B pharmacy Third year semester-V sub- Pharmacology-II

1. ANTIHYPERTENSIVE DRUGS
Presented by:
Mr. Shaikh Akhil
M.Pharm
Asst. Prof. Dept. of
Pharmacology,
BCCO Pharmacy, Naigaon,
S.R.T.M. University,
Nanded

2. Definition-Hypertension is common cardiovascular disease
determined by increase blood pressure (pressure exerted
by blood against the wall of a blood vessel )in arteries.
Normal blood pressure-
120/80 mmHg
systolic/diastolic
Symptoms that may occur
include:
•Confusion
•Ear noise or buzzing
•Fatigue
•Irregular heartbeat
•Nosebleed
•Vision changes
BP= CO X SVR
BP = Blood pressure
CO =Cardiac output
SVR=Systemic vascular
resistance

3. Category Systolic Blood
Pressure(mmHg)
Diastolic Blood
Pressure(mmHg)
Pre-hypertension 120-139 80
Hypertension – Stage 1 140-159 90-99
Hypertension – Stage 2 160-179 100-109
Hypertension – Stage 3 >180 >110
CATEGORIES OF HYPERTENSION
ACCORDING TO EUROPEAN SOCIETY OF
CARDIOLOGY.

4. Types of
Hypertension
Essential Secondary
A disorder of unknown origin affecting the
Blood Pressure regulating mechanisms
Secondary to other disease processes
RISK FACTORS-
•Hyperlipidaemia –more LDL content
•Tension and stress
•Smoking-more nicotine intake
•Diabetes mellitus
•Imbalance between vasoconstrictor and
vasodilators peptides

5. Treatment-Why???

6. Antihypertensive Drug Therapy

7. DIURETICS :
EXAMPLES:Thiazides: chlorthalidone
High ceiling:Furosemide
K+ sparing:Spironolactone,
MOA: Act on V-2 receptor in kidneys (vasopressin
receptor) having an antediuretic function----
leads to diuresis----increased secretion of Na &
H2O decrease in blood volume ----decreased CO--
--decreased BP.
Adverse Reactions
•dizziness,
•electrolyte
imbalance/depletion,
•hypokalemia,
•hyperlipidemia,
•hyperglycemia
(Thiazides)
Contraindications
•hypersensitivity,
•compromised kidney
function
•hyponatremia

9. Central Sympatholytics (a-2
Agonists) Drugs: clonidine, methyldopa
Site of Action:CNS medullary ,cardiovascular
centers
MOA: CNS a-2 adrenergic stimulation----
autoinhibitory feed back mechanism----
decreased sympathetic outflow----decreased
norepinephrine release----vasodilatation----
decreased PR---- decreased BP.
Adverse Effect:dry mouth; sedation; drowsiness;nasal
congestion
SYMPATHOLYTIC DRUGS
a-1 Adrenergic blockers (Antagonists)
Drugs:Prazocin,Terazocin
Site of Action: peripheral arterioles, smooth muscle
MOA:Blocks a-1 receptor(in post synaptic neurone as well as in
vascular smooth muscles)---- cause vasodialatation due to relaxation
of vascular smooth muscles---- decreased PR----also reduces preload
by pooling of blood----decreased CO ---- decreased BP.
Adverse Effects:nausea; drowsiness; postural hypotension;headache

10. b -ADRNERGIC BLOCKERS(ANTAGONISTS)
Drugs: Non Selective– Propranolol,Timolol, Pindolol
Cardioselective –Atenolol, Metoprolol(acts only on
beta-1 receptor )
Site of Action: heart,kidney.
MOA: 1.heart:blocks b -1receptor---reduce heart rate ----
decreased CO---- decreased BP
2.kidney:decreased renin production(mediated by b-
1 receptor)----depresses RAS system---- decreased PR----
decreased BP
Advantages:No postural hypotension;No salt and water
retention
Low incidence of side effects
Adverse Effects:impotence; bradycardia; fatigue; exercise
intolerance
Contraindication: asthma;bradycardia;hypersensitivity

12. CALCIUM CHANNEL BLOCKERS (CCBs)
Drugs: verapamil ; nifedipine ; diltiazem ;
amlodipine:felodipine
Site of Action- Vascular
smooth muscle
K
Ca
Na
MOA:Blocks long acting
voltage sensitive calcinm
channels
Advantages:
No sedation or other CNS effects
Can be given to asthma patients &
angina patients
No impairment of renal perfusion
No deleterious effect on uric acid
level& electrolyte
balance
Side effects:
flushing; headache; tachycardia;
peripheral oedema
gastroesophageal reflux
Contraindications:
Congestive heart failure;
Pregnancy and lactation

13. DRUGS ACTING ON RENIN
ANGIOTENSIN SYSTEM (RAS)
1ACE inhibitors: captopril;enalapril;
lisinopril
2 renin inhibitors: Aliskiren; remikinen
3 AT1 receptor antagonists:losartan
;candesartan
1st line of Drug:
No postural hypotension or
electrolyte imbalance (no fatigue or
weakness)
Safe in asthmatics and diabetics
Prevention of secondary
hyperaldosteronism and K+ loss
Reverse the ventricular hypertrophy
and increase in lumen size of vessel
No hyperuraecemia or deleterious
effect on plasma lipid profile
Side effects:
Dry cough;
Steep fall in BP with 1st dose
Skin rash
Angioneurotic oedema