Antihypertensive, Angiotensin Receptor blockers, Thiazide, Beta Adrenergics
Antihypertensives do not cure hypertension; they only control it. Hypertension is defined as the systolic blood pressure of 140 and diastolic blood pressure of 90 or greater. It increases the risk of heart failure, stroke and MI. Prehypertension is a range of 130/80 to 139/89. DASH is a Dietary Approaches to Stop Hypertension. After withdrawal of the antihypertensives, the symptoms could easily return back if the all the factor remain the same. Abrupt withdrawal can cause rebound hypertension, so it should be gradually reduced. Frequently the antihypertensive are prescribed on a trial basis to find the right dosage or medication. Side effects include postural hypotension and bradycardia. One exception of antihypertensive side effects includes hydralazine (Apresoline) that can cause tachycardia – even though it is an antiarrhythmic and hypotensive. Patients taking antihypertensive meds should not be skipping or double dosing the meds. Avoids tubs and hot showers, and stay away from grapefruit juice while taking calcium channel blockers.
– Thiazide Diuretics are as effective as other antihypertensive agents. But thiazide diuretics are the most cost-effective antihypertensive to date.
– Beta adrenergic and calcium channel blockers are generally well tolerated and are suitable for initial therapy in some patients. Calcium channel blockers are initial therapy option for hypertensive patients with diabetes or high coronary disease risk. Beta blockers can help hypertensive patients with angina, post myocardial infarction and certain arrhythmias.
– Angiotensin-Converting Enzyme (ACE) Inhibitors are captopril or enalapril. Inhibition of ACE lower blood pressure by decrease vasoconstriction. There is no significant changes in heart rate or cardiac output. ACEIs are first or second line of agents for treatment of hypertension. ACEIs are also good for patients who also have heart failures, diabetes, renal disease and cerebrovascular disease. Side effects of ACEIs include loss of taste perception and hyperkalemia.
– Angiontensin Receptor Blockers (ARBs) similar to ACEIs in that it decrease BP but no significant changes in heart rate. Also they both block the hormone that causes vasoconstriction, both of them work on different sites. Side effects are relatively uncommon but includes respiratory tract infections, hyperkalemia and dizziness. Contraindicated in renal and heart disease patients unlike ACEIs.
– Methyldopa is a central-acting alpha adrenergic agent, which is usually administered with diuretic. It is the drug of choice for hypertension pregnant women because of safety to the fetus.
– Clonidine is also a central-acting alpha-adrenergic agent. It has also been used successfully in a variety of other conditions including nicotine/opiate withdrawal, vascular headaches, glaucoma, ulcerative colitis, tourette’s syndrome and treatment of severe pain in cancer patients.
– Prazosin (Minipres) is a peripheral acting alpha-adrenergic blocker. Other agents in this class are used to treat BPH.
– Hydralazine is a peripheral vasodilator. Remember earlier we talked about – the one exception of antihypertensive side effects. The hydralazine (Apresoline) that can cause tachycardia – even though it is an antiarrhythmic and hypotensive. Therefore, it is good for hypertensive patient with CHF because it increases heart rate and cardiac output. Contraindication is SLE.