Hypertension: by J. Jayasutha Dept of Pharmacy Practice
Hypertension: by J. Jayasutha Dept of Pharmacy Practice
Hypertension: by J. Jayasutha Dept of Pharmacy Practice
By
J. Jayasutha
Persistent elevation of arterial blood pressure
Arterial blood pressure = cardiac output ×
Peripheral vascular resistance
JNC 8 Classification
Category
SBP mmHg
DBP mmHg
(90-95%) (5-10%)
No Known Cause
Causes of Secondary
hypertension
Stress Preeclampsia
Cushings syndrome
Pathophysiology of Hypertension
Humoral mechanism
• Renin angiotensin aldosterone system
• Natriuretic hormone
• Insulin resistance and hyperinsulinemia
Neuronal regulation
Endothelial mechanism
Peripheral autoregulatory components
Electrolytes
Renin angiotensin aldosterone system
Hypertension
Clinical Presentation
Headache
Dizziness
Blurred vision
Nausea and vomiting
Chest pain
Shortness of breath
Diagnosis
System Tests
Treatment
Non Pharmacological
Pharmacological
Lifestyle Changes to Treat High Blood
Pressure
Losing weight if you are overweight or obese
smoking cessation
Eating a healthy diet, including the DASH diet (eating more fruits,
vegetables, and low fat dairy products, less saturated and total
fat)
Pharmacological treatment of hypertension
Loop diuretics:
Beta blockers
Calcium channel Angiotensin II receptor
Bumetanide
Atenolol
blockers:
antagonist
Ethacrynic acid
Metoprolol
Dihydropyridines:
Candesartan
Furosemide
Nadolol
Amlodipine
Eprosartan
Torsemide
Oxprenolol
Felodipine
Irbesartan
Pindolol
Isradipine
Losartan
Thiazide diuretics:
Propranolol
Lercanidipine
Olmesartan
Epitizide
Timolol
Nicardipine
Telmisartan
Hydrochlorothia
Nifedipine
Valsartan
zide
Alpha blockers:
Nimodipine
chlorothiazide
Doxazosin
Nitrendipine
Central alpha agonist
Bendroflumethia Phentolamine
Non-dihydropyridines:
Clonidine
zide
Indoramin
Diltiazem
Guanabenz
Phenoxybenzamin Verapamil
Methyldopa
Thiazide-like diuretics:
e
Moxonidine
Indapamide
Prazosin
ACE inhibitors
Chlorthalidone
Terazosin
Captopril
Vasodilators
Metolazone
Tolazoline
Enalapril
Sodium nitropruside
Fosinopril
Potassium-sparing Mixed alpha + beta Lisinopril
Peripheral adrenergic
diuretics:
blockers:
Perindopril
agonist
Amiloride
Bucindolol
Quinapril
Reserpine
Triamterene
Carvedilol
Ramipril
Spironolactone
Labetalol
Trandolapril
Benazepril
Diuretics
Thiazide diuretics
• lower blood pressure initially by increasing sodium and
water excretion. This causes a decrease in extracellular
volume, resulting in a decrease in cardiac output and
renal blood flow
ADR: Hypercalcemia
Angiotensin converting enzyme (ACE) inhibitors:
Block production of the hormone angiotensin II, a compound in the
blood that causes narrowing of blood vessels and increases blood
pressure. By reducing production of angiotensin II, ACE inhibitors
allow blood vessels to widen, which lowers blood pressure and
improves heart output
Sideeffects: dry hacking cough, angioedema
Angiotensin II receptor blockers (ARBs): Block the effects of
angiotensin II on cells in the heart and blood vessels. Similar to ACE
inhibitors, ARBs can widen blood vessels and lower blood press
Side effects — The main difference between ARBs and ACE inhibitors
is that ARBs do not produce cough.
Dizziness, drowsiness, headache, nausea, dry mouth,
abdominal pain, or other side effects. Angioedema is less common
with ARBs than with ACE inhibitors
Calcium channel blockers drugs reduce the amount of calcium that enters
the smooth muscle in blood vessel walls and heart muscle. Muscle cells
require calcium to contract. Thus, by inhibiting the flow of calcium across
muscle cell membranes, calcium channel blockers cause muscle cells to
relax and blood vessels to dilate, reducing blood pressure as well as
reducing the force and rate of the heartbeat.
Adverse effects:
Beta-blockers reduce heart rate and decrease the force of heart
contraction by blocking the action of adrenaline receptors.
Beta blockers may worsen symptoms of asthma, other lung
diseases, or blood vessel disease outside the heart.I n addition, beta
blockers may mask symptoms of low blood sugar (hypoglycemia) in
people with diabetes who are treated with insulin. Beta blockers
can also cause fatigue, dizziness, insomnia, a decreased ability to
exercise, a slow heart rate, rash, and cold hands and feet due to
reduced blood flow to the limbs
Alpha 1 receptor blockers: inhibit catecholamine uptake in smooth
muscle cells of the peripheral vasculature, resulting in vasodilation.
They do not alter alpha 1 receptor activity and therefore do not
cause reflex tachycardia.
side effect is a first-dose phenomenon characterized by orthostatic
hypotension accompanied by transient dizziness or faintness,
palpitations, and even syncope within 1 to 3 hours of the first dose
or after later dosage increases.
Central alpha 2 agonist: lower blood pressure primarily by
stimulating alpha 2 adrenergic receptors in the brain, which
reduces sympathetic outflow from the vasomotor center and
increases vagal tone. Stimulation of presynaptic alpha 2
receptors peripherally may contribute to the reduction in
sympathetic tone. Consequently, there may be decreases in
heart rate, cardiac output, total peripheral resistance,
plasma renin activity, and baroreceptor reflexes.
Direct vasodilators relax (dilate) the blood vessels to
allow blood to flow under lower pressure.
Renin Inhibitors
hyperkalemia
Thank You