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Antihypertensive agents

Antihypertensive agents. Hypertension :. Typical Diurnal Blood Pressure Rhythm in a "Dipper". Antihypertensive agents. Classification of antihypertensives : ACE inhibitors : Captopril, Enalapril. Angiotensin Antagonist : Losartan

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Antihypertensive agents

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  1. Antihypertensive agents Hypertension :

  2. Typical Diurnal Blood Pressure Rhythm in a "Dipper"

  3. Antihypertensive agents Classification of antihypertensives : • ACE inhibitors : Captopril, Enalapril. • Angiotensin Antagonist : Losartan • Calcium channel blockers : Verapamil, Diltiazem, Nifedipine. • Beta adrenergic blockers : Propranolol. • Alpha adrenergic blockers : Prazosin.

  4. Antihypertensive agents Diuretics : • Thiazides : Hydrochlorothiazides , Metolazone, Indapamide. • High ceiling diuretics : Furesomide, Bumetanide, Ethacrynic acid • K sparing diuretics : Spironolactone, Triamterene, Amiloride Alpha -2 agonist: Clonidine, Methyldopa

  5. Antihypertensive agents Vasodilators: • Arteriolar : Hydralazine, Minoxidil. • Arteriolar + Venous : ACE inhibitors • Venodilator : Nitrates

  6. Antihypertensive agents Angiotensin Converting Enzyme (ACE) Inhibitors: • Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril • Reduction in arterial resistance (after load) • Reduction in venous tension (preload) • Reduction in aldosterone secretion

  7. Antihypertensive agents

  8. ACE inhibitors

  9. Antihypertensive agents Indications for ACE inhibitors includes: Congestive heart failure (CHF) Hypertension Left ventricular dysfunction Prevention of nephropathy in diabetes mellitus

  10. ACE Inhibitors Adverse effects: Common adverse effects includes hypotension, cough, hyperkalemia. Rash and taste disturbances with captopril Angioedema Cautions and contraindications: Pregnancy Bilateral renal artery stenosis

  11. Antihypertensive agents ANGIOTENSIN RECEPTOR BLOCKERS ARB (AT 1 BLOCKERS): Losartan, Erbesartan, Candesartan • Competitive antagonists of Angiotensin II • No inhibition of ACE or breakdown of bradykinin

  12. Antihypertensives agents

  13. Antihypertensive agents Hydralazine : • Direct arteriolar vasodilator. • Release of nitric oxide cause the vasodilation of the arteries. • Reflex sympathetic system activation can cause tachycardia. • Norepinephrine release from nerve endings can increase myocardial contractility

  14. Antihypertensive agents Hydralazine : Adverse effects • Throbbing headache , palpitation • SLE – in slow acetylators or on prolonged use at a higher dose • Precipitation of angina and MI

  15. Antihypertensive agents Hydralazine : Uses • Hypertension not controlled by first line of anti hypertensives • Can be used hypertension of pregnancy • Hypertensive emergencies

  16. Antihypertensive agents Minoxidil : • Arteriolar vasodilator - K channel activator • Chronic therapy – excess growth of hair on face, back and arms • Used in life threatening hypertension • Used in hypertension with renal failure

  17. Antihypertensive agents Hypertensive emergencies : • Sodium Nitroprusside • NTG • Diazoxide • Hydralazine • Enalaprilat • Nicardipine • Esmolol • Nifedipine - Sublingual

  18. THE CHOICE OF THE ANTIHYPERTENSIVE IN PATIENTS WITH CONCOMITANT DISEASES. Pregnancy C.I Cautious OK AVOID Concomitant disease Antihypertensive drug Diuretics ß-block. Ca-block. ACE-inhibitor Diabetes C.I AVOID OK INDI CATED Gout AVOID -- -- -- Dyslipidemia C.I AVOID -- -- Angina pectoris -- I I -- Cardiac failure I judicious OK I

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