Drugs used in hypertension


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Drugs used in Hypertension

By: Sara Khalid Memon ,3rd year MBBS, LUMHS

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Drugs used in hypertension

  1. 1. Presented by: Sara Khalid Memon – Group B3 3rd year, MBBS, LUMHS
  2. 2. Hypertension can be defined as: A sustained rise in blood pressure. It is a condition in which the arteries have persistently high blood pressure, making harder for the heart to pump blood in the vessels. Basically it has 2 main components; the SYSTOLIC and the DIASTOLIC blood pressure.
  3. 3. Parameters on which blood pressure depends Cardiac output Total Peripheral Resistance SYSTOLIC BP DIASTOLIC BP > Stroke Volume And Heart Rate Preload can be defined as the initial stretching of the cardiac myocytes prior to contraction (EDV) Afterload is the load against which the heart has to pump(TPR)
  4. 4. H Y P E R T E N S I O N
  5. 5. > Centrally acting sympatholytic drugs > Ganglionic Blockers > Sympathetic Nerve Ending Blockers > Adrenergic Receptor Blockers a) Alpha 1 blockers b) Beta blockers c) Mixed blockers > Direct Vasodilators > Calcium Channel Blockers > Angiotensin Converting Enzyme Inhibitors >Angiotensin Receptor Blockers >Renin Inhibitor > Diuretics
  6. 6. Clonidine: Advantage: Used in Hypertension when other drugs have not responded adequately. Disadvantage: Sedation, Depression, rebound hypertension on withdrawal Alpha-Methyl Dopa: Advantage: Used in Hypertension when other drugs have not responded adequately. Has less effects on FETUS so can be used in pregnancy. Disadvantage: Sedation, Depression, causes hematologic immunotoxicity (making coomb’s test +ve)
  7. 7. Guanethidine: Replaces norepinephrine in the vesicle and itself acts as false neurotransmitter. Disadvantage: Orthostatic Hypotension. Reserpine: Reserpine irreversibly blocks the Vesicular monoamine transporter. This normally transports free amine neurotransmitters from the cytoplasm of the presynaptic nerve terminal into storage vesicles. Disadvantage: Depression of CNS Metyrosine: Makes the Tyrosine hydroxylase enzyme dysfunctional. Disadvantage: Diarrhea, Trembling of hands and fingers
  8. 8. A) Alpha blockers: Selectives: Prazosine, terazosin Adverse Effect: Orthostatic Hypotension Non-Selectives: Phenoxybenzamine, Phentolamine Adverse Effect: Tachycardia, Palpitation B) Beta blockers : Selectives: Metoprolol, Atenolol Adverse Effect: Dizziness, Drowsiness, Fatigue, Diarrhea Non-Selectives: Propranolol Adverse Effect: Drowsiness, Sedation, Asthma
  9. 9. C) Mixed blockers: Acting on Alpha as well as on Beta receptors. Labetolol, Carvidolol, Bucindolol Adverse Effects: Drowsiness, Fatigue, Insomnia, Orthostatic Hypotension NOTE: Nebivolol is a newer beta blocker with some direct vasodilator action Relatively very less adverse effects and is highly cardioselective !!!
  10. 10. Hydralazine: Acts primarily on the arteries and arterioles. >Advantage: Accepted method for controlling blood pressure in pregnant hypertensives. >Disadvantage: Almost always causes reflex tachycardia. Minoxidil: Dilates resistance vessels >Advantage: Used in hypertension refractive to other drugs. Other use is causing hypertrichosis >Disadvantage: Fluid retention, Reflex Tachycardia
  11. 11. Verapamil: Acts on both cardiac and smooth muscles(more action on heart) Advantage: Additional used in treatment of angina, supraventricular tachyarrythmias, migraine headache Disadvantage: Facial flushing, dizziness, constipation Diltiazem: Acts on both cardiac and smooth muscles equally. Advantage: Used for hypertension, Angina Disadvantage: Hypotension, bradycardia
  12. 12. Nifedipine: Acts more on arterial smooth muscles than on heart Advantage: Vasoselective Disadvantage: Lethargy, Bradycardia, Hypotension
  13. 13. Captopril, Enapril, Lisinopril, Prindropril, Ramipril Advantage: Effective in CCF and Diabetic Nephropathy too Losartan, Cadesartan, Valsartan, Telmisartan Advantage: Do not increase the bradycardia level. Aliskiren, Pepstatin Advantage: Acts directly on the required substrate.
  14. 14. Cough (dry Cough) Angioedema Proteinuria Taste changes Hypotension Contraindicated in Pregnancy Rashes Increased K+ Levels Low Ang II and Aldosterone levels
  15. 15. Advantage: Effective in controlling blood pressure in long term. Controls BP in Supine as well as standing positions so postural hypotension doesn’t occur. > Loop Diuretics : Furosamide > Thiazides : Hydrochlorothiazide > Potassium Sparing Diuretics : Amiloride, Spironolactone Disadvantage: Of Thiazides include, hypokalemia, hyperuricemia; Of Loop Diuretics include, Ototoxicity; Of Potassium Sparing group include, Gastric upsets, Gynecomastia in males, Menstrual irregularities in females.
  16. 16. > Diuretics are very effective in Elderly patients, Blacks, Inexpensive and can be used for Prolonged maintenance. > Beta Blockers are wonderful if the patient also has supraventricular tachycardia and/ Angina and/ MI and/Migraine. > Beta blockers and ACE inhibitors are very effective in white and young hypertensives. > Vasodilating drugs cause salt and water retention and cardiostimulatory effects. > Hydralazine should be used with diuretics and beta blockers. > Alpha Blockers always cause postural hypotension.
  17. 17. New Antihypertensive Drugs >Monatepil, a dual alpha-receptor and calcium channel blocker, has potent antihypertensive effect, lowers serum cholesterol and also has antiatherosclerotic effect. >Dual ACE and endopeptidase inhibitor, such as alatriopril, has a "broad spectrum" antihypertensive effect and may be effective in majority of hypertensive patients. Many other are under clinical testing and not yet approved .. !
  18. 18. > Physical Exercise > Weight loss > Salt Restriction > Avoid Smoking > Reducing Alcohol Consumption > Relaxation techniques > K+ rich diets > Red meat should be avoided