cknow
Example: prazosin
• Block a-1 receptors and cause
vasodilation
• Reduce peripheral resistance and
venous return
• Exert beneficial effects on lipids and
insulin sensitivity
• Drugs of choice in patients with co-
existing BPH
Side effects-
Postural hypotension,
Class of drugs Main side-effects Contraindications/
Special Precautions
Diuretics Electrolyte imbalance, Hypersensitivity,
Anuria
(e.g. Hydrochloro- total and LDL cholesterol
thiazide) levels, HDL cholesterol
levels, glucose levels,
uric acid levels
b-blockers Impotence, Bradycardia,
(e.g. Atenolol) Fatigue Bradycardia,
Conduction
disturbances,
Diabetes,
Asthma, Severe
cardiac
failure
Lifestyle Modifications
Not at Goal Blood Pressure (<140/90 mmHg)
(<130/80 mmHg for those with diabetes or chronic kidney disease)
Initial Drug Choices
Without Compelling With Compelling
Indications Indications
Stage 1 Hypertension Stage 2 Hypertension Drug(s) for the compelling indications
(SBP 140–159 or DBP 90–99 mmHg) (SBP >160 or DBP >100 mmHg) Other antihypertensive drugs (diuretics,
Thiazide-type diuretics for most. 2-drug combination for most (usually ACEI, ARB, BB, CCB)
May consider ACEI, ARB, BB, CCB, thiazide-type diuretic and as needed.
or combination. ACEI, or ARB, or BB, or CCB)
Not at Goal
Blood Pressure
Optimize dosages or add additional drugs
until goal blood pressure is achieved.
Consider consultation with hypertension specialist.
Condition Preferred drugs Other drugs Drugs to be
that can be used avoided
Asthma Calcium channel a-blockers/Angiotensin-II b-blockers
blockers receptor blockers/Diuretics/
ACE-inhibitors
Diabetes a-blockers/ACE Calcium channel blockers Diuretics/
mellitus inhibitors/ b-blockers
Angiotensin-II
receptor blockers
High cholesterol a-blockers ACE inhibitors/ A-II b-blockers/
levels receptor blockers/ Calcium Diuretics
channel blockers
Elderly patients Calcium channel b-blockers/ACE- (abo
60 years) blockers/Diuretics inhibitors/Angiotensin-II
receptor blockers/a- blockers
BPH a-blockers b-blockers/ ACE inhibitors/
Angiotensin-II receptor
blockers/ Diuretics/
Calcium channel blockers
Class of drug Main side-effects Contraindications/ Special
Precautions
Calcium channel blockers Pedal edema, Headache Non-dihydropyridine
(e.g. Amlodipine, CCBs (e.g diltiazem)–
Diltiazem) Hypersensitivity,
Bradycardia, Conduction
disturbances, CHF, LV
dysfunction.
a-blockers Postural hypotension Hypersensitivity
(e.g. prazosin)
ACE-inhibitors Cough, Hypotension, Hypersensitivity, Pregnancy,
(e.g. Lisinopril) Angioneurotic edema Bilateral renal artery
stenosis
Angiotensin-II receptor Headache, Dizziness Hypersensitivity, Pregnancy,
blockers (e.g. Losartan) Bilateral renal artery
stenosis
Condition Preferred Drugs
Pregnancy Nifedipine, labetalol,
hydralazine, beta-
blockers, methyldopa,
prazosin
Coronary heart
disease Beta-blockers, ACE
inhibitors, Calcium
channel blockers
Congestive heart
failure ACE inhibitors,
beta-blockers
1999 WHO-ISH guidelines
▪Improper BP measurement
▪Excess sodium intake
▪Inadequate diuretic therapy
▪Medication
• Inadequate doses
• Drug actions and interactions (e.g., (NSAIDs), illicit drugs,
sympathomimetics, OCP)
• Over-the-counter drugs and some herbal supplements
▪Excess alcohol intake
▪Identifiable causes of HTN
• Hypertension is a major cause of morbidity and
mortality, and needs to be treated
• It is an extremely common condition; however it is still
under-diagnosed and undertreated
• Hypertension is easy to diagnose and easy to treat
• Aim of the management is to save the target organ from
the deleterious effect
• Besides pharmacology we have other choices and one
has to be acquainted with that choice
• Life style modification should always be encouraged in
all Hypertensive patients
Que 1) Life style intervention for management of
hypertension includes all except:
a) Regular aerobic activity 30 min /day
b) Salt intake to <6 gm./day
c) Attain and maintaining BMI >25k/m2
d) Diets rich in fruits and vegetables and restricted
content of saturated fats
e) Moderation of alcohol consumption
Que 2) Hypertension management is helpful in
the prevention of all except:
a) Coronary heart disease
b) Heart failure
c) Chronic kidney disease
d) Deep venous thrombosis
e) Cerebrovascular disease
Que 3) Isolated systolic hypertension is common
in:
a) Young
b) Elderly
c) Pregnancy
d) Blacks
Que 4) Antihypertensive agent recommended
for the protection of cardiovascular diseases is:
a) Calcium channel blockers
b) Diuretics
c) ACE inhibitors
d) Alpha antagonists
e) Central sympatholytic
Que 5) Angiotensin Receptor Blockers play Reno
protective effect through all except:
a) Decreasing proteinuria
b) Decreasing intraglomerular pressure
c) Preventing endothelial dysfunction
d) Inhibiting conversion of angiotensin-I to
angiotensin –II
e) Blocking the angiotesin mediated renal
remodelling
Que 6) which of the following is the side effect
of ACE inhibitors:
a) Hyperkalaemia
b) Hypercalcemia
c) Hyperglycaemia
d) Hypertension
e) Hypermagnesemia
Que 7) Calcium channel blockers cause all
except:
a) Pedal oedema
b) Flushing
c) Hyperkalaemia
d) Headache
Que 8) : Safest drug for hypertension in
pregnancy is:
a) ACE inhibitors
b) Angiotensin receptor blockers
c) Diuretic
d) Methyldopa
Que9) the first line antihypertensive in diabetic
patients is:
a) Diuretics
b) Angiotensin converting enzyme inhibitors
c) Beta blockers
d) Calcium channel blockers
Que10) which of the following antihypertensive
agent is relatively contraindicated in congestive
cardiac failure:
a) ACE inhibitors
b) Angiotensin receptor blockers
c) Beta blockers
d) Diuretics
