Drugs used in Hypertension By: Sara Khalid Memon ,3rd year MBBS, LUMHS

1. Presented by:
Sara Khalid Memon – Group B3
3rd year, MBBS, LUMHS

2. Hypertension can be defined as:
A sustained rise in blood pressure.
It is a condition in which the arteries have
persistently high blood pressure, making harder
for the heart to pump blood in the vessels.
Basically it has 2 main components; the SYSTOLIC
and the DIASTOLIC blood pressure.

3. Parameters on which blood pressure depends
Cardiac output Total Peripheral Resistance
SYSTOLIC BP DIASTOLIC BP
> Stroke Volume And Heart Rate
Preload can be defined as the initial stretching
of the cardiac myocytes prior to contraction (EDV)
Afterload is the load against which the heart
has to pump(TPR)

4. H
Y
P
E
R
T
E
N
S
I
O
N

5. > Centrally acting sympatholytic drugs
> Ganglionic Blockers
> Sympathetic Nerve Ending Blockers
> Adrenergic Receptor Blockers
a) Alpha 1 blockers
b) Beta blockers
c) Mixed blockers
> Direct Vasodilators
> Calcium Channel Blockers
> Angiotensin Converting Enzyme Inhibitors
>Angiotensin Receptor Blockers
>Renin Inhibitor
> Diuretics

6. Clonidine:
Advantage: Used in Hypertension when other drugs have
not responded adequately.
Disadvantage: Sedation, Depression, rebound
hypertension on withdrawal
Alpha-Methyl Dopa:
Advantage: Used in Hypertension when other drugs have
not responded adequately. Has less effects on FETUS so
can be used in pregnancy.
Disadvantage: Sedation, Depression, causes hematologic
immunotoxicity (making coomb’s test +ve)

8. Guanethidine: Replaces norepinephrine in the vesicle
and itself acts as false neurotransmitter.
Disadvantage: Orthostatic Hypotension.
Reserpine: Reserpine irreversibly blocks the Vesicular
monoamine transporter. This normally transports free
amine neurotransmitters from the cytoplasm of the
presynaptic nerve terminal into storage vesicles.
Disadvantage: Depression of CNS
Metyrosine: Makes the Tyrosine hydroxylase enzyme
dysfunctional.
Disadvantage: Diarrhea, Trembling of hands and fingers

10. A) Alpha blockers:
Selectives: Prazosine, terazosin
Adverse Effect: Orthostatic Hypotension
Non-Selectives: Phenoxybenzamine, Phentolamine
Adverse Effect: Tachycardia, Palpitation
B) Beta blockers :
Selectives: Metoprolol, Atenolol
Adverse Effect: Dizziness, Drowsiness, Fatigue, Diarrhea
Non-Selectives: Propranolol
Adverse Effect: Drowsiness, Sedation, Asthma

11. C) Mixed blockers:
Acting on Alpha as well as on Beta receptors.
Labetolol, Carvidolol, Bucindolol
Adverse Effects: Drowsiness, Fatigue, Insomnia,
Orthostatic Hypotension
NOTE: Nebivolol is a newer beta blocker with some direct
vasodilator action
Relatively very less adverse effects and is highly
cardioselective !!!

14. Hydralazine: Acts primarily on the arteries and
arterioles.
>Advantage: Accepted method for controlling blood
pressure in pregnant hypertensives.
>Disadvantage: Almost always causes reflex
tachycardia.
Minoxidil: Dilates resistance vessels
>Advantage: Used in hypertension refractive to other
drugs. Other use is causing hypertrichosis
>Disadvantage: Fluid retention, Reflex Tachycardia

16. Verapamil: Acts on both cardiac and smooth
muscles(more action on heart)
Advantage: Additional used in treatment of angina,
supraventricular tachyarrythmias, migraine headache
Disadvantage: Facial flushing, dizziness, constipation
Diltiazem: Acts on both cardiac and smooth muscles
equally.
Advantage: Used for hypertension, Angina
Disadvantage: Hypotension, bradycardia

17. Nifedipine: Acts more on arterial smooth muscles
than on heart
Advantage: Vasoselective
Disadvantage: Lethargy, Bradycardia, Hypotension

19. Captopril, Enapril, Lisinopril, Prindropril, Ramipril
Advantage: Effective in CCF and Diabetic Nephropathy too
Losartan, Cadesartan, Valsartan, Telmisartan
Advantage: Do not increase the bradycardia level.
Aliskiren, Pepstatin
Advantage: Acts directly on the required substrate.

22. Cough (dry Cough)
Angioedema
Proteinuria
Taste changes
Hypotension
Contraindicated in Pregnancy
Rashes
Increased K+ Levels
Low Ang II and Aldosterone levels

23. Advantage: Effective in controlling blood pressure in long
term. Controls BP in Supine as well as standing positions so
postural hypotension doesn’t occur.
> Loop Diuretics : Furosamide
> Thiazides : Hydrochlorothiazide
> Potassium Sparing Diuretics : Amiloride, Spironolactone
Disadvantage:
Of Thiazides include, hypokalemia, hyperuricemia;
Of Loop Diuretics include, Ototoxicity;
Of Potassium Sparing group include, Gastric upsets,
Gynecomastia in males, Menstrual irregularities in females.

25. > Diuretics are very effective in Elderly patients, Blacks,
Inexpensive and can be used for Prolonged maintenance.
> Beta Blockers are wonderful if the patient also has
supraventricular tachycardia and/ Angina and/ MI
and/Migraine.
> Beta blockers and ACE inhibitors are very effective in
white and young hypertensives.
> Vasodilating drugs cause salt and water retention and
cardiostimulatory effects.
> Hydralazine should be used with diuretics and beta
blockers.
> Alpha Blockers always cause postural hypotension.

26. New Antihypertensive Drugs
>Monatepil, a dual alpha-receptor and calcium channel
blocker, has potent antihypertensive effect, lowers
serum cholesterol and also has antiatherosclerotic
effect.
>Dual ACE and endopeptidase inhibitor, such as
alatriopril, has a "broad spectrum" antihypertensive
effect and may be effective in majority of hypertensive
patients.
Many other are under clinical testing and not yet approved .. !

27. > Physical Exercise
> Weight loss
> Salt Restriction
> Avoid Smoking
> Reducing Alcohol Consumption
> Relaxation techniques
> K+ rich diets
> Red meat should be avoided