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Presented by:
• Sameena Ramzan
M.Pharma 1st year
• Branch : Pharmaceutical chemistry
Hypertension is a very common disorder , particularly past middle age. It is not a disease itself, but
is an important risk factor for cardiovascular mortality and morbidity.
For practical purposes “Hypertension “could be that level of BP at or above which long-term
antihypertensive treatment will reduce Cardiovascular mortality.
The ganglion blockers developed in the 1950s were effective, but produced a variety of side effects. Reserpine
was a breakthrough but produced mental depression. The therapeutic potential of Hydralazine couldn’t be tapped
fully because of marked side effects. The antihypertensives of the 1960-70s were methyldopa, 𝛽 blockers,
thiazide and high ceiling diuretics & clonidine. The status of beta blockers and diuretics were consolidated in the
1970s and selective alpha blockers Prazosin broke new grounds.
The antihypertensives introduced in 1980-90s were angiotensin II converting enzyme (ACE) inhibitors &
calcium channel blockers.
Angiotensin receptor blockers (ARBs) were added soon after, and the direct renin blocker Aliskiren is the latest
drug.
Pharmacological classification of Antihypertensive agents:
Synthesis of Diuretics used as antihypertensive agents:
1.Thiazides :
MECHANISM OF ACTION:
Thiazides are medium efficacy diuretics with primary site of action in the cortical diluting
segment or the early DT (site III) . Here they inhibit Na+ —Cl– symport at the luminal
membrane.
Initially, the diuresis reduces plasma and e.c.f. Volume by 5—15% and this decreases
cardiac output. Thiazides are mild antihypertensives, average fall in mean arterial pressure
is ~10mmHg.
4-Chloro-N-furfuryl-5-Sulphamoylanthranilic acid
Mechanism of Action:
The major site of action is thick ascending limb of loop of Henle, therefore, called loop diuretics. Furosemide inhibits Na + -
K+ -2Cl– cotransport (site II) . The corticomedullary osmotic gradient is abolished and positive as well as negative free water
clearance is blocked. K+ excretion is increased mainly due to high Na + load reaching DT.
FUROSEMIDE has weak Case inhibitory action, increases bicarbonate excretion as well ; urinary pH may rise but the
predominant urinary ion is Cl–.
Synthesis :
Adverse effects of Diuretics:
Most of the adverse effects of these drugs are related to fluid and electrolyte changes caused by
1.
them.
2.Hypokalaemia
3.Hyperuricaemia
4.Hyperglycaemia & dyslipidaemia
5.Magnesium depletion
6.Allergic Manifestations
7.Hearing loss
Daily Dose(mg) :
Hydrochlorothiazide: 12.5 – 100
Furosemide: usually 20-80 mg once daily in the morning
Trade names :
Hydrochlorothiazide: AQUAZIDE, HYDRIDE THIAZIDE, ESIDREX
Furosemide: LASIX, FRUSENEX
Mechanism of Action:
Captopril, a dipeptide analogue, is the first orally active ACE inhibitor. It is sulfhydryl
Containing dipeptide surrogate of proline which abolishes the presser action of Ang I but
not that of Ang II. It doesn’t block AT1 or AT2 receptors.
Fall in BP is more marked when sodium ion has been depleted by diuretics, because renin
level is high .
ACE inhibitors causes feedback increase in renin release resulting in overproduction of Ang
I. Since it’s conversion to Ang II is blocked, Ang I is diverted to produce more Ang (1-7)
which has vasodilator property and could contribute to the BP lowering action.
Calcium channel blockers inhibit these channels (L-type) in cardiac and smooth
muscles. By decreasing calcium influx during action potential in a frequency and
voltage dependant manner , they reduce Systolic intracellular calcium concentration
and muscle contraction.
1.Palpitation
2.Flushing
3.Ankle edema
4.Headache, drowsiness, nausea
5.Gastroesophageal reflux may be worsened
Daily Dose :
Nifedipine : 5-20mg BD oral
TRADE NAMES: CALCIGARD, DEPIN, NIFELAT
Synthesis and Mechanism of
beta-blockers:
Mechanism Of Action:
These drugs block the beta – adrenergic receptors of the heart , slow the
heart , reduce the force of contraction and reduce the cardiac output.
The interaction of the drugs with alpha 2 receptors is expressed in the suppression of
vasomotor centre neurons of the medulla and reduction of hypothalamus activity , which
leads to a decline in sympathetic impulses to the vessels and heart . Cardiac output and
heart rate are moderately reduced and consequently arterial pressure is reduced.
Adverse Effects:
1.Sedation
2.Impotence
3.Postural hypotension
4.Reduced mental capacity
5.Positive coomb’s test occurs with methyldopa in 1/6 patients, few develop haemolytic
anaemia
6.Rebound hypertension
Daily Dose :
Clonidine: 100 micro gram
Methyldopa: 0.25-0.5 g
Trade names:
Clonidine : CATAPRES, ARKAMIN
Methyldopa : EMDOPA, ALPHADOPA
Synthesis and Mechanism of action of Arteriolar dilator :
Mechanism Of Action:
Hydralazine is a directly acting arteriolar vasodilator with little
action on venous capacitance vessels.
3.Postural hypotension
6.Hirusitism was observed as a frequent side effect of minoxidil but now is used
in alopecia.
Daily Dose:
Hydralazine: 25-50mg
Trade name: NEPRESOL
Synthesis and Mechanism of Arteriolar + Venodilator:
Sodium Nitroprusside:
Mechanism of Action:
Sodium Nitroprusside is a rapidly (within seconds) and consistently acting vasodilator
with brief duration of action(2-5min)
Nitroprusside relaxes both resistance and capacitance vessels, reduces t.p.r as well as
cardiac output. Myocardial work is reduced.
1.Thiocyanate toxicity
Daily Dose: