‫بسم هللا الرحمن الرحيم‬

Hypertension
Treatment
Dr. Nasr Aldeen Yousif Ahmed
Consultant Physician and Cardiologist
Gezira University

14/06/2024
 Goals of Therapy
▪ Reduce CVD and renal morbidity and mortality.

▪ Treat to
BP <140/90 mmHg or BP <130/80 mmHg in patients with diabetes
or chronic kidney disease.

▪ Achieve SBP goal especially in persons >50 years of age.

 Lifestyle measures

• Maintain normal weight for adults (body mass index 20-25 kg/m2)
• Reduce salt intake to <100 mmol/day.
• Limit alcohol consumption.
• Regular aerobic physical exercise for 30 minutes per day, ideally
on most of days of the week but at least on three days of the week.
• Consume of fresh fruit and vegetables.
• Reduce the intake of total and saturated fat .
 Drug Therapy

A large number of drugs is available to lower BP, with different

modes of action:
 1. Thiazide Diuretics:

◼ Examples: bendroflumethiazide (2.5–5mg daily) and

cyclopenthiazide (0.25–0.5mg daily), hydrochlorothiazide (Esidrex).

◼ Advantages: cheap, no sedation effect, potentiate other drugs.

◼ Disadvantages: increased serum cholesterol,
Impaired glucose tolerance, hyperuricaemia (which may precipitate
gout) and hypokalemia. These tend to occur with higher doses of
thiazide diuretics.
 Other diuretics:
◼ Loop diuretics: such as furosemide (40mg daily) do have a
hypotensive effect , but are not routinely used in the treatment of
essential hypertension.
◼ Potassium sparing diuretics: such as amiloride (5–10mg daily) or
spironolactone (50–200mg daily) are not effective agents when used
alone, with the exception of spironolactone in the treatment of
hypertension and hypokalemia associated with primary
hyperaldosteronism.
 2. B- blockers:

▪ mode of action:
1- a fall in cardiac output, resulting from slower and less contractile
heart.
2- central effect ~ reducing efferent sympathetic outflow.
▪ examples: * non-selective drugs: Propranolol, Oxpronolol.
* selective: Atenolol, Metoprolol, Bisoprolol,
Carvidalol.
◼ - Advantages: used in angina and arrhythmias, used in
thyrotoxicosis, combat tachycardia of vasodilators, lower plasma
renin, in low dosage.
◼ Disadvantages: bronchospasm, HF, fatigue, cold hands, mask
hypoglycemia in IDDM.
 3. Vasodilators:

▪ 1- Hydralazine: dilates arterioles, used in hypertensive

emergencies IV, useful in RF. disadvantages: reflex tachycardia,
SLE-like syndrome.
◼ 2- minoxidil :(up to 50mg daily). S/E :severe edema, excessive
hair growth and coarse facial features.
◼ (If these agents are used, it is usually in combination with a
beta-blocker).
 4. Calcium channel blockers:
◼ Mechanism of action: arteriolar dilatation, and some also reduce the
force of cardiac contraction.
◼ Examples:
1- Verapamil: has antiarrhythmic activity, depress AV conduction.
2- Nifedipine: no effect on AV conduction, may cause tachycardia and
flushing
3- Amlodipine: single dose, less S/E.
 Dihydropyridines Non dihydropyridines
Examples 1. Nifedipine 1. Verapamil
2. amlodipine 2. Diltiazem
3. felodipine
Effect on heart Increase Decrease
rate
Site of action vasculature Vasculature and heart
Side effects Headache, ankle Constipation, heart
swelling, flushing. failure, heart block.
5. ACE inhibitors:

◼ Mechanism of action: block the conversion of

angiotensin I to angiotensin II , which is a potent
vasoconstrictor .They also block the degradation of
bradykinin, a potent vasodilator.
◼ Advantages:
◼ There is evidence that black African patients
respond less well to ACE inhibitors unless
combined with diuretics.
◼ They are particularly useful in diabetics with
nephropathy (they decrease the protein urea &slow
disease progression).
◼ Examples:
◼ Enalapril (10–20mg daily).
◼ Captopril (50–150mg daily in divided doses).
◼ Ramipril (2.5–10mg daily).
◼ Lisinopril (10–20mg daily)
◼ and in those patients with left ventricular dysfunction, where they have been
shown to improve survival. (prevent remodeling).
◼ S/E:
◼ Deterioration of renal function in those with severe bilateral
renovascular
◼ Mild dry cough due to their effect on bradykinin.
◼ Angeoneurotic edema.
 6. Angiotensin- 2 receptors
antagonists:
◼ Mechanism of action: selectively block the receptors for angiotensin
II does not inhibit breakdown of bradykinine, thus does not cause dry
cough.
◼ S/E: Less than in ACE inhibitors.
◼ They are currently used for patients who can not tolerate ACE inhibitors
because of persistent cough.
◼ Examples: losartan ,candesartan, valsartan, irbesartan and
telmisartan.
 7. Centrally acting agents:
◼ Mechanism of action: Reducing efferent sympathetic outflow to
CVS.
◼ S/E: tiredness, depression, sedation, postural hypotension.
◼ Examples:
◼ 1. Reserpine: marked depression with suicidal attempts.
◼ 2. Methyldopa: autoimmune hemolytic anemia, SLE-like syndrome. Preferable
antihypertensive in pregnancy.
◼ 3. Clonidine: may cause rebound HTN on withdrall” overshoot phenomenon”
◼ 4. moxonidine.
 8. Alpha-blockers
Mechanism of action: post synaptic α1receptor blockade with
resulting vasodilatation.
◼ Examples: the newer agents:
◼ doxazosin(1–4mgdaily).
◼ Advantages: (pheochromocytoma/ benign prostatic hyperplasia).

◼ Labetalol is an agent That has combined alpha-and beta- blocking

properties, but is not commonly used, except in pregnancy-induced
hypertension.
Thank You