Antihypertensive Drugs

Gale Encyclopedia of Surgery,  (2004)  by Samuel Uretsky

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Antihypertensive drugs

Definition

Antihypertensive drugs are medicines that help lower blood pressure.

Purpose

All antihypertensive agents lower blood pressure, although the mechanisms of action vary greatly. Within this therapeutic class, there are several subgroups. There are a very large number of drugs used to control hypertension, and the drugs listed below are representatives, but not the only members of their classes.

Description

The calcium channel blocking agents, also called slow channel blockers or calcium antagonists, inhibit the movement of ionic calcium across the cell membrane. This reduces the force of contraction of heart muscles and arteries. Although the calcium channel blockers are treated as a group, there are four different chemical classes, leading to significant variations in the activity of individual drugs. Nifedipine (Adalat, Procardia) has the greatest effect on the blood vessels, while verapamil (Calan, Isoptin) and diltiazem (Cardizem) have a greater effect on the heart muscle itself.

Peripheral vasodilators such as hydralazine (Apresoline), isoxuprine (Vasodilan), and minoxidil (Loniten) act by relaxing blood vessels.

There are several groups of drugs that act by reducing adrenergic nerve stimulation, the excitatory nerve stimulation that causes contraction of the muscles in the arteries, veins, and heart. These drugs include the beta-adrenergic blockers and alpha/beta adrenergic blockers. There are also non-specific adrenergic blocking agents.

Beta-adrenergic blocking agents include propranolol (Inderal), atenolol (Tenormin), and pindolol (Visken). Propranolol acts on the beta-adrenergic receptors anywhere in the body, and has been used as a treatment for emotional anxiety and rapid heart beat. Atenolol and acebutolol (Sectral) act specifically on the nerves of the heart and circulation.

There are two alpha/beta adrenergic blockers, labetolol (Normodyne, Trandate) and carvedilol (Coreg). These work similarly to the beta blockers.

Angiotensin-converting enzyme inhibitors (ACE inhibitors) act by inhibiting the production of angiotensin II, a substance that induces both constriction of blood vessels and retention of sodium, which leads to water retention and increased blood volume. There are 10 ACE inhibitors currently marketed in the United States, including captopril (Capoten), benazepril (Lotensin), enalapril (Vasotec), and quinapril (Acupril). The primary difference between these drugs is their onset and duration of action.

The ACE II inhibitors, losartan (Cozaar), candesartan (Atacand), irbesartan (Avapro), telmisartan (Micardis), valsartan (Diovan), and eprosartan (Teveten) directly inhibit the effects of ACE II rather than blocking its production. Their actions are similar to the ACE inhibitors, but they appear to have a more favorable side effect and safety profile.

In addition to these drugs, other classes of drugs have been used to lower blood pressure, most notably the thiazide diuretics . There are 12 thiazide diuretics marketed in the United States, including hydrochlorothiazide (Hydrodiuril, Esidrex), indapamide (Lozol), polythiazide (Renese), and hydroflumethiazide (Diucardin). The drugs in this class appear to lower blood pressure through several

Antihypertensive Drugs Brand Name (Generic Name) Possible Common Side Effects Include: Accupril (quinapril hydrochloride) Headache, dizziness Aldatazide Diarrhea, fever, headache, decreased coordination Aldactone (spironolactone) Cramps, drowsiness, stomach disorders Aldomet (methyldopa) Fluid retention, headache, weak feeling Altace (ramipril) Headache, cough Calan, Calan SR (verapamil hydrochloride) Constipation, fatigue, decreased blood pressure Capoten (captopril) Decreased sense of taste, decreased blood pressure tiching, rash Cardene (nicardipine Hydrochloride) Dizziness, headache, indigestion and nausea, increased heartbeat Cardizem (diltiazem hydrochloride) Dizziness, fluid retention, headache, nausea, skin rash Cardura (doxazosin mesylate) Dizziness, fatigue, drowsiness, headache Catapres Dry mouth, drowsiness, dizziness, constipation Corgard (nadolol) Behaviorial changes, dizziness, decreased heartbeat, tiredness Corzide Dizziness, decreased heartbeat, fatigue, cold hands and feet Diuril (chlorothiazide) Cramps, constipation or diarrhea, dizziness, fever, increased glocose level in urine Dyazide Blurred vision, muscle and abdominal pain, fatigue DynaCirc (isradipine) Chest pain, fluid retention, headache, fatigue HydroDIURIL (hydrochlorothiazide) Upset stomach, headache, cramps, loss of appetite Hygroton (chlorthalidone) Anemia, constipation or diarrhea, cramps, itching Hytrin (terazosin hydrochloride) Dizziness, labored breathing, nausea, swelling Inderal (propranolol hydrochloride) Constipation or diarrhea, tingling sensation, nausea and vomiting Inderide Blurred vision, cramps, fatigue, loss of appetite Lasix (furosemide) Back and muscle pain, indigestion, nausea Lopressor (metoprolol tartrate) Diarrhea, itching/rash, tiredness Lotensin (benazepril hydrochloride) Nausea, dizziness, fatigue, headache Alozol (indapamide) Anxiety, headache, loss of energy, muscle cramps Maxzide Cramps, labored breathing, drowsiness, irritated stomach Minipress (prazosin hdrochloride) Headache, nausea, weakness, dizziness Moduretic Diarrhea, fatigue, itching, loss of appetite Monopril (fosinopril sodium) Nausea and vomiting, headache, cough Normodyne (labetalol hydrochloride) Fatigue, nausea, stuffy nose Plendil (felodipine) Pain in back, chest, muscles, joints, and abdomen, itching, dry mouth, respiratory problems Procardia, Procardia X (nifedipine) Swelling, constipation, decreased blood pressure, nausea, fatigue Sectral (acebutolol hydrochloride) Constipation or diarrhea, gas, chest and joint pain Ser-Ap-Es Blurred vision, cramps, muscle pain, dizziness Tenex (guanfacine hydrochloride) Headache, constipation, dry mouth, weakness Tenoretic Decreased heartbeat, fatigue, nausea Tenormin (atenolol) Nausea, fatigue, dizziness Veseretic Diarrhea, muscle cramps, rash Vasotec (enalapril maleate) Chest pain, blurred vision, constipation or diarrhea, hives, nausea Visken (pindolol) Muscle cramps, labored breathing, nausea, fluid retention Wytensin (guanabenz acetate) Headache, drowsiness, dizziness Zaroxolyn (metolazone) Constipation or diarrhea, chest pain, spasms, nausea Zestoretic (lisinopril hydrochlorothiazide) Fatigue, headache, dizziness Zestril (lisinopril) Labored breathing, abdominal and chest pain, nausea, decreased blood pressure