Hypertension : BPDIASTOLIC SYSTOLIC Normal< 130< 85 Mild hypertension 140 - 15990 - 99 Moderate hypertension 160 - 179100 - 109 Severe Hypertension 180.

Hypertension :BP DIASTOLIC SYSTOLIC

Normal < 130 < 85

Mild hypertension

140 - 159 90 - 99

Moderate hypertension

160 - 179 100 - 109

Severe Hypertension

180 - 209 110 - 119

Typical Diurnal Blood Pressure Rhythm in a "Dipper"

Classification of antihypertensives :

ACE inhibitors : Captopril, Enalapril. Angiotensin Antagonist : Losartan Calcium channel blockers : Verapamil,

Diltiazem, Nifedipine. Beta adrenergic blockers : Propranolol. Alpha adrenergic blockers : Prazosin.

Diuretics : Thiazides : Hydrochlorothiazides ,

Metolazone, Indapamide. High ceiling diuretics : Furesomide,

Bumetanide, Ethacrynic acid K sparing diuretics : Spironolactone,

Triamterene, AmilorideAlpha -2 agonist: Clonidine, Methyldopa

Vasodilators: Arteriolar : Hydralazine, Minoxidil. Arteriolar + Venous : ACE

inhibitors Venodilator : Nitrates

Angiotensin Converting Enzyme (ACE) Inhibitors:

Captopril, Lisinopril, Enalapril, Ramipril, Benazepril, Fosinopril

Reduction in arterial resistance (after load)

Reduction in venous tension (preload)

Reduction in aldosterone secretion

Indications for ACE inhibitors includes: Congestive heart failure (CHF) Hypertension Left ventricular dysfunction Prevention of nephropathy in

diabetes mellitus

Adverse effects: Common adverse effects includes

hypotension, cough, hyperkalemia. Rash and taste disturbances with

captopril AngioedemaCautions and contraindications: Pregnancy Bilateral renal artery stenosis

ANGIOTENSIN RECEPTOR

BLOCKERS ARB (AT 1 BLOCKERS):

Losartan, Erbesartan, Candesartan Competitive antagonists of

Angiotensin II No inhibition of ACE or breakdown

of bradykinin

Antihypertensives agents

Hydralazine : Direct arteriolar vasodilator. Release of nitric oxide cause the

vasodilation of the arteries. Reflex sympathetic system activation

can cause tachycardia. Norepinephrine release from nerve

endings can increase myocardial contractility

Hydralazine : Adverse effects Throbbing headache , palpitation SLE – in slow acetylators or on

prolonged use at a higher dose Precipitation of angina and MI

Hydralazine : Uses Hypertension not controlled by first

line of anti hypertensives Can be used hypertension of

pregnancy Hypertensive emergencies

Minoxidil : Arteriolar vasodilator - K channel

activator Chronic therapy – excess growth of

hair on face, back and arms Used in life threatening hypertension Used in hypertension with renal

failure

Hypertensive emergencies : Sodium Nitroprusside NTG Diazoxide Hydralazine Enalaprilat Nicardipine Esmolol Nifedipine - Sublingual

THE CHOICE OF THE ANTIHYPERTENSIVE IN PATIENTS WITH CONCOMITANT DISEASES.

Concomitantdisease

Antihypertensive drugDiuretics ß-

block.Ca-block.

ACE-inhibitor

Diabetes

C.I AVOID  

OK INDI CATED

 Gout

AVOID   

--   

--   

--

 Dyslipidemia

C.I AVOID   

--   

--

 Angina pectoris

--   I I   

--

 Cardiac failure

I judicious

OK   I

 Pregnancy

  C.I

 Cautious

  OK AVOID