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HTN Jmi
HTN Jmi
HTN (Hypertension) is Chronic elevation in blood pressure > 140/90 mmHg ANTIHYPERTENSIVE DRUGS are those drugs used to combat hypertension.
5. DIURETICS
THIAZIDES: HYDROCHLOROTHIAZIDE,CHLORTHALIDONE
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Other Anti-hypertensives
6. + BLOCKERS: LABETALOL, CARVEDILOL 7. ADRENERGIC BLOCKERS: PRAZOSIN, TERAZOSIN 8. CENTRAL SYMPATHOLYTICS: CLONIDINE, METHYL DOPA 9. VASODILATORS : Arterioles- HYDRALAZINE, Minoxidil, Diazoxide Venous + Arteriole- SOD. NITROPRUSSIDE, Nicorandil, blockers 10. Newer drugs- Natriuretic peptides, Fenoldopam 11. Obsolete agents- Reserpine, Guanethidine, Trimethaphan
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Antihypertensive drugs
BP = CO X PVR CO = HR X SV Anatomical sites for regulating BP 1. Arterioles 2. Heart 3. Post-capillary venules 4. Kidney
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DIURETICS -THIAZIDES
MECHANISM OF ACTION:1.Diuresis reduces plasma and e.c.f vol by 5-15% leads to decreased CO 2. Despite compensatory mech. fall in BP is maintained by a slowly developing reduction in PVR. 3. Reduction in PVR is due to persisting sod and vol. deficit 4. Fall in B.P develops over 2-4 weeks
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POTASSIUM SPARING DIURETICS Spironolactone or amiloride lower b.p slightly. Used in conjunction with a thiazide (1) to prevent pot.loss. (2) to augment Anti-HTN action.
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C/I Pregnancy Bilateral renal artery stenosis D.i Pot. Sparing diuretics Pot. Supplements
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Advantages of CCBs 1.Quick onset of action. 2.Can be administered once a day. 3.No sedation or CNS effects. 4.Not contraindicated in asthma and angina 5. Do not impair renal perfusion. 6. Do not effect male sexual function. 7. No effect on plasma lipid profile,uric acid level,electrolyte balance. 8. No adverse foetal effects.
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Disadvantages of CCBs
1. Negative inotropic/dromotropic action of diltiazem may worsen CHF & cardiac conduction defects.
2. By smooth muscle relaxant action- worsen GERD. May accentuate bladder voiding difficulty in males.
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3.
BLOCKERS
Response develops over 1-3 wks. Cardioselective- Atenolol / Metoprolol Non-cardioselective- Plol/ Pindolol Others- Carveidilol / Celiprolol Drugs with ISA cause less reduction of H.R and C.O ,but lower vascular resistance by beta 2 agonism. Non selective beta blockers decrease RBF 20 and GFR.
Demerits- BLOCKERS
C/I-Peripheral vascular disease / ----. Unfavourable efffect on lipid profile. Fared poorly on quality of life. Rebound HTN occurs on sudden discontinuation of beta blockers.
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ADVANTAGES- BLOCKERS
Absence of postural HTN. No Bowel alteration. No Salt and water retention. Less S/E. Low cost. Once a day regimen. Cardioprotective potential.
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VASODILATORS
Arteriolar vasodilators Hydralazine, Minoxidil, Diazoxide
Arteriolar & venous vasodilators Sodium nitroprusside Adrenergic blockers- eg., Prazosin Nicorandil
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ARTERIOLAR VASODILATORS
Hydralazine-
MECHANISM OF ACTION: Endothelium dependent may involve generation of NO and stimulation of cGMP.
USES:
drug of choice in acute severe hypertension in pregnancy
CHF ( + ISDN)
Emergency HTN- IV Hydralazine
ADVERSE EFFECTS:
Lupus erythematosus
CONTRAINDICATIONS: CAD
ARTERIOLAR VASODILATORS
Minoxidil (Prodrug)-
MECHANISM OF ACTION: K+ channel opener relax VSM PVR BP. USES: Adjuvant use in HTN Male patterened Alopecia ADR:
ARTERIOLAR VASODILATORS
Diazoxide-
MECHANISM OF ACTION: K+ channel opener relax VSM PVR BP. USES: Emergency HTN ADR: reflex sympathetic activation Hyperglycaemia
hypertensive emergencies
CHF with pulmonary edema acute aortic dissection controlled hypotension during anesthesia
vomiting
lactic acidosis
disorientation
thiocyanate toxicity
MECHANISM OF ACTION:
block action of nor-epinephrine on vascular adrenergic receptors Dilates both resistance and capacitance vessels ((arteriolar & venodilaor) BP
USES :
in conjugation with diuretics and blockers drug of second line
ADVERSE EFFECTS ( ADRENERGIC BLOCKERS): postural hypotension ( first dose effect) headache
drowsiness
dry mouth
weakness
palpitation fluid retention nasal blockage blurred vision
CENTRAL SYMPATHOLYTICS
IMIDAZOLE DERIVATIVE- CLONIDINE -METHYL DOPA MOA:- Stimulation of pre-synaptic 2 receptors. Decrease sympathetic outflow Plasma NA declines heart rate and cardiac output t.p.r. and BP USES : add on therapy non emergent HT in pregnancy(-METHYL DOPA)
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lupus erythrematosus
rebound hypertension
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orthostatic hypotension
Management of Hypertension
BP category Normal SBP (mm Hg) < 120 DBP (mm Hg) < 80 NonPharma T/t Encourge life style changes Drug therapy
No Anti-HT drugs
PreHypertensive
120-139
80-89
No Anti-HT drugs except compelling indications ABCD & combinations ABCD & combinations
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Stage-I HT Stage-II HT
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DRUG THERAPY
A + C or D Or B + C or D A or B + C + D
A or B + C + D + blocker or spironolactone
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Management of HT Emergencies
Goal- to reduce BP by 25%(not more) within mins to 1 hr.
- excessive reductions- IHD / Cererbral & Renal ischaemia
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