This document discusses antihypertensive drugs used to treat hypertension. It defines hypertension and classifies blood pressure levels. It covers the causes of primary and secondary hypertension. Non-pharmacological treatments including lifestyle modifications are outlined. The major classes of antihypertensive drugs are described as sympatholytics, vasodilators, agents acting on the renin-angiotensin-aldosterone system, and diuretics. Examples are provided for each subclass. The document concludes that hypertension is common and can be treated through medication and lifestyle changes.

1. ANTIHYPERTENSIVE DRUGS
PRESENTED BY:
SHREYASHI PAL
B.Pharm
3rd Year
Guru Nanak Institute of Pharmaceutical Science and Technology
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2. CONTENTS
• Introduction
• Classification of Blood Pressure in Adults
• Types of Hypertension
• Causes of Secondary Hypertension
• Causes of Primary Hypertension
• Non-Pharmacological Treatment
• Pharmacological Treatment
• Classification of drugs
• Sympatholytics
• Vasodilators
• Agents acting on Renin-Angiotensin-Aldosterone System (RAAS)
• Diuretics
• Conclusion
• Reference
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3. INTRODUCTION
• Hypertension is a common disorder that, if not
effectively treated, results in a deadly
increased probability of coronary thrombosis ,
strokes and renal failures.
• The early feature of hypertension may include
increased cardiac output followed by increased
peripheral resistance.
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4. CLASSIFICATION OF BLOOD
PRESSURE IN ADULTS
CLASSIFICATION SYSTOLIC (mm of
Hg)
DIASTOLIC(mm of
Hg)
Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 Hypertension 140-159 or 90-99
Stage 2 Hypertension ≥160 or ≥100
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5. TYPES OF HYPERTENSION
Hypertension may be resulted from
• A specific cause (known as Secondary
Hypertension)
• From an underlying patho-physiological
mechanism of unknown etiology (primary or
essential hypertension)
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6. CAUSES OF SECONDARY
HYPERTENSION
• Secondary hypertension accounts for fewer than
10% of cases, and most of these are caused by
chronic kidney disease or renovascular disease.
• Other conditions causing secondary hypertension
include Cushing’s syndrome, hyperthyroidism,
hyperparathyroidism, primary aldosteronism,
pregnancy. Some drugs that may increase BP
include corticosteroids, estrogens, nonsteroidal
anti inflammatory drugs (NSAIDs) etc..
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7. CAUSES OF PRIMARY
HYPERTENSION
Factors that may contribute to the development of primary hypertension,
are:
 Humoral abnormalities involving the renin-angiotensin-aldosterone
system
 A pathologic disturbance in the CNS, autonomic nerve fibers,
adrenergic receptors.
 Abnormalities in either the renal or tissue autoregulatory processes for
sodium excretion, plasma volume, and arteriolar constriction
 A deficiency in the local synthesis of vasodilating substances in the
vascular endothelium, such as prostacyclin, bradykinin, and nitric oxide
 A high sodium intake and increased circulating natriuretic hormone
inhibition of intracellular sodium transport, resulting in increased
vascular reactivity and a rise in BP
 Increased intracellular concentration of calcium, leading to altered
vascular smooth muscle function and increased peripheral vascular
resistance.
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8. NON-PHARMACOLOGICAL
TREATMENT
All patients with prehypertension and hypertension
should be prescribed lifestyle modifications,
including
(1) weight reduction if overweight
(2) adoption of the Dietary Approaches to Stop
Hypertension eating plan
(3) dietary sodium restriction ideally to 1.5 g/day.
(4) regular aerobic physical activity
(5) moderate alcohol consumption
(6) smoking cessation.
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9. PHARMOCOLOGIC TREATMENT
CLASSIFICATION OF DRUGS
The drugs available for the treatment and control
of hypertension may be divided into four
major classes.
A. Sympatholytics
B. Vasodilators
C. Agents acting on Renin-Angiotensin-
Aldosterone System (RAAS)
D. Diuretics
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11. SYMPATHOLYTICS
Sympatholytics are further subdivided into the
following
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SUBDIVISIONS EXAMPLES
α1 Antagonist Prazosin, Terazosin.
β Blocker Propanolol, Metoprolol, Atenolol
α+β Blocker Labetolol, Carvedilol
Centrally acting Methyldopa Methylnorepinephrine, Clonidine
Agents depleting neurotransmitter Reserpine, Guanethidine
Ganglion blocking agents Trimethaphan

12. VASODILATORS
The subdivisions of vasodilators are as follows:
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SUBDIVISIONS EXAMPLES
Arterial Vasodilator Hydralazine, Dihydralazine
Arterial and Venous
Vasodilator
Sodium nitroprusside
Potassium Channel Agonist Diazoxide, Minoxidil
Calcium Channel Blocker Verapamil, Diltiazem,
Nifedipine, Felodipine,
Amlodipine

13. AGENTS ACTING ON RENIN-
ANGIOTENSIN-ALDOSTERONE
SYSTEM (RAAS)
Subdivisions of this class are as follows:
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SUBDIVISION EXAMPLE
Angiotensin I Receptor Blocker Losartan, Telmisartan
Angiotensin Converting Enzyme
Inhibitor (pril groups of drug).
Captopril, Enalapril, Lisinopril,
Fosinopril,Ramipril

14. DIURETICS
The subdivisions of diuretics are as follows:
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SUBDIVISION EXAMPLE
Thiazide derivatives Chlorthiazide,
Hydrochlorthiazide
Loop Diuretics/ High ceiling
diuretics
Furosemide,Torsemide
Potassium sparing diuretics Spiranolactone

15. CONCLUSION
Hypertension is a common disorder that can be seen
within maximum people now-a-days. This
disorder can be treated with proper medication
and changes in lifestyle.
Further research on antihypertensive drugs are
carried out.
Lifestyle modification alone is appropriate therapy
for patients with prehypertension. Patients
diagnosed with stage 1 or 2 hypertension should
be placed on lifestyle modifications and drug
therapy concurrently
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16. REFERENCES
 H.P. Rang, M.M. Dale, J.M. Ritter, P.K. Moore;
Pharmacology; Fifth Edition; pages- 298 to 302.
 K.D. Tripathi; Essentials of Medical
Pharmacology; Sixth Edition; pages-539 to 554.
 Barbara G. Wells, Joseph T. DiPiro, Terry L.
Schwinghammer, Cecily V. DiPiro;
Pharmacotherapy Handbook; Seventh Edition;
pages- 111 to 129.
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