A basic introduction about hypertension

1. HYPERTENSION-
AN INTRODUCTION
PRESENTED BY
ASHUTOSH B. MAHALE
&DNYANESHWAR B. GAWADE
M.PHARMACY FIRST YEAR ( PHARMACOLOGY )
UNIVERSITY DEPARTMENT OF PHARMACEUTICAL SCIENCES, R.T.M NAGPUR UNIVERSITY ,
NAGPUR

2. INTRODUCTION
Defination-
Hypertension is a hemodynamic disorder
A well accepted definition of hypertension was suggested by Evans
and Rose: “
Hypertension should be defined in the terms of blood pressure
level above which investigation and treatment do good more than
harm”
 A patient is said to be hypertensive when his SBP≥ 140 mm Hg &
DBP ≥ 90 mm Hg provided that the patient is not on
antihypertensive drugs.

3. REGULATION OF BLOOD PRESSURE
• It means maintaining a constant blood pressure within a
narrow variation both increase in BP(hypertension) and
decrease in BP in (hypotension) are harmful in body.
• The mechanism of regulation of BP is divided in to two
groups
• Nervous regulation of BP.
• Hormonal regulation of BP
Slow acting
mechanism
• By change in GFR
Rapidaly acting
mechanism

4. TYPES OF HYPERTENSION
ESH-ESC Guidelines, 2003
Classification Systolic BP Diastolic BP
NORMAL ≤120 ≤80
Pre-hypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 ≥160 ≥100
Isolated systolic hypertension ≥140 ≥90
Primary hypertension Secondary hypertension
Benign hypertension Cardiovascular hypertension
Malignant hypertension Renal hypertension
Endocrine hypertension
Neurogenic hypertension

5. Etiology of Hypertension
Primary (essential or idiopathic) hypertension
 Contributing factors
• ↑ SNS activity
• ↑ Sodium retaining hormones and vasoconstrictors
• Diabetes mellitus
• > Ideal body weight
• ↑ Sodium intake
• Excessive alcohol intake

6. SECONDARY
• Elevated BP with a specific cause
5% to 10% of adult cases
 Contributing factors:
• Renal disease
• Endocrine disorders
• Neurologic disorders
• Cirrhosis
• Sleep apnea
If someone under 20 or over 50 suddenly develops hypertension, esp.
severe then suspect secondary cause
HYPERTENSION

7. CAUSES OF HYPERTENSION
CAUSES
1) Essential hypertension
2) Renal
• Acute nephritis
• Polycystic kidney
3) Vascular
• Arteriosclerosis, coaractation of aorta.
4) Endocrine
• Pheochromocytoma, cushing syndrome
5) Neurological
• Lead encephalopathy

8. PATHOGENESIS OF HYPERTENSION

9. PRINCIPLE OF HYPERRTENSION TREATMENT
• Reduction of body weight
• Sodium restriction
• Alcohol restriction
• Physical exercise
NON
PHARMACOLOGICAL
MANAGEMENT
• Antihypertensive agents
PHARMACOLOGICAL
MANAGEMENT

10. CLASSIFICATION OF ANTIHYPERTENSION AGENTS
category examples
DIURETICS Thiazide
Loop diuretics
K+ sparing diuretics
Hydrochorthiazide
Furosemide
spironolactone
SYMPATHOLYTICS AGENTS Α receptor antagonist
Β receptor antagonist
α+β receptor antagonist
Centrally acting adrenergic
Adrenergic neuron blocker
Terazosin
Atenolol
Labetalol
Methyldopa,clonidine
reserpine
CA + CHANNEL BLOCKER Dihydropyridine
Phenylalkylamine
benzothiazepine
Amlodipine
Verapamil
diltiazem
Angiotensin converting enzyme
INHIBITOR
Captopril,enalapril
angII receptor antagonist Telmisartan,candesartan
DIRECT RENIN INHIBITOR aliskiren
VASODILATOR Arterial
Arterial+ venous
Hydralazine
nitroprusside

11. DIURETICS MOA

12. SYMPATHOLYTIC AGENTS
category Mechanism of action Side effect Drug interaction
Beta blocker (atenolol) cardiac output
Renin secretion
Intolerance,
Airways
obstruction
Accumulation of lidocaine
Alpha blocker (prazosin) Block noradrenaline
mediated tonic
vasoconstriction
Postural hypotension
Centrally acting adrenergic
agent (methyldopa)
Taken up by
noradrenergic
nerve terminals
and converted to
α-methyl
noradrenaline,
which is released
as a false
transmitter. This
acts centrally
as an α2-agonist
and reduces
sympathetic
outflow
Drowsiness, depression

13. CALCIUM CHANNEL BLOCKER
CATEGORY MECHANISM OF ACTION SIDE EFFCET DRUG INTERACTION
Dihydropyridine
(amlodipine )
Calcium-channel
blockers inhibit Ca2
influx through
voltage-
dependent L-type
calcium channels.
Cytoplasmic Ca2
concentrations control
the contractile state of
actomyosin.
Headache , flushing, ankle
swelling
Benzothiazepine
(diltiazem )
Generallly mild
Phenylaklylamine
(verapamil )
constipation i.V verapamil cause
circulatory collapse with
patient treated with alpha
blocker

14. ACE INHIBITOR & AT II INHIBITOR

17. THANK YOU