05/09/2025
📌 ANTIHYPERTENSIVES (Blood Pressure drugs)
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🔹 Definition
Antihypertensives are drugs used to lower high blood pressure and manage cardiovascular conditions like heart failure, angina, and arrhythmias.
🔹 Major classes & common examples
1. Diuretics (water pills)
Thiazides: Hydrochlorothiazide (HCTZ), Chlorthalidone, Indapamide
Loop: Furosemide, Bumetanide, Torsemide
Potassium-sparing: Spironolactone, Amiloride, Eplerenone
2. Beta-blockers (β-blockers)
Cardioselective: Atenolol, Metoprolol, Bisoprolol, Nebivolol
Non-selective: Propranolol, Nadolol, Timolol
With alpha-blocking activity: Carvedilol, Labetalol
3. Calcium Channel Blockers (CCBs)
Dihydropyridines: Amlodipine, Nifedipine, Felodipine
Non-dihydropyridines: Verapamil, Diltiazem
4. ACE Inhibitors
Lisinopril, Enalapril, Ramipril, Captopril, Perindopril
5. ARBs (Angiotensin II Receptor Blockers)
Losartan, Valsartan, Telmisartan, Olmesartan, Irbesartan
6. Alpha-blockers
Prazosin, Doxazosin, Terazosin
7. Central Acting Agents
Methyldopa, Clonidine, Moxonidine
8. Direct Vasodilators
Hydralazine, Minoxidil
9. Other special agents
Aliskiren (direct renin inhibitor)
Isosorbide dinitrate (for heart failure with hydralazine in some patients)
🔹 Main Uses (Therapeutic Indications)
Primary hypertension (all classes depending on patient profile)
Heart failure: ACE inhibitors, ARBs, Beta-blockers, Spironolactone
Angina (chest pain): Beta-blockers, CCBs
Arrhythmias: Beta-blockers, Verapamil, Amiodarone (not first-line BP)
Post-heart attack (MI): Beta-blockers, ACE inhibitors
Pregnancy hypertension/preeclampsia: Methyldopa, Labetalol, Hydralazine
Kidney protection in diabetics: ACE inhibitors, ARBs
🔹 Side Effects (Class-Based)
Diuretics: frequent urination, low potassium (except spironolactone), gout
Beta-blockers: fatigue, bradycardia, cold extremities, worsen asthma, erectile dysfunction
CCBs (Amlodipine/Nifedipine): ankle swelling, flushing, headache, dizziness
Verapamil/Diltiazem: constipation, slow heart rate
ACE inhibitors: persistent dry cough, high potassium, angioedema
ARBs: similar to ACE inhibitors but no cough
Alpha-blockers: dizziness, fainting (esp. first dose), nasal congestion
Methyldopa: sedation, depression, liver problems
Clonidine: dry mouth, rebound hypertension if stopped suddenly
Hydralazine/Minoxidil: headache, fluid retention, reflex tachycardia, Minoxidil → hair growth
🔹 Contraindications
❌ Beta-blockers → asthma, severe bradycardia, heart block
❌ ACE inhibitors/ARBs → pregnancy, bilateral renal artery stenosis, history of angioedema
❌ Diuretics → gout (thiazides), renal failure (HCTZ ineffective if GFR
