Applied Therapeutics - Theoretic | By : Dr.

Tawfeq Mohammed | Pharmacy department - 2nd stage

Hypertension
 If B.P ≥ 140/90 : hypertension.
 If B.P <50/10 : postural hypotension.
Types of B.P :
1) Normal : ≥ 120/80 .
2) Pre-normal : 121-139/81-89 .
3) Stage I : 140-159/90-99 .
4) Stage II : ≥160/100 .
 There are two types of HT : Essential HT & Secondary HT (treatable).
 Secondary hypertension : younger age , not respond to drug groups , previously
uncontrolled then controlled.
Causes : renal , endocrine , pregnancy induced , drugs' induced.
 Drugs like : (Contraceptions , Steroids , NSAIDs) are contraindicated.
 Hypertension urgency : > 200/130 mmHg. Without end organ damage , we should ↓
B.P within days.
 Hypertension emergency (malignant) : > 200/130 mmHg. With end organ damage ,
we should ↓ B.P as rapid as 25% within 6 hours , then ↓ to 160/100 within another 6
hours (not ↓ less than 160/100 , if this occurs → ischemia , maybe angina →
vascular damage , so the patient should be properly monitored at I.C.U.
 At diagnosis , examine B.P at deferent periods , positions , but the cuff should be at
the same level of heart.
 Investigations : primary (x-ray , ECG , Serum K) , Renal : ultra sound.
 If patient in stage I : continue these points for 6 months :
1- ↓ body wt.
2- ↓ smoking.
3- Stop alcohol (if the patient is drinking).
4- Na (food salt) less than 6 gm/day (3-5 gm/day is O.K).
 If no response : give therapeutics.
(1) Diuretics : 1st line treatment for elderly. (diuretic + antihypertensive → ↑ survival).
Thiazides (ex: hydrochlorothiazide) maybe given to elderly patients.
Side effects of Thiazides : allergic pancreatitis, hyperglycemia, hypokalaemia.
Side effects of K. sparing agents : hyperkalaemia, gynecomastia (Contra. In R.F).
(2) β-blockers: selective {Atenolol (Tenormin)®} , non-selective {Propranolol (Inderal)®},
Oxprenolol , Nadolol.
 α & β blockers : Carvidilol , Labetalol.
Side effects : bronchospasm , bradycardia , H.F , hypotension.
Contraindications : asthma , uncontrolled H.F.
 All β-blockers act as non-selective in high dose.
(3) Central adrenergic drugs :
- Methyldopa (Aldomet)®. Side effect : autoimmune hemolytic anemia in long
term treatment , so that it is used only in pregnancy.
- Clonidine. Side effect : depression.
- Minoxidil. Side effect : hirsutism (androgen specific area).

Re-arranged & Printed by : Hasan al-Yaqoobi | hssony_89@yahoo.com | www.phabas.tk

Applied Therapeutics - Theoretic | By : Dr. Tawfeq Mohammed | Pharmacy department - 2nd stage

(4) Ca. channel blockers :

 Dihydropyridine : Nifedipine (in special cases) , Amlodipine.
Used in HT , prophylaxis of angina.
Side effects : Amlodipine : edema.
Nifedipine : tachycardia , reflex tachycardia , gravitational edema.
 Non-Dihydropyridine : cause AV-node block in high dose.
Diltiazem : prophylaxis & treatment of angina , HT.
Side effects : gynecomastia , extra pyramidal symptoms , depression.
Verapamil : treatment of angina , HT , arrhythmia.
Side effects : constipation , fatigue , leg edema.
(5) ACEI : Captopril , Enalapril , Lisinopril.
(6) AgII blockers : Losartan , Valsartan.
(7) α-blockers : Prazosin , Terazosin , Doxazosin , Phenoxybenzamine.
Side effects : tachycardia , aggravate of ischemic heart disease.
(8) Direct vasodilators : Hydralazine , used in pregnancy & emergency.
Side effects : hypotension, headache, nausea, sweeting, arrhythmia, ppt. of angina.
(9) Nitrates : Glyceryl trinitrate (Angesid®) , Isorbide dinitrate (Isordil®). May given I.V
when the sublingual form is ineffective. having useful role in angina.
 Hypertension & Pregnancy :
 All H.T drugs can be given in pregnancy , except ACEI .
 In emergency : Hydralazine (5-10 mg) diluted with 10 ml of NaCl 0.9% (slow infusion
for 10 minutes) , then repeated every 0.5 - 10 hour.
 Pregnancy induced H.T :
- 1st choice : Methyldopa , Hydralazine.
- 2nd choice : β-blocker , diuretic.
 H.T & IHD : β-blocker , Ca. Channel blocker , ACEI , AgII blocker.
 H.T & R.F : if serum creatinin < 3 gm : ACEI , AgII blocker.
If serum creatinin > 3 gm : diuretic , CCB (ACEI , AgII blocker are Contra.).
 H.T & H.F : Systolic H.F : ACEI , AgII blocker , diuretic.
Diastolic H.F : β-blocker , CCB (non-dihydropyridine).
 Diabetic & H.T : Type I : ACEI , AgII blocker , CCB. Type II : CCB.
 Treatment of emergency H.T :
1- 1st choice : Sodium nitroprusside (should be protected from light).
Side effects : cyanide toxicity after 24 hours. Therefore we must check the level
of the cyanide (normal = 12). If toxicity occurs : discontinue , then treatment.
2- ACEI : Enalapril.
3- In H.T + R.F , serum creatinin > 3gm : α , β-blocker : Labetalol.
4- H.T + IHD with pulmonary edema : Angesid ®.
5- Direct vasodilators : Hydralazine , ↑ dose until ↓ B.P.
Diazoxide : by rapid I.V (less than 30 seconds).
6- α-blocker : Phentolamine.
7- β-blocker : Esmolol.
 Treatment of pheochromacytoma : start with α-blocker then take β-blocker. If
started with β-blocker → ↑ receptors & cause re-uptake → death.

Re-arranged & Printed by : Hasan al-Yaqoobi | hssony_89@yahoo.com | www.phabas.tk