Treatment for hypertension begins with modifying diet, encouraging exercise, and, if indicated, counseling about weight loss. If these measures aren't enough, drugs can help.
Calcium channel blockers
- Dilate the arteries to lower blood pressure
- Decrease cardiac contractility
- Examples: amlodipine (Norvasc), felodipine (Plendil)
ACE inhibitors
Beta-blockers
- Block catecholamine-induced increases in blood pressure
- Examples: propranolol (Inderal), nadolol (Corgard)
Angiotensin II receptor blockers (ARBs)
- Inhibit vasoconstriction
- Protect against renal failure in patients with type 2 diabetes
- Examples: losartan (Cozaar), olmesartan (Benicar)
- Decrease peripheral vascular resistance by inhibiting the sympathetic nervous system
- Examples: clonidine (Catapres), doxazosin (Cardura), carvedilol (Coreg)
- Block renin and help blood vessels relax
- Example: aliskiren (Tekturna)
- Help kidneys excrete water and electrolytes, which lowers blood pressure
- Thiazide example: hydrochlorothiazide (HydroDIURIL)
- Loop example: furosemide (Lasix)
- Potassium sparing, example: triamterene (spironolactone) and Dyrenium (Aldactone) (http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129)
Selective aldosterone receptor antagonists
- Used as a second-line treatment when other drugs fail
- Eplerenone (Inspra), spironolactone (Aldactone) (https://www.drugs.com/drug-class/aldosterone-receptor-antagonists.html)
- Relax arteries, veins, or both
- Oral example: hydralazine
For hypertensive crisis
- Example: I.V. nitroprusside (Nitropress)
Treating hypertension
Antihypertensives and the RAAS
The renin-angiotensin-aldosterone system (RAAS) regulates the body's sodium and water levels and blood pressure.
- Juxtaglomerular cells near the glomeruli in each kidney secrete the enzyme renin into the blood.
- Renin circulates throughout the body and converts angiotensinogen, made in the liver, to angiotensin I.
- In the lungs, angiotensin I is converted by hydrolysis to angiotensin II.
- Angiotensin II acts on the adrenal cortex to stimulate production of the hormone aldosterone. Aldosterone acts on the juxtaglomerular cells to increase sodium and water retention and to stimulate or depress further renin secretion, completing the feedback system that automatically readjusts homeostasis.
Adverse reactions of antihypertensive drugs
|