The document discusses various antihypertensive drugs used to treat hypertension, categorizing them into essential and secondary hypertension. It outlines different classes of medications including diuretics, beta blockers, calcium channel blockers, ACE inhibitors, and others, specifying their mechanisms, typical side effects, and specific indications. The document emphasizes the importance of cautious use, especially in patients with pulmonary issues and the potential for significant adverse effects when combined with other antihypertensives.

1. Antihypertensive
Drugs

2.  Hypertension (HTN) - An increase in BP such
that systolic is > 140 mm/hg & diastolic > 90
mm/hg on 2 or more occasions after initial
screening
 Essential HTN = most common. About 90% of
clients.
 Secondary HTN is about 10% of HTN, related
to endocrine or renal disorders

4. Step 1
Diuretic, Beta Blocker, Calcium blocker,
Angiotensin-converting enzyme
Step 2
Diuretic with beta blocker
Sympatholytics
Step 3
Direct-acting vasodilator
Sympatholytic with diuretic
Step 4
Adrenergic neuron blocker
Combinations from steps I, II & III

5. * Promote Na depletion  decrease in
extra cellular fluid (ECF)
* First line category in treatment of mild
HTN
* Hydrochlorothiazide most frequently
prescribed for first line Rx of mild HTN
* Can be used alone or with other anti
HTN agents

6. 1. BETA-ADRENERGICS
2. CENTRAL ACTING SYMPATHOLYTICS
3. ALPHA-ADRENERGICS
4. ADRENERGIC NEURON BLOCKERS
5. ALPHA & BETA ADRENERGIC BLOCKERS

7. e.g.: Atenolol (Tenormin), Metoprolol
(Lopressor) - Beta-1 cardio selective
Propranolol (Inderal) -
Nonselective Beta-1, Beta-2 blocker
- may be combined with a diuretic
- Reduces cardiac output (CO) by diminishing
sympathetic nervous system response

8. - With continued use the vascular resistance
diminished & BP lowered
- Reduces HR & contractility
- Reduces renin release from kidneys
Nonselective = inhibits Beta-1 (heart) & Beta-2
(bronchial) receptors
- HR slows & BP decreases
- Bronchoconstriction occurs
Cardio selective - Preferred - acts mainly on Beta-1
receptors
& bronchospasms less likely - not absolute protection
*Use cautiously in clients w/ pulmonary history*

9.  Clonidine HCL , Methyldopa
- Stimulate Alpha-2 receptors  decrease sympathetic
activity decrease epinephrine , nor epinephrine &
decreases renin release  decrease peripheral vascular
resistance
- Can be used with other agents
- Clonidine = a new transdermal preparation - provides a 7
day duration of action
- Used with diuretics – to prevent Na+ and fluid retention
- Do not D/C drug abruptly - HTN crisis possible

10.  Prazosin HCl
- Blocks alpha adrenergic receptors
vasodilatation & a decrease in BP
- Helps maintain renal blood flow
- Useful in clients with lipid abnormalities -
decrease VLDL & LDL - responsible for build-
up of fatty plaques in arteries & increases HDL
- Can cause Na & H2O retention - diuretics may
be added

11. • Safe for diabetics, do not affect respiratory
function.
• Used in HTN, refractory CHF, Benign prostatic
hypertrophy (BPH)
• Side effects – dizziness, drowsiness, HA, N, V,
&D., impotence, vertigo, urinary frequency, tinnitus,
dry mouth
• Adverse - Orthostatic hypotension, palpitations,
tachycardia
• When taken with other antihypertensive agent 
severe hypotension

12. * Potent drugs that block nor epinephrine form
sympathetic nerve endings  a decrease in nor
epinephrine -> decrease in BP
* Decrease in both cardiac output & peripheral
vascular resistance
Reserpine ,Guanethidine - Potent - used for severe
HTN
These drugs used alone or with diuretics to decrease
peripheral edema
* Common SE = Orthostatic Hypotension

13. Carvideolol , Labetalol
- Blocks both alpha-1 & beta-1 receptors
- Block alpha-1 = dilation of arterioles & veins
-Effect on alpha receptors stronger than on beta receptors
so have a decrease BP & pulse rate
- Block beta-1 lead to decreased HR & AV contractility
- Large doses could block beta-2 receptors  inc. in air way
resistance - Do not give to severe asthmatics. AV block
SE = Orthostatic Hypotension, GI, nervousness, dry mouth
& fatigue

14. Hydralazine - moderate. to severe HTN
Sodium Nitroprusside - Very potent - for
hypertensive Emergencies
- Act by relaxing smooth muscles of bld. vessels -
mainly arteries  vasodilation 
- Increase blood flow to brain & kidneys
- With vasodilation the BP decrease Na & H2O
retained
 peripheral edema. Diuretics used to counter this
SE
- SE = numerous - tachycardia, palpitations, edema,
dizzyness, GI bleeding

15. Captopril, Enalapril , Lisinopril
- Prevents conversion of Angiotensin I to angiotensin
II (vasoconstrictor) & blocks release of aldosterone.
Aldosterone promotes Na retention & K excretion.
Block aldosterone & Na excreted, but H2O & K
retained
- Used to treat HTN primarily, - but not a 1st line
drug. Also used in heart failure.
- SE = hyperkalemia & 1st dose hypotension (more
common with combination of Diuretic & ACE
inhibitor.

16. Losartan , Telmesartan , Candesartan
- Newer drugs similar to ACE inhibitors + prevent
release of aldosterone (Na+ retaining hormone)
- Act on renin - angiotensin system
- Diff between ACE &AII is A-II blockers block
angiotensin from angiotensin I receptors found in
many tissues - blocks at receptor site.
- A-II blockers cause vasodilation & decrease
peripheral resistance

17. ACE inhibitors inhibit the
enzyme necessary for the
conversion of A-I to A-II
A-II blockers - block
angiotensin II from receptors
in blood vessels, adrenals, and
all other tissues.

18. Verapamil , Nifedipine , Diltiazem
- Free calcium muscle contractility,
peripheral resistance & BP .
So, Calcium blockers decrease calcium levels &
promote vasodilation
- Drugs can be used with patients prone to
asthma
- SE. Flushing, headache, dizzyness, ankle
edema, bradycardia, AV node block,