Antihypertensive drugs Classification

Antihypertensive drugs Classification

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What is Hypertension

  • Hypertension is the most common health disorder in the middle age group.
  • Hypertension is the most important risk factor for cardiovascular mortality and morbidity.
  • Hypertension means ‘ elevated blood pressure of more than 140/90 mm of Hg in the body.
  • Normal blood pressure – 120/80 mm of Hg.
  • Antihypertensive drugs are used to treat hypertension.

 

Hypertension classification

  • Prehypertension

= systolic BP = 120 – 139 mmHg.

= Diastolic BP= 80 – 89 mmHg.

  • Stage 1 hypertension

= Systolic = 140 – 159 mmHg.

= Diastolic = 90 – 99 mmHg.

  • Stage 2 hypertension

= Systolic = above 160 mmHg.

= Diastolic = above 100 mmHg.

  • Emergency hypertension

= Systolic = above 180 mmHg.

= Diastolic = above 120 mmHg.

  • Isolated systolic hypertension

= systolic = 140 and above

= Diastolic = below 90 mmHg.

 

  1. Primary hypertension-

It is idiopathic hypertension and the most common hypertension.

  1. Secondary hypertension – 

Occur due to disease condition.

Antihypertensive drugs Classification:-

  • Classification of antihypertensive drugs
  • Blood pressure is controlled by the anatomic nervous system renin-angiotensin – Aldosterone system.
  • The hypertensive drugs act on the heart, kidney, and blood vessels by influencing these systems.
  • Hypertensive drugs are
  1.  Beta-blockers.
  2. Alpha-blockers.
  3. Alpha and beta blockers
  4. Calcium channel blockers
  5. Central sympatholytic
  6. Vasodilators
  7.  Diuretics
  8. ACE inhibitors
  9. Angiotensin receptor blockers (ARB – inhibitors).

 

  1. Beta blockers –

  • It is a beta-adrenergic blocking agent that causes vasoconstriction in the blood vessels.
  • Beta-blocker drugs prevent the stimulation of beta-adrenergic receptors of the sympathetic nervous system and decrease cardiac output and lead to low blood pressure.
  • Drugs – Atenolol, timolol, metoprolol, propranolol, betaxolol, etc.
  • Dose – 25 – 100 mg.

Uses of Beta Blocker

  • To treat mild hypertension.
  • Arrhythmia.
  • Angina pectoris.
  • Chest pain and heart attack.
  • Glaucoma.
  • Myocardial infarction.

Contradiction of Beta Blocker

  • Asthma, COPD
  • Bradycardia and cardiogenic shock
  • Peripheral vascular disease
  • Prinzmetal angina, heart block.

Adverse effects of Beta Blocker

  • Orthostatic hypotension,
  • fatigue, nausea and vomiting,
  • bradycardia etc.

 

  1. Alpha-blockers 

It is an adrenoceptor antagonist which prevents the stimulation of the adrenergic receptors and leads to decreased blood pressure.

Alpha bocker Drugs

  • Doxazosin
  • Prazosin
  • Terazosin
  • Alpha blocker drugs cause the blood vessels dilation there by lowering blood pressure.

Uses of alpha blocker

  • Hypertension
  • Benign prostatic hyperplasia
  • Congestive heart failure
  • Pheochromocytoma.

Contraindication of alpha blocker

  • Hypersensitivity, hypotension
  • Pregnancy, lactation.

 

  1. Alpha beta blockers

  • The combined drugs are used to treat high blood pressure.
  • The drug causes vasodilation and decreases cardiac output.
  • Drug – Labetalol 50 mg BD.

 

  1. Calcium channel blockers –

It is a calcium channel antagonist that interferes in the movement of calcium through calcium channels.

  • The drug is used to treat hypertension.

Calcium channel blocker Mechanism of action-

Calcium channel blocker drugs

Block the entry of calcium ions into calcium channels

Reduce intracellular calcium ions

Relax vascular smooth muscles

Vasodilation

Decrease blood pressure.

 

  • Calcium channel blocker Drugs

    • Amlodipine – 5 -10 mg OD
    • Nifedipine – 5 – 20 mg orally OD
    • Verapamil – 40 – 160 mg
    • Diltiazem – 30 – 60 mg.

 

  • Amlodipine and nifedipine drugs decrease the main arterial pressure and increase the heart rate.
  • Diltiazem and verapamil drugs depress the SA node and decrease the heart rate.

 

Calcium channel blocker drug uses 

  • Hypertension
  • Angina
  • Arrhythmia

Calcium channel blocker Adverse effects

  • Ankle edema, nausea, constipation.
  • Hypotension, drowsiness, headache.
  • Palpitation

 

  1. Vasodilators drugs-

Vasodilators drugs Mechanism of action

Vasodilators drugs

Relax the vascular smooth muscles

Vasodilation

Decrease blood pressure.

 

  • Vasodilators drug name-

  • Hydralazine – 25 – 50 mg TDS.
  • Minoxidil.
  • These drugs are directly worked on the vessel walls.
  • Adverse effect – Rapid heartbeat, nausea or vomiting, edema, headache, hirsutism etc.

 

  1. Central sympatholytic drugs

Central sympatholytics drugs

Stimulate the A2 adrenergic receptor in the brain stem center

Decrease the sympathetic nerve activity and outflow

Decrease blood pressure.

 

  • Drugs
  • Clonidine (Catapres) – 100 ug OD.
  • Methyldopa (Aldomet) – 250 – 500 mg TDS.
  • Methyldopa is a drug of choice of hypertension during pregnancy.
  1. Diuretics drugs – 

The drugs are responsible for increasing urine output.

  • Drugs are
  • High efficacy drug = furosemide – 20 – 80 mg.
  • Medium efficacy drug = hydrochlorothiazide drug

= Thiazide-like drugs.

  • Low efficacy drug = spironolactone – 25 – 50 mg.

 

diuretics drug Mechanism of action

Diuretics drugs

Increase the urine output

Decrease the extracellular fluid and plasma volume

Decrease cardiac output

Decrease blood pressure.

 

Uses Diuretics drugs

  • Hypertension
  • Edema and congestive heart failure.
  • Acute pulmonary edema.
  • Renal disease and liver cirrhosis.
  • Glaucoma.

 

Contraindication of Diuretics drugs

  • Gout disorder
  • Diabetes patient
  • Pregnant mother
  • Dehydrated patient.

 

Side effects of Diuretics drugs 

  • hypokalaemia
  • hyperglycemia
  • vertigo etc.

 

  1. ACE inhibitors –

  2. It is an angiotensin-converting enzyme inhibitor, which is used to treat high blood pressure and heart failure.

ACE inhibitor Mechanism of action

ACE inhibitor drugs

Angiotensin – 1st is not converting into angiotensin – 2nd

Decreased production of angiotensin – 2nd

Decrease the sodium and water retention

Cause the vasodilation

  • Decrease blood volume
  • Decrease blood pressure
  • Decrease sympathetic activity
  • Decrease ventricular preload and afterload
  • Inhibit vascular and cardiac hypertrophy.

 

ACE inhibitor Drugs

  1. Captopril – 25 – 150 mg
  2. Lisinopril – 5 – 40 mg
  3. Enalapril – 2.5 – 40 mg
  4. Ramipril- 1.25 – 10 mg.

Uses of ACE inhibitor-

  • Hypertension
  • Congestive heart failure (CHF)
  • Myocardial infarction (MI)
  • Diabetic nephropathy
  • Treat high cardiovascular risk patients.

 

Contraindication of ACE inhibitor-

  • Pregnancy
  • Renal artery stenosis
  • Azotaemia
  • Hypotension
  • Hyperkalaemia patient
  • Severe stenosis of aortic and mitral valve
  • History of allergy.

 

ACE inhibitor Adverse effects

  • Hypotension, urticaria, cough
  • Rashes, angioedema, hyperkalemia
  • Proteinuria, taste change, leukopenia etc.

 

  1. ARB inhibitors –

  • Angiotensin receptor blocker drug.
  • It has a similar effect as ACE inhibitors.
  • The drug blocks the effect of angiotensin 2nd.
  • The ARB inhibitor drug is prescribed if the patient cannot tolerate the ACE inhibitor drugs.

ARB inhibitors Mechanism of action-

ARB inhibitors drugs

To inhibit the action of angiotensin 2

Decrease sodium and water retention

Vasodilation

Decrease blood pressure.

ARB inhibitors Drugs 

Atacand (Candesartan) – 8mg.

Cozaar (losartan) – 25 – 50 mg.

Micardis (Telmisartan) – 20 – 80 mg.

Diovan (Valsartan) – 80 – 160 mg.

Benicar (olmesartan) – 20 – 40 mg.

 

ARB inhibitors Use- 

  • Hypertension, congestive heart failure (CHF)
  • Myocardial infarction (MI)
  • Diabetic nephropathy.

 

ARB inhibitors Adverse effects

  • Hyperkalaemia, hypotension, fainting
  • Dizziness, fatigue, vomiting, diarrhoea
  • Angioedema, back pain, etc.

 

Key points

  • what is The most common hypertension is a – Primary hypertension
  • Secondary hypertension occurs due to – Disease conditions
  • Which system controls the blood pressure? – Autonomic nervous system
  • Alpha and beta blockers combined drug is – Labetalol
  • Drug of choice for pregnancy-induced hypertension – Methyldopa
  • ACE inhibitor drug full form? – Angiotensin-converting enzymes
  • ACE inhibitor drugs cause the – Decreased production of angiotensin 2nd
  • Which hypertensive drugs are contraindicated in pregnancy? – ACE inhibitors
  • ARB inhibitor drug full form – Angiotensin receptor blocker drug
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