Antihypertensive

Chapter 7:  Antihypertensive Drugs

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Table of Contents
 

 

 

Anti-Hypertensive Drug Classes
 Diuretics  Sympatholytics  Vasodilators Calcium Channel Blockers  Angiotensin Converting Enzyme (ACE) Inhibitor

Diuretics

Thiazides

  • Hydrochlorothiazide (HydroDIURIL)
  • Chlorthalidone (Hygroton)
  • Chlorothiazide (Diuril)
  • Indapamide (Lozol)
  • Metolazone (Zaroxolyn)

Potassium Sparing

  • Amiloride (Midamor)
  • Spironolactone (Aldactone)
  • Triamterene (Dyrenium)

Loop Diuretics

  • Furosemide (Lasix), Bumetanide (Bumex), Ethacrynic acid (Edecrin)
  • Torsemide (Demadex)

 

Furosemide

 

Sympatholytics

Centrally Active

Adrenergic Neuron Blocker

Adrenoceptor Antagonists

Clonidine

 

Dexmedetomidine (Precedex)

 

 

Stoelting, R.K., "Antihypertensive Drugs", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, 302-312.

Methyldopa

 

Labetalol 

 

Stoelting, R.K., "Antihypertensive Drugs", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, 302-312.

Vasodilators
Diazoxide (Hyperstat) Hydralazine (Apresoline) Minoxidil (Loniten) Nitroprusside sodium (Nipride)
Nitroprusside

 

Calcium Channel Blockers

 

 

Amlodipine

 

Diltiazem

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Angiotensin Converting Enzyme Inibitors

 

***angiotensin receptor blocker

 

Essential Hypertension (represents greater than 90% of hypertension cases)

Control of Blood Pressure

Arterial pressure is determined by a number of interacting factors

Antihypertensive Drugs and Anesthesia

Stoelting, R.K., "Antihypertensive Drugs", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, 302-312.

  Considerations:  Anesthetic Management in Hypertensive Patients

Hypertension:  Organ Systems Effects

Chronic Hypertension: Effects on Cardiac function

Hulyalkar, A. R., and Miller, E.D., Evaluation of the Hypertensive Patient in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 157-165, 1998. Stoelting, R.K., "Calcium Channel Blockers", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, p. 352-353.

Watershed Infarct image courtesy of the Digital Slice of Life Cooperative Project (http://medstat.med.utah.edu/kw/sol/sss/index.html)

Malignant Nephrosclerosis Images

Image contribution by Saint Francis Hospital

Hulyalkar, A. R., and Miller, E.D., Evaluation of the Hypertensive Patient in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 157-165, 1998.

Hypertension & Anesthetic management

Hulyalkar, A. R., and Miller, E.D., Evaluation of the Hypertensive Patient in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 157-165, 1998. Stoelting, R.K., "Calcium Channel Blockers", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, p. 350; Stoelting, R.K., "Antihypertensive Drugs", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, 302-312;and "Peripheral Vasodilators", in Pharmacology and Physiology in Anesthetic Practice, Lippincott-Raven Publishers, 1999, 315-322.

Pharmacological Management of Hypertension

Antihypertensive Medication Sequence

Note the progression of antihypertensive medication 

  1. beginning with a low dosage of either an ACE inhibitor, calcium channel blocker or beta blocker
  2. and proceeding, if needed to add a diuretic
  3. and ultimately additional more powerful drugs, such as centrally acting sympatholytics, peripheral vasodilators or combination.

At each step dosages are reviewed and if the patient's hypertension is controlled then therapy may be continued with review for possible removal of medication.

Figure adapted from Harrison's "Principles of Internal Medicine, Thirteenth Edition, p. 1128

 

Hemorrhage, Subarachnoid, Hypertensive Vessels (left); Hemorrhage, Intraventricular Medulla, Extension into Lateral Recess and Subarachnoid Space (right): Courtesy of Digital Slice of Life (http://medstat.med.utah.edu/kw/sol/sss/index.html)

CT imaging: Right Renal Artery Stenosis (left); bilateral Renal Artery Stenosis (right)-(http://www.ctisus.org/angioatlas/abdominal/2_ras5a.html) used with permission
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