DRUG TREATMENT

FOR
CARDIOVASCULAR
DISEASE
PART 3
Cardiovascular System

It is composed of the heart

which acts as the main organ
of this system and directs
what happens to the rest of
its components which are
the veins, arteries, and other
tributaries.
Hypertension
 It is clinically defined as an increase in blood pressure levels necessitating
administration of therapy to the person in order to decrease the
morbidity and mortality caused by the disease condition itself
 Two Different Categories:
 Essential Hypertension – most common in the middle aged
population(males more than females); hypertension with no
identifiable cause
- Factors: stress, sodium-based diet, obesity, and smoking
Secondary Hypertension - caused by an identifiable underlying
primary cause; less common, affecting only 5% of hypertensive
patients. It has many different causes including endocrine
disease, kidney disease, and tumors. It also can be a side effect of
many medications.
Key factors in control of blood pressure:
Pressure within the artery should be kept in control since it is
responsible for perfusion of the bodily organ system.
• Cardiac output (CO) - the amount of blood pumped by the heart per
minute; product of heart rate
• Peripheral resistance (PR) - the resistance of the arteries to blood
flow; As the arteries constrict, the resistance increases and as they
dilate, resistance decreases.
• Arterial blood pressure (BP) – product of cardiac output (CO) and
peripheral resistance (PR)

BP= CO X PR
Two Mechanism involved in Blood Pressure Levels:

 Baroreceptors
 responsible for detecting minute changes in the blood pressure
 Located in the aortic arch and carotid sinuses
 Increases sympathetic responses and decreases parasympathetic output of the heart
 Promotes vasoconstriction and increases cardiac output resulting to elevated blood pressure

 Renin Angiotensin Aldosterone System (RAAS)

 The Pathophysiology of Hypertension
Angiotensinogen
from the liver
Angiotensin I Angiotensin Angiotensin II Vasoconstriction
converting enzyme
(ACE)

stimulates Increased
Low blood peripheral
flow to the resistance
Renin more High
kidneys increased
damaged in blood
blood vessels pressure

Increased in
Aldosterone
Na+ ion Increased
Increased
(Adrenal gland)
reabsorption cardiac
blood volume
followed by output
increased
H2O
reabsorption
If hypertension is left untreated:
 CAD (Coronary heart disease) and cardiac death
Stroke
Renal failure
Loss of vision
 Because hypertension has no symptoms, it is difficult to diagnose
and treat, and it is often called the “silent killer”
Approach to treatment of hypertensive patients:
• Patients with hypertension should be treated individually and with caution since some patients respond to a
single drug while some would require a combination therapy of two or more antihypertensive medications.
• ALWAYS REMEMBER:
 “ABCD” for the Types of Antihypertensive medications
A- ACE inhibitors
B- Beta blockers
C- Calcium channel blockers
D- Diuretics
“look at D BACK” for the Treatment approach
D- Diuretics
B- Beta blockers
A- ACE inhibitors
C- Calcium channel blockers
 DIURETICS
 Or also called water pills, are medications designed to increase the amount of water and salt expelled
from body as urine.
 considered the first line drugs in the treatment of hypertension
 Proven safe and efficient in the prevention of various diseases (such as stroke, congestive heart failure
and all-cause mortality) and safe for use in elderly population
 Five classes:
• Thiazide diuretics and Thiazide-like diuretics
• Loop diuretics
• Carbonic Anhydrase inhibitors
• Potassium-sparing diuretics
• Osmotic Diuretics
 Most common adverse effects seen with diuretics: gastrointestinal (GI) upset, fluid and electrolyte
imbalances, hypotension, and electrolyte disturbances
THIAZIDE DIURETICS: Treatment of EDEMA caused by heart failure,
• BENDROFLUMETHIAZIDE liver disease, or renal disease; monotherapy or
• CHLOROTHIAZIDE as adjunctive treatment of hypertension
• HYDROCHLOROTHIAZIDE
• HYDROFLUMETHIAZIDE
• METHYCHLOTHIAZIDE
THIAZIDE-LIKE DIURETICS
• CHLORTHALIDONE
• INDAPAMIDE
• METORAZONE
LOOP DIURETICS: Treatment of ACUTE HEART FAILURE; acute
• BEMETANIDE pulmonary edema; hypertension; and edema of HF,
• ETHACRYNIC ACID renal disease, or liver disease.
• FEROSEMIDE
• TORSEMIDE

CARBONIC ANHYDRASE INHIBITORS: Treatment for GLAUCOMA (an eye disease that is often
• ACETAZOLAMIDE associated with elevated intraocular pressure, in which
• METHAZOLAMIDE damage to the eye (optic) nerve can lead to loss of vision and
even blindness)
POTASSIUM-SPARING DIURETICS:
• AMILORIDE (not for use in children)
• TRIAMTERENE (not for use in children)
• SPIRONOLACTONE (can be used in children with
careful monitoring of electrolytes)
OSMOTIC DIURETICS:
• MANNITOL
Adjunctive treatment of edema caused by HF, liver
disease, hypertension, hyperkalemia, and
hyperaldosteronism
Treatment of elevated intracranial pressure, acute
renal failure, acute glaucoma, also used to decrease
intracranial pressure, prevent oliguric phase of renal
failure, and to promote movement of toxic substances
through the kidneys
 THIAZIDE DIURETICS and THIAZIDE-LIKE DIURETICS

 Belongs to a chemical class of drugs called the “Sulfonamides”

 They act to block the chloride pump
- Blocking of chloride of the chloride pump keeps the chloride and the sodium in the tubule
to be excreted in the urine, thus preventing reabsorption of both chloride and sodium in
the vascular system
 Considered to be mild diuretics compared with the more potent loop diuretics
 First-line drugs used to manage essential hypertension when drug therapy is needed.
 They are well-absorbed from the GI tract after oral administration:
Onset: 1 to 3 hours
Peak: 4 to 6 hours
Duration: 6 to 12 hours
Then, they are metabolized in the liver and excreted in urine. These diuretics cross the placenta
and enter the breastmilk.
 Hydrochlorothiazide – most frequently used of the thiazide diuretics and the prototype of this
class
 Chlorothiazide – available for IV transfusion