The document defines blood pressure and hypertension. It then provides a table classifying blood pressure readings according to JNC7 guidelines. The next sections describe a patient's symptoms, medical history, and examination findings. Criticisms are noted of the prescription provided. The role of angiotensin receptor blockers in hypertension is then summarized.

1. Ayan Adhikary
Mahammad Samim Mondal
Kushal Talukdar
1 1

2. Definition:-The lateral pressure exerted by a flowing blood column on a blood
vessel is called Blood Pressure. The chronic elevation of this blood pressure is
known as Hypertension.
[acc. to (JNC7) Systolic BP- ≥140mmHg, Diastolic BP- ≥ 90 mmHg]
Classification Systolic pressure Diastolic pressure
[JNC7] (mmHg) (mmHg)
Normal 90-119 60-79
Prehypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 ≥160 ≥100
Isolated Systolic ≥140 <90
Hypertension
2 2

3. 3 3

4.  Suffering from subacute
transient headache with pain in
the limbs, easy fatigability and
dizziness.
 She has no loss of appetite, & no
sleep, bladder or bowel disorder
 Menopause attained 7 yrs ago, no
OCP usage .
 She has no history suggestive of
any major illness or relating to
this condition.
 No history of drug
addiction/abuse & no drug
allergy.
 On physical examination, the
patient is alert and cooperative
 On systemic examination nothing
of significance was found.
4 4

5. Criticism
I
n s
(Subscription & Signature)
 Superscription??
 Salt restricted diet??
c
 Brand Names??
r
 Tazloc-trio+Amlodipine??
i
 Time of intake not specified.
p t OD??
 PTML 500??
i
 Secondary hypertension is
o n
not excluded??
5 (Initial)5
The patient is suffering from Primary Hypertension.

6. Angiotensin Receptor Blockers
KINETICS/DYNAMICS
Other BP Lowering Mechanisms Angiotensinogen
1.Central & peripheral sympathetic stimulation
Bradykinin
2.Release of aldosterone & adrenaline from adrenals Aliskiren Renin
3.Renal actions promoting salt & water reabsorption ACE
4.Vasopressin release & Cardiac growth promotion inhibitors Angiotensin I
Inactive
Angiotensin II
peptides AIIRAs
AT1 receptor AT2
receptor
Pharmacokinetics: Adrenaline Release
 Administered orally with bioavailibility-33% Vasodilation
Telmisartan has no active metabolite, peak action BP Attenuate growth and
disease progression
within 3hrs & lasts 24hrs (20-80mg OD)
PL-C
Advantage over ACE inhibitors -No IP3 /DAG Phospholipid
cough, angioedema ,dysgeusia & complete inhibition
of AT2 with AT1 sparing effect
Activation Of MLCK
Vasoconstriction
6 6 BP

7. Thiazides are the drug of choice in uncomplicated hypertension available for
parenteral administration
Chlorothiazide(0.5-2gm in two
divided doses),Indapamide(2.5gm
single daily dose) etc.
Pharmacokinetics
Administered orally with
Bioavailability=9-56% (dose dependent)
t 1/2 (chlorothiazide)= 1.5 hrs
Contraindications
Dyslipidemia,Gout,Hypokalemia,Erectile
Dysfunction
7 7

8. DOC for low renin hypertension & isolated systolic hypertension
Pharmacokinetics:
Oral bioavailability 65-90%(half life-30-50hrs)
(Dosage-tab. 5-10mg OD)
Contraindications
 Unstable angina
 Breastfeeding
 Aortic stenosis
Patient of severe CAD, CCB can
increase anginal frequency &
severity.
Excessive lowering of BP in patients
taking other BP medication
8 8

9. Hypertensive Emergency
• Sodium Nitroprusside i.v. 20-300 μg/min
• Glycerol Trinitrate i.v. 5-20 μg/min
• Esmolol & Phentolamine
 severe hypertension
( SP≥180mmHg DP≥120mmHg)
 acute impairment of one or more organ systems
like CVS, CNS & renal
 may be irreversible organ damage
Mean BP
should be
lowered by no
more than
25% within
minutes to
few hours &
then gradually
to not lower
than 160/100
mmHg
9 9

10. 10 10

11. ADRs(Adverse Drug Reactions) are among the leading cause of mortality &
morbidity. Regular monitoring of ADR is important specially in a chronic
asymptomatic disorder like Hypertension.
The following study was conducted in med. OPD of Majeeida Hospital, New
Delhi.
CCBs are the most prescribed drugs (31.7%) & β blockers are associated with
highest no. of ADR (7.5%)
Approved Combinations
Combinations better avoided
(JNC7)
ACEInhibitor/ARB Adr blocker +
+ Diuretics Clonidine
Hydralazine/DHP Nifedipine+
+ Beta-blocker Diuretic
CVS (35.30%)
Vasodilator/Symp Hydralazine+DHP Respiratory(11.8%)
11 atholytics+ 11 GI(20.6%)
Diuretic Others(32.3%)

12. Verapamil * Propranolol
(Pharmacodynamic intr.)
Heart Failure Precipitation
AV block & sever bradycardia
Enalapril *
Spironolactone
(Pharmacodynamic intr.)
Hyperkalaemia
Cardiac arrythmias
Lithium * Thiazide
(Pharmacokinetic intr.)
Increased toxicity of lithium
12 12

13. WHO’s current European policy
Amlodipine Tablet: 5 mg (as maleate,
Priority interventions of the action plan for mesylate or besylate).
noncommunicable diseases 2012-2016 include:
Bisoprolol* Tablet: 1.25 mg; 5 mg.
Promotion of a healthy diet through marketing and fiscal measures * 􀂆 includes metoprolol
and carvedilol as
Elimination of trans fats & Salt reduction
alternatives.
Cardio-metabolic risk reduction assessment and management
Promotion of physical activity and mobility
Enalapril Tablet: 2.5 mg; 5 mg (as
hydrogen maleate).
Hydralazine* Powder for injection: 20
mg (hydrochloride) in
ampoule.
Tablet: 25 mg; 50 mg
(hydrochloride).
A ml o d i p i n e , Hydrochlorothiazide Oral liquid: 50 mg/5 ml.
A t e n o l o l , C h l o r t h a l i d o n e *, Solid oral dosage form:
Cl o n i d i n e , Hy d r o c h l o r i d e *
12.5 mg; 25 mg.
,E n a l a p r i l Methyldopa* Tablet: 250 mg.
,M a l e a t e ,L o s a r t a n ,p o t a s s i u m *,M e
t hy l dopa , sodium nitroprusside Powder for infusion: 50
N i f e d i p i n e ,P r o p r a n o l o l ,
13 13 mg in ampoule.

14. Risk factors
A diet high in saturated fat
Excessive salt consumption
Overweight and obesity
A sedentary lifestyle and lack of exercise
Excessive alcohol consumption
Smoking
Un-managed stress
A family history of high blood pressure
Being over 65 years of age
Co-morbidities such as diabetes
Manage high blood pressure by:
e a t i n g a h e a l t h y
d i e t , r e d u c i n g s a l t
i n t a k e , e x e r c i s i n g
r e g u l a r l y , s t o p p i n g
s mo k i n g , r e d u c i n g a l c o h o l
c o n s u m p t i o n , efforts to reduce
Community-based
ma n a g i n g s t r e s s , h a v i n g
blood pressure and stroke in Japan
r e g u l a r b l o o d p r e s s u r e c h e c k s .
14 14

15. 15 15