Chapter 13 Antihypertensive Drugs
1. Sustained hypertension leads to cardiovascular and renal damage, especially myocardial infarction (MI) and stroke.
Table 13-1 Classification of Blood Pressure for Adults
| Category | Systolic, MM Hg | Diastolic, MM Hg |
|---|---|---|
| Hypotensive | <90 | or <60 |
| Normal | 90−119 | and 60−79 |
| Prehypertension | 120−139 | or 80−89 |
| Stage 1 Hypertension | 140−159 | or 90−99 |
| Stage 2 Hypertension | ≥160 | or ≥100 |
1. Diuretics decrease filling pressure of the heart (preload) and reduce peripheral resistance (decrease afterload).
TABLE 13-2 Selection of Antihypertensive Drugs
| Patient Characteristic | Most Preferred Drugs | Least Preferred Drugs |
|---|---|---|
| Demographic Traits | ||
| African heritage | Calcium channel blocker, thiazide diuretic | — |
| Pregnancy | Methyldopa, hydralazine | ACE inhibitor, angiotensin receptor antagonist (ARB) |
| Lifestyle Traits | ||
| Physically active | ACE inhibitor, calcium channel blocker, alpha blocker | Beta blocker |
| Noncompliance | Oral centrally acting α-adrenoceptor agonist | |
| Concomitant Conditions | ||
| Angina pectoris | Hydralazine, minoxidil | |
| Asthma, COPD | Calcium channel blocker, ACE inhibitor | Beta blocker |
| Benign prostatic hyperplasia | Alpha blocker | — |
| Collagen disease | ACE inhibitor (but not captopril), calcium channel blocker | Hydralazine, methyldopa |
| Depression | ACE inhibitor, calcium channel blocker | Centrally acting α-adrenoceptor agonist, beta blocker, reserpine |
| Diabetes mellitus | ACE inhibitor, calcium channel blocker, angiotensin receptor antagonist | Beta blocker, diuretic |
| Gout | — | Diuretic |
| Heart failure | ACE inhibitor, diuretic Hydralazine | Calcium channel blocker |
| Hypercholesterolemia | Alpha blocker, ACE inhibitor, calcium channel blocker | Beta blocker, thiazide |
| Migraine | Beta blocker, calcium channel blocker | — |
| Myocardial infarction | Beta blocker, ACE inhibitor, ARB | — |
| Osteoporosis | Thiazide | — |
| Peripheral vascular disease | ACE inhibitor, calcium channel blocker, alpha blocker | Beta blocker |
ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; COPD, chronic obstructive pulmonary disease.
2. Thiazides and thiazide-related diuretics are most often used because they have vasodilatory properties in addition to diuretic effects.
4. Loop diuretics are only used in patients who don’t respond or are allergic to thiazide diuretics (ethacrynic acid).
5. Potassium-sparing diuretics are usually used in combination with other diuretics to prevent loss of potassium.
A thiazide or thiazide-like diuretic is a good medication to use first in treatment of hypertension.
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