 Students should be able to understand:

 Pathophysiology of Hypertension
 Approach towards Hypertension
 Classification of anti hypertensive drugs
 M.O.A, Pharmacological actions, Therapeutic uses
and Side effects of CCBs
 M.O.A, Pharmacological actions, Therapeutic uses
and Side effects of Vasodilators
Category Systolic BP (mm Hg) Diastolic BP (mm Hg)

Optimal <120 <75

Normal 120-129 75-85

High normal 130-139 85-89

Hypertension
Mild/stage 1 140-159 90-99
Moderate/stage 2 160-179 100-109
Severe/stage 3 180-200 110-120
Malignant HTN/ >200 >120
Hypertensive crisis Stage 4
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
 Anti-adrenergic agents
 Angiotensin-converting enzyme inhibitors
 Angiotensin II receptor blockers
 Renin Blockers aliskerin
 Calcium channel blockers
 Diuretics
 Vasodilators
 Non Dihydropyridines
 Benzothiazepines:
 Diltiazem
 Phenylalkamines:
 Verapamil (Calan)
 Dihydropyridines:
 Amlodipine 1st generation Prototype
 Nifedipine
 Isradipine
 Nicardipine
 Felodipine
Diltiazem & Verapamil

Nifedipine
(and other
dihydropyridines
 Cause smooth muscle relaxation by blocking the
calcium channels, preventing influx of calcium
and so muscle contraction
 L type calcium channels
 This causes decreased peripheral smooth muscle
tone, decreased systemic vascular resistance
 Result: decreased blood pressure
 Angina
 Hypertension
 Dysrhythmias
 Migraine headaches
 Cardiovascular
 hypotension, palpitations, tachycardia

 Gastrointestinal
 constipation, nausea

 Other
 rash, flushing, peripheral edema, dermatitis
 Headache
 Directly relaxes arteriolar smooth muscle
 Result: Decreased systemic vascular response,
Decreased afterload
 oral
 Hydralazine release NO
 Minoxidil K channel opener
 Parenteral
 Sodium nitroprusside Releases NO
 Diazoxide K channel opener (Diuretic)
 Fenolopam D1 agonist
 Treatment of hypertension
 May be used in combination with other agents
 Sodium nitroprusside and Diazoxide I/V are
reserved for the management of hypertensive
emergencies/hypertensive crisis/stage 4
 Hydralazine:
 tachycardia, salt & water retention, edema,
Lupus like syndrome
 Minoxidil increased hair growth
Sodium nitroprusside:
 bradycardia, hypotension, possible
cyanide toxicity
 Diazoxide: Hypotension, Hyperglycemia