2. What is hypertension
Also called high blood pressure
It is condition in which the force of blood against the artery wall
is too high.
Hypertension is define as the blood pressure above 140/90
through risk appear to increase even above 80/120
Arteriosclerosis may contribute to HBP but is not only the factor
It is classified in two class i.e. primary and secondary
3. Non pharmacological therapy for the
treatment of hypertension
140/90 blood pressure can be easily cure by treating
patient with weight loss
By restriction of sodium intake
Increasing aerobic exercise
Moderating alcohol consumption
4. Anti hypertensive drugs
Arterial pressure = cardiac output * peripheral vascular
resistance
antihypertensive drugs are those drugs that decrease HBP
by either decreasing cardiac output or peripheral
resistance and both
6. Diuretics
Thiazides and related agonist = hydrochlorothiazide,
chlorothiazide, indapamides
High ceiling / loop inhibitor = furosemide , torsemide
K+ sparing = amiloride spironolactone
7. Moa
Diuretic decrease the total peripheral resistance.
Diuretics drugs decrease extracellular vilume by intracting
with
thiazide sensitive Nacl co- transpoter expressed Na+
excreation in the urine blood pressure fall
Thiazide also promotes vasodilation in isolated arteies
8. High ceiling diuretics
Furosemide is a protype drug
Fall in bp entirely depend upon reduction in plasma
volume and c.o.
T.p.r. and vascular response are not reduced
K+ sparing diuretics decrease bp slightly but they are
used only in combination with thiazide diuretics to
prevent k+ loose
9. Diuretics
Positive
No fluid retension and
tolerance
No or less postural
hypotension
No side affect on cns
Effective for systolic
hypertension
Low cost
Flat drc
Negatives
Hypokalemia
Erectile dysfunction
Carbs intolerance due to
inhibtion of insulin release
dyslipidemia
Hyperureceemia ewdfscxz
11. Moa
Ace inhibitor
Decrease tpr
Dilation of arterioles and compliance of longer
artery is increase
Both systolic and diastolic bp fall
12. Angiotensinogen receptor blocker
At1 and AT2 are angiotensinogen receptor
present at a specific site
ARB are the G protein coupled receptor
Lorsartam is an AT1 antagonist while PD
123177 is a AT antagonist
13. MOA
Losartam block AT receptor
Output of SNS decrease
Increase vasodilation of vaculasr smooth muscle
14. moa
Losartan not inhibit ACE therefore more angiotensinogen
is produce
Which act on AT2 receptor
But Losartan block overpert action of angiotensinogen 2
on At2 receptor ( such as vasoconstriction central and
peripheral sympathetic stimulation etc.)
Ccombination with ACE inhibitor will result in blockage of
both AT1 and AT2 receptor
15. Calcium channel blocker
They decrease the peripheral resistance without
compromising c.o.
Calcium channel blocker have –( chonotropic and ionotropic )
action on heart
They decrease sinus rate and rate of conduction which lead
to fall in bp
16. Beta adrenergic blocker
Selective B1 antagonist : metroprolol , atenolol
Non Selective beta blocker : propranolol
Non selective beta blocker
are not widely used alone
because of their
contraindication to cadiac,
pulmonary and peripheral
vascular disease
17. Beta blocker
these drug act on b receptor
Decrease the heart rate and force of
construction
Cardiac output decrease
18. Alpha adrenergic blocker
Selective alpha 1 adrenergic blocker : prazosin
Other alpha blocker are terazosin doxazosin
Prazosin is moderately potent
antihypertensive drug with many
desirable features.
But not the first line of drug because
tolerance and fluid retention
developed with monotherapy
19. MOA
They dilate both resistance and capacitance of
vessel
Reduction in TPR
Cardiac output decrease
Blood pressure fall
20. Alpha blocker also have cardio
stimulation renin release action in long
term therapy therefore, fall in BP is
compensate by cardiac stimulation
Postural hypotension, headache,
drowsiness, dry mouth are some
of the adverse effect of Alpha
blocker
22. CLONIDINE
It is an imidazoline derivative having a complex action
It is partial agonist with high affinity and internsic activity
toward ALPHA 2a subtype receptor
They decrease sympathetic stimulation out flow BP fall
Bradicardia
They also decrease NA release from peripheral adrenergic
neuron
23. Methyl dopa
Methyl dopa is a alpha-methyl analoguos of
dopamine precursor
IT act on Alpha 2 receptor to decrease the total
peripheral resistance more then heart rate and
cardiac output
Larg dose of drug inhibite the enzyme dopa
decarboxylase in brain and periphery that lead to
decrease NA synthesis and formed false methyl
NA
25. Arteriloar
Decrease in TPR
Great reduction in diastolic then systolic BP
Tolerance to hypertension developed uless diuretics
and Beta blocker given with drugs
26. Arteriolar + venous ( sodium
nitropuside)
It relax both resistance and capacitance of vessel
Reduction in TPR
Cardiac output also decrease by decrease in venous return
It is used in patein with cardiac disease
