antihypertensive agents

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antihypertensive agents

drugs including angiotensin-converting enzyme (ACE) inhibitors (A), beta-blockers (B), calcium channel blockers (C) and diuretics (D) used to control hypertension; a combined drug approach is advocated, especially in patients with diabetes, e.g. A + C or B + D see (Table 1) local anaesthetics should be used with caution in patients taking antihypertensive drugs, especially beta-blockers (Table 2)
Table 1: Drug treatment of hypertension
Drug typeExamplesComments
Thiazide diureticsBendroflumethiazide
Chlortalidone (Hygroton)
Cyclopenthiazide (Navidrex)
Indapamide (Natrilix)
Metolazone (Metenix 5)
Xipamide (Diurexan)
Indicated for hypertension in elderly patients
Tend to exacerbate diabetes, gout, systemic lupus erythematosus
May cause postural hypotension
Beta-blockers (‘.…lol’)Propranolol (Inderal)
Acebutolol (Sectral)
Atenolol (Tenormin)
Bisoprolol (Cardicor)
Carvedilol (Eucardic)
Celiprolol (Celectol)
Esmolol (Brevibloc)
Labetalol (Transdate)
Metoprolol (Betaloc)
Nadolol (Corgard)
Nebivol (Nebilet)
Oxprenolol (Trasicor)
Pindolol (Visken)
Sotalol (Beta-Cardone)
Timolol (Betim)
Should not be used by patients with asthma or bradycardia or hypotension
Should be avoided in patients with a history of Raynaud's
May cause distal paraesthesia, impotence, dizziness and exacerbation of psoriasis
Angiotensin-converting enzyme (ACE) inhibitors (‘..…pril’)Captopril
Cilazapril (Vascace)
Enalapril (Innovace)
Fosinopril (Staril)
Imidapril (Tanatril)
Lisinpril (Carace; Zestril)
Moexipril (Perdix)
Perindopril (Coversyl)
Quinapril (Accupro)
Ramipril (Tritace)
Trandolapril (Gopten)
Used only with care in patients taking diuretics, or those with peripheral vascular disease, generalized atherosclerosis and kidney disease
May cause profound hypotension, persistent cough, renal impairment, angioedema and pruritic rashes
Angiotensin II receptor antagonists (‘.…sartan’)Candesartan (Animax)
Eprosartan (Teveten)
Irbesartan (Aprovel)
Losartan (Cozaar)
Olmesartan (Olmetec)
Telmisartan (Micardis)
Valsartan (Diovan)
Used only with caution in patients with aortic or mitral valve stenosis, or renal artery disease
Tend not to be effective in Afro-Caribbean patients with left ventricular hypertrophy
Calcium-channel blockers (‘.…dipine’)Amlodipine (Istin)
Diltiazem (Calcicard)
Felodipine (Plendil)
Isradipine (Prescal)
Lacidipine (Motens)
Lercadidipine (Zanidip)
Nicardipine (Cardene)
Nifedipine (Adalat)
Nimodipine (Nimotrop)
Nisoldipine (Syscor MR)
Verapamil (Cordilox)
May cause abdominal pain, nausea, flushing, oedema, headache, dizziness, constipation and sleep disturbance
Alpha-blockers (‘.…zosin’)Doxazosin (Cardura)
Indoramin (Baratol)
Prazosin (Hypovase)
Terazosin (Hytrin)
Should not be used in patients with urinary incontinence
Tend to cause hypotension, dizziness, vertigo, headache, fatigue

Where antihypertensive drugs are used in combination, a rule-of-thumb guide indicates:

A + C (ACE inhibitors + calcium channel blockers)

B + D (beta-blockers + diuretics)

Table 2: Types of adverse drug reaction
ACommon, dose-related, predictable, augmented drug effect in patients showing excessive response to normal drug dosage; managed by dose reduction
BBizarre, rare, unpredictable, non-dose-related, immunological-based, severe drug reaction; drug must be withdrawn immediately
CGradual reduction of drug effectiveness over time; due to adaptation/habituation
DDelayed effects of drug
EEnd-of-use withdrawal reaction
FUnexpected failure of therapeutic effect, possibly due to interaction with another drug
References in periodicals archive ?
Five patients who required rapid-acting antihypertensive agents did not receive them, with systolic blood pressure ranging from 173 to 200 mmHg and diastolic from 113 to 123 mmHg.
1 outlines the steps for the use of rapid-acting antihypertensive agents for acute-onset severe hypertension during pregnancy and the postpartum period.
Guidelines from the European Stroke Organization provide similar recommendations with regard to blood pressure thresholds for treatment; however, they do not recommend specific antihypertensive agents (European Stroke Organisation Executive Committee & Writing Committee, 2008).
d) Discontinue nonpharmacological management and start combination pharmacological management using two antihypertensive agents
Previous studies of a possible link between breast cancer risk on the one hand and antihypertensive agents in general, and CCBs in particular, on the other hand, have produced inconsistent results.
18) In addition, multiple antihypertensive agents are usually required to achieve long-term control in most patients, particularly in African Americans who, as noted earlier, tend to have more-severe hypertension.
In the present study we have evaluated the efficacy of sildenafil citrate in men having erectile dysfunction receiving concomitant treatment with antihypertensive agents.
There have been no randomized, controlled trials of other antihypertensive agents in pregnancy, but anecdotes and case reports suggest that other [beta]-blockers and diltiazem are effective and may be used, he said.
For men taking VIAGRA and high blood pressure medication, the incidence of treatment-related adverse events was similar to that for the VIAGRA-treated men not taking any antihypertensive agents.
Combination of Two Antihypertensive Agents Recommended
The study suggests that distinctions may be made between specific antihypertensive agents and these may have distinguishable effects on different targets organs, and the grouping of such agents for purposes of analysis may be flawed.