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Tuesday, 1 March 2011

Antihypertensive drug classification


Antihypertensive drug classification

The antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Evidence suggests that reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia,heart failure, and mortality from cardiovascular disease.[2] There are many classes of antihypertensives, which lower blood pressure by different means; among the most important and most widely used are the thiazide diuretics, the ACE inhibitors, the calcium channel blockers, thebeta blockers, and the angiotensin II receptor antagonists or ARBs.
Which type of medication to use initially for hypertension has been the subject of several large studies and resulting national guidelines. The fundamental goal of treatment should be the prevention of the important endpoints of hypertension, such as heart attack, stroke and heart failure. Patient age, associated clinical conditions and end-organ damage also play a part in determining dosage and type of medication administered.The several classes of antihypertensives differ in side effect profiles, ability to prevent endpoints, and cost. The choice of more expensive agents, where cheaper ones would be equally effective, may have negative impacts on national healthcare budgets.[ As of 2009, the best available evidence favors the thiazide diuretics as the first-line treatment of choice for high blood pressure when drugs are necessary.

Adrenergic receptor antagonists

Beta blockers

§                                 atenolol
§                                 metoprolol
§                                 nadolol
§                                 oxprenolol
§                                 pindolol
§                                 propranolol
§                                 timolol
§                     Alpha blockers:
§                                 doxazosin
§                                 phentolamine
§                                 indoramin
§                                 phenoxybenzamine
§                                 prazosin
§                                 terazosin
§                                 tolazoline
§                     Mixed Alpha + Beta blockers:
§                                 bucindolol
§                                 carvedilol
§                                 labetalol

Diuretics

Diuretics help the kidneys eliminate excess salt and water from the body's tissues and blood.
§                     Loop diuretics:
§                                 bumetanide
§                                 ethacrynic acid
§                                 furosemide
§                                 torsemide
§                     Thiazide diuretics:
§                                 epitizide
§                                 hydrochlorothiazide and chlorothiazide
§                                 bendroflumethiazide
§                     Thiazide-like diuretics:
§                                 indapamide
§                                 chlorthalidone
§                                 metolazone
§                     Potassium-sparing diuretics:
§                                 amiloride
§                                 triamterene
§                                 spironolactone

Calcium channel blockers

Calcium channel blockers block the entry of calcium into muscle cells in artery walls.
§                     dihydropyridines:
§                                 amlodipine
§                                 felodipine
§                                 isradipine
§                                 lercanidipine
§                                 nicardipine
§                                 nifedipine
§                                 nimodipine
§                                 nitrendipine
§                     non-dihydropyridines:
§                                 diltiazem
§                                 verapamil

ACE inhibitors

ACE inhibitors inhibit the activity of Angiotensin-converting enzyme (ACE), an enzyme responsible for the conversion of angiotensin I into angiotensin II, a potent vasoconstrictor.
§                     captopril
§                     enalapril
§                     fosinopril
§                     lisinopril
§                     perindopril
§                     quinapril
§                     ramipril
§                     trandolapril
§                     benazepril

Angiotensin II receptor antagonists

§                     candesartan
§                     eprosartan
§                     irbesartan
§                     losartan
§                     olmesartan
§                     telmisartan
§                     valsartan

Aldosterone antagonists

Aldosterone receptor antagonists:
§                     eplerenone
§                     spironolactone
Aldosterone antagonists are not recommended as first-line agents for blood pressure, but spironolactone and eplerenone are both used in the treatment of heart failure.

Centrally acting adrenergic drugs

Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain which open peripheral arteries easing blood flow. Central alpha agonists, such as clonidine, are usually prescribed when all other anti-hypertensive medications have failed. For treating hypertension, these drugs are usually administered in combination with a diuretic.
§                     Clonidine
§                     Guanabenz
§                     Methyldopa
§                     Moxonidine
Adverse effects of this class of drugs include sedation, drying of the nasal mucosa and rebound hypertension.
Some adrenergic neuron blockers are used for the most resistant forms of hypertension:
§                     Guanethidine
§                     Reserpine

Vasodilators

Vasodilators act directly on the smooth muscle of arteries to relax their walls so blood can move more easily through them; they are only used in hypertensive emergencies or when other drugs have failed, and even so are rarely given alone.
Sodium nitroprusside, a very potent, short-acting vasodilator, is most commonly used for the quick, temporary reduction of blood pressure in emergencies (such as malignant hypertension or aortic dissection).[17][18] Hydralazine and its derivatives are also used in the treatment of severe hypertension, although they should be avoided in emergencies.[18] They are no longer indicated as first-line therapy for high blood pressure due to side effects and safety concerns, but hydralazine remains a drug of choice in gestational hypertension.

Adrenergic receptor agonists

§                     Alpha-2 agonists:
§                                 clonidine
§                                 methyldopa
§                                 Guanfacine

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