ANTIHYPERTENSIVE

DRUGS
Dr Deepti Patil
INTRODUCTION

Anti-Hypertensive Drugs are used to control

blood pressure in people whose blood pressure
is too high.
Blood pressure is a measurement of the force
with which blood moves through the body's
system of blood vessels.
Treatments for high blood pressure depend on
the type of hypertension.
 HISTORY
Antihypertensive drug therapy has been
remarkably improved in the last 50 yrs.
Before 1950 hardly effective and tolerated
antihypertensive were available.
Ganglion blockers developed in the 1950’s were
effective but inconvenient.
Guanethidine introduced in 1961 was an
improvement on ganglion blockers.
 Cont…..

Antihypertensives of 1960-70 were

methyldopa, β blockers, thiazide and high
ceiling diuretics.
In 1980-90, ACE inhibitors and calcium
channel blockers are the latest
Antihypertensives.
DEFINITION
 Anti-Hypertensive Drugs are medicines that help
lower blood pressure in people whose blood
pressure is too high.
 WHO-ISH guidelines have defined it to be 140mmHg
systolic and 90mmHg diastolic,
Though the chance of risk appears even above
120/80mmHg
 For practical purpose Hypertension means, the level of
BP at or above which long term hypertensive treatment
reduce cardiovascular mortality.
 CLASSIFICATION
Diuretics Thiazides: Hydrochlorothiazide,
Chlorothalidone, Indapamide.
High ceiling: Furosemide, etc
K+ Sparing: Spironolactone,
Amiloride.
ACE inhibitors Captopril, Enalapril, Lisinopril,
Perindopril, Ramipril, Fosinopril etc
Angiotensin (AT1 Losartan, Candesartan, irbesartan,
receptor) Valsartan, Telmisartan.
blockers
 Cont…...
Calcium channel Verapamil, Diltiazem, Nifedipine,
blockers Felodipine, Amlodipine,
Nitrendipine, Lacidipine, etc.
β Adrenergic Propranolol, Metaprolol, Atenolol,
blockers etc.

β+α Adrenergic Labetalol, Carvedilol

blockers

α Adrenergic Prazosin, Terazosin, Doxazosin,

blockers Phentolamine,
Phenoxybenzamine.
Cont….
Central Clonidine, Methyldopa
sympatholytics

Vasodilators Arteriolar: Hydralazine, Minoxidill,

Diazoxide.
Arteriolar+venous: Sodium
nitroprusside
Reclassified BP readings
BP Classification BP(mmHg)
Systolic & Diastolic

Normal <120 and <80

Prehypertensive 120-139 and 80-89

Hypertensive stage I 140-159 and 90-99

Hypertensive stage II ≥160 and ≥ 100

 Compelling Indications For Use Of
Antihypertensive Drugs

1. Heart failure
2. High coronary artery disease (CAD) risk.
3. H/o MI in the past.
4. H/o stroke in the past
5. Diabetes
6. Chronic renal disease
Selection Of First Line
Antihypertensive Drugs
Diuretics

Standard Antihypertensive drugs

Do not lower B.P in normotensives

These drugs which causes a net loss of

Na+ and water in urine.
Suitable for :
1. Elderly patients
2. Low renin hypertension
3. Isolated systolic hypertension
4. Obese with volume overload
5. Renal disease with Na+ retention
6. Low cost therapy
To be avoided:

1. Gout or family history of gout

2. Abnormal lipid profile

3. Pregnancy induced hypertension.

Drawbacks
Hyperkelemia
Carbohydrate intolerance
Dyslipidemia
Hyperuricaemia
GIT and CNS disturbances
Hearing loss (rarely)
Calcium Channel Blockers
They lower the B.P by decreasing the
peripheral resistance without
compromising cardiac output
Vasodilatation
Fluid retention is insignificant.
Their action is independent of patients
renin status.
Suitable for :
1. Who have low renin and more arterial
wall stiffness.
2. Isolated systolic hypertension
3. Physically or mentally active patients.
4. Asthma/COPD patients
5. Pregnant hypertensive
To be avoided:
1. Myocardial inadequacy, CHF
2. Conduction defect, sick sinus
3. Receiving β blockers
4. Ischemic heart disease; post MI cases
5. Left ventricular hypertrophy
6. Males with prostate enlargement
7. Gastroesophageal reflux
ACE inhibitor

First choice drug in all grades of essential

as well as renovascular hypertension
Most patients require relatively lower
doses which are well tolerated
If used alone controls hypertension in
about 50% of patients.
If used in addition of diuretics/βblockers
extends efficacy to ~90%
Suitable for :
1. High renin cases or those on low salt diet
2. Sexually active (relatively young)
3. Diabetics, specially with nephropathy.
4. Coexisting angina, post MI cases
5. Coexisting left ventricular systolic.
dysfunction or CHF & left ventricular
hypertrophy.
6. Gout, PVD, dyslipidemic patients.
To be avoided:

1. Bilateral or unilateral renal artery

stenosis.
2. Pregnancy
3. Hyperkelemia
4. Patient on high dose diuretic therapy
5. Preexisting dry cough (ACE inhibitor)
β Adrenergic blockers

Mild anti hypertensives

Used in mild to moderate cases.
Their hypotensive response develops
over 1-3weeks and is well sustained.
Do not significantly lower BP in
normotensives.
Suitable for:
1. Angina or post MI patient
2. Anxiety or tachycardia
3. Tense young patient
4. Non-obese, high renin hypertensive
5. Low cost therapy
6. Pregnancy
To be avoided:

1. Left ventricular failure, CHF

2. Bradycardia, conduction defects
3. Asthma, PVD
4. Diabetic patient
5. Abnormal lipid profile
6. Requirement of optimum physical and
mental activity.
Antihypertensives during pregnancy

Hydralazine (vasodilator)

Methyldopa

CCB’s (discontinued before labor)

Prazosin and clonidine

Antihypertensives avoided during
pregnancy
Diuretics
ACE inhibitors
Reserpine
Nonselective β blockers
Sod.nitroprusside
Thank you