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HYPERTENSION
Y7PH0566,
YEDLA PRADEEP KUMAR,
4TH B.PHARMACY,
CIPS,LAM,
GUNTUR.
CONTENTS
• KNOWING THE TITLE • PHARMACOTHERAPY OF
• STAGES OF HYPERTENSION
HYPERTENSION • INDIVIDUAL CLASSES OF
• ETIOLOGY OF DRUGS
HYPERTENSION • DRUG SELECTION
• COMPLICATIONS OF • COMBINATIONAL
HYPERTENSION THERAPY
• HISTORY OF • THERAPY TO SPECIAL
HYPERTENSION POPULATIONS
TREATMENT • CHRONOTHERAPEUTICS
• TREATMENT OF IN THE TREATMENT OF
HYPERTENSION HYPERTENSION
• NON-PHARMACOLOGIC • EVALUATION OF
THERAPY THERAPUTIC OUTCOMES
• REFERENCES
KNOWING THE TITLE……………...
Miscellaneous
(clonidine,
hydralazine,
reserpine)
INDIVIDUAL CLASSES
DIURETICS: OF DRUGS
a. Thiazides are the preferred type of diuretics for treating hypertension, are
effective in lowering blood pressure.
b. However, as renal function declines, sodium and fluid accumulate, and the
use of a more potent loop diuretic is necessary
c. Potassium-sparing diuretics are weak antihypertensives when used alone but
provide an additive hypotensive effect when combined with thiazide or loop
diuretics.
BETA BLOCKERS:
Atenolol, betaxolol, bisoprolol, and metoprolol are cardio selective at low doses
and may be safer than nonselective blockers in patients with asthma, chronic
obstructive pulmonary disease (COPD), diabetes, and peripheral arterial
disease.
ACE INHIBITORS:
d. Enlapril(or)lisnopril are generally preferred.
e. All ACE inhibitors can be dosed once daily for hypertension except captopril,
which is usually dosed 2 or 3 times daily. The absorption of captopril is
reduced by 30% to 40% when given with food.
AT-II RECEPTOR ANTAGONISTS:
a. Losartan is prototype drug
b. Used for patients intolerable to ACE inhibitors
Ca+2 CHANNEL BLOCKERS:
c. Verapamil decreases heart rate, slows AV nodal conduction, and produces a
negative ionotropic effect that may precipitate heart failure.
d. Diltiazem decreases AV conduction and heart rate to a lesser extent than verapamil.
e. Nifedipine, nicadipine, amlodipine have a high affinity for Ca+2 vascular channels.
ALPHA BLOCKERS:
f. Prazosin, terazosin, and doxazosin are selective receptor blockers.
g. Mild to moderate hypertension treatment.
MISCELLANEOUS:
• Includes centrally acting drugs and vasodilators and reserpine
a. Clonidine, guanabenz, guanfacine, and methyldopa lower blood pressure primarily
by stimulating adrenergic receptors in the brain, decreases heart rate, cardiac
output, total peripheral resistance, plasma renin activity, and baroreceptor reflexes.
b. Hydralazine and minoxidil cause direct arteriolar smooth muscle relaxation.
Minoxidil is a more potent vasodilator than hydralazine.
c. Reserpine depletes norepinephrine from sympathetic nerve endings ,this reduces
sympathetic tone, decreasing peripheral vascular resistance and blood pressure.
DRUG SELECTION
Generally drugs are selected based on the severity of
the disease and underlying complications.
1ST LINE DRUGS: DIURETICS/BETA BLOCKERS
2ND LINE DRUGS: DIURETICS/BETA
BLOCKERS+VASODILATORS/ACE INHIBITORS
3RD LINE DRUGS: METHYLDOPA, CLONIDINE,
ADRENARGIC NEURONE BLOCKERS
4TH LINE DRUGS: MINOXIDIL/ HYDRALAZINE /
DIAZOXIDE
Numerous
drugs
Treatment algorithms
COMBINATIONAL THERAPY
Cases where combinational therapy is preferred
over monotherapy
HYPERTENSION: A COMPANION TO
BRENNER AND RECTOR’S THE KIDNEY
BY Suzanne Oparil, M.D.
Michael A.Weber, M.D.
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