Antihypertensive drugs

Type of hyertension
Essential Hypertension= most common. About
90% of clients.
* Exact Origin unknown. Contributing Factors ‐
family history, hyperlipidemia, diabetes,
obesity, aging, stress, excessive ETOH &
smoking.
Secondary Hypertension is about 10% , related
to endocrine or renal disorders
Stages of hypertension
Antihypertensives are a class of drugs that
are used to treat hypertension (high blood
pressure).

Classification (ABCD)
Angiotensin converting Enzyme (ACE) inhibitor
Angiotensin-II receptor blocker
Alpha-1 receptor blocker
Alpha-2 receptor agonist
Beta adrenoceptor blocker
Calcium channel blocker
Diuretics
Angiotensin converting
Enzyme (ACE) inhibitor
 Angiotensin converting
Enzyme (ACE) inhibitor (--pril)
•e.g., Ramipril, Captopril, Enalpril etc
•Inhibits ACE enzyme
•Blocks the synthesis of angiotensin-II
-Causes vasoconstriction
-Reduces aldosterone: reduced Na+ and

water retention

SE: Dry cough, Rash, Nausea, Vomiting

• Angiotensin converting enzyme is a zinc containing
glycoprotein
• The important binding sites of ACE are cationic Site to attract
carboxylate ion
• Zinc ion that can polarize the carbonyl group of amide function
to make it more susceptible to hydrolysis

ACE inhibitor
Among the three zinc binding group, sulfhydryl
group is superior, but they form disulfide which
may result in shorter duration of action.

 N -ring must contain a carboxylic acid group to

mimic the C -terminal carboxylate of ACE substrate.
 Larger hydrophilic heterocyclic in the N -ring
increase the potency and alter pharmacokinetic
properties.
 X -is usually a methyl group, which mimic the side
chain alanine of the ACE substrate.
 When the stereochemistry of inhibitor is consistent
optimum activity occurs with L-amino acid.
 Classification of ACE inhibitor

Sulfhydryl containing inhibitors. eg.Captopril

Dicarboxylate containing inhibitors:

eg. Enalapril, Lisinopril,Quinapril,Ramipril,
Trandopril, Spirapril,Moxeipril,Benazepril

Phosphate containing inhibitor:eg.Fosinopril

 Enalpril

Lisinopril
Lysine analogue of Enalpril

Fosinopril
Synthesis of Captopril
Angiotensin II receptor blocker
Angiotensin II receptor blocker (-sartan)
 Losartan,valsartan, irbesartan, olmesartan, 
candesartan, fimasartan and azilsartan
 They block the activation of Angiotensin receptors,
preventing the binding of angiotensin II.
 Dec. Activity of angiotensin II, dec. blood pressure
 Dec activity of angiotensin II, dec. aldosterone
secretion, dec. Na+ ion retention
 Used primarily for the treatment
of hypertension where the patient is intolerant
of ACE inhibitor therapy
 SE: Headache, nausea, dizziness, Back pain
 Imidazole ring

Losartan Valsartan

In Valsartan, the imidazole ring of losartan is

replaced by acylated amino acid
• The U.S. Food and Drug Administration in July’
2018 recalled valsartan medicines manufactured
by the Chinese company Zhejiang Huahai
Pharmaceuticals.
• The FDA and European health agencies took this
step after learning that these products could have
been contaminated with N-nitrosodimethylamine
(NDMA), which is believed to cause cancer.
• But Danish patients exposed to NDMA in valsartan
products do not appear to be more likely to
develop cancer, according to the study. It was
published Sept. 13 in the BMJ.
Alpha-1 receptor blocker
 Stimulation of alpha-1 receptor
• In smooth muscle cells of blood
vessels the principal effect of alpha-1
receptors is vasoconstriction. Lead to
Increase blood pressure.

• Blood vessels with α1-adrenergic receptors

are present in the skin,  kidney (renal
artery) and brain.
 alpha-1 receptor blocker

• MOA: Competitive antagonist at α−1

receptors on vascular smooth muscle.

• Site of Action- peripheral arterioles, smooth

muscle

• Blocking α-receptors on vascular smooth

muscle allows muscle relaxation, dilation of
vessel, and reduced resistance.
 Quinazoline derivative and possesses quinazoline,
piperazine and acyl moieties.
 The presence of 4th amino group and hetero moiety at 2nd
position is essential for α1 receptor antagonistic activity
 Alpha1 blocker

By changing the furan ring in

prazosin to tetrahydrofuran ring (as
in alfuzosin) the t1/2 is greatly
increased, allowing once-a-day
dosing.

 The affinity and selectivity for alpha-1 receptors seems to be

determined by structure between the quinazoline and the furan
ring. 
 Alpha 2 receptors
• Alpha 2 receptors in the brain stem and in the
periphery inhibit sympathetic activity and thus
lower blood pressure. 
• Alpha 2 receptor agonists such as clonidine
reduce sympathetic overflow.
 Alpha 2 receptor agonist
e.g., clonidine, methyldopa
1. Site of Action
CNS medullary
cardiovascular centers

• 2. Mechanism of Action
 Alpha 2 receptor agonist

Methyldopa

Clonidine

Guanfacine
Structural comparison between the neurotransmitter
norepinephrine and the drug clonidine. Both drugs bind
to alpha-2 adrenergic receptors.

Similarities between the two structures are shown

highlighted in red.
• Beta adrenoceptor blocker (-olol)
• Calcium channel blocker (-dipine)
 Diuretics

 Loop diuertics
 Thiazide diuretics
 Potassium sparing agents
https://slideplayer.com/slide/10587411/
 Loop Diuretics/ High Ceiling Diuretics
• TAL responsible for 35% reabsorption of filtered
sodium.
• Therefore loop diuretics are highly efficacious or
“High Ceiling Diuretics”
• The Na+ —K+ —2Cl– symport and sodium
pump together generate a positive lumen
potential that drives the reabsorption of Ca++
and Mg++,Therefore, Ca++ and Mg++ inhibited
as well.
 5-Sulfamoyl-2-aminobenzoic acid
derivatives

Furosemide

4-Chloro-N-fufuryl-5-sulphamoylanthracillic acid
 5-sulfamoyl-3-aminobenzoic acid
derivatives.

Bumetanide

3-butylamino-4-phenoxy-5-sulphamoylbenzoic acid
 SAR

• The substituent at C1 must be acidic…the carboxyl

group gives optimal activity.
• A sulfamoyl group in the C5 is a pre-requisite for
optimal high ceiling diuretic activity.
• The activating group in the C4 position can be Cl- or
CF3 as was with thiazide diuretics.
• Phenoxy, alkoxy, anilino, benzyl or benzoyl groups
substituted at 4th position decreases diuretic activity.
• Furfuryl, benzyl and thienyl methyl group at 2-position
increases the activity.
Synthesis of furosemide
https://www.youtube.com/watch?v=1SsYduKxE0Q /

https://www.slideshare.net/manassehsallau/ft
hg-presentation

https://slideplayer.com/slide/10587411/
Discovery and development of statins

https://en.wikipedia.org/wiki/Discovery_and_d
evelopment_of_statins