Antihypertensive

From Freepedia

Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension. There are many classes of antihypertensives, which—by varying means—act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.

Which type of medication to use initially for hypertension has been the subject of several large studies. The JNC7 (The Seventh Report of the Joint National Committee on Prevention of Detection, Evaluation and Treatment of High Blood Pressure) recommends starting with a thiazide diuretic if single therapy is being initiated and a another medication is not indicated. This is based on a slightly better outcome for chlorothiazide in the ALLHAT study versus other anti-hypertensives and because thiazide diuretics are relatively cheap. Another large study (ANBP2) published after the JNC7 did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors. The bottom line is this - the fundamental goal of treatment should be blood pressure control and in reality all three classes of medications are very effective.

Contents 1 Available drugs 1.1 Diuretics 1.2 Antiadrenergics 1.3 ACE inhibitors 1.4 Calcium channel blockers 1.5 Angiotensin II receptor antagonists 1.6 Aldosterone antagonists 1.7 Vasodilators 2 Choice 2.1 See also

Available drugs

Diuretics

• Diuretics help the kidneys eliminate excess salt and water from the body's tissues and blood.
  • Amiloride
  • Loop diuretic
    • bumetanide
    • ethacrynic acid
    • furosemide
  • Thiazide diuretics
    • chlorothalidone
    • epitizide
    • hydrochlorothiazide and chlorothiazide
    • indapamide
    • triamterene

Antiadrenergics

• Antiadrenergics
  • Beta blockers
    • atenolol
    • metoprolol
    • oxprenolol
    • pindolol
    • propanolol
  • Alpha blockers

ACE inhibitors

• ACE inhibitors block the production of substances that constrict blood vessels.
  • captopril
  • enalapril
  • lisinopril
  • ramipril

Calcium channel blockers

• Calcium channel blockers block the entry of calcium into muscle cells in artery walls.
  • amlodipine
  • dihydropyridines
  • diltiazem
  • felodipine
  • isradipine
  • nifedipine
  • nimodipine
  • nitrendipine
  • verapamil

Angiotensin II receptor antagonists

• ATII inhibitors
  • irbesartan
  • losartan
  • telmisartan
  • valsartan

Aldosterone antagonists

• Aldosterone antagonists
  • spironolactone

Vasodilators

• Vasodilators act directly on arteries to relax their walls so blood can move more easily through them, only used in emergencies.

Choice

The choice between the drugs is to a large degree determined by their side-effects. For example, asthmatics have been reported to have worsening symptoms when using beta blockers. Most drugs have other uses; sometimes the presence of other symptoms can warrant the use of one particular antihypertensive (such as beta blockers in case of tremor and nervousness, and alpha blockers in case of benign prostatic hyperplasia).

See also

• arterial hypertension