Hypertension And use of Antihypertensive (chapter 4/7)

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 Hypertension= sustained systolic B.P of >140mmHg or a sustained Diastolic B.P of >90mmHg 

DASH= Dietary Approach to Stop Hypertension…include fruit, vegetables, low fat dairy products, low in fat cholesterol & sodium

Hypertension Antihypertensive drugs, review from lipincott and kadzung


Renin inhibitors

Aliskerin= directly inhibit RENIN….contraindicated in Pregnancy…cause cough, angioedema, hyperkalemia, diarrhea  

Centrally acting adrenergic drugs

Clonidine=α2-agonist...Centrally decrease Adrenergic outflow …decrease sympathetic firing rate &noeepinephrine release…. 

Useful in Hypertension complicated by renal  disease…..cause Na+ water retention... rebound hypertension occur  

 α 2-Methyldopa = converted into MethylNorepinephrine….. Centrally decrease Adrenergic outflow ….decrease total peripheral resistance& B.P … treat Hypertenson  

with Renal Impairment……cause sedation, dizziness...can be used in pregnancy

Vasodilators

MOA=direct smooth muscle relaxant…vasodilation...decrease Resistance..Decrease

B.P Also cause K+ influx...hyperpolarization…inhibit Ca++ influx

They incease Renin…Na+water retention…

Hydralazine=vasodilation of arteries…can use in Pregnancy..Lupus like syndrome occur at high dose

Minoxidil=Dilation ofArterioles & Venules...for treatment of Malignant Hypertension..

cause Hypertrichosis body hair growth…used to treat male baldness

Hypertensive Emergency1. 

Sodium Nitroprusside= i/v..t1/2 in min…prompt vasodilation with reflex tachycardia..act on the veins..

Cyanide ion produce on metabolism…Sodium Thiosulphate used to produce Thiosulphate which is less toxic 

Light sensitive 

2. Labetalol= used in emergency...α & β blocker..

3. Fenoldopam=Dopamine-1-receptor agonist…i/v…decrease B.P & relax Renal by increasing perfusion…..contraindicated in Glaucoma

4. Nicardipine=Ca++ blocker…i.v infusion..initial dose 5mg, increase to 15mg….t1/2 8hr

For white & young patients= ACEI +β-Blocker 

For black & elder patients= Ca++ channel blocker & Diuretics.


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