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DRUGS USED IN
HYPERTENSIONGM. AMANBAG. FARMAKOLOGI FK. UNUD
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INTRODUCTION
BLOOD PRESSURE DETERMINED BY:
> Blood volume
> Sym!"#e#$% #o&e > '"(%ul") (moo#! mu(%le #o&e
> A&*$o#e&($& e+e%#
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STRATEGIES FOR TREATING ,YPERTENSION
REDUCTION OF BLOOD 'OLUME
REDUCTION OF SYMP,ATETIC TONE
REDUCTION OF 'ASCULAR SMOOT, MUSCLE TONE
REDUCTION OF ANGIOTENSIN EFFECT
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REDUCTION OF BLOOD 'OLUME
Thiazide Diuretic :
> #!e mo(# $mo)#" -o) "$
!ye)#e&($ve d)u* > e(e%$"lly -o) lo&* #e)m #!e)"y
> -o) m$ld "&d mode)"#e !ye)#e&($o&
Furosemide Diuretic:
> u(ed $& (eve)e !ye)#e&($o&
> m"l$*&" !ye)#e&($o&
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REDUCTION IN SYMP,ATETIC TONE
Ce)"lly "%#$&* (ym"#!ole*$%
d)u*(G"&*l$o& lo%/$&* "*e(
Ad)e&e)*$% &eu)o& lo%/$&* d)u*(
0Postganglionic SymphateticNerve Terminal Blocker 1
Ad)e&o%e#o) lo%/$&* d)u*(
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CENTRALLY ACTING
SYMPAT,OPLEGIC DRUGSCLONIDINE
> (ele%#$ve 23 "*o&$(#
> %"& %"u(e )eou&d !ye)#e&($o&$-
"dm$&$(#)"#$o& (#o (udde&ly
> %"& %"u(e (ed"#$o&
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CENTRALLY ACTING
SYMP,ATOPLEGIC DRUGMETHLDOP!
> %o&ve)#ed #o 2 me#!yl do"m$&e
"&d 2 me#!yl&o)e$&e!)$&e
> (ele%#$ve 23 "*o&$(#
> %"& %"u(e (ed"#$o&
> %ome&("#o)y )e(o&(e ("l#)e#e$o&
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GANGLION BLOCKING AGENTS
0GABA1He"amethoni#m $ Trimetharphan
> lo%/ ")"(ym"#!e#$% &e)ve4 %"&
%"u(e A#)o$&e l$/e e+e%#
> lo%/ (ym!"#e#$% &e)ve4 %"& %"u(e
o)#!o(#"#$% !yo#e&($o& "&d (e5u"l dy(-u&%#$o&
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POSTGANGLIONIC SYMP,ATETIC
NER'E TERMINAL BLOCKER%ESE%PINE
> $&!$$# )eu#"/e 0u#"/e 6 7
u#"/e31 > dele#$o& o- NE4 Do"m$&e4
Se)o#o&$&
0e)$!e)"l "&d %e)"l1
> #o5$% e+e%# : de)e(($o&
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POSTGANGLIONIC SYMP,ATETIC
NER'E TERMINAL BLOCKERS&'!NETHIDINE
> *u"&e#!$d$&e u#"/e #o*e#!e) 8$#! NE
"&d (#o)e $& NE ve($%le 0NE 9 G1 > $- (#$mul"#ed &e)ve #e)m$&"l )ele"(e NE
7 G #o*e#!e)
> (o #!"# #!e e+e%# o- NE $& o(#(y&"#$%
de%)e"(e: BP de%)e"(e 0(y(#ol$% "&d
d$"(#ol$%1
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ADRENOCEPTOR BLOCKERα BLO!ERS
> &o& (ele%#$ve 0P!eol"m$&e 7
P!e&o5ye& ;"m$&e1 : lo%/ 26 "&d 23 )e%e#o)
> (ele%#$ve 26 lo%/e) 0P)";o($&1
" BLO!ERS
> P)o)"&olol
> B$(o)olol
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Non selective a receptor (locker :
> Blo%/ a) "&d a* )e%e#o)
> Blo%/ a* )e%e#o) %"& %"u(e$&%)e"(e
NE )ele"(e
> S#$mul"#e
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Selective +) receptor (locker :
> Sele%#$vely lo%/ 26 )e%e#o)
> Do &o# (#$mul"#e NE )ele"(e
> No #"%!y%")d$"
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< BLOCKERS
NON CARDIOSELECTI'E 0P)o)"&olol1CARDIOSELECTI'E 0Me#o)olol4 B$(o)olol1
PARTIAL AGONIST 8$#! ISA 0P$&dolol4A%eu#olol1
BLOCK 2 AND < RECEPTOR 0L"e#"lol1
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< BLOCKERSPROPR#NOLOL:
> E=%"%$ou( $& !ye)#e&($o& "&d $(%!em$"
!e")# d$(e"(e > U(ed $& m$ld #o mode)"#e !ye)#e&($o&
> I& (eve)e !ye)#e&($o&4 < lo%/e)( u(e-ul$&
)eve$&* #"%!y%")d$" y d$)e%# "%#$o&o- v"(od$l"#o) 0e*. ,yd)"l";$&e1
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Me%!"&$(m o- "%#$o&:
> Redu%e COP
> De%)e"(e v"(%ul") )e($(#"&%e > Redu%e A&*$o#e&($&
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'ASODILATORSORAL 'ASODILATORS: !yd)"l";$&e4 M$&o5$d$l
> u(ed -o) lo&* #e)m
PARENTERAL 'ASODILATORS : N$#)o)u(($de4D$";o5$de.
> u(ed #o #)e"# !ye)#e&($ve eme)*e&%$e(
CALCIUM C,ANNEL BLOCKERS 0CCB1:
Amlod$$&e4 'e)""m$l4 D$l#$";em
> u(ed $& o#! %$)%um(#"&%e(
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ANGIOTENSIN
ANTAGONIST#E INHIBITOR : C"#o)$l4 E&"l")$l
> A&*$o#e&($& II 7 Aldo(#e)o& lood level
)edu%e > B)"dy/$&$& )o"ly $&%)e"(e
> M$&$m"l %ome&("#o)y )e(o&(e
> S$de e+e%# : %ou*!
#NGIOTENSIN REEPTOR BLO!ER$#RB%& Lo(")#"&4 '"l(")#"&
#'( ote's '
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#'( ote's 'I
$i'acti)edeca*e*tid
e%
Brad+,i'i'$acti)e
)asodi-ator%
#'(iote'si'co')erti'(
e'z+me
#E I
I'acti)emeta.o-ite
#'(iote'si' II$acti)e
)asoco'strictor1
#T /
rece*tor
#T /rece*tor.-oc,ers
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The si0 a'tih+*erte'si)e
recomme'ded .+ 1HO:D$u)e#$%(
Be#" Blo%/e)(
ACE I(
CCB(
Al!" Blo%/e)(ARB(
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2o'othera*+
versus
Po-+*harmac+
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#d)a'ta(es o3 mo'othera*+P"#$e( mo)e %o&ve&$e 8$#!
mo&o#!e)"y
M"&y "#$e( do 8ell o& " ($&*led)u* $& m$ld mode)"#e!ye)#e&($o&
S$ml$%$#y e##e) %oml$"&%e
Le(( ($de e+e%#
I- ($de e+e%# do o%%u)4 #!eP! ($%$"& /&o8 #!e d)u
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3or the ma'a(eme't o3
h+*erte'sio'
Mo&o#!e)"y "# lo8 do(e
A%!$eved BP %o)ol Do &o# "%!$eved BP %o)o
%o$&uedAdded "&o#!e) %l"((
o- A, "*e
T$#)"#ed u8")d #o !$*!e) do(e
Th .- 3
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The *ro.-em o3mo'othera*+
Re(o&(e )"#e 8$#! 6 %l"(( o- A, $( lo8
?"(#e #!e #$me -o) #$#)"#ed do("*e
u8")d o) (8$#%! d)u* $& o)de) #o )e"%!*o"l BP
M"&y o- #!e %ommo& "dve)(e eve( ")edo(e dee&de
Come&("#o)y )e(o&(e
I&%)e"(ed )"#e o- "dve)(e eve le"d #ode%)e"(e "#$e %oml$"&%e
ye) e&( o
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ye) e&( o&
T)e"#me
De%)e"(ed Blood P)e((u)e
lo%/ed y lo%/edy d$u)e#$%( e#" lo%/e)
ACE I
I&%)e"(ed (ym"#!e#$%ou# @o8
0e)$!e)"l )e($(#"&%e1
Re&$& $&%)e"(ed0RAAS1
#"%!y%")d$" S"l# "&d w"#e))e#e$o&
I&%)e"(ed BP
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NC 'II0 o$ N"#$o&"l Comm$##ee Reo)# o& P)eve$o& De#e%#$o&4 Ev"lu"#$o& "&d
T)e"#me o- ,$*! Blood P)e((u)e 1
S#"*e I ,ye)#e&($o&0 6 6 1
Mo&o#!e)"y 8$#!#!$";$de 0 mo(# 14 ACEI4
ARB4 BB4 CCB
Poly!")m"%yCom$&"#$o& e#8ee& #!$";$de
"&d "#!e) %l"((
Poly!")m"%y3 d)u* %om$&"#$o& -o) mo(#u(u"lly T!$";$de "&d ACEI4
ARB4BB4CCB
No# "# *o"l BP
O#$m$;e do("*e(
Add "dd$#$o&"l d)u*(
S#"*e II,ye)#e&($o&0>6>61
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TERI2#!#SIH