Professional Documents
Culture Documents
Antihypertensive Agents Saitoti S
Antihypertensive Agents Saitoti S
SAITOTI S.
Hypertension
Hypertension
Stage 1 140-159 90-99
Stage 2 160-169 100-109
Stage 3 180-209 110-119
Stage 4 210 120
Classification of Blood Pressure
Primary Hypertension
• Specific cause unknown
• 90% of the cases
• Also known as essential or idiopathic hypertension
Secondary Hypertension
• Cause is known (such as eclampsia of pregnancy,
renal artery disease, pheochromocytoma)
• 10% of the cases
Blood Pressure = CO x SVR
• CO = Cardiac output
• SVR = Systemic vascular resistance
Antihypertensive Agents
• Adrenergic agents
• Angiotensin-converting enzyme inhibitors
• Angiotensin II receptor blockers
• Calcium channel blockers
• Diuretics
• Vasodilators
Antihypertensive Agents: Categories
• Adrenergic Agents
– Alpha1 blockers
– Beta blockers (cardioselective and nonselective)
– Centrally acting alpha blockers
– Combined alpha-beta blockers
– Peripheral-acting adrenergic agents
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Alpha1 Blockers (peripherally acting)
• Block the alpha1-adrenergic receptors
• The SNS is not stimulated
Adrenergic Agents
Alpha1 Blockers
• doxazosin (Cardura)
• prazosin (Minipress)
• terazosin (Hytrin)
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Central-Acting Adrenergics
• Stimulate alpha2-adrenergic receptors
• Sympathetic outflow from the CNS is decreased
Adrenergic Agents
Central-Acting Adrenergics
• clonidine (Catapres)
• methyldopa (Aldomet)
(drug of choice for hypertension in pregnancy)
Antihypertensive Agents:
Mechanism of Action
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
• Inhibit release of norepinephrine
• Also deplete norepinephrine stores
• SNS (peripheral adrenergic nerves) is not stimulated
Adrenergic Agents
Adrenergic Neuronal Blockers
(peripherally acting)
• reserpine
• guanadrel (Hylorel)
• guanethidine (Ismelin)
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
• Alpha1 blockers (peripherally acting)
– Treatment of hypertension
– Relief of symptoms of BPH
– Management of severe CHF when used
with cardiac glycosides and diuretics
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
• Central-Acting Adrenergics
– Treatment of hypertension, either alone or
with other agents
– Usually used after other agents have failed
due to side effects
– Also may be used for treatment of severe
dysmenorrhea, menopausal flushing, glaucoma
– Clonidine is useful in the management of
withdrawal symptoms in opioid- or nicotine-
dependent persons
Antihypertensive Agents:
Adrenergic Agents
Therapeutic Uses
• Adrenergic neuronal blockers
(peripherally acting)
– Treatment of hypertension, either alone or with
other agents
– Seldom used because of frequent side effects
Antihypertensive Agents:
Adrenergic Agents
Side Effects
Most common: dry mouth drowsiness
sedation constipation
Other: headaches sleep disturbances
nausea rash
cardiac disturbances (palpitations)
• Gastrointestinal
– constipation, nausea
• Other
– rash, flushing, peripheral edema, dermatitis
Antihypertensive Agents: Diuretics
Vasodilators
• diazoxide (Hyperstat)
• hydralazine HCl (Apresoline)
• minoxidil (Loniten, Rogaine)
• sodium nitroprusside (Nipride, Nitropress)
Antihypertensive Agents:
Therapeutic Uses
Vasodilators
• Treatment of hypertension
• May be used in combination with other agents
• Sodium nitroprusside and diazoxide IV are reserved
for the management of hypertensive emergencies
Antihypertensive Agents: Side
Effects
Vasodilators
• Hydralazine:
– dizziness, headache, anxiety, tachycardia,
nausea and vomiting, diarrhea, anemia,
dyspnea, edema, nasal congestion
• Sodium nitroprusside:
– bradycardia, hypotension, possible
cyanide toxicity
Antihypertensive Agents:
Nursing Implications
• Before beginning therapy, obtain a thorough
health history and head-to-toe physical
examination.