For our beloved student

1. Dr. Haji Bahadar
Assistant Professor
Khyber Medical University-IPMS

2. Blood pressure is the force exerted by blood against the
walls blood vessels.
Factors that determine the blood pressure:
1- Cardiac output (CO).
2- Total peripheral resistance (PR).
3- Elasticity of the aorta and large arteries.
4- Blood volume and circulatory capacity.
BP = CO X PR

3. Hypertension is defined as having a blood pressure higher than 140/ 90
mmHg

5.  1. Diuretics
 2. Beta adrenergic blockers
 3. Calcium channel blockers (self study)
 4. Angiotensin converting enzyme inhibitors
 5. Angiotensin receptor blockers(self study)
 7. Direct arterial vasodilators (self study)
 8. Drug used in hypertensive emergency(self
study)

6. A diuretic is any substance that promotes diuresis, that is, the
increased production of urine.
Types of diuretics
a. Thiazides: Hydrochlorothiazide, Chlorthalidone
MOA: Inhibit sodium-chloride transporter in the distal tubule.
Because this transporter normally only reabsorbs about 5% of
filtered sodium
b. Loop diuretics: Furosemide, Torsemide, Bumetanide
MOA: Loop diuretics inhibit the sodium-potassium-chloride
cotransporter in the thick ascending limb
c. Potassium-sparing diuretics:
 MOA: Amiloride and triamterene (inhibitors of epithelial sodium
transport at the late distal and collecting ducts) as well as
spironolactone and eplerenone (aldosterone receptor antagonists)
reduce potassium loss in the urine.

9.  Hypertension
 Heart failure
 Pulmonary and systemic edema

13. Mechanism of action: Beta blockers reduce the blood
pressure by blocking the effects of the hormone epinephrine.
Beta blockers such as pindolol (Visken), penbutolol sulfate (Levatol), and acebutolol
hydrochloride (Sectral) differ from other beta blockers as they possess intrinsic
sympathomimetic activity (ISA), which means they mimic the effects of epinephrineand
norepinephrine and can cause an increase in blood pressure

14.  Beta-blockers decrease arterial blood pressure by
reducing cardiac output. Many forms of hypertension
are associated with an increase in blood volume and
cardiac output. Therefore, reducing cardiac output by
beta-blockade can be an effective treatment for
hypertension, especially when used in conjunction
with a diuretic.
 Hypertension in some patients is caused by emotional
stress, which causes enhanced sympathetic activity.
Beta-blockers can be very effective in these patients.

15. Cardiac Effects of beta blockers
Decrease contractility
(negative intropy)
Decrease heart rate
(negative chronotropy)
Decrease conduction velocity
(negative dromotropy)

17.  Hypertension
 Angina

18.  Bronchoconstriction can occur, especially when
non-selective beta-blockers are administered to
asthmatic patients. Therefore, non-selective beta-
blockers are contraindicated in patients with
asthma or chronic obstructive pulmonary disease