This document discusses antihypertensive drugs and hypertension management. It begins with an introduction to hypertension and outlines types of hypertension like primary or essential hypertension. It then discusses risk factors, diagnosis, and management of hypertension including both non-pharmacological lifestyle changes and various classes of pharmacological treatments. Specific drug classes are explained like ACE inhibitors, calcium channel blockers, diuretics, and others. The document also covers hypertension during pregnancy and hypertensive emergencies. It concludes with precautions for using antihypertensive drugs.

1. Antihypertensive Drugs and
Hypertension Management
Presented by: Pharm. Anas Haruna Indabawa
Intern pharmacist, FMC Azare, Bauchi State.
March, 2018.

2. OUTLINES
 Introduction
 Diagnosis
 Types of Hypertension
 Risk of Hypertension
 Management of Hypertension
 Non-Pharmacological
 Pharmacological
 Hypertension and Pregnancy
 Hypertensive Emergencies
 Precautions in use of Antihypertensive Drugs

3. INTRODUCTION
 Hypertension can be defined as: A sustained rise in
blood pressure.
 Blood Pressure is given by two(2) parameters.
 Cardiac Output: Given by the rate and stroke volume of
the heart.
 Total Peripheral Resistance: Given by the blood volume
and the level of vasoconstriction
 Hypertension is a pathologically increased blood pressure
due to an increase in any of these parameters.
BP = CO × TPR

4. Diagnosis
A blood pressure reading, given in millimeters of mercury (mm Hg), has two
numbers. The first, or upper, number measures the pressure in your arteries
when your heart beats (systolic pressure). The second, or lower, number
measures the pressure in your arteries between beats (diastolic pressure).

5. Types of Hypertension
A disorder of unknown origin affecting the Blood Pressure regulating
mechanisms is termed as primary or essential hypertension. If it occurs
as a result of another condition, it is called secondary hypertension.

6. Risk Factor of Hypertension
 The cause of
hypertension is often
not known.
 Around 1 in every 20
cases of hypertension is
the effect of an
underlying condition or
medication.
 Chronic kidney
disease (CKD) is a
common cause of high
blood pressure because
the kidneys do not filter
out fluid. This fluid
excess leads to
hypertension.

7. MANAGEMENT OF HYPERTENSION

8. NON PHARMACOLOGICAL
MANAGEMENT
No matter what
medications your
doctor prescribes to
treat your high blood
pressure, you'll need to
make lifestyle changes
to lower your blood
pressure.
Several lifestyle
modifications,
including:-

9. PHARMACOLOGICAL
MANAGEMENT

10. TREATMENT STRATEGIES
 For most patients, the blood pressure goal when treating
hypertension is a SBP<140 mm Hg and a DBP< 90 mm Hg.
 Mild hypertension can sometimes be controlled with
monotherapy, but most patients require more than one
drug to achieve blood pressure control.
 Current recommendations are:
To initiate therapy with a thiazide diuretic, ACE inhibitor,
angiotensin receptor blocker (ARB), or calcium channel blocker
(CCB).
 If blood pressure is inadequately controlled, a second drug
should be added.

11. Treatment Guideline

12. Renin Angiotensin Aldosterone
Inhibitors

13. Renin Angiotensin Aldosterone
Inhibitors
Angiotensin-converting
enzyme (ACE) inhibitors.
These medications
help to relax blood
vessels by blocking the
formation of a natural
chemical that narrows
blood vessels. E.g
Lisinopril, Captopril,
Enalapril, Ramipril,
Fosinopril, etc.
Angiotensin II receptor
blockers (ARBs).
These medications help
relax blood vessels by
blocking the action, not
the formation, of a
natural chemical that
narrows blood vessels.
E.g Losartan,
Candisartan, Valsartan,
Telmisartan, Irbesartan,
Olmesartan, etc.
Renin inhibitors.
Aliskiren (Tekturna)
slows down the
production of renin, an
enzyme produced by
your kidneys that starts
a chain of chemical
steps that increases
blood pressure.

14. Renin Angiotensin Aldosterone
Inhibitors

15. Centrally Acting & Adrenoceptor-
blocking Agents

16. Centrally Acting & Adrenoceptor-
blocking Agents
A2 Receptor
Agonist
These medications
prevent brain from
signaling nervous
system to increase
heart rate and narrow
blood vessels.
Examples include
clonidine (Catapres,
Kapvay), guanfacine
(Intuniv, Tenex) and
methyldopa.
Β- Blockers
These medications
reduce the workload on
your heart and open
your blood vessels,
causing your heart to
beat slower and with
less force.
Examples: Propranolol,
Atenolol, Metoprolol,
Carvedilol, etc.
A1 Receptor
Antagonist
These medications
reduce nerve impulses
to blood vessels,
reducing the effects of
natural chemicals that
narrow blood vessels.
Alpha blockers include
Terazosin, doxazosin,
and Prazosin.

17. Calcium Channel Blockers
Examples of calcium channel
blockers include:
 Verapamil
 Diltiazem
 Nifedipine
 Amlodipine
 Felodipine
 Isradipine
 Nicardipine
 Nisoldipine
Calcium channel blockers prevent calcium from entering cells of the heart and
blood vessel walls, resulting in lower blood pressure.

18. Vasodilators
Arteriolor Dilator:
Hydralazine, Minoxidil,
Diazoxide
Venodilator: Nitrates
e.g Nitroglycerin,
Isosorbide dinitrate,
Isosorbide
mononitrate
Mixed Arteriolar and
Venodilator: Sodium
Nitroprusside
vasodilator drugs relax the smooth muscle in blood vessels, which causes the vessels to
dilate. Dilation of arterial (resistance) vessels leads to a reduction in systemic vascular
resistance, which leads to a fall in arterial blood pressure. Dilation of venous (capacitance)
vessels decreases venous blood pressure.

19. Diuretics
High ceiling diuretics
Inhibit the sodium-
potassium-chloride
cotransporter in the thick
ascending limb E.g
Furosemide, Bumetanide,
Torsemide.
Thiazide diuretics
which are the most
commonly used diuretic,
inhibit the sodium-chloride
transporter in the distal
tubule. Eg
Bendroflumethiazide,
Hydrochlorthiazide,
Indapamide, Xipamide, etc.
Weak diuretics
potassium-sparing
diuretics
Drugs in this class
antagonize the actions of
aldosterone at the distal
segment of the distal
tubule. This causes more
sodium (and water) to pass
into the collecting duct
and be excreted in the
urine. E.g Spironolactone
Acts on Kidney to increase excretion of Na and H2O – decrease in blood
volume – decreased blood pressure.

20. HYPERTENSION AND PREGNANCY
 Gestational hypertension: Is the
development of new hypertension in
a pregnant woman after 20 weeks'
gestation without the presence of
protein in the urine.
 Pre-eclampsia Is gestational
hypertension
plus proteinuria (>300 mg of protein in
a 24-hour urine sample). Severe pre-
eclampsia involves a blood pressure
greater than 160/110.
 Eclampsia: This is when tonic-clonic
seizures appear in a pregnant woman
with high blood pressure and
proteinuria.

21. Pregnancy Hypertension Drugs
Drug treatment options are limited, as many antihypertensive may negatively affect
the fetus. Safe drugs use for treatment include the following mnemonics (Better
Mother Care During Hypertensive Pregnancy)
Better – Beta Blockers (Cadioselective & Labetalol)
Mother – Methyl dopa (Drug of Choice)
Care – Clonidine
During – Dihydropyridine (SR-Nifedipine and Odipine)
Hypertensive – Hydralazine (DOC in hypertensive emergencies in pregnancy)
Pregnancy – Prazosin ( And other alpha blockers

22. HYPERTENSIVE EMERGENCIES
 Hypertension:
o Stage I: 140-159/90-99
o Stage II: >160/100
 Hypertensive Urgency:
o Systolic BP >180 or Diastolic BP >120
in the absence of end-organ damage
 Hypertensive Emergencies:
o SBP >180 OR DBP>120 in the
presence of end-organ damage
 Malignant Hypertension: End-
organ damage--eyes, kidneys,
brain (hemorrhage/infarct)
affected
 Hypertensive encephalopathy:
Cerebral edema leading to
neurological symptoms
 Once the diagnosis of hypertension is
made and end-organ damage
confirmed, the BP should be lowered
by about 25% of the mean arterial
pressure.
 There are 2 main classes of drugs:
o Vasodilators
 Nitroprusside
 Nitroglycerine
 Nicardipine
 Hydralazine
 Diazoxide
 Fenoldopam
o Adrenergic inhibitors
 Labetalol (a+b blocker)

23. PRECAUTIONS IN USE OF ANTIHYPERTENSIVE
DRUGS
Never combine:
 Alpha or beta blocker and clonidine - Antagonism
 Nifedepine and diuretic - Synergism
 Hydralazine with DHP or prazosin – same type of Action
 Diltiazem and verapamil with beta blocker –bradycardia
 Methyldopa and clonidine

24. References
 Tripathi K.D Cardiovascular drugs. Essentials of Medical
Pharmacology Seventh edition, Jaypee brothers medical publishers
(p) ltd.
 William B: British Hypertension Society. Guidelines for management
of hypertension: report of the 4th working party of the British
Hypertension Society. J Hum Hypertens. 2004.
 https://www.mayoclinic.org/diseases-conditions/high-blood-
pressure/diagnosis-treatment/drc-20373417
 Khedun SM, Maharaj B, Moodley J. Effects of antihypertensive drugs
on the unborn child. What is known, and how should this influence
prescribing? Paediatr Drugs 2000; 2 (6): 419-36
 Magee LA. Treating hypertension in women of child-bearing age and
during pregnancy. Drug Safety 2001; 24 (6): 457-74

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