea,
abdominal pain andblood disorders
Angioedema though rare can be severel At
thefirst sign of angioedema ACE inhibitors
should be stopped.