Anti hypertensive drugs classification detailed explanation with diagrams. Diuretics, renin angiotensin inhibitors, sympathetic inhibitors, calcium channel blockers, vasodilators

1. Dr. Resu Neha Reddy
MD Pharmacology
Osmania Medical College

2.  HYPERTENSION Very common
 Middle age
 Cardiovascular morbidity & mortality
 BLOOD PRESSURE – Lateral pressure exerted by moving column of blood on
wall of blood vessels.
 TYPES OF HYPERTENSION:
 PRIMARY /ESSENTIAL:
 No specific cause 95% cases
 SECONDARY HYPERTENSION:
 Due to specific disease or drug 5% cases

3. Normal Regulation of Blood Pressure
According to the Hydraulic equation:
Arterial blood pressure (BP) is directly proportionate to the
product of the blood flow (cardiac output, CO) and the
resistance to passage of blood through precapillary arterioles
(peripheral vascular resistance, PVR)
BP = CO × PVR

4. BLOOD PRESSURE
CATEGORY SYSTOLIC DIASTOLIC
NORMAL < 120 < 80
PRE-HYPERTENSION 120 - 139 80 – 89
STAGE 1 HTN 140 - 159 90 – 99
STAGE 2 HTN 160 - 179 100 – 109
HYPERTENSIVE CRISIS ≥ 180 ≥ 110
 NICE (2011), JNC8 (2014), WHO-ISH (2003)  cut-off level  140/90 mm Hg
 JNC8  150/90 mm Hg > 60 yrs = HTN

5. CARDIOVASCULAR RISK FACTORS
1. Age > 55 yrs (men), > 65 yrs (women)
2. Family h/o premature CV disease
3. Smoking
4. Dyslipidemia (high LDL, TG & low HDL )
5. DM
6. HTN
7. Obesity (BMI > 30)
8. CKD (Microalbuminuria or GFR < 60ml/min)
9. Secondary life style

7. Classification Of Antihypertensives
1. Diuretics
2. Renin Angiotensin Inhibitors
3. Sympathetic inhibitors
4. Calcium Channel Blockers
5. Vasodilators

8. Diuretics:
 Thiazides: Hydrochlorthiazide, chlorthalidone
 Loop diuretics: furosemide
 K sparing diuretics: Spironolactone, Eplerenone
Renin Angiotensin Inhibitors:
 Angiotensin converting enzyme inhibitors:
Captopril, Enalapril, Lisinopril, Ramipril, Perindopril, Fosinopril, Qinapril
 Angiotensin 1 Receptor (AT1R) antagonists:
Losartan, Valsartan, Telmisartan, Olmesartan, Candesartan
 Direct Renin Inhibitor:
Aliskiren
Classification Of Antihypertensives

9. Sympatholytics:
 Central Sympatholytics: Clonidine, Methyldopa
 Alpha Adrenergic Blockers: Prazosin, Terazosin, Doxazosin, Phentolamine
 Beta Adrenergic Blockers: Propranolol, Metoprolol, Atenolol
 Alpha + Beta Blockers: Labetalol, Carvedilol
Calcium channel Blockers:
 Phenylalkylamine: Verapamil
 Benzothiazepine: Diltiazem
 Dihydropyridines: Nifedipine, Amlodipine, Nicardipine, Nimodipine
Classification Of Antihypertensives

10. Vasodilators:
 Arteriolar dilator:
 Hydralazine
 Minoxidil
 Arteriolar and venodilator:
 Sodium Nitroprusside
Classification Of Antihypertensives

11. DIURETICS

16. HYPERGLYCEMIA MORE COMMON ---
HYPERURICEMIA MORE COMMON ---
HYPERCALCEMIA MORE COMMON ON CHRONIC
ADMINISTARTION
THIAZIDES LOOP DIURETICS
HYPOKALEMIA MORE COMMON LESS COMMON
DEHYDRATION
FALL IN BP
LESS COMMON SEEN WITH OVER USE
DILUTIONAL
HYPONATREMIA
RARE AFTER VIGOROUS USE
HEARING LOSS --- SEEN
RENAL INSUFFICIENCY AGGRAVATED  LOW GFR CAN BE USED
DIURETICS

39. TREATMENT OF HYPERTENSION

40. JNC-7 GUIDELINES
A ACE Inhibitors,
ARBs
B Beta Blockers
C CCB
D Diuretics
JNC-8 GUIDELINES
A ACE Inhibitors,
ARBs
C CCB
D Diuretics

41. BB
BB+CCB

45. HYPERTENSIVE DRUGS SAFE IN PREGNANCY
Better Beta Blockers – Labetalol
Mother Methyldopa
Care Clonidine
During Dihydropyridines
Hypertensive Hydralazine
Pregnancy Prazosin & All Alpha Blockers

47. THANK YOU…