Antihypertensives

Dr.U.P.Rathnakar MD.DIH.PGDHM Assistant Professor Dept of Pharmacology KMC, Mangalore

BLOOD PRESSURE

•Systolic blood pressure (SBP): is Maximum pressure recorded during ventricular systole. •Diastolic blood pressure (DBP): Minimum pressure recorded during ventricular diastole.

JNC VII Classification

Category
Normal Prehypertension Hypertension Stage 1 (mild) Stage 2 (moderate) Stage 3 (severe)

Blood Pressure (mmHg) Systolic Diastolic

<120 120-139 140-159 160-179 ≥ 180

<80 80-89 90-99 100-109 ≥110

CLASS IFIC ATION
• ACE Inhibitors: Captopril, enalapril, lisinopril, • Angiotensin-II-receptor antagonists: Losartan, candesartan, • Calcium channel blockers: Nifedipine SR, amlodipine, • Diuretics • Hydrochlorothiazide, Furosemide, Amiloride, triamterene, spironolactone. • Sympatholytics  α-Adrenergic blockers: Prazocin  β-Adrenergic blockers: Propranolol, atenolol, • Vasodilators • Hydralazine, Na Nitroprusside

Normal Regulation of Blood Pressure

•↓TOTAL PERIPHERAL RESISTANCE ACE Inhibitors, Angiotensin Receptor Blockers (ARB’S), Vasodilators, α-Adrenergic Blockers, •↓ Cardiac output •β adrenergic receptor blocker •↓ Blood volume and body sodium stores Diuretics

•Centrally acting Clonidine

•Renin Angiotensin System ACE-I, ARB’s

Why treat HTN?

• Multiple organ damage – heart, kidney, brain (CVA), eyes

Diuretics in Hypertension •Thiazides-Usually used •First-line therapy •Mild to moderate HT •Combined with Amiloride •ADE? •Other uses?

β-Blockers – Mechanism of action

ADE: •Impotence, loss of libido •Precipitation of asthma •LV dysfunction, •Caution inDM

Beta Blockers

CALCIUM CHANNEL BLOCKERS Amlodipine, Nifedipine (extended release), felodipine verapamil, diltiazem

• Block Ca2+ channels→arterial smooth muscle relaxant action • Dilate coronary, cerebral and peripheral arteries → reduce total arterial resistance • ADE: • Nifedipine immediate release:Reflex
tachycardia, Headache, Flushing, Peripheral edema • Verapamil and Diltiazem: Bradycardia

ACE inhibitors

Captopril, enalapril, lisinopril, ramipril

ACE

ACE inhibitors

Captopril, enalapril, lisinopril, ramipril

ACE-I

ARB
Angiotensin receptors

ADE
Dry cough

Adverse effects and Uses Of ACE-I

Hyper K+

Rashes

Post.Hypo

USES •CHF •HTN

Fever

Sodium nitroprusside

• Use – severe HTN, CHF as IV infusion • Nursing implication

• Infusion should be protected from light and discarded after 24 hrs • Discarded if colour changes to pale orange or dark brown

Treatment strategies
• Lifestyle modification - Weight reduction (BMI-18.5-24.9) - Consume diet rich in fruits, vegetables and low fat dietary product with a reduced content of saturated and total fat - Restricted sodium intake (< 6g NaCl) - Regular physical activity (30 min/day) - Limit alcohol consumption

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