Lecture Notes: Common Anti-Hypertensive Medications

Introduction

• Presenter: Dr. Bill Deal Jones
• Focus: Anti-hypertensive medications
• Categories of treatment:
  • Lifestyle modification (Diet, DASH diet, exercise)
  • Pharmacotherapies based on diagnosis and comorbidities

Anti-Hypertensive Medication Categories (ABCD)

1. A - ACE Inhibitors and ARBs
2. B - Beta Blockers
3. C - Calcium Channel Blockers
4. D - Diuretics

ACE Inhibitors and ARBs

• Common ACE Inhibitors: Lisinopril, Captopril, Ramipril
  • First-line agents
  • Benefits: Improved cardiovascular outcomes, reduced heart failure hospitalization, slowed kidney disease progression
  • Common Side Effects: Angioedema, cough
• Common ARBs: Valsartan, Candesartan
  • First-line agents
  • Improved cardiovascular outcomes
  • Side Effects: Similar to ACE inhibitors
• Mechanism: Targets Renin-Angiotensin-Aldosterone system, reducing Angiotensin II

Beta Blockers

• Examples: Carvedilol, Metoprolol
  • Use in post-myocardial infarction and congestive heart failure
  • Decrease heart rate, may increase depression, asthma, elevate lipids and potassium
• Mechanism: Block beta receptors, affect norepinephrine, can be non-selective

Calcium Channel Blockers

• Types:
  • Dihydropyridines (e.g., Nifedipine, Amlodipine)
  • Non-Dihydropyridines (e.g., Diltiazem)
• Effects: Peripheral vasodilation, heart rate changes, myocardial contractility
• Side Effects: Edema, constipation, possible heart failure
• Mechanism: Block calcium channels, affecting cardiac and smooth muscle

Diuretics

• Thiazide Diuretics: Hydrochlorothiazide, Chlorthalidone
  • Decrease sodium reabsorption, increase calcium, uric acid, lipids
  • Possible hyponatremia
• Loop Diuretics: Furosemide (Lasix)
  • Inhibit sodium, chloride, potassium reabsorption
  • Watch for hypokalemia
• Clinical Pearls: Can trigger gout, different pharmacologic effects based on type

Other Anti-Hypertensive Medications

• Alpha 1 Antagonists (e.g., Prazosin)
  • Cause vasodilation, not primary for hypertension
  • Used in PTSD nightmares, BPH treatment
• Alpha 2 Agonists
  • Decrease peripheral resistance
  • Used in opioid withdrawal, cause sedation

Nitrates

• Function: Convert to nitric oxide causing vasodilation
• Indications: Angina, post-MI, CHF
• Contraindications: Right ventricular failure

Hydralazine

• Function: Direct arteriolar dilator
• Not primary for hypertension
• Side Effects: Lupus-like condition, cardiac output increase

Spironolactone

• Function: Diuretic, blocks aldosterone
• Use in CHF: Good for ejection fraction ≤ 35%
• Side Effects: Can cause gynecomastia, watch creatinine levels

Conclusion

• Introduction to anti-hypertensive tools, not specific management
• Mostly target renin-angiotensin-aldosterone or vascular system
• Used in congestive heart failure
• Follow clinical guidelines, be aware of side effects

Final Note: Always stay informed on clinical practice guidelines, side effects, and new developments in treatments.