Hypertension, or high blood pressure, can be caused by various factors and lead to serious health issues if left untreated. There are several classes of antihypertensive medications that work via different mechanisms to lower blood pressure. Beta blockers work by blocking epinephrine and norepinephrine effects to reduce heart rate and cardiac output. Angiotensin-converting enzyme (ACE) inhibitors inhibit the conversion of angiotensin I to angiotensin II to cause vasodilation and lower blood pressure. Angiotensin II receptor blockers (ARBs) selectively block the binding of angiotensin II to receptors to produce effects similar to ACE inhibitors. Calcium channel blockers inhibit the movement of calcium

1. Antihypertensives
Hypertension;
high blood pressure that stays elevated over time.
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Can lead to coronary artery disease, heart failure, stroke, CKD, retinopathy, Afib, aneurysms
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90% essential or idiopathic HTN
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Risk factors: age, obesity, physical inactivity, high-sodium, excess alcohol, smoking, family history
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Goal of therapy directed at decreasing cardiac output and TPR
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Mechanisms involved in increasing BP
BP; force of blood passing through arteries,veins,capilleries.
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Barorecetors; pressure sensitive nerve endings,detect pressure changes in arterial only. *relays signal to
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medulla:regulates force/speed of heart contraction.
medulla oblongata; regulates-force/speed of heart contractions
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(RAAS) Renin-angiotensin-aldosterone system; (hormonal response), long term BP
maintenance, angiotensin, aldosterone
decrease in BP leads to decrease in blood flow to kidneys.
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Juxtaglomerular Cells respond to release the enzyme RENIN
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Renin converts the inactive plasma protein angiotensin (in liver) into angiotenisn I.
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Angiotensin I is converted in the lungs to angiotensin II.
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Angiotensin II stimulated the adrenal cortex to release aldosterone.
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Aldosterone directs the kidney to reabsorb more sodium and Secrete K
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which leads to increased retention of Water.
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Water follows sodium back into the Extracellular fluid.
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Beta blockers
They work by blocking the effects of the hormone epinephrine and norepinephrine.
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They Reducing blood pressure.
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They Decrease heart rate.
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Beta-1 receptors; located primarily in the heart. (Acebutolol, Bisoprolol, Esmolol, Metoprolol)
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Beta-2 receptors; located in the smooth muscle of lungs, uterus, and other organs.
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2. Nonselective beta blockers; means that it will affect both beta-1 and beta-2 receptors. (Nadolol,
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Propranolol, Timolol, Carvedilol, Labetalol )
Clinical indications: HTN (less CO, less b1-mediated renin release) HF, angina pectoris, MI,
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supraventricular tachycardia, hyperthyroidism, glaucoma
Adverse effects
Cardiovascular inhibition- bradycardia, low BP, AV block, HF exacerbation
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CNS- lethargy, insomnia, seizures
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Dyslipidemia w/ metoprolol
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Erectile dysfunction
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Masked hypoglycemia (caution in DM)
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Asthma/COPD exacerbations (nonselectives-B2 blockade)
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Must be tapered over weeks to avoid withdrawal-angina, MI
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ACE inhibitors
Name; captopril, enalapril, lisinopril, benazepril, ramipril.
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Mechanism;
inhibit the conversion of angiotensin-1 to its more active from (angiotensin-2).
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ACE inhibitors counteract or inhibit all of the pharmacological effects of angiotensin-2, so they cause
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vasodilation, decrease aldosterone levels, Na+ & fluid wasting & K+ retention.
found mainly in the lungs
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Reduces Na+ and H20 reabsorption in the kidneys
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Increase renal blood flow
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Inhibits aldosterone release
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Decreases vasoconstriction
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Decreases BP
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ARBs ( Losartan, candesartan, valsartan)
ARBs block the action of angiotensin II, alowing the blood vessels to widen, thus making it easier for the heart
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to pump blood.
Mechanism;
Selectively block binding of angiotensin II to AT1 receptor.
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Effects similar to ACE inhibitors but ARBs do not increase bradykinin.
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Clinical:
Hypertension, Heart Failure, Chronic Kidney Disease
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Effects;
Hperkalemia, decrease GFR, Hypotension, teratogen.
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Aliskiren
Mechanism;
Aliskiren is a direct inhibitor of renin, blockers conversion of angiotensinogen to angiotensin 1.
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Clinical:
Hypertension
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Effects;
Hperkalemia, decrease GFR, Hypotension, angioderma.
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CCBs

3. A2-agonists aka Sympatholytics
adrenergic receptor
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located in postganglionic sympathetic nerve endings
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Inhibits release of norepinephrine; dilates blood vessels; produces hypotension; decreases gastrointestinal
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motility and tone.
Clonidine;
For refractory HTN
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Adverse: CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound HTN with
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abrupt cessation
Methyldopa
For HTN in pregnancy (alternatives: Nifedipine, Labetalol, Hydralazine
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Adverse: hemolytic anemia, drug-induced lupus, hyperprolactinemia
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antihyperlipidemics
Drugs that control lipids in the blood.
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two lipids that are found in blood (Cholesterol and Triglycerides)
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hyperlipidemia; Elevation of plasma cholesterol and/or TAGs and Low HDL levels.
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atherosclerosis; A disorder where lipid deposits accumulate in the linings in blood vessels. It slowly
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4. degeneates the body and blocks blood flow.
Drugs; Bile Salts, Cholestyramine, Colestipol, Atorastati, Lovastatin
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