Drugs

Antihypertensive Drugs : Classification, Uses, Side Effects, & Contraindications

Antihypertensive Drugs : Definition, Classification, Example, Mechanism of Action, Uses, Side Effects, Contraindications, & Interactions

Definition

  • Antihypertensive drugs are agents used to lower BP in hypertension.

Classification

1. Diuretics

Thiazides

  • Thiazides and related drugs (chlorthalidone, etc.) are the diuretic of choice in uncomplicated hypertension.

E.g.

  • Hydrochlorothiazide
  • Chlorthalidone
  • Indapamide

High ceiling

E.g.

  • Furosemide
  • Torsemide
  • Ethacrynic acid

K+ sparing 

E.g.

  • Spironolactone
  • Amiloride
  • Triamterene
  • Eplerenone
  • Metolazone

2. ACE inhibitors

  • The ACE inhibitors are one of the first choice drugs in all grades of essential as well as renovascular hypertension (except those with bilateral renal artery stenosis).
  • Most patients require relatively lower doses ( enalapril 2.5-10 mg/ day or equivalent) which are well tolerated.
  • Used alone they control hypertension in ∼50% patients, and addition of a diuretic / β-blocker extends efficacy to ∼90%.
  • Dry persistent cough is the most common side effect requiring discontinuation of ACE inhibitors.

E.g.

  • Captopril
  • Enalapril
  • Lisinopril
  • Benazepril
  • Perindopril
  • Ramipril
  • Fosinopril
  • Moexipril
  • Quinapril
  • Trandolapril

3. Angiotensin receptor (AT1) blockers (ARBs)

  • ARBs are remarkably free of side effects. Because they do not increase kinin levels, the ACE inhibitor related cough is not encountered.

E.g.

  • Losartan
  • Candesartan
  • Irbesartan
  • Valsartan
  • Eprosartan
  • Telmisartan
  • Olmesartan
  • Azilsartan medoxomil

4. Calcium channel blockers (CCBs)

  • Calcium channel blockers (CCBs) are another class of first line antihypertensive drugs.
  • The onset of antihypertensive action is quick.
  • With the availability of long acting preparations, most agents can be administered once a day.

Advantages of CCBs are:

  • Monotherapy with CCBs is effective in ∼50% hypertensive patients; their action is independent of patient’s renin status, and they may improve arterial compliance.
  • Do not compromise haemodynamics.
  • No CNS effects; cerebral perfusion is maintained.
  • No contraindication for asthma, angina (especially variant) & PVD patients: may benefit these conditions.
  • No impairment in renal perfusion.
  • No effect on male libido.
  • No deleterious effect on plasma lipid profile, uric acid level & electrolyte balance.
  • No/minimal effect on quality of life.
  • No adverse effects on foetus; can be used during pregnancy (but can weaken uterine contractions during labour).

E.g.

  • Verapamil
  • Diltiazem
  • Nifedipine
  • Felodipine
  • Amlodipine
  • Nitrendipine
  • Lacidipine
  • Clevidipine
  • Isradipine
  • Nicardipine
  • Nisoldipine
  • Nimlodipine
  • Lercanidipine
  • Benidipine

5. β-blockers

  • They are mild antihypertensives; do not significantly lower BP in normotensives.
  • The hypotensive response to β-blockers develops over 1-3 weeks and is well sustained.
  • All β-blockers, irrespective of associated properties, exert similar antihypertensive effect.

E.g.

  • Propranolol
  • Metoprolol
  • Atenolol
  • Acebutolol
  • Betaxolol
  • Pindolol
  • Bisoprolol
  • Esmolol
  • Nadolol
  • Timolol
  • Nebivolol
  • Penbutolol

6. β+α- blockers

E.g.

  • Labetalol
  • Carvedilol

7. α- blockers

E.g.

  • Prazosin
  • Terazosin
  • Doxazosin
  • Phentolamine
  • Phenoxybenzamine

8. Central sympatholytics

E.g.

  • Clonidine
  • Methyldopa

9. Vasodilators

Arteriolar vasodilators

E.g.

  • Hydralazine/ Dihydralazine
  • Minoxidil
  • Diazoxide

Arteriolar + Venous dilators

E.g.

  • Sodium nitroprusside

10. Renin inhibitors

E.g.

  • Aliskiren
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