ANTIHYPERTENSIVE

Hypertension(HN) is defined as BP
140/90mmHg more+
died
Its associated with increased mortality and
morbidity.
Causes:
1-Essential(primary): the cause is unknown 95%
2-Secondary to Renal, Endocrine and other
diseases (5%)
 Factors that Elevate the BP

1- Renin Angiotensin system increase

2- Sympathetic stimulation ( B1 increase
HR), alpha 1( increase peripheral vascular
resistance)
3- Blood volume the higher the volume the
higher the BP

drug

Antihypertensive classification
angio:vessle
tenstion: contraction
1-Angiotensin Converting Enzyme Inhibitors
(ACE )
Captopril, Enalapril, Lisinopril
2- Angiotensin II-receptor
antagonist(ARBs)
*irbesartan
Losartan, Valsartan, Erbesartan
3- Direct Renin Inhibitors(DRI): Aliskirin
ccg
ACE ,DRI &ARBs

this make vasoconstriction so should inhibit

Main actions of these 3 classes….

1- decrease vascular resistance, mainly

arteriolar ( decreases the afterload)
without affecting the HR
2- Reduce production of aldosteron
therby reducing the water volume
3- increases bradykinin which in
turn,increases the Nitros Oxide which is a
potent vasodilator
 nephroprotective

contraindicated= not allowed

LVH=Left ventricular hypertrophy

 Side Effects (SE)
1- Dry cough with ACEI(10%) due to increased in
Bradykinin and substance P in the lung( not with ARBs)
2- HyperKalemia and increased S creatinine
( monitor K and S creatinin 2 Wks after staring
therpay) and should be stopped when the raise of
S.creatinin 30% above the
3-hypotension especially with ACEI, so better to start
at small doses @ bed time in the elderly
baseline
Others: Angioneurotic edema with ACE, rash, fever,
these 3 classes are contraindicated in Pregnancy

Introduction
CV basics
CV basics

CV basics
 CV basics

(BB)Beta Blockers

BB acts by reducing the HR and CO

Non-selective BB: act on B1,B2
receptors: Propranolol
Selective BB: on B1( Atenolol ,metoprolol
and Bisoprolol)
Others:
Alpha,B1 and B2: Carvediolol
Indication:Rx of HTN specially those with
HF ,angina and tachyarrhythemia, Aortic
dissection
SE:
1- Hypotension 2-Bradycardia 3-Fatique
5-Insomnia 6-sexual dysfunction 7-
Bronchospasm
8-Vivis dreams 9-Dyslipidemia( lowering HDL
and increase TG) With non selective BB

BB

Contraindications:
1-IV BB are contraindicated in patient
with acute heart failure( acute pulmonary
edema)
2- Asthmatic patients( non-selective BB)
3-Hypotensions
4-Advanced AV blocks
BB shouldn’t be withdrawn abruptly in
patients with angina pectoris because
sudden withdrawal causes rebound angina

Calcium channel blockers CCB

Blocks Ca channls
Types:
1-Dihydropyridines: Nifidipine, Amlodipine,
Felodipine, it relaxes the arteriolar smooth
muscle cells by blocking the Ca channles
2-Non-dihydropyridines: Diltiazem , Verapamil
Acts mainly by blocking the Ca channles in
myocardium reducing contractlity( negative
inotropic effect) and by blocking the Ca channels
in the conductive system causes
bradycardia( negative chronotropic effect)
 Clinical indications:

1-HTN: specially with DHP: Amodipine has

long t1/2
2- Supraventrcular arrhythemias: specially
when BB are contraincated in Asthmatic
and in those with periphral A disease ,
verpamil IV is highly effective
3-DHP: for Rynoid disease to relieve the
periphral areriolar spasm

SE: leg edema,dizzniess, headache,gingival

hyperplasia and hypotenison
Diuretics yellow=type of diuretics drug

Thiazide diuretics: Hydrochlothiazides(HCTZ)

Thiazide-like: Chlorothalidone and Indapamide

Acts by inhibiting Na/CL transport in the

distal convoluted tubular cells resulting in
increasing luminal Na/CL causing osmotic
diuresis
Used in the treatment of HTN alone or
with other classes of
antihypertensives( like ARBs+HCTZ), they
loss efficacy in renal failure( except
metolazone)
SE: hypokalaemia, Hypomagnesemia,
hyperuricemia, hyperglycemia and
hypertriglycerlimia

Loop diuretics and potassium sparing diuretics :

usually are not used for hypertension alone( will be
discussed in heart failure)

Alpha 1 adrenoceptor blocking agents: Prazocin and

Terazocin reducing both acts on arteriolar and
venouls, it has weak effect alone,the main side
effects: postural hypotension so should be used in
small incremental doses and at bed time
They are used also for the management of benign
prostatic hyperplasia(BPH)
Combined alpha and B blockers
Labetolol , carvedilol
Labetolol is used for the treatment of
hypertension in pregnancy and emergency
hyoertension
Notes: carvediolol, Metoprolol succinates
and Bisoprolol improved survival in patient
with heart failure and angina

Centrally acting antihypertensive

A-Clonidine: act on the central alpha 2

receptors reducing the central
sympathetic outflow thereby reducing the
total vascular tone, its uses as add onused primarily for
the treatment of hypertension that has not responded adequately
to treatment with two or more drugs

therapy in resistant hypertension. Its

shouldn’t be stopped abruptly because risk
of rebound severe hypertension
B- Methyldopa: the same action of
clonidine but has little withdrawal effect
and has safe use record in pregnancy

Direct vasodilators:

1-Hydralazine:These medications acts by

direct vasodilatation of the small arteries and
arterioles yet, I cause a reflex tachycardia
which worsen angina and heart failure so that
its not used a sole therapy in HTN and beta
blockers are added to them , rather it can be
used IV in emergency hypertension
SE: lupus like skin rash lupus-like syndrome
Minoxidil: the same as Hydralyzine with
the main SE is hypertrichosis( increase in
hair growth), so it can be used as topical
preparations for those with alopecia