anti hypertensive
TRANSCRIPT
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??BRAIN
STROKE
HEART FAILURE
,Coronary
Heart Disease
RETINOPATHY
RENAL FAILUR
E
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One in three adults worldwide, according to the report, has raised blood pressure – a condition that causes around half of all deaths from stroke and heart disease.
Overall prevalence for hypertension in India is 29.8%.
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Presented by- Guided by- Dr. Puneshwar Keshari Dr. Harini A.P.G. IInd Year Associate Professor& HOD Department of Dravya Guna SDM College of Ayurveda & Hospital Hassan
ANTIHYPERTENSIVE
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1. What is blood pressure?2. Regulation of blood pressure3. Parameters on which blood pressure depends4. What is Hypertension?5. Types of Hypertension6. Classification of Blood Pressure7. What is Antihypertensive?8. Classification of Antihypertensive9. Treatment of Hypertension10. Antihypertensive models11. Hypertension in Ayurveda12. Research updates13. Discussion14. Conclusion15. References
Content
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What is Blood Pressure?
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Regulation of Blood PressureBy definition, BP = CO X PVR
Physiologically, in both normal and hypertensive individuals, blood pressure is maintained by moment-to-moment regulation of cardiac output and peripheral vascular resistance, exerted at three anatomic sites: arterioles, postcapillary venules (capacitance vessels), and heart.
A fourth anatomic control site, the kidney, contributes to maintenance of blood pressure by regulating the volume of intravascular fluid.
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Baroreceptor reflex (aortic arch and carotid sinuses)Contd….
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Contd…
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Parameters on which blood pressure depends
Cardiac output Total Peripheral Resistance
Stroke Volume And Heart Rate SYSTOLIC BP DIASTOLIC BP
Preload: Preload can be defined as the initial stretching of the cardiac myocytes prior to contraction (EDV)Afterload: Afterload is the load against which the heart has to pump(TPR)
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What is Hypertension?
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HYPERTENSION: Hypertension can be defined as:
A sustained rise in blood pressure.
It is a condition in which the arteries have persistently high blood pressure, making harder for the heart to pump blood in the vessels.
Basically it has 2 main components; the SYSTOLIC and the DIASTOLIC blood pressure.
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What are the types of Hypertension?
Types ofHypertension
Essential Secondary
A disorder of unknown origin affecting theBlood Pressure regulating mechanisms Secondary to other disease processes
Environmental Factors
Stress Na+ Intake Obesity Smoking
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Classification of Blood PressureThe JNC 7 (2003)- 7th Report of Joint National
Committee(of USA) on prevention, detection, evaluation and treatment of high blood pressure,
Classified HTN as follows-BP Classification Systolic BP in mm
of HgDiastolic BP in mm of Hg
Normal < 120 < 80Prehypertension 120- 139 80- 89Hypertension Stage I 140 -159 90 - 99Hypertension Stage II ≥ 160 ≥ 100
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What is Antihypertensive?
The drugs used in the treatment of hypertension act by reducing
the cardiac output and/or reducing the total peripheral resistance, without correcting
the cause
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CLASSIFICATION OF ANTIHYPERTENSIVE Drugs
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Antihypertensive Drugs
4. Direct renin inhibitor
Aliskiren
2.ACE inhibitorsEg. Captopril, Enalapril, Lisinopril etc.
3. Angiotensin ( AT1 receptor) blockersEg. Losartan, Candesartan etc.
1. DiureticsThiazides:
Hydroclorothiazide, etc
High ceiling: Furosemide, etc.
Potassium Sparing: Spironolactone, Amiloride
5. Calcium channel blockers
Verapamil, Diltiazem, Nifedipine, Lacidipine, etc.
6. Beta Adrenergic blockers Propranolol, Metoprolol, Atenolol, etc
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Classification contd….
7. Beta+ alpha Adrenergic blockers
Labetalol, Carvedilol
8. Alpha Adrenergic blockersPrazosin, Terazosin, Doxazosin etc.
9. Cenral SympatholyticsClonidine, Methyldopa
10. VasodilatorsArteriolar : Hydralazine, Minoxidil, DiazoxideArteriolar + Venous : Sodium nitroprusside
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MOA: 1- ↑ renal excretion of Na & water ↓ plasma volume ↓ C.O. 2- ↓ peripheral resistance ( desensitize smooth muscles to
action of catecholamine)
Advantage: Effective in controlling blood pressure in long term. Controls BP in Supine as well as standing positions so postural hypotension doesn’t occur.
Disadvantage: Of Thiazides include, hypokalemia, hyperuricemia; Of Loop Diuretics include, Ototoxicity;Of Potassium Sparing group include, Gastric upsets, Gynecomastia in males, Menstrual irregularities in females
Diuretics
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Diuretics ….site of action
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ACE InhibitorsMOA: ↓ ang II ↓ vasocostriction ↓ degradation of Bradykinin ( vasodilator)
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Adverse effects of ACE inhibitors
C APTOP R IL
Cough (dry Cough)AngioedemaProteinuriaTaste changesHypotensionContraindicated in PregnancyRashesIncreased K+ LevelsLow Ang II and Aldosterone levels
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Angiotensin ( AT1 receptor ) Blockers
Specific angiotensin receptors have been discovered, grouped and abbreviated as – AT1 and AT2
They are present on the surface of the target cells
Most of the physiological actions of angiotensin are mediated via AT1 receptor
Losartan is the specific AT1 blocker Available as 25 and 50 mg tablets
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Upper respiratory infections Headache May cause occasional dizziness, inability
to sleep, diarrhea, dyspnea, heartburn, nasal congestion, back pain, fatigue
SIDE EFFEECTS OF ANGIOTENSIN BLOCKER
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Direct Renin Inhibitors Aliskiren the only available member . Acts by blocking catalytic activity of renin
and inhibiting production of Ang I and Ang II.
Second line antihypertensive when established ACE inhibitors or ARBs cannot be used, or to supplement them.
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Calcium channel blockers
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Calcium channel blocker ..contd…
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Side effects of Calcium channel blockersCalcium Channel Blockers Cardiovascular
◦ hypotension, palpitations, tachycardia
Gastrointestinal◦ constipation, nausea
Other◦ rash, flushing, peripheral edema, dermatitis
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Beta blockers :Selectives: Metoprolol, AtenololAdverse Effect: Dizziness, Drowsiness, Fatigue, DiarrheaNon-Selectives: PropranololAdverse Effect: Drowsiness, Sedation, Asthma
βAdrenergic Blockers
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Mixed blockersActing on Alpha as well as on Beta receptors.
Labetolol, Carvidolol, BucindololAdverse Effects: Drowsiness, Fatigue, Insomnia, Orthostatic Hypotension
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Alpha Adrenergic blockersSelectives: Prazosine, terazosin
Adverse Effect: Orthostatic Hypotension
Non-Selectives: Phenoxybenzamine, Phentolamine
Adverse Effect: Tachycardia, PalpitationAdvantages- improvement in carbohydrate
metabolism, lowers LDL, increases HDLDose- available as 0.5, 1, 2.5 and 5 mg. 1-4
mg TDS
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Central Sympatholytics
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Directly relaxes arteriolar smooth muscle Result: decreased systemic vascular response,
decreased afterload, andPERIPHERAL VASODILATION
Eg.- Hydralazine (Hypertension in Pregnancy, Dose 25-50 mg OD), Minoxidil, Sodium nitroprusside
Adverse effects- Hydralazine- Dizziness, Dyspnoea, oedema etc. Sodium nitroprusside- Bradycardia
Vasodilators
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Treatment of Hypertension
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In the past, most studies on experimental hypertension were carried
out on Dogs.
Currently, rat is the preferred animal species
Spontaneous hypertensive rat (SHR), the genetic strain of hypertensive rat, is the animal of choice
Antihypertensive Screening Model
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1.Renovascular hypertension2. Dietary hypertension3. Endocrine hypertension4. Neurogenic hypertension5. Psychogenic hypertension6. Genetic hypertension7. Other models
Types of animal models of hypertension
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GOLDBlAtT HYPERTENSIONIschemia of kidney Blood pressure
RENIN ANGIOTENSIN MECHANISM
Clamping of Renal artery for 4 hours and reopening
Accumulated Renin is released
ACUTE HYPERTENSION
RENOVASCULAR MODEL…
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Sprague – Dawley Rats (300gm) are anesthetized ĉ Hexobarbital sodium (100mg/kg) Intra peritonially.
Cannulate the trachea for respiration and the Jugular vein for test compound administration.
A transducer is connected to the carotid artery for recording the pressure.
A PVC coated clip is placed in the left hilum of the kidney by fixing with the back muscle for 3.5 - 4hr.
Pentolinium is administered for ganglionic block. Relaese the clip and record the rise in B.P. Administer the test drug through I.V. and monitor the
pressure continuously. Increase in B.P after releasing the clip and reduction
after the drug administration is determined. Compare using percentage values
Contd….( 2Kidney 1 clip method)
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CHRONIC RENAL HYPERTENSION(1 Kidney- I -Clip Method)
-Sprague – Dawley Rats (200 - 300gm) are anesthetized ĉ -Phenobarbitone sodium (100mg/kg) Intra peritonially.
-A flank parallel incision is made in the left lumbar area. -Renal artery is dissected, cleaned and ‘U’ shaped silver
clip is slipped around near the aorta. -The internal gap b/w the clip is adjusted to 0.25 – 0.38 nm. -The right kidney is removed after tying off the renal
pedicel. -After 4-5 weeks the B.P is measured and the animals are
divided into groups of different doses. -Test drug is administered for 3 days -Pressure before and after drug administration(3min) are
recorded. -Percent reduction in pressure is calculated and compare to
the Std.
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AYUREDIC CONCEPT ABOUT HYPERTENSION AND ANTIHYPERTENSIVE
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Hypertension in Ayurveda may fall underPittavruta udana(Su.S.Ni.1/35) Raktagata
vata(Ch.Chi. 28/31), Pittavruta vata, Raktavruta vata, Pranavruta
udana, Rakta vega vridhi, Rasa bhara, Rakta Samvardhana, Vyanabala,
Uccharaktachapa, Siragata vata, Bhrama(Ch.su.20/10.Ma.Ni.17/1), Raktamada(Ch.su. 24/34), Moorcha(Ma.Ni.17),
Sanyasa , Dhamanipratichaya, Raktabhara Vridhi etc
Hypertension in Ayurveda
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RESEARCH UPDATES ABOUT ANTIHYPERTENSIVE HERBS
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Name of the Journal- Pharmacogn.Rev. 2011Jan-June; 5(9): 30-40
Name of the Authors- Nahida Tabassum and Feroz Ahmad
Total 49 plants are reviewed for Antihypertensive effect by experimental, Clinical and Phytochemical evaluations
Role of natural herbs in the treatment of hypertension
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Agathosma betulina Cassia occidentalis Hibiscus sabdariffa Pueraria lobata
Allium sativum Castanospermum australe
Lavandula stoechas Punica granatum
Annona muricata Coleus forskohlii Lepidium latifolium Raphanus sativus
Apium graveolens Commelina virginica Linum usitatissimum Rauwolfia serpentina Aristolochia manshuriensis
Crataegus pinnatifida
Lumnitzera racemosa Rhaptopetalum coriaceum oliver
Artocarpus altilis Crinum glaucum Lycopersicon esculentum
Sesamum indicum
Avena sativa Cuscuta reflexa Moringa oleifera Solanum sisymbriifolium
Blond psyllium Daucus carota Musanga cecropiodes Theobroma cacao
Camellia sinensis Desmodium styracifolium
Ocimum basilicum Triticum aestivum
Capparis cartilaginea Fuchsia magellanica Peganum harmala Uncaria rhynchophylla Carum copticum Glycine max Phyllanthus amarus Viscum album Cassia absus Gossypium
barbadense Pinus pinaster Vitex doniana
Contd…
Zingiber officinale
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1. Annona muricataHindi name – Lakshman phalaFamily- AnnonaceaeParts used – fruit, leaves, barkThe leaf extract of the plant has been reported to lower an elevated BP by decreasing the peripheral vascular resistance.2. Apium graveolens Family: ApiaceaeSanskrit name- AjmodaParts used - FruitThe juice was mixed with equal amount of honey and about 8
ounces were taken orally three times each day for up to one week. It has also been reported to reduce systolic and diastolic BP.
Antihypertensive herbs
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3. Cassia occidentalisFamily- CaesalpiniaceaeSanskrit name- KasmardaParts used- Seeds, Panchanga In vitro studies of the leaf extract have shown a relaxant effect on
the aortic rings. The studies revealed that cassia extract may be relaxing smooth muscle and reducing BP by inhibiting Ca2+ influx through receptor-operated channel and voltage-sensitive channel, showing its nonselectivity on these Ca2+ channels.
4. Cuscuta reflexaFamily- Cuscutaceae Sanskrit name- AmarvelaParts used- whole plant
Crude extract of C. reflexa has been reported to cause a decrease in systolic and diastolic BP as well as HR in anesthetized rats.
Contd….
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5. Moringa oleifera Family- MoringaceaeSanskrit name- ShigruParts used- Leaves, Fruit, Root In anesthetized rats, the crude extract of the leaves of M. oleifera caused a fall in systolic, diastolic, and mean BP in a dose-
dependent manner.
6. Phyllanthus amarusFamily- EuphorbiaceaeSanskrit name- Bhoomi AamalkiParts used- whole plantintravenous administration of the aqueous extract of the leaves of
this plant (5-80 mg/kg) to anesthetized NMT male rabbits produced a significant fall in mean diastolic, systolic, and mean arterial pressures in a graded dose-response manner.
Contd…
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Name of the Journal- World journal of Pharmaceutical research, Vol.3(8): 769- 777Name of Authors- V.Velpandian*, N.Anbu, S.Elangovan, M.
Mohamed MusthafaConclusion- Drug- Sadamanjil Chooranam (Nardostachys
jatamansi) Dose - 500mg and 1000mg/kg body weight Route- Oral Method of screening- 2 kidney 1 clipped, Gold Blatt
occlusion method Result- statistically significant decrease in systolic
and diastolic blood pressure in renovascular hypertensive rat through the action on renin angiotensin system.
ANTIHYPERTENSIVE ACTIVITY OF Nardostachys jatamansi INHYPERTNSIVE RATS FOLLOWING RENAL GOLD BLATTOCCLUSION METHOD
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DISSCUSSION -The prevalence of Hypertension(HTN) is
growing on day by day. -Both Primary and Secondary HTNs are directly
or indirectly related with food habit, sedentary life styles and consumption of various drugs.
-The antihypertensive drugs are classified according to their site of action, their target receptors and their mode of actions.
-Older drugs for Hypertension are outdated due to their various adverse effects and newer are going on to be incorporating in treatment schedule.
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Contd… -All types of antihypertensive drugs are only
able to do symptomatic decrease in blood pressure. They are not able to treat the real cause of Hypertension.
-Hypertension can be correlated with various Vata and Raktagata vyadhi but the exact terminology is not dealt in classical Ayurvedic texts.
-There are various herbs which are proven as safe and better antihypertensive and search for new one should be done on the basis of scientifically proven and widely accepted Screening models of Antihypertensive.
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Hypertension is becoming a global burden and the world is looking towards natural remedies system like Ayurveda, even though there are various antihypertensive drugs in contemporary system of medicine. So it is a high time to adopt proper screening model of antihypertensive and search for best solution from herbs for HTN.
CONCLUSION
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1. Tripathi. KD, Essential of Medical Pharmacology
2. Nahida Tabassum and Feroz Ahmad, Pharmacogn.Rev. 2011Jan-June; 5(9): 30-40
3. Dr.G.H.ANANTHASAYANA, MANAGEMENT OF ESSENTIAL HYPERTENSION IN AYURVEDIC PERSPECTIVES, ( Desertation work submitted to RGUHS)
4. D.K. BADYAL, H. LATA*, A.P. DADHICH, Indian Journal of Pharmacology 2003; 35: 349-362
5. V.Velpandian*, N.Anbu, S.Elangovan, M. Mohamed Musthafa, wjpr, Vol.3(8): 769- 777
6. www.google searh.net.
REFERENCES
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