Presentation on VARIOUS ANTIHYPERTENSIVE AGENTS

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Presentation on VARIOUS ANTIHYPERTENSIVE AGENTS

• PRESENTERS
• Fatema Zohra Talukdar BPH 02505066
• Samira Ayesha Siddiqa BPH 02505069
• Kousik Ahmed Khan BPH 02505070
• Md. Taherul Islam BPH 02505085

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Hypertension

• Hypertension is a disease characterized by an
  elevated of BP according to age and sex.
• Normal upper clinical level
• Systolic 140 mm of Hg.
• Diastolic 95 mm of Hg.

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Hypertension

• Borderline Hypertension (BP 140/90 mm Hg)
• Mild Hypertension (BP 140-160/95-105 mm Hg)
• Moderate Hypertension (BP 140/105-120 mm Hg)
• Severe Hypertension (BP 140/gt120 mm Hg)

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Hypertension

• There are several factors that have been
  identified that contribute to the development of
  primary hypertension and several drugs target
  these processes
• I) Neural factor
• II) Hormonal factor
• III) Electrolyte factor
• IV) Vessel wall factor
• V) Genetic factor

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Antihypertensive agents

• Some drugs which increase BP i.e., Adrenaline,
  Nor-adrenaline, Ephedrine, Ergot etc.
• So, the agents which are used in the treatment of
  hypertension are called antihypertensive agents.

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Classification of Antihypertensive agents

• There are a number of drugs which are used as
  antihypertensive agents.
• I) Diuretics
• II) Sympatholytic agents
• III) Vaso-dilators
• IV) Angiotensin converting enzyme (ACE)
  inhibitors

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Classification of Antihypertensive agents

• I) Diuretics
• a) Low maximal efficacy- Thiazides (e.g.
  Hydrochlorothiazide), Phthalimidines.
• b) High maximal efficacy- Frusemide,
  
  Ethacrynic acid.
• c) K sparing- Spironolactone, Triamterene,
  Amiloride.

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Classification of Antihypertensive agents

• II) Sympatholytic agents
• a) Acting on CNS- Methyldopa (Aldomet),
  Clonidine.
• b) Autonomic ganglion blocker- Trimethaphan.
• c) Acting of post-ganglionic sympathetic
  neurone- Guanethidine, Reserpine, MAO
  inhibitors.
• d) Receptor blockers-
• a-receptor blockers- Prazosin, Phentolamine,
  Phenoxybenzamine.
• ß -receptor blockers- Propanolol, Metoprolol,
  Nadolol, Labetolol, Atenolol, Acebutalol.

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Classification of Antihypertensive agents

• III) Vaso-dilators-
• a) Arterial dilators- Hydralazine, Diazoxide,
  Minoxidil.
• b) Ca-antagonist- (? Ca influx in the arterial
  smooth muscles.) e.g. Verapamil, Nifedepine,
  Diltiazem.
• IV) Angiotensin converting enzyme (ACE)
  inhibitors-
• e.g. Saralasin, Captopril, Cilazapril,
  Enalapril, Linopril, Lisinopril.

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Diuretics
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Frusemide (Tablet/Injection)

• Frusemide is a short acting loop diuretic of
  sulfonamide group.
• Mode of action Frusemide inhibits the
  Na/K/2Cl- co-transport in the ascending limb of
  loop of henle and blocks rhe re-absorption of
  electrolytes (Na, K and Cl- ions) and water.
• Indication Oedema of cardiac, Hepatic or renal
  origin, Toxaemia of pregnency, Mild or Moderate
  hypertension.
• Contraindication Precomatose srare associared
  with liver cirrhosis.

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Frusemide (Tablet/Injection)

• Side Effects Rashes tinnitus and deafness in
  impaired renal function.
• Cautions Causes hypokalaemia hyponatraemia
  aggravates diabetes and gout, liver failure,
  prostatism.
• Dose (For adult) By mouth, initially 20-80 mg
  once or twice daily, then adjusted according to
  response.

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Available Diuretics in Bangladesh
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Sympatholytic agents
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Celiprolol hcl (tablet)

• Mode of action
• Celiprolol is a ß1-selective (Cardio selective),
  ß-adrenoreceptor blocking agent, which possesses
  mild ß2 agonist activity and weak a2 blocking
  activity, but does not exhibit quinidine-like
  membrane stabilizing properties. These and other
  receptor moduling effects may account for its
  absence of cardiopressant effect, lack of adverse
  effects on serum lipids, decrease in peripheral
  vascular resistance as well as a reduced risk of
  adverse bronchopulmonary effects compared with
  other ß adrenoreceptor blocking agents.

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Celiprolol hcl (tablet)

• Indication
• Celiprolol is indicated for the treatment of
  hypertension and effort-induced angina pectoris.
• Contraindication
• All b blockers are contraindicated in bronchial
  asthma or other obstructive lung disorders,
  uncontrolled heart failure, cardiogenic shock,
  sick-sinus syndrome and also avoid in several
  renal impairment.

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Celiprolol hcl (tablet)

• Side effects
• Side effects are transient and mild. The most
  frequently observed are headache, dizziness,
  fatigue, oedema, rash, weakness, bradycardia,
  palpitation etc.
• Precaution
• Avoid abrupt withdrawal specially in angina.
  Celiprolol therapy must be reported to the
  anaesthetist prior to general anaesthesia.
• Dose
• The recommended initial dose is 200 mg once
  daily. The dose may be increased to 400 mg once
  daily if necessary at 2 to 4 week intervals.

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Available Sympatholytic agents in Bangladesh
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Angiotensin converting enzyme (ACE) inhibitors
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Captopril (Tablet)

• Mode of action
• Angiotensine converting enzyme or ACE inhibitors
  inhibit the conversion of angiotensin I to
  angiotensin II. (Angiotensin II is one of most
  potent vasoconstrictors and it increase systolic
  and diastolic blood pressure). They are effective
  and generally well tolerated. ACE inhibitors
  decrease total peripheral resistance which
  ultimately decrease the increased blood volume.
• Indication
• Captopril is indicated for the treatment of
  hypertension, Heart failure, Myocardial
  infraction, Diabetic nephropathy etc.
• Contraindication
• Hypersensivity to ACE inhibitors known or
  suspected renovascular disease aortic stenosis
  pregnancy porphyria.

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Captopril (Tablet)

• Side effects
• Side effects are headache, dizziness, fatigue,
  trackycardia, jaundice, diarrhea, hyperkalaemia,
  hyponatraemia, palpitations, back pain,
  pancreatitis, mood changes etc.
• Caution
• Renal function and electrolytes should be
  checked before starting ACE inhibitors and
  monitored during treatment.
• Dose
• For severe hypertension 25 mg twice daily
  increasing if necessary to 50 mg three times
  daily.

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Available ACE inhibitors in Bangladesh
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