33 Antihypertensives

• antihypertensives work by either decreasing CO or decrease TPR

Beta Blockers

• do not want to block b2

• not really used for hypertension
• b1 blockade: general lower BP, including portal system
• b2 increase flow to liver, block to decrease flow

• carvedilol: clinical trial shows benefit, not because of special receptor

• at low sympathetic level, higher activation of beta receptor than sympathetic activity, thus agonist
• high level, lower activation of beta receptor than sympathetic, thus blocker

• fatigue, etc: blunt CNS activity
• hyperlipidemia not clinically relevant

• given because many benefits
• diabetics often hypoglycemic because taking insulin
• BB cause hypoglycemia and masks symptoms, except sweating (Ach receptors)

• decompensated
• acute HF: pt with pulmonary edema/sick from HF can get very sick with BB's lowering of CO

• stimulates myocardiocytes at different site
• stimulate heart and bypass beta receptors

Alpha Drugs

• tamsulosin very good for BPH

• warm autoimmune hemolytic anemia

CCB

Dihydropyridines

• pt not taking CCB: arteriole constrict, leading to lower hydrostatic pressure in capillaries
• CCB: dilate arteriole, higher hydrostatic pressure

• like b1, slow HR, decrease contractility

AII

• inhibits renin, decrease AI production

• HCTZ: used often for antihypertensives by inhibit Na absorption

Hydralazine

Hypertensive Emergency

• rapid acting drugs that can be titrated carefully

• increased renal perfusion

Antihypertensive SE

• diuretic pts: dependent on AII to maintain BP
• ACE I block AII
• occurs with first dose of ACE I given to diuretic pt

Choosing Antihypertensives

• RAAS blockade leads to malformation
• ACE I: decrease AII, renal failure
• aldosterone decrease: more K