Use of α blockers in Hypertension α-Blockers block neuromuscular transmission by occupying the postsynaptic α1-adrenoceptor on the smooth muscle cell, causing vasodilation. Their major adverse effects are dizziness, headache, orthostatic hypotension (particularly first-dose hypotension), and an increased risk of falls and hip fractures). Since the early termination of the doxazosin arm of Antihypertensive and Lipid-Lowering …
Use of β blockers in Hypertension Although traditionally an acceptable first-line therapy for hypertension, β-blockers (particularly atenolol, which has 72% of the clinical trial data) are not recommended by contemporary guidelines as initial therapy for patients with uncomplicated hypertension. Four possible mechanisms have been invoked for how β-blockers reduce BP: 1. Inhibit renin release from the …
Use of renin inhibitors in Hypertension Initial enthusiasm for these drugs has been tempered by the findings of the ALTITUDE trial, which randomized patients with type 2 diabetes mellitus to: • Aliskiren and an ACEi inhibitor or ARB; or • Placebo and an ACEi inhibitor or ARB ALTITUDE was stopped early, after there was a signal for …
Use of angiotensin receptor blockers in Hypertension ARBs inhibit the binding of angiotensin II to its subtype 1 receptor, which also results in vasodilation and BP lowering. They do not cause as much cough as ACE inhibitors, and whether they cause angioedema is unclear. Just like ACE inhibitors, ARBs should not be used in pregnancy …
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Use of ACE inhibitors in Hypertension ACE inhibitors inhibit the conversion of angiotensin I to angiotensin II, thereby producing vasodilation and lowering BP. Because the hydrolysis of bradykinin is also inhibited by these drugs, cough (7% to 12%) can occur. Angioedema (0.7%) can also occur via pathobiology that remains obscure, and its occurrence can be …
Use of CCBs in Hypertension The many available CCBs can be divided pharmacologically into two subgroups: dihydropyridines (e.g., nifedipine, amlodipine) and nondihydropyridines (e.g., verapamil, diltiazem). The latter typically have negative inotropic and chronotropic properties, whereas the former are more vasoselective and can increase heart rate, especially acutely if immediate-release preparations are given. All CCBs inhibit …
What classes of antihypertensive agents are currently available? Diuretics, CCBs, ACE inhibitors, ARBs, direct renin inhibitors, β-blockers, and α-blockers are available. There are additional drug classes available, which have more profound adverse effects and which are not first-line or second-line or even third-line agents. These include mineralocorticoid receptor antagonists, α-adrenergic receptor agonists (e.g., clonidine, guanfacine, …
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