Rule of Halves
100 50
25
12.5
Hypertension
Types of Hypertension
Primary hypertension
Secondary hypertension
Hypertension
High blood pressure
Normal: Systolic < 130 mm Diastolic < 85 mm Hg Hg
Normal
High normal Hypertension Stage 1 Stage 2 Stage 3 Stage 4
<130
130-139 140-159 160-169 180-209 210
<85
85-89 90-99 100-109 110-119 120
Secondary Hypertension
Cause is known (such as eclampsia of pregnancy, renal artery disease, pheochromocytoma) 10% of the cases
Instructors may want to insert EIC Image #69: Blood Pressure: Normal Regulation
Antihypertensive Agents
Medications used to treat hypertension
Stimulation of alpha1-adrenergic receptors causes HYPERtension Blocking alpha1-adrenergic receptors causes decreased blood pressure
Antihypertensive Agents:
Adrenergic Agents Alpha1 Blockers
doxazosin (Cardura) prazosin (Minipress) terazosin (Hytrin)
Antihypertensive Agents:
Adrenergic Agents Central-Acting Adrenergics
clonidine (Catapres) methyldopa (Aldomet) (drug of choice for hypertension in pregnancy)
Antihypertensive Agents:
Adrenergic Agents Adrenergic Neuronal Blockers (peripherally acting)
reserpine guanadrel (Hylorel) guanethidine (Ismelin)
Therapeutic Uses
Treatment of hypertension Relief of symptoms of BPH Management of of severe CHF when used with cardiac glycosides and diuretics
Treatment of hypertension, either alone or with other agents Seldom used because of frequent side effects
dry mouth drowsiness sedation constipation headaches sleep disturbances nausea rash cardiac disturbances (palpitations)
Antihypertensive Agents
ACE Inhibitors
captopril (Capoten) Short half-life, must be dosed more frequently than others enalapril (Vasotec)
(A II
Antihypertensive Agents:
Angiotensin II Receptor Blockers
losartan (Cozaar) eposartan (Teveten) valsartan (Diovan) irbesartan (Avapro) candesartan (Atacand) telmisartan (Micardis)
Antihypertensive Agents
Calcium Channel Blockers
Benzothiazepines:
diltiazem (Cardizem, Dilacor)
Phenylalkamines:
verapamil (Calan, Isoptin)
Dihydropyridines:
amlodipine (Norvasc), bepridil (Vascor), nicardipine (Cardene) nifedipine (Procardia), nimodipine (Nimotop)
constipation, nausea
Other
Antihypertensive Agents
Vasodilators
diazoxide (Hyperstat) hydralazine HCl (Apresoline) minoxidil (Loniten, Rogaine) sodium nitroprusside (Nipride, Nitropress)
Sodium nitroprusside:
bradycardia, hypotension, possible cyanide toxicity
Assess for contraindications to specific antihypertensive agents. Assess for conditions that require cautious use of these agents.