Anti-Hypertensives

Classification

• Normal <120/80

• Pre HTN <139/89

• Stage I 140-159/90-99

• Stage II >160/100

• Etiology– Secondary/Primary (essential)

Hypertension

• Diagnosis

– Risk factors

– Long-term consequences

Agent Classification

• Diuretics

• Sympathoplegics

• Direct Vasodilators

• Angiotensin Inhibitors– ACE– ARB’s

Diuretics Indications

• CHF• Kidney Disease• Hepatic Cirrhosis• Edema• HTN• Hypercalcemia• Nephrolithiasis• Diabetes Insipidus

Diuretic Agents• Carbonic Anhydrase

– Acetazolamide

– Dorzolamide

– Brinzolamide

• Osmotic– Mannitol

• Loop– Furosemide

– Torsemide

– Bumetanide

• Thiazides– Hydrochlorothiazide

(HCTZ)

• K+ Sparing– Spironolactone

– Triamterene

• Super size me – Combos

Sympathoplegic Agents

• Centrally Acting

– Methyldopa

– Clonidine

– Guanfacine

Receptor Blockers Alpha Beta

• Prazosin• Doxazosin• Terazosin

• Propranolol• Metoprolol• Atenolol

Vasodilators

• MOA

• SE

• Agents

– Hydralazine

– Minoxidil

Calcium Channel Blockers• MOA/SE• Agents

– Diltiazem (Cardizem)– Verapamil (Calan)– Amlodipine (Norvasc)– Nifedipine(Adalat)

• Therapeutic Uses– HTN– Angina– Arrhythmias– Migraine

Angiotensin InhibitorsACE ARB’s

• MOA/SE

• Agents

– Captopril

– Enalapril

– Lisinopril

– Benazepril

– Fosinopril

• MOA/SE

• Agents

– Losartan

– Valsartan

– Candesartan

Chronic Management

• Non Drug Treatments

• Stepped Care Therapy

Summary Slide

• Hypertension Classification• Agent Classification

– Diuretics – Sympathoplegic Agents– Receptor Blockers

• Alpha/Beta

– Vasodilators– Calcium Channel Blockers

Summary Slide (cont.)

• Angiotensin Inhibitors– ACE – ARB’s

• Chronic Management

Case Study Hypertension

SS, Latino male, 45 yr old, 5’6”, #195, smokes x1ppd x 32 years. Enters the clinic due to recently developed cough/wheeze x3 mos. He is concerned it is work related cancer. The translator indicates he work for a winery & is currently pulling in the grape harvest. He thought it was allergies, but it is not going away. BP supine 153/94 standing 159/90 HTNx8years

Meds: Albuterol MDI 2 puffs qid & prn Benazepril 20mg qd IBU 600mg qid & prn Loratadine 10mg prn Nasonex prn

Dyazide 50/75 qd ASA when IBU fails Restricts salt uses substitute Uses cultural product to help his nature

Points to Ponder

• What stage of HTN is SS? Consider his HTN management.

• Possible etiology of his current complaint.

• What non-drug options are open?

• Better choices of stepped care therapy?

• Spot any drug interactions?