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Hypertension (Antihypertensives)

Antihypertensives

Amiloride Enalapril Nifedipine
Amlodipine Felodipine Perindopril
Atenolol Furosemide Prazosin
Bisoprolol Irbesartan Propranolol
Captopril Labetolol Ramipril
Carvedilol Losartan Spironolactone
Chlorothiazide Methyldopa Telmisartan
Clonidine Metolazone Valsartan
Diltiazem Metoprolol Verapamil
Minoxidil

ANTIHYPERTENSIVES

Types ACTIONS SIDE EFFECTS SPECIAL PRECAUTION
Beta – Blockers :
Atenolol
Bisoprolol
Carvedilol
Labetolol
Metoprolol
Propranolol
  • Control high blood pressure
  • Relieve cardiac chest pain or angina
  • Control irregular heartbeats or other abnormal heart rhythms
  • Prevent additional heart attacks
  • Help treat congestive heart failure
  • Other indications include : glaucoma, migraine headaches, tremors
Common :

  • dizziness or lightheaded
    ness
  • drowsiness
  • insomnia
  • unusual tiredness or fatigue
  • cold hands and feet

Less common :

  • breathing difficulties
  • swelling of feet and lower legs
  • heartbeat less than 50 beats a minute

If any of these occur, contact your doctor immediately.

Tell your doctor / pharmacist if you

  • take allergy shots or
  • are on medicine for asthma or hay fever
  • Have lung disease,
  • Have diabetes
  • Have depression.

These conditions can be aggravated by beta blockers.

Angiotensin Converting Enzyme Inhibitors :
Captopril
Enalapril
Perindopril
Ramipril
  • Control high blood pressure
  • Treat congestive heart failure
  • Other indications : improve kidney function in diabetes
Common :

  • dizziness
  • lightheaded
    ness, especially upon standing up
  • red, itchy skin rash
  • chronic, nagging cough or sore throat

The nagging cough associated with ACE inhibitors can be aggravating, is usually “dry,” and is not associated with shortness of breath.

Less common :

  • swelling of the face, lips and / or tongue and difficulty breathing

If any of these occur, contact your doctor immediately.

Tell your doctor / pharmacist if you have

  • gout
  • arthritis
  • heart disease or high blood pressure
  • kidney disease
  • lupus These medications can also cause
  • low blood pressure
  • deterioration of your kidney
  • increase in your potassium level

Your doctor will order blood tests to check potassium and kidney function after you have started on one of these medications.

Calcium Channel Blockers : Amlodipine
Diltiazem
Felodipine
Nifedipine
Verapamil

  • Relieve or prevent cardiac chest pain or angina
  • Treat high blood pressure
  • Control irregular heartbeats or abnormal heart rhythms (verapamil and diltiazem only)
  • Other uses: relieve symptoms caused by spasms from brain hemorrhage
Common :

  • dizziness when standing up
  • diarrhea or constipation
  • blurred vision

Less common :

  • difficulty breathing
  • swelling of the hands and / or feet
  • irregular heartbeats
  • swelling of the gum tissue

If any of these occur, contact your doctor immediately.

Tell your doctor / pharmacist if you

  • are on other medications to treat a heart condition or high blood pressure
  • have ever been treated for a slow heart beat or congestive heart failure

Do not stop taking these medications suddenly or without your doctor’s guidance. Suddenly stopping this medication can cause unpleasant and even harmful effects on your heart and blood vessels.

Angiotensin Ii Receptor Antagonists :
Losartan
Telmisartan
Valsartan
  • treat high blood pressure
  • treat Congestive heart failure

Angiotensin II receptor antagonists are medications that lower blood pressure by blocking a hormone in the body that can constrict blood vessels.

Common :

  • dizziness
  • faintness
  • headache
  • nausea
  • diarrhea

Less common :

  • sleep disturbances
  • cough
  • swelling of the face, lips and / or tongue and difficulty breathing

If any of these occur , contact your doctor immediately.

Tell your doctor / pharmacist if you

  • Have any other medical conditions, especially kidney disease

These drugs can also cause your kidney function to deteriorate or your potassium level to elevate. Your doctor may ask you to get a blood test occasionally to check on this.

Diuretics :

Thiazide Diuretics
Chlorothiazide
Metolazone

Loop Diuretics
Furosemide

Potassium Sparing Diuretics
Amiloride
Spironolactone
Moduretic (Amiloride Plus Hydrochlortizide)

Diuretics are used to treat :

  • High blood pressure
  • Congestive heart failure
  • Excess fluid retention

Diuretics work by causing the kidneys to excrete unneeded water and salt into the urine. Therefore, diuretics are often referred to as “water pills” .

Common :

  • frequent urination
  • dizziness on standing
  • thirst
  • weakness

Less common :

  • sore throat
  • bruising
  • skin rash

If any of these occur, contact your doctor immediately.

Tell your doctor / pharmacist if you

  • are on lithium, sleeping pills or other medication to treat arthritis or high blood pressure.
  • have diseases of the liver or kidneys, diabetes or gout
  • are allergic to sulfa drugs

Diuretics can cause you to lose potassium. When your potassium level is low, you may feel more tired. Low potassium can also cause muscle cramping or abnormal heart rhythms. It is important to have your blood level of potassium checked on a regular basis to make sure that it is within normal limits. Your doctor may ask you to take a potassium supplement.

Although most diuretics can cause your potassium level to be too low, potassium sparing diuretics listed above can cause your potassium level to be too high.

It is usually best to take diuretics in the morning to avoid disturbing your sleep with trips to the toilet at night.

Centrally Acting Antihypertensives:
Clonidine
Methyldopa
  • lower heart rate
  • reduce blood pressure

They work by preventing your brain from sending signals to your nervous system to speed up your heart rate and narrow your blood vessels. As a result, your heart doesn’t pump as hard and your blood flows more easily through your blood vessels.

Common :

  • confusion
  • dizziness
  • drowsiness
  • sedation
  • impotence
  • constipation
  • dry mouth
  • headache

Less common :

  • rapid heartbeat
  • slow heartbeat
  • palpitations
  • chest pain
  • congestive heart failure

If any of these occur, contact your doctor immediately.

Abruptly stopping use of some central-acting agents can cause a sudden, dangerous increase in blood pressure. Do not stop taking these medications without talking to your doctor.

Alpha-Adrenergic Blocking Agents (Alpha Blocker)

Prazosin

Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from stimulating the muscles in the walls of smaller arteries and veins. This stimulation makes the vessel walls constrict. Blocking that effect causes the vessels to remain open and relaxed. This improves blood flow and lowers blood pressure. Common :

  • headache
  • pounding heartbeat
  • nausea
  • weakness

Less common :

  • skin rash
  • nasal congestion

Tell your doctor / pharmacist if you

  • have sudden loss of consciousness When you first start taking an alpha blocker, you may develop pronounced low blood pressure and dizziness, which can make you suddenly faint when you rise from a sitting or lying position. This symptom is called “first dose effect”
  • have liver disease

Alpha blockers can cause heart failure with long-term use. As a result, alpha blockers are less likely to be used alone to treat high blood pressure – a condition that often requires long-term medication use. Talk to your doctor about your situation.

Direct Vasodilator Minoxidil Direct vasodilators are medications that open (dilate) blood vessels. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily, your heart doesn’t have to pump as hard and blood pressure is reduced.

Common :

  • fluid retention
  • dizziness
  • flushing
  • headache
  • excessive hair growth
  • nasal congestion

Less common :

  • chest pain
  • rapid heartbeat
  • heart palpitation

If any of these occur, contact your doctor immediately.

Direct vasodilators are potent medications and are generally used only as a last resort, when other medications haven’t adequately controlled your blood pressure.

In large doses, some direct vasodilators can increase your risk of developing lupus, a connective tissue disease.

Last Reviewed : 10 July 2008
Writer : Dr. Nour Hanah Othman
  : Hadijah bt. Mohd Taib
  : Rosidah bt. Din
  : Nor Eizlin bt. Mohd Helmi