Prof. RavisankarVignan Pharmacy collegeValdlamudiGuntur Dist.Andhra PradeshIndia.banuman35@gmail.com00919059994000
HYPERTENSIONIt is defined as a physiologic condition where there isan increase in the arterial blood pressure abovenormal....
Hypotension may be defined as a physiologic state where there is aHYPERTENSION IS DEVIDED IN TO 2 TYPES:1.PRIMARY HYPERTEN...
In PRIMARY OR ESSENTIAL HYPERTENSION In majority of casses where etiologyIs unknown cause and is known as primary hyperten...
CAUSES OF HYPERTENSION
Classification(category ofHypertension)Systolic BloodPressure(mmHg)DiastolicBloodPressure(mmHg)Normal (B.P) 120 and 80Preh...
On etiological basis hypertension is divided into twotypes1.Primary hypertensionA definite cause is not known in primaryhy...
2.Secondary HypertensionIn some cases Hypertension may be secondary toother diseases likea.Endocrine disorders•Pheochromoc...
Stenotic renal arteryStenotic renal artery
Classification of antihypertensive agents10Hypertension = Disease of the blood vesselsVascular biology alteredTreat the va...
The Renin-Angiotensin Cascade and the 3 Available Approaches toPharmacologic Inhibition of Production or Action of Angiote...
Depending on chemical classificationACE inhibitorsSulphydrylE.g:CaptoprilDicarboxylateE.g:Enalapril,LisinoprilPhosphateE.g...
CAPTOPRILENALAPRILFOSINOPRIL
Structure activity relationship[SAR]R Groups that bindto Zn+2ionCH CR1(NORing)Essential forstabilisationMethyl groupresemb...
Mechanism of actionThey inhibit ACE which is involved in the conversion of AngIto Ang II.•Which is a potent vasoconstricto...
UsesFirst choice in treatment of Hypertension.In left ventricular failureIn diabetic nephropathyIn myocardial infarction
•Benazepril (Lotensin®)•Captopril (Capoten®)•Fosinopril (Monopril®)•Lisinopril(Prinivil®,Zestril®)•Enalapril (Vasotec®)•Qu...
Angiotencin receptor Antagonists
CH2NNHXAcidic groupSTRUCTURE ACTIVITY RELATIONSHIP[SAR]Essential foractivity tomimic Asp1carboxylate ofAng-IISubstitutedwi...
Mechanism of actionThey act by blocking the Angiotensin I which regulates theeffects of angiotensin on B.P,heart and sodiu...
UsesIn treatment of hypertension as an alternative toACE Inhibitors.
 Valsartan (Diovan®) Telmisartin (Micardis®) Candesartan (Atacand®) Losartin (Cozaar®)Irbesartin (Avapro®)Angiotensin...
Diuretics•28Diuretics ("water pills") increase thekidneys excretion of salt (sodium) andwater, decreasing the volume of fl...
Thiazidechlorthalidone, hydrochlorothiazide (HCTZ),indapamide, metolazoneLoopbumetanide, furosemide, torsemidePotassium-sp...
Thiazide DiureticsDose in morning to avoid nocturnal diuresisMore effective antihypertensives than loop diuretics .Chlor...
Loop DiureticsDose in AM or afternoon to avoid nocturnal diuresisHigher doses may be needed for patients withseverely de...
Mechanism of Actioninhibit Na+ and Cl- transporter in distal convolutedtubulesincreased Na+ and Cl- excretionweak inhibito...
Potassium-sparing Diuretics Dose in AM or afternoon to avoid nocturnal diuresis Generally reserved for diuretic-induced ...
Aldosterone antagonistsDose in AM or afternoon to avoid nocturnal diuresisAdverse effects:may cause hyperkalemia especia...
Calcium channel blockersDepending upon their chemical structureBenzothiazepinesEg:DiltiazemDiphenylalkylaminesEg:Verapamil...
Verapamil DiltiazemNifedipineNifedipine
NHCH3RCOORROOCN1 substitutionreduses the activityPresence of nonpolar alkyl orcyclo alkylreduces theactivityEster group fo...
DRUGS Mode ofactionAdverseDrugreactionsUsesDiltiazem Acts byinhibitingVoltagesensitiveCalciumchannels inmyocardiumand vasc...
•Idradipine (DynaCirc®)•Nicardipine (Cardene®)•Nisoldipine (Sular®)•Felodipine (Plendil®)•Amlodipine (Norvasc®)Calcium cha...
Centrally acting sympatholyticsMechanism of actionMethyldopa is an α2 adrenergic receptor agonist acts centrally bydecreas...
Adverse effectsSedation and drowsynessConstipationGynacomastiaSexual impotenseUsesTreat of Hypertension in combination...
clonidineMode of action:Its acts by stimulating α2-adrenergic receptros andthereby reducing sympathetic outflow andnoradre...
In moderate to severehypertensionFor withdrawl therapyof alcohol opioidsTo diagnosepheochromocytomaSedation and drowsi...
PrazosinPrazosin phentolamineAdrenergic receptor antagonist
Drugs Mode ofactionAdversedrugreactionUsesprazosinIt acts byselectiveblocking ofα-1 receptorsin theperipheralblood vessels...
Drugs Mode ofactionAdversedrugreactionUsesPhentolamineIt blocksboth α1 andα2-receptorsleading tovasodilationand increasein...
PROPANOLOL ATENOLOLLABETOLOLβ-adrenergic Blockers
PROPRANOLOL
Drugs Mode ofactionAdversedrugeffectsUsesPropanolol Inhibitssympatheticactivity byblocking β1and β2receptors•Fatigue•Brady...
Drug Mode ofactionAdverse drugreactionsUsesAtenolol InhibitSympatheticactivity byselectiveblockage ofβ1 receptors.•Fatigue...
Drug Mode ofactionAdverseeffectsUses•Carvedilol•LabetalolThey blockβ and α1receptorthere byinhibitsympatheticactivity.•Dry...
MINOXIDIL HYDRALAZINEDirect vasodilators
Drug Mode ofactionAdverseeffectsUsesMinoxidil It opens thepotassiumchannelsand causeshyperpolarization.•Tachycardia•Fluidr...
Drug Mode ofactionAdverseeffectsUsesHydralazine Directrelaxation ofvascularsmoothmuscles bystimulatingcGMP•Flushing•Tachyc...
Say No to Smoking, Excessive Drinking (smoking16% CHF)Shake That Salt HabitControl Your PressureGood Reasons to Exercisebl...
Dietary approaches to stop hypertension
"The way drugs are being used to control high bloodpressure today is much more effective than in the past,"Saunders said. ...
The treatment of hypertension has become one of the greatest challenges formedical professionals today. It is estimated th...
Aliskirin latest antihypertensive agnet.
REFERENCESWilson and Gisvolds Text book of Organic Medicinal AndPharmaceutical chemistryPrinciples of Medicinal chemistry ...
Principles of Medicinal chemistry by William foeyeAdvanced practical Medicinal chemistry by AshutoshkarProfiles in drug sy...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION,...
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ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION, MECHANISM OF ACTION, SAR, ACE INHIBITORS, ARB , DIURETICS(WATER PILLS), TIPS TO STOP SILENT KILLER.

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ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION, MECHANISM OF ACTION, SAR, ACE INHIBITORS, ARB , DIURETICS(WATER PILLS), TIPS TO STOP SILENT KILLER.
BY P. RAVISANKAR, VIGNAN PHARMACY COLLEGE, VADLAMUDI, GUNTUR,A.P, INDIA.

Published in: Education, Health & Medicine

ANTI HYPERTENSIVE AGENTS [MEDICINAL CHEMISTRY] BY P.RAVISANKAR, HYPERTENSION,TYPES,CAUSES OF HYPERTENSION, CLASSIFICATION, MECHANISM OF ACTION, SAR, ACE INHIBITORS, ARB , DIURETICS(WATER PILLS), TIPS TO STOP SILENT KILLER.

  1. 1. Prof. RavisankarVignan Pharmacy collegeValdlamudiGuntur Dist.Andhra PradeshIndia.banuman35@gmail.com00919059994000
  2. 2. HYPERTENSIONIt is defined as a physiologic condition where there isan increase in the arterial blood pressure abovenormal.•Normal B.P is 120/80 mm Hg.•An individual is hypertensive whenB.P is >140/90 mm Hg.
  3. 3. Hypotension may be defined as a physiologic state where there is aHYPERTENSION IS DEVIDED IN TO 2 TYPES:1.PRIMARY HYPERTENSION OR ESSENTIAL HYPERTENSION1.SECONDARY HYPERTENSION OR MALIGNANT HYPERTENSION.
  4. 4. In PRIMARY OR ESSENTIAL HYPERTENSION In majority of casses where etiologyIs unknown cause and is known as primary hypertension.The following factors may contribute to elevate of B.P•Dietary intake of more sodium and less potassium.In some cases primary hypertension may be herediatary.Advancement of age.Decreased vascular synthesis of Nitric oxide (No)( is useful in vasodialatation)In SECONDARY HYPERTENSION where etiology can be identified.Secondary hypertension is due toRenal disease (kidney disorders ( Chronic glomerular nephritis.)Adrenal disease (endocrine disorders)Pheochromocytoma (tumour on adrenal medulla) which secretes excessivecatechol amines like adrenaline and nor adrenaline)Hyper aldosteronism.Muscular disorders:Contraction (narrowing)of aorta.Renal artery stenosis(narrowing of artery )Toxemia of pregnancy (presence of toxins in the blood stream)Encephalitis(inflammation of the briain)Increased intra cranial pressure.Thyrotoxicosis(toxic condition caused by over activity of thyroid gland)oral contraceptives.
  5. 5. CAUSES OF HYPERTENSION
  6. 6. Classification(category ofHypertension)Systolic BloodPressure(mmHg)DiastolicBloodPressure(mmHg)Normal (B.P) 120 and 80Prehypertension 121-139 or 81-89Stage 1 (mild)hypertension140-159 or 90-99Stage 2hypertension(moderate)160-179 or 100-1096Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42(6):1206–1252.Stage III (severe) 180-209 110-119.Stage iV (very >210 >120.severe)
  7. 7. On etiological basis hypertension is divided into twotypes1.Primary hypertensionA definite cause is not known in primaryhypertension.Following factors may contribute to elevation of B.P.•Dietary intake of more sodium and less potassium.•Decrease in vascular synthesis of nitric oxideresponsible for vasodilation.•In some cases it may be heriditary.
  8. 8. 2.Secondary HypertensionIn some cases Hypertension may be secondary toother diseases likea.Endocrine disorders•Pheochromocytoma•Hyperaldosteronismb.Chronic glomerular nephritisc.Muscular disorders•Contraction of aorta•Renal artery stenosis
  9. 9. Stenotic renal arteryStenotic renal artery
  10. 10. Classification of antihypertensive agents10Hypertension = Disease of the blood vesselsVascular biology alteredTreat the vasculatureTherapeutic optionsBetaBlockersACE ARB Diuretics CCB OthersAdapted from Vascular Biology Working Group, University of FloridaCollege of Medicine, Carl Pepine, MD, Director
  11. 11. The Renin-Angiotensin Cascade and the 3 Available Approaches toPharmacologic Inhibition of Production or Action of Angiotensin II. Directrenin inhibitors (DRI), angiotensin-converting enzyme inhibitors (ACEI),and angiotensin (AT) type 1 receptor blockers (ARB).Drugs interacting with Renin-Angiotensin system
  12. 12. Depending on chemical classificationACE inhibitorsSulphydrylE.g:CaptoprilDicarboxylateE.g:Enalapril,LisinoprilPhosphateE.g:Fosinopril
  13. 13. CAPTOPRILENALAPRILFOSINOPRIL
  14. 14. Structure activity relationship[SAR]R Groups that bindto Zn+2ionCH CR1(NORing)Essential forstabilisationMethyl groupresembles sidechain ofalanineEnhances thepotency of thecompoundSulfhydrylgroup leads toshorterduration ofactionn-butylamine indicarboxylatecontainingcomponds orallyactive.
  15. 15. Mechanism of actionThey inhibit ACE which is involved in the conversion of AngIto Ang II.•Which is a potent vasoconstrictor.Adverse effects•Dry cough•Dysgysia•Skin rashes•Foetal toxicity
  16. 16. UsesFirst choice in treatment of Hypertension.In left ventricular failureIn diabetic nephropathyIn myocardial infarction
  17. 17. •Benazepril (Lotensin®)•Captopril (Capoten®)•Fosinopril (Monopril®)•Lisinopril(Prinivil®,Zestril®)•Enalapril (Vasotec®)•Quinapril (Accupril®)•Ramipril (Altace®)•Trandolapril (Mavik®)ACE inhibitors
  18. 18. Angiotencin receptor Antagonists
  19. 19. CH2NNHXAcidic groupSTRUCTURE ACTIVITY RELATIONSHIP[SAR]Essential foractivity tomimic Asp1carboxylate ofAng-IISubstitutedwithketones,cooHformsIonic,dipole-dipole helpsdrug tointeract withAT1Require to mimicthe His sidechain ofAngiotensin-II
  20. 20. Mechanism of actionThey act by blocking the Angiotensin I which regulates theeffects of angiotensin on B.P,heart and sodium and waterbalance.Adverse effectsHyperkalaemiaAngioedemaFoetal toxicityGidisturbances
  21. 21. UsesIn treatment of hypertension as an alternative toACE Inhibitors.
  22. 22.  Valsartan (Diovan®) Telmisartin (Micardis®) Candesartan (Atacand®) Losartin (Cozaar®)Irbesartin (Avapro®)Angiotensin receptor blockers
  23. 23. Diuretics•28Diuretics ("water pills") increase thekidneys excretion of salt (sodium) andwater, decreasing the volume of fluid inthe bloodstream and the pressure in thearteries. Diuretics are the oldest andmost studied antihypertensive agents.
  24. 24. Thiazidechlorthalidone, hydrochlorothiazide (HCTZ),indapamide, metolazoneLoopbumetanide, furosemide, torsemidePotassium-sparingamiloride, triamtereneAldosterone antagonistseplerenone, spironolactoneCLASSIFICATION
  25. 25. Thiazide DiureticsDose in morning to avoid nocturnal diuresisMore effective antihypertensives than loop diuretics .Chlorthalidone 1.5 to 2 times as potent as HCTZAdverse effects• hypokalemia• hypomagnesemia• hypercalcemia• sexual dysfunctionlithium toxicity withConcurrent adminstration.3131
  26. 26. Loop DiureticsDose in AM or afternoon to avoid nocturnal diuresisHigher doses may be needed for patients withseverely decreased glomerular filtration rate or heartfailureFurosemideAdverse effects:hypokalemia,hypomagnesemia, hypocalcemia32
  27. 27. Mechanism of Actioninhibit Na+ and Cl- transporter in distal convolutedtubulesincreased Na+ and Cl- excretionweak inhibitors of carbonic anhydrase, increasedHCO3- excretionincreased K+/Mg2+excretiondecrease Ca2+ excretion
  28. 28. Potassium-sparing Diuretics Dose in AM or afternoon to avoid nocturnal diuresis Generally reserved for diuretic-induced hypokalemiapatients Weak diuretics, generally used in combination withthiazide diuretics to minimize hypokalemiaAdverse effects:may cause hyperkalemia especially in combination with anACE inhibitor, angiotensin-receptor blocker or potassiumsupplementsavoid in patients with diabetes35
  29. 29. Aldosterone antagonistsDose in AM or afternoon to avoid nocturnal diuresisAdverse effects:may cause hyperkalemia especially in combination with ACEinhibitor, angiotensin-receptor blocker or potassiumsupplementsGynecomastia: up to 10% of patients takingspironolactone36
  30. 30. Calcium channel blockersDepending upon their chemical structureBenzothiazepinesEg:DiltiazemDiphenylalkylaminesEg:Verapamil1,4-dihydropyridinesEg:NifedipineDiaminopropanol etherEg:Bepridil
  31. 31. Verapamil DiltiazemNifedipineNifedipine
  32. 32. NHCH3RCOORROOCN1 substitutionreduses the activityPresence of nonpolar alkyl orcyclo alkylreduces theactivityEster group foroptimumactivity,-NO2may decreasesthe activityMethyl group ispresent except inamlodipineSAR of 1,4-dihydropyridinesPotency is highwhen compared toothersElectron withdrawing groupsdecreases theactivity
  33. 33. DRUGS Mode ofactionAdverseDrugreactionsUsesDiltiazem Acts byinhibitingVoltagesensitiveCalciumchannels inmyocardiumand vascularsmooth muscles.oConstipationoDizzinessoOedemaoInarrythmiasoIn AnginaVerapamil oFlushingoOedema•In AnginaIn ArrythmiasNifedipine oTachycardia In Angina
  34. 34. •Idradipine (DynaCirc®)•Nicardipine (Cardene®)•Nisoldipine (Sular®)•Felodipine (Plendil®)•Amlodipine (Norvasc®)Calcium channel blockers
  35. 35. Centrally acting sympatholyticsMechanism of actionMethyldopa is an α2 adrenergic receptor agonist acts centrally bydecreasing the sympathetic outflow which inturn lowers B.P.Methyldopa
  36. 36. Adverse effectsSedation and drowsynessConstipationGynacomastiaSexual impotenseUsesTreat of Hypertension in combinationWith diuretics.
  37. 37. clonidineMode of action:Its acts by stimulating α2-adrenergic receptros andthereby reducing sympathetic outflow andnoradrenaline release
  38. 38. In moderate to severehypertensionFor withdrawl therapyof alcohol opioidsTo diagnosepheochromocytomaSedation and drowsinessDryness of mouth andnaseConstipationBradycardiaAdverse drug reaction uses
  39. 39. PrazosinPrazosin phentolamineAdrenergic receptor antagonist
  40. 40. Drugs Mode ofactionAdversedrugreactionUsesprazosinIt acts byselectiveblocking ofα-1 receptorsin theperipheralblood vesselsleading tovasodilationFirst doseeffect:Posturalhypotensionand syncopeDrowsinessHeadacheNasalcongestionIn thetreatment ofmoderate toservehypertensionincombinatonwith a β-blocker and adiureticAdrenergic receptor antagonistsα-blockers
  41. 41. Drugs Mode ofactionAdversedrugreactionUsesPhentolamineIt blocksboth α1 andα2-receptorsleading tovasodilationand increaseinnoradrenaline releaseHypotensionTachycardiaIncrease ingastric acidsecretionPheochromocytoma
  42. 42. PROPANOLOL ATENOLOLLABETOLOLβ-adrenergic Blockers
  43. 43. PROPRANOLOL
  44. 44. Drugs Mode ofactionAdversedrugeffectsUsesPropanolol Inhibitssympatheticactivity byblocking β1and β2receptors•Fatigue•Bradycardia•Hypoglycemia•In angina•Inmyocardialinfarction•Inarrythmiasβ-adrenergic Blockers
  45. 45. Drug Mode ofactionAdverse drugreactionsUsesAtenolol InhibitSympatheticactivity byselectiveblockage ofβ1 receptors.•Fatigue•BradycardiaIn anginaInarrythmias
  46. 46. Drug Mode ofactionAdverseeffectsUses•Carvedilol•LabetalolThey blockβ and α1receptorthere byinhibitsympatheticactivity.•Dry mouth•Gidisturbances•Sexualdysfunction•Cavedilol-CHF•Labetalol-Emergencies
  47. 47. MINOXIDIL HYDRALAZINEDirect vasodilators
  48. 48. Drug Mode ofactionAdverseeffectsUsesMinoxidil It opens thepotassiumchannelsand causeshyperpolarization.•Tachycardia•Fluidretension•Hypertrichosis•IntreatmentofBaldnessDirect Vasodilators
  49. 49. Drug Mode ofactionAdverseeffectsUsesHydralazine Directrelaxation ofvascularsmoothmuscles bystimulatingcGMP•Flushing•Tachycardia•FluidretensionEmergencies
  50. 50. Say No to Smoking, Excessive Drinking (smoking16% CHF)Shake That Salt HabitControl Your PressureGood Reasons to Exerciseblood pressure checked every time they visit theirdoctor.Being obese or overweight.yoga asanas.Have the dash diet.Tips to stop the silent killerSalt
  51. 51. Dietary approaches to stop hypertension
  52. 52. "The way drugs are being used to control high bloodpressure today is much more effective than in the past,"Saunders said. "Doctors are using ACE inhibitors,Calcium channel blockers, Beta-blockers, Angiotensin-receptor blockers (ARBs), Alpha-blockers and low-dosediuretics in ways that dont cause the sexualcomplications and other side effects of older therapies.Also, these new drugs only need to be taken once a day,instead of two or three times a day. This is a lot easier forpatients." .We need to make sure that we eat eight servings of fruitsand vegetables a day, and get more exercise. We need toget ourselves and our children away from the televisionsets and the computers, and start them exercising early intheir lives."CONCLUSION
  53. 53. The treatment of hypertension has become one of the greatest challenges formedical professionals today. It is estimated that by 2025 some 1.56 billion peoplewill have hypertensionThe first direct renin inhibitor, aliskiren, thus constitutes an important milestonein the history of RAS blockade.When Aliskiren bound to the (pro)renin receptor, Aliskiren binds to the S3bpbinding pocket of renin, essential for its activity.Binding to this pocket preventsthe conversion of angiotensinogen to angiotensin I.The use of the direct rennin inhibitor, aliskiren, combined with the angiotensinreceptor blocker, valsartan. “Dual renin system blockade” gave enhanced bloodpressure lowering in patients with mild to moderate hypertension.Aliskiren produces dose-dependent blood pressure (BP) reduction and 24-h BPcontrol up to a dose of approximately 300 mg once daily. Its antihypertensivepotency is approximately equivalent to that of angiotensin receptor blockers,angiotensin-converting enzyme inhibitors, and diuretics.Clinical trials are currently underway assessing the effects of aliskiren combinedwith an angiotensin receptor blocker on intermediate markers of end organdamage, and long-term end point trials are planned. The results of these studieswill ultimately determine the place of renin inhibition and aliskiren in thetreatment of hypertension and related cardiovascular disorders.
  54. 54. Aliskirin latest antihypertensive agnet.
  55. 55. REFERENCESWilson and Gisvolds Text book of Organic Medicinal AndPharmaceutical chemistryPrinciples of Medicinal chemistry Dr.S.S.KadamDr.K.R..MahadikDr.K.G.BotharaText book of Medicinal chemistry vol-1 K.IlangoP.Valentine
  56. 56. Principles of Medicinal chemistry by William foeyeAdvanced practical Medicinal chemistry by AshutoshkarProfiles in drug synthesis vol-1 Dr.v.N.GOGTEThe organic chemistry of drug synthesis vol-3 DANIELLEDNISER,LESTER .A.MITSCHERMedicinal chemistry D.SRIRAM,P.YOGEESWARIEssentials of Medicinal chemistry II Edition –ANDREJUS KAROLKOVAS

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