PRACTICAL APPLICATIONS OF THE ANTIHYPERTENSIVE DRUGS

I. THEORETICAL PART

CLASSIFICATION

Diuretics
 Thiazides and related agents: HYDROCHLOROTHIAZIDE, INDAPAMIDE,
CHLORTHALIDONE
 Loop diuretics: FUROSEMIDE, ETHACRYNIC ACID, BUMETANIDE
 Potassium sparing diuretics: AMILORIDE, SPIRONOLACTONE, TRIAMTERENE
Sympatholytics
 Beta-blockers:
o Non-selective agents (β1 and β2): ALPRENOLOL, PINDOLOL,
CARTEOLOL, PROPRANOLOL, NADOLOL, SOTALOL, OXPRENOLOL,
TIMOLOL
o Selective agents (β1): ACEBUTOLOL, ESMOLOL, ATENOLOL,
METOPROLOL, BETAXOLOL, NEBIVOLOL, BISOPROLOL
 Alfa-blockers: DOXAZOSIN, PRAZOSIN, TERAZOSIN
 Alfa and beta blockers: LABETOLOL, CARVEDILOL
 Sympathetic inhibitors with central action: METHYLDOPA, CLONIDINE,
GUANABENZ, GUANFACINE
 Sympathetic inhibitors with peripheral action: GUANADREL, RESERPINE
Calcium channel blockers:
 Dihydropyridines: AMLODIPINE, NIFEDIPINE, FELODIPINE, NIMODIPINE,
LACIDIPINE, NITRENDIPINE, NICARDIPINE
 Phenylalkylamine: VERAPAMIL, GALLOPAMIL
 Benzothiazepine: DILTIAZEM
Renine-angiotensine-aldosterone system inhibitors
 Angiotensin converting enzyme (ACE) inhibitors: CAPTOPRIL, ENALAPRIL,
FOSINOPRIL, LISINOPRIL, PERINDOPRIL, QUINAPRIL, RAMIPRIL,
TRANDOLAPRIL, BENAZEPRIL
 Angiotensin II receptor antagonists: CANDESARTAN, EPROSARTAN,
IRBESARTAN, LOSARTAN, TELMISARTAN, VALSARTAN
Vasodilators: HYDRALAZINE, MINOXIDIL, DIAZOXID, SODIUM NITROPRUSSIDE

GENERAL PRINCIPLES OF ADMINISTRATION

1. Antihypertensive drugs are administered in low doses, which can be increased every
2-3 weeks if nececssary, according to the blood pressure values.
2. The patient should not drink alcohol (decreases BP) or smoke (decreases the effect of
ACE inhibitors).
3. Diuretics are administered as first intention treatment in case of elderly patients with
mild to moderate hypertension. For the long term treatment a low dose of thiazide
diuretic is to be administered.
4. Loop diuretics are administered usually in emergencies. Furosemide, IV rapidly, could
determine deafness. To avoid this side effect, the rhythm of administration should be
lower than 4 mg/min.
5. During the treatment with diuretics, monitoring of plasmatic potassium, magnesium,
calcium, chloride, glycemia and uric acid concentration is necessary.
 6. The most frequent side effect of thiazide diuretics is hypopotasemia. For this reason,
the association with potassium sparing diuretics is useful.
7. ACE inhibitors are the golden standard in case of heart failure and can be administered
in high risk patients with HBP (elderly, with diabetes). If dry cough appears, we can
choose an angiotensin II receptor antagonist. Direct renin inhibitors are not considered
to be first line drugs, because there are insufficient long term studies.
8. Betablockers are administered in young hypertensive patients with hyperkinetic
syndrome, ischemia or patients under treatment with direct vasodilators.
9. Betablockers have a high risk of rebound and we have to reduce the dose slowly.
10. Nonselective betablockers should not be administered in patients with bronchial
asthma, chronic bronchitis or COPD. In case of selective betablockers, selectivity will
be lost after high doses.
11. Betablockers should be avoided in diabetic patients because they mask the symptoms
of hypoglycemia.
12. Acute intoxication with betablockers are treated with Atropine IV (for bradycardia),
temporary pace-maker, Isoprenaline or alfa agonists (increase the blood pressure) and
antiseizure agents.
13. Verapamil and Diltiazem have an inotrop negative effect and should not be
administered in association with betablockers. Nifedipine produces vasodilation and
should not be associated with nitrates (hypotension and reflex tachycardia).
14. The antihypertensive drug should be choosen according to the associated pathology:

Associated disease Antihypertensive drug

Left ventricular hypertrophy ACE inhibitors, calcium channel blockers, sartans
Atherosclerosis Calcium channel io, ACE inhibitors
Renal disease ACE inhibitors, sartans
Acute myocardial infarction in Betablockers, ACE inhibitors, sartans
the past
Pectoral angina Betablockers, calcium channel blockers
Heart failure Diuretics, betablockers, ACE inhibitors, sartans
Aortic aneurism Betablockers
Atrial fibrillation Betablockers, non-dihydropyridines
Peripheral arteriopathy ACE inhibitors, calcium channel blockers
Diabetes ACE inhibitors, sartans
Pregnancy Methyl-dopa, betablockers, calcium channel blockers

Generic drug Brand name Route of Pharmaceutical dosage

administratio form
n
Hydrochlorothiazide Nefrix p.o. Tab. 25 mg, 50 mg
Indapamide Tertensif p.o. Tab. 1,5 mg
Chlorthalidone Hygroton p.o. Tab. 25 mg, 50 mg
Furosemide Lasix p.o. Tab. 40 mg
IM, IV Vials 20 mg/2 ml, 40
mg/ 4 ml, 250 mg/ 2 ml
Ethacrynic acid Edecrin p.o. Tab. 25 mg
Spironolactone Aldactona p.o. Dj. 25 mg, 50 mg
Caps. 100 mg
Amiloride Moduretic p.o. Tab. 5 mg/50 mg
 (+Hydrochlorothiazide
)
Triamteren Maxzide p.o. Tab. 75 mg/50 mg
(+Hydrochlorothiazide
)
Captopril Captopril p.o. Tab. 25 mg, 50 mg
(2-3 times/day)
Enalapril Enap p.o. Tab. 2,5 mg, 5 mg, 10
mg, 20 mg (1- 2
times/day)
IV Vials 1,25 mg
Lisinopril Ranolip p.o. Tab. 5 mg, 10 mg, 20
mg (1 tab./day)
Ramipril Tritace p.o.. Tab. 2,5 mg, 5 mg, 10
mg
Fosinopril Monopril p.o. Tab. 10 mg, 20 mg
Perindopril Prestarium p.o. Tab. 5 mg, 10 mg
Trandolapril Gopten p.o. Caps. 4 mg (1 caps./day)
Quinapril Accupro p.o. Tab. 5 mg, 10 mg, 20
mg
Losartan Cozaar p.o. Tab. 12,5 mg, 50 mg
Valsartan Diovan p.o. Tab. 80 mg, 160 mg
Irbesartan Aprovel p.o. Tab. 150 mg, 300 mg
Telmisartan Micardis, Pritor p.o. Tab. 40 mg, 80 mg
Candesartan Atacand p.o. Tab. 4 mg, 8 mg, 16 mg
Propranolol Propranolol fabiol p.o. Tab. 10 mg, 40 mg
Sotalol Darob, Sotalex p.o. Tab. 80 mg, 160 mg
Atenolol Tenormin p.o. Tab. 50 mg, 100 mg
Metoprolol Betaloc, Betaloc-zok, p.o. Tab. 50 mg, 100 mg,
Egiloc 200 mg
Betaloc IV vials 1mg/1 ml
Bisoprolol Concor p.o. Tab. 5 mg, 10 mg
Nebivolol Nebilet p.o. Tab. 5 mg
Betaxolol Lokren p.o. Tab. 20 mg
Carvedilol Dilatrend p.o. Tab. 12,5 mg, 25 mg
Nifedipine Nifedipin p.o. Tab. 20 mg (2-3
times/day)
Amlodipine Norvasc p.o. Caps. 5 mg, 10 mg
Felodipine Plendil p.o. Tab. 2,5 mg, 5 mg, 10
mg
Lercanidipine Leridip p.o. Tab. 20 mg
Nitrendipine Lusopress p.o. Tab. 20 mg
Diltiazem Dilzem p.o. Tab. 60 mg, 90 mg
Verapamil Isoptin p.o. Tab. 40 mg, 240 mg
i.v. Vials 5 mg/2 ml

II. PRACTICAL PART

1. Write a medical prescription to a patient with HBP stage II.
2. Write a medical prescription to a patient with HBP stage I and COPD.
3. Write a medical prescription to a patient with HBP stage I and diabetes mellitus type
II.