Antihypertensive drugs

CLINICAL USES OF ANTIHYPERTENSIVES

First line antihypertensive drugs

  • ACE inhibitors
  • AT1 antagonists
  • β -adrenergic blockers
  • Calcium channel blockers
  • Diuretics

Diuretics

  • Thiazides and related drugs are drugs of choice in uncomplicated hypertension
  • Thiazides are mild antihypertensives
  • Effective in elderly patients
    • They are effective in Isolated systolic hypertension,
    • low renin hypertension
    • Obese with volume overload
  • They are indicated in hypertension complicated by
    • Heart failure
    • Risk of Coronary artery disease
    • Diabetes
  • Diuretics should be avoided in
    • Patients with abnormal lipid profile
    • Pregnancy induced hypertension

ACE Inhibitors/AT1 blockers

  • First choice drug in all grades of essential as well as renovascular hypertension
  • ACE inhibitors should be avoided in
    • Bilateral renal artery stenosis
    • Pregnancy
    • Hyperkalaemia
  • Most appropriate antihypertensives in patients with
    • Diabetes
    • Nephropathy/chronic kidney disease
    • Left ventricular hypertrophy
    • Post Myocardial Infarction
    • Gout
    • Dyslipidemia
  • They appear to be more effective in relatively young patients
  • ACE inhibitors produce persistent cough (during the first two weeks) and dysguesia (loss of taste sensation).

β -blockers

  • Mild antihypertensive
  • They are indicated as antihypertensive in patients with
    • Stable heart failure
    • Post myocardial infarction
    • High coronary artery disease risk
  • Highly suitable for
    • Patients with coexisting anxiety or tachycardia
    • Relatively young non-obese patients
    • High renin hypertensive patients
    • Migraine patients
    • Pregnant individuals
  • Contraindicated in
    • Peripheral vascular disease
    • Pulmonary disease-asthma, COPD
    • Cardiac disease-Conduction defects, decompensated heart failure
    • Abnormal lipid profile

Calcium Channel blockers

  • Preferred in
    • Elderly hypertensive patients who have poor arterial wall compliance
    • Isolated systolic hypertension
    • Asthma/COPD patients
    • Pregnant hypertensive
    • Diabetes
  • Prevents recurrent stroke
  • Verapamil and diltiazem should be avoided in
  • Dihydropyridines should be avoided in
    • Ischaemic heart disease
    • Post myocardial infarction
    • Gastroesophageal reflux
    • Males with prostate enlargement
Last modified: Wednesday, 25 April 2012, 11:51 AM