Download as PPTX, PDF, TXT or read online from Scribd
Download as pptx, pdf, or txt
You are on page 1/ 15
Antihypertensive
Drugs: Part II Dr Chitra Khanwelkar Professor & HOD Pharmacology KIMS, Karad ACE Inhibitors All grades respond well Monotherapy effective in 50% Addition of diuretic/Beta blocker --- 90% More effective in patients < 55 years age Better response in white race
Mech: By blocking ACE reduce Angiotensin
II. Lead to arteriolar dilatation Advantages: Do not affect QOL Renoprotective, cardioprotective Retard diabetic nephropathy, retinopathy Reverse/retard left ventricular hypertrophy Disadvantages: Renal failure in bilateral renal artery stenosis Fetopathic Hyperkalemia with potassium sparing diuretics Brassy cough, angioedema,dysguesia,rashes JNC 8 Guidelines Most appropriate as First choice in associated Diabetes mellitus Nephropathy LVH CHF Angina MI Best combined with diuretic/beta blocker ARB Equivalent to ACEI But more popular due to lack of ADR Indications same as ACEI Preferred in black races All long term benefits same as ACEI Do not affect QOL CCB All groups are effective equally Monotherapy effective in 50% Effective in both high and low renin patients Use of rapid acting DHP is outdated Mech: Block L type voltage dependentCCB
and cause cardiac depression and/or
arteriolar vasodilatation . This results in decreased CO and/or decreased TPR. Amlodipine 5-10 mg OD Advantages: OD administration No postural hypotension No CNS depression No impairment of renal perfusion No decrease in male sexual function No metabolic ADR No effect on QOL Can be used in Pregnancy, asthma, PVD,
angina( also in variant)
Disadvantages: DHP can increase bladder voiding problems DHP can cause GE reflux Cardiac arrhythmia worsened by DHP CHF, conduction blocks worsened by
verapamil and diltiazem
May weaken uterine contractions in labour JNC 8 Guidelines First line drug in elderly But less suitable for monotherapy May produce stroke prevention Best for cyclosporin induced hypertension in
renal transplant patients.
Beta Blockers No effect in normotensives Monotherapy effective in 30-40% Stage I Effect develops over 2-3 weeks OD administration Mech: Decreased CO, decreased renin,
decreased sympathetic outflow.
Atenolol 50 mg OD Advantages: Less ADR with cardioselective Prevent sudden cardiac deaths in post MI Good for stable CHF with HT Disadvantages: Affect QOL( increase lipids,mental
depression,loss of libido, muscle weakness,
forgetfullness) Rebound hypertension,angina,MI JNC 8 Guidelines Cardioselective drugs one of the first choice for young non obese patients, who are more prone for stress Less suitable for elderly Labetalol for emergencies Carvedilol for CHF with hypertension Alpha Blockers Prazosin: Favourable effect on lipid profile.Good for diabetics,BPH. Can be used in pregnancy. Phenoxybenzamine/Phentolamine: For
hypertensive emergency in clonidine
withdrawal, pheochromocytoma, cheese reaction. Questions Write advantages and disadvantages of ACE inhibitors as antihypertensive. Write advantages and disadvantages of
ARBs as antihypertensive Write mechanism of action and advantages
of amlodipine as antihypertensive. Write advantages and disadvantages of
