6- Common medications to manage hypertension:

 Calcium Blocker:
- When the brain signals the muscle to contract, the body pulls calcium from the
blood into the muscle cells. The calcium binds with the troponin and draws it
out of position. When the troponin and tropomyosin move, this activates the
actin and myosin to move toward each other and contract the muscle.
- Increasing the calcium intake lowers blood pressure even in individuals within
a normal blood pressure range.
- How do calcium channel blockers work?
They block voltage gated Ca+2 channels slow the rate at which calcium
passes into the heart muscle and into the
vessel walls. This relaxes all smooth
muscles: vascular, bronchial, GIT, uterine.
The relaxed vessels let blood flow more
easily through them, thereby lowering blood
pressure.
- Calcium channels blockers:
Calcium channel blockers are available in
short-acting and long-acting forms.

 Amlodipine (Norvasc)
 Diltiazem (Cardizem, Tiazac, others)
 Felodipine
 Isradipine
 Nicardipine
 Nifedipine (Procardia)
 Nisoldipine (Sular)
 Verapamil (Calan SR, Verelan)

- Mainly cardiac effects: Verampil, diltiazem

- Mainly vascular effects: nifedipine, amlodipine

- When are Calcium channel blockers used?

 Coronary artery disease

 Chest pain (angina)
 Irregular heartbeats (arrhythmia)
 Blood vessel conditions, such as Raynaud's disease

- Pharmacological effect:
  Effects on vascular smooth muscle:
 Vasodilatation of systemic arterial smooth muscles: Dec
systemic blood pressure
 Vasodilation of coronary arterial smooth muscle: Inc blood
supply to cardiac muscle
 Cardiac Muscle:
 SA node -> decrease rate of nodal discharge
 AV node -> decreases AV conduction
 Decrease heart rate
 Decrease myocardial contractility
 Decrease conduction
- Side Effect:
 Constipation
 Dizziness
 Palpitation
 Fatigue
 Flushing
 Headache
 Nausea
 Rash
 Swelling in the feet and lower leg
 Diuretics:
- help rid your body of salt (sodium) and water. Most of these medicines help
your kidneys release more sodium into your urine. The sodium helps remove
water from your blood, decreasing the amount of fluid flowing through your
veins and arteries. This reduces blood pressure.
- Types:
1) Thiazide:
 They act directly on the kidneys and promote diuresis (urine flow) by
inhibiting the sodium/chloride cotransporter located in the distal
convoluted tubule of a nephron. Thiazides decrease sodium
reabsorption which increases fluid loss in urine, which in turn
decreases extracellular fluid and plasma volume. This reduces cardiac
output and lowers blood pressure.
 In combination with other
antihypertensive ex: ACEI and
Beta-blocker.
 Ex:
 Chlorothizaide
 Chlorthalidone
 Hydrochlorothiazide
 Indapamide
 Metolazone
2) Loop Diuretics:
  act at the ascending limb of the loop of Henle in the kidney. They
are primarily used to treat hypertension and edema often due to
congestive heart failure or chronic kidney disease.
 While thiazide diuretics are more effective in patients with normal
kidney function, loop diuretics are more effective in patients with
impaired kidney function.
 They work by making the kidneys pass out more fluid. As more
fluid is passed out by the kidneys, less fluid remains in the
bloodstream. 
 Ex:
 Bumetanide (Bumex)
 Ethacrynic acid (Edecrin)
 Furosemide (Lasix)
 Torsemide (Soaanz)
3) Potassium Sparing:


Sometimes when you take a diuretic, you lose too much potassium
from your body along with the extra water you pass. This can
make your potassium levels low, which can be quite dangerous.
The potassium-sparing diuretics help to stop this happening.
 Ex:
 Amiloride
 Triamterene
 Eplerenone
 Spironolactone