this power point gives a brief information regarding stepped care approach and categories of drugs used in hypertension

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,