Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). Medication, also referred to as medicine, can be loosely defined as any substance intended for use in the diagnosis cure mitigation treatment or prevention of disease Medicine is the art and science of healing It encompasses a range of Health care practices evolved to maintain and restore Human Health by the Pharmacology (from Greek grc φάρμακον pharmakon, "drug" and grc -λογία -logia) is the study of how Drugs Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated 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 cardiovascular disease. Blood pressure is also the title of a short story by Damon Runyan in Guys and Dolls and Other Stories Coronary disease (or coronary heart disease) refers to the failure of Coronary circulation to supply adequate circulation to Cardiac muscle and surrounding Dementia (from Latin de- "apart away" + Mens ( genitive mentis) "mind" is the progressive decline Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply Death is the termination of the biological functions that define living Organisms It refers both to a specific Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and

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. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Several classes of medications are effective in reducing blood pressure. However, these classes 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. ^[1]

In the United States, 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 another medication is not indicated. Thiazide is a term used to describe a type of molecule and a class of Diuretic. ^[2] This is based on a slightly better outcome for chlortalidone in the ALLHAT study versus other anti-hypertensives and because thiazide diuretics are relatively cheap. Chlortalidone (formerly spelled chlorthalidone in the UK and still so called in the United States is a drug used to treat hypertension ^[3] A subsequent smaller study (ANBP2) published after the JNC7 did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older male patients. ^[4]

Despite thiazides being cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry. ^[5]

In the United Kingdom, the June 2006 "Hypertension: management of hypertension in adults in primary care"^[6] guideline of the National Institute for Health and Clinical Excellence, downgraded the role of beta-blockers due to their risk of provoking type 2 diabetes. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic ^[7]

Contents 1 Available drugs 1.1 Diuretics 1.2 Adrenergic receptor antagonists 1.3 Adrenergic receptor agonist 1.4 Calcium channel blockers 1.5 ACE inhibitors 1.6 Angiotensin II receptor antagonists 1.7 Aldosterone antagonists 1.8 Vasodilators 1.9 Centrally acting adrenergic drugs 2 Future treatment options 2.1 Blood pressure vaccine 3 Choice 4 See Also 5 References 6 External links

Available drugs

Diuretics

Diuretics help the kidneys eliminate excess salt and water from the body's tissues and blood. Hydrochlorothiazide, sometimes abbreviated HCT, HCTZ, or HZT is a popular Diuretic drug of the Thiazide class that acts by inhibiting Thiazide is a term used to describe a type of molecule and a class of Diuretic. A diuretic is any Drug that elevates the rate of urination ( Diuresis)

• Loop diuretics:
  • bumetanide
  • ethacrynic acid
  • furosemide
  • torsemide
• Thiazide diuretics:
  • chlortalidone
  • epitizide
  • hydrochlorothiazide and chlorothiazide
  • bendroflumethiazide
• Thiazide-like diuretics:
  • indapamide
  • chlorthalidone
  • metolazone
• Potassium-sparing diuretics:
  • amiloride
  • triamterene
  • spironolactone

Only the thiazide and thiazide-like diuretics have good evidence of beneficial effects on important endpoints of hypertension, and hence, should usually be the 1st choice when selecting a diuretic to treat hypertension. Loop diuretics are Diuretics that act on the ascending Loop of Henle in the Kidney. Bumetanide is a Loop diuretic Furosemide ( INN) or frusemide (former BAN) is a Loop diuretic used in the treatment of congestive Heart failure and Edema Torasemide ( rINN) or torsemide ( USAN) is a Pyridine - Sulfonyl[[urea]] type Loop diuretic mainly used in the management Thiazide is a term used to describe a type of molecule and a class of Diuretic. Chlortalidone (formerly spelled chlorthalidone in the UK and still so called in the United States is a drug used to treat hypertension Hydrochlorothiazide, sometimes abbreviated HCT, HCTZ, or HZT is a popular Diuretic drug of the Thiazide class that acts by inhibiting Chlorothiazide sodium ( Diuril) is a Diuretic used within the hospital setting or for personal use to manage excess fluid associated with Congestive heart failure Bendroflumethiazide INN (formerly BAN bendrofluazide) is a Thiazide Diuretic, used to treat Hypertension. Indapamide is a non-thiazide sulphonamide Diuretic drug marketed by Servier, generally used in the treatment of Hypertension, as well as Chlortalidone (formerly spelled chlorthalidone in the UK and still so called in the United States is a drug used to treat hypertension Not to be confused with Metaxalone, a muscle relaxant Metolazone is a Thiazide diuretic marketed under the brand names Zaroxolyn Potassium-sparing diuretics are Diuretic drugs that do not promote the secretion of Potassium into the Urine. Amiloride is a potassium-sparing diuretic, first approved for use in 1967 (then known as MK 870 used in the management of Hypertension and Congestive Triamterene (trade name Dyrenium) is a Potassium-sparing diuretic used in combination with Thiazide diuretics for the treatment of Hypertension Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, Verospiron or Berlactone Thiazide is a term used to describe a type of molecule and a class of Diuretic. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated The reason why thiazides-type diuretics are better than the others is (at least in part) thought to be because of their vasodilating properties.

Although the diuretic effect of thiazides may be apparent shortly after administration, it takes longer (weeks of treatment) for the full anti-hypertensive effect to develop.

Adrenergic receptor antagonists

• Beta blockers (no longer 1st line therapy in many countries - see Lancet 29 October 2005):
  • atenolol
  • metoprolol
  • nadolol
  • oxprenolol
  • pindolol
  • propranolol
  • timolol
• Alpha blockers:
  • doxazosin
  • phentolamine
  • indoramin
  • phenoxybenzamine
  • prazosin
  • terazosin
  • tolazoline
• Mixed Alpha + Beta blockers:
  • bucindolol
  • carvedilol
  • labetalol

Although beta blockers lower blood pressure, they do not have as positive a benefit on endpoints as some other antihypertensives. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias Events 437 - Valentinian III, Western Roman Emperor, marries Licinia Eudoxia, daughter of his cousin Theodosius II Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. Atenolol is a β1 receptor specific antagonist a drug belonging to the group of β-blockers, a class of drugs used primarily in Cardiovascular diseases Metoprolol is a selective β1 receptor blocker used in treatment of several diseases of thecardiovascular system especially Hypertension. Nadolol ( Corgard) is a non-selective Beta-blocker used in the treatment of high blood pressure, migraine headaches, and chest pain Oxprenolol is a non-selective Beta blocker with some intrinsic sympathomimetic activity Pindolol is a Beta blocker drug Pharmacology Pindolol is a nonselective beta blocker with partial beta-agonist activity Propranolol ( INN) is a non-selective Beta blocker mainly used in the treatment of Hypertension. Timolol maleate is a non-selective beta-adrenergic receptor blocker. Alpha blockers (or adrenergic alpha-antagonists) are agents that act as antagonists of alpha adrenergic receptors Classification They can be divided Doxazosin mesylate, a Quinazoline compound sold by Pfizer under the brand names Cardura and Carduran, is an Alpha blocker used to Phentolamine (Regitine is a reversible nonselective alpha- Adrenergic antagonist. Indoramin (trade name Baratol) is a Piperidine Antiadrenergic agent Phenoxybenzamine (marketed under the trade name Dibenzyline is a non-specific irreversible Alpha blocker. Prazosin, trade names Minipress, Vasoflex and Hypovase, is a Sympatholytic drug used to treat high blood pressure ( Hypertension Terazosin ( Hytrin) is a selective Alpha 1 antagonist used for treatment of symptoms of an enlarged Prostate ( BPH) Tolazoline is a non-selective competitive α- Adrenergic receptor antagonist. Carvedilol is a non-selective beta blocker indicated in the treatment of mild to moderate Congestive heart failure (CHF Labetalol ( Normodyne, Trandate, fixed combination with Hydrochlorothiazide: Normozyde) is a Drug that is a Racemic mixture Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias ^[8] In particular, atenolol seems to be less useful in hypertension than several other agents. Atenolol is a β1 receptor specific antagonist a drug belonging to the group of β-blockers, a class of drugs used primarily in Cardiovascular diseases ^[9] However, beta blockers have an important role in the prevention of heart attack in people who have already had a heart attack. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias ^[10]

Despite lowering blood pressure, alpha blockers have significantly poorer endpoint outcomes than other antihypertensives, and are no longer recommended as a first-line choice in the treatment of hypertension. Alpha blockers (or adrenergic alpha-antagonists) are agents that act as antagonists of alpha adrenergic receptors Classification They can be divided ^[11] However, they may be useful for some men with symptoms of prostate disease. Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of

Adrenergic receptor agonist

• Alpha-2 agonists:
  • clonidine
  • methyldopa

Calcium channel blockers

Calcium channel blockers block the entry of calcium into muscle cells in artery walls. The adrenergic receptors (or adrenoceptors) are a class of G protein-coupled receptors that are targets of the Catecholamines Adrenergic receptors Clonidine is a direct-acting α2 Adrenergic agonist prescribed historically as an Antihypertensive agent Methyldopa or alpha-methyldopa (brand names Aldomet, Apo-Methyldopa, Dopamet, Novomedopa) is a centrally-acting adrenergic Antihypertensive Calcium channel blockers are a class of drugs and natural substances with effects on many excitable cells of the body like the muscle of the Heart, smooth muscles

• dihydropyridines:
  • amlodipine
  • felodipine
  • isradipine
  • lercanidipine
  • nifedipine(Adalat)
  • 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. Dihydropyridine is a molecule based upon Pyridine, and the parent of a class of Molecules that have been semi- saturated with two Substituents Amlodipine (as Besylate, Mesylate or Maleate) is a long-acting Calcium channel blocker (dihydropyridine used as an Anti-hypertensive Felodipine is a Calcium channel blocker (calcium antagonist a drug used to control Hypertension (high blood pressure Isradipine (tradenames DynaCirc, Prescal) is a Calcium channel blocker of the Dihydropyridine class Lercanidipine is a Calcium channel blocker of the Dihydropyridine class Nifedipine (brand name Adalat, Nifedical, and Procardia) is a Dihydropyridine Calcium channel blocker. Nimodipine (marketed by Bayer as Nimotop Nitrendipine is a Pyridine Calcium channel blocker. Diltiazem is a member of the group of drugs known as Benzothiazepines which are a class of Calcium channel blockers used in the treatment of Hypertension Verapamil (brand names Isoptin, Verelan, Calan, Bosoptin, Covera-HS) is an L-type Calcium channel blocker. Captopril ( rINN) (ˈkæptəprɪl is an Angiotensin-converting enzyme inhibitor ( ACE inhibitor) used for the treatment of Hypertension and some ACE inhibitors, or inhibitors of '''A'''ngiotensin-'''C'''onverting '''E'''nzyme, are a group of Pharmaceuticals that are used primarily in treatment of Hypertension Angiotensin I converting enzyme ( ACE,) is an Exopeptidase. Functions It has two primary functions it catalyses the conversion of Angiotensin causes blood vessels to constrict and drives blood pressure up Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels particularly the large Arteries, Arterioles

• captopril
• enalapril
• fosinopril
• lisinopril
• perindopril
• quinapril
• ramipril
• trandolapril
• benazepril

Angiotensin II receptor antagonists

Angiotensin II receptor antagonists work by antagonizing the activation of angiotensin receptors. Captopril ( rINN) (ˈkæptəprɪl is an Angiotensin-converting enzyme inhibitor ( ACE inhibitor) used for the treatment of Hypertension and some Enalapril is an angiotensin converting enzyme (ACE inhibitor used in the treatment of Hypertension and some types of chronic Heart failure. Fosinopril is an angiotensin converting enzyme (ACE inhibitor used for the treatment of Hypertension and some types of chronic Heart failure. Lisinopril ( lye-SIN-o-pril) is a drug of the angiotensin converting enzyme (ACE inhibitor class that is primarily used in treatment of Hypertension, Perindopril (Coversyl Aceon is a long-acting ACE inhibitor. Indications Essential Hypertension. Quinapril (marketed under the brand name Accupril by Pfizer) is an Angiotensin-converting enzyme inhibitor ( ACE inhibitor) used in Ramipril (marketed as Tritace/Ramace or Altace) is an angiotensin-converting enzyme (ACE inhibitor, used to treat Hypertension and Trandolapril is an ACE inhibitor used to Benazepril, brand name Lotensin, is a medication used to treat high blood pressure ( Hypertension) Congestive heart failure, and Chronic renal failure Valsartan is an Angiotensin II receptor antagonist (more commonly called an "ARB" which stands for Angiotensin Receptor Blocker acting on the AT1 Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs AT1-receptor antagonists or sartans, are a group of A receptor antagonist is a type of receptor ligand or Drug that does not provoke a biological response itself upon binding to a receptor, but blocks The angiotensin receptors are a class of G protein-coupled receptors with Angiotensins as ligands They are important in the Renin-angiotensin system

• 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,^[2] but spironolactone and eplerenone are both used in the treatment of heart failure. Candesartan ( rINN) (ˌkændɨˈsɑrtən is an Angiotensin II receptor antagonist used mainly for the treatment of Hypertension. Eprosartan is an Angiotensin II receptor antagonist used for the treatment of high blood pressure. Irbesartan ( INN) (ɜrbəˈsɑrtən is an Angiotensin II receptor antagonist used mainly for the treatment of Hypertension. Losartan ( rINN) (loʊˈsɑrtən is an Angiotensin II receptor antagonist drug used mainly to treat high blood pressure ( Hypertension) Olmesartan (BenicarOlmetec belongs to the class of medicines called Angiotensin II receptor antagonists to treat high blood pressure. Telmisartan ( INN) (tɛlmɪˈsɑrtən is an Angiotensin II receptor antagonist (ARB used in the management of Hypertension. Valsartan is an Angiotensin II receptor antagonist (more commonly called an "ARB" which stands for Angiotensin Receptor Blocker acting on the AT1 Aldosterone is a hormone that causes the tubules of the kidneys to retain sodium and water Eplerenone ( INN) (ɛpˈlɛrənoʊn is an Aldosterone antagonist used as an adjunct in the management of Chronic heart failure. Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, Verospiron or Berlactone Aldosterone is a hormone that causes the tubules of the kidneys to retain sodium and water Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, Verospiron or Berlactone Eplerenone ( INN) (ɛpˈlɛrənoʊn is an Aldosterone antagonist used as an adjunct in the management of Chronic heart failure. Heart failure is a Cardiac condition that occurs when a problem with the structure or function of the Heart impairs its ability to supply

Vasodilators

Vasodilators act directly on arteries to relax their walls so blood can move more easily through them; they are only used in medical emergencies. A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health

• sodium nitroprusside

Centrally acting adrenergic drugs

Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain which open peripheral arteries easing blood flow. Sodium nitroprusside is the Chemical compound with the formula Na2·2H2O 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. Clonidine is a direct-acting α2 Adrenergic agonist prescribed historically as an Antihypertensive agent Guanabenz (pronounced GWAHN-a-benz sold under the trade name Wytensin) is an Alpha agonist of the alpha-2 type that is used as an Antihypertensive drug Methyldopa or alpha-methyldopa (brand names Aldomet, Apo-Methyldopa, Dopamet, Novomedopa) is a centrally-acting adrenergic Antihypertensive Moxonidine ( INN) (mɒkˈsɒnɪdiːn is a new generation centrally acting Antihypertensive drug licensed for the treatment of mild to moderate essential Hypertension

Some adrenergic neuron blockers are used for the most resistant forms of hypertension:

• Guanethidine
• Reserpine

Future treatment options

Blood pressure vaccine

Blood pressure vaccinations are being trialed and may become a treatment option for high blood pressure in the future. Guanethidine is an Antihypertensive drug that reduces the release of Catecholamines, such as noradrenaline Reserpine is an Indole Alkaloid Antipsychotic and Antihypertensive drug that has been used for the control of high blood pressure Research published in The Lancet on the 8 March 2008 titled, “Vaccination against high blood pressure: a new strategy” showed patients experienced a drop in systolic and diastolic blood pressure after taking the vaccine. This article is about the journal For other uses of the term "lancet" see Lancet (disambiguation. Events 1618 - Johannes Kepler discovers the third law of planetary motion. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Effective blood pressure vaccines would assist those people who forget to take their medication. It would also help those who stop taking their medication due to side effects or falsely believing they don't need them anymore once their blood pressure is lowered. ^[12]

Choice

The choice between the drugs is to a large degree determined by the characteristics of the patient being prescribed for, the drugs' side-effects, and cost. For example, asthmatics have been reported to have worsening symptoms when using beta blockers. Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias 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). Tremor is an unintentional somewhat rhythmic muscle movement involving to-and-from movements (oscillations of one or more parts of the body Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components Alpha blockers (or adrenergic alpha-antagonists) are agents that act as antagonists of alpha adrenergic receptors Classification They can be divided Benign prostatic hyperplasia ( BPH) also known as nodular hyperplasia, benign prostatic hypertrophy (technically a misnomer or benign enlargement of The JNC 7 report outlines compelling reasons to choose one drug over the others for certain individual patients. ^[2]

See Also

• Blood pressure
• Hypertension
• Prehypertension
• Pulse pressure

References

External links

• Official Adalat (Nifedipine) site, Bayer

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