Monday, May 17, 2021

Classes of Blood Pressure Medications with Examples

by | September 25, 2020 0

Blood pressure medications also known as antihypertensive drugs or hypotensives are drugs that are employed to relax, dilate and lower blood pressure (BP) to normal. It must be pointed out that there is no hard line drawn between hypertensive and normotensive subjects. However, it is generally accepted that systolic/diastolic blood pressure of 120/80 mm Hg or less is normal while a figure of systolic/diastolic blood pressure of 140/90 mmHg is considered the upper limit of ‘normal’.

Read Also: Understanding blood pressure readings

Several antihypertensive drugs with different sites and mechanism of actions are now available. Nevertheless, none can be said to be the ideal antihypertensive medication. Initial drug selection depends on the degree of blood pressure elevation and presence of compelling indications for selected drugs.

Classes of blood pressure medications

The classes of blood pressure medications include

  1. Angiotensin-Converting Enzyme Inhibitors (ACEIs)
  2. Beta-blockers
  3. Diuretics
  4. Angiotensin II receptor blockers (ARBs)
  5. Calcium channel blockers (CCBs)
  6. α-Adrenoreceptor blockers
  7. Central α2-agonists
  8. Direct vasodilators
  9. Direct renin inhibitors
  10. Aldosterone receptor antagonists (ARAs)

1. Angiotensin-Converting Enzyme Inhibitors (ACEIs)

The ACEIs directly inhibit conversion of angiotensin I to angiotensin II, a potent vasoconstrictor and stimulator of aldosterone secretion. This helps blood vessels relax and reduces blood pressure. ACEIs also block kininase production and thus, prevent degradation of bradykinin. This appears to be important in the aetiology of ACEI induced cough, which is a troublesome side effect in 10–20% of users.

Examples of ACE inhibitors used in the management of hypertension include

Generic name Common brand names Usual dose range (mg/day) Daily frequency
Benazepril Lotensin 10 – 40 1 or 2
Captopril Capoten 12.5 – 150 2 or 3
Enalapril Vasotec 5 – 40 1 or 2
Fosinopril Monopril 10 – 40 1
Lisinopril Prinivil, Zestril 10 – 40 1
Moexipril Univasc 7.5 – 30 1 or 2
Perindopril Aceon 4 – 16 1
Quinapril Accupril 10 – 80 1 or 2
Ramipril Altace 2.5 – 10 1 or 2
Trandolapril Mavik 1 – 4 1

Some noted possible side effects of ACEIs

  • Dry cough
  • Rash
  • Taste disturbance
  • Renal dysfunction
  • Angioedema

2. Beta-blockers (Beta-Adrenergic Blockers)

β-Blockers have several direct effects on the cardiovascular system. They can decrease cardiac contractility and cardiac output (CO), lower heart rate, blunt sympathetic reflex with exercise, reduce central release of adrenergic substances, inhibit norepinephrine release peripherally, and decrease renin release from the kidney. All these contribute to their antihypertensive effects.

Examples of beta-blockers include

Generic name Common brand names Usual dose range (mg/day) Daily frequency
a.      Cardioselective beta-blockers
Atenolol Tenormin 25 – 100 1
Betaxolol Kerlone 5 – 20 1
Bisoprolol Zebeta 2.5 – 10 1
Metoprolol tartrate Lopressor 100 – 400 2
Metoprolol succinate extended
release
Toprol XL 50 – 200

 

1
b.      Nonselective beta-blockers
Nadolol Corgard 40 – 120 1
Propranolol Inderal 160 – 480 2
Propranolol long acting Inderal LA, Inderal XL, InnoPran XL 80 – 320 1
Timolol Blocadren 10 – 40 1
c.       Beta-blockers with intrinsic sympathomimetic activity
Acebutolol Sectral 200 – 800 2
Carteolol Cartrol 2.5 – 10 1
Pindolol Visken 10 – 60 2
d.       Mixed α- and β- blockers
Carvedilol Coreg 12.5 – 50 2
Carvedilol phosphate Coreg CR 20 – 80 1
Labetalol Normodyne, Trandate 200 – 800 2
e.        Cardioselective and vasodilatory beta-blockers
Nebivolol Bystolic 5 – 20 1

Some noted possible side effects of Beta-blockers

  • Tiredness/fatigue
  • Reduced exercise tolerance
  • Bradycardia
  • Cold peripheries
  • Claudication
  • Wheezing
  • Impotence

3. Diuretics

Diuretics, also called water pills, are drugs that are used to facilitate elimination of extracellular fluid from the body. They exert their effect directly on the kidneys and reduce blood pressure by causing diuresis.

 

Generic name Common brand names Usual dose range (mg/day) Daily frequency
a.      Thiazide diuretics
Chlorthalidone Hygroton 12.5–25 1
Hydrochlorothiazide Esidrix, HydroDiuril, Microzide, Oretic 12.5–50 1
Indapamide Lozol 1.25–2.5 1
Metolazone Zaroxolyn 2.5–10 1
b.      Loop diuretics
Bumetanide Bumex 0.5–4 2
Furosemide Lasix 20–80 2
Torsemide Demadex 5–10 1
c.       Potassium-sparing diuretics
Amiloride Midamor 5–10 1 or 2
Amiloride/ hydrochlorothiazide Moduretic 5–10/50–100 1
Triamterene Dyrenium 50–100 1 or 2
Triamterene/ hydrochlorothiazide Dyazide 37.5–75/25–50 1

Some noted possible side effects of diuretics

Thiazide diuretics

  • Hypokalaemia
  • Gout
  • Glucose intolerance
  • Hyperlipidaemia
  • Impotence
  • Uraemia
  • Dehydration

Loop diuretics

  • Dehydration
  • Hypotension
  • Electrolyte Imbalance ( e.g., hyponatremia, hypochloremia, hypokalemia, hypocalcemia, hypomagnesemia)
  • Hyperglycemia
  • Hyperuricemia
  • Ototoxicity

Potassium sparing diuretics

  • Headache
  • Dizziness
  • Nausea
  • Skin rash
  • Dry mouth

Read Also: Understanding the Various Types of Hypertension

4. Angiotensin II receptor blockers (ARBs)

ARBs modulate the Renin-Angiotensin-Aldosterone System (RAAS) by directly blocking the angiotensin II type 1 receptor site, preventing angiotensin II-mediated vasoconstriction and aldosterone release. Examples of ARBs include

Generic name Common brand names Usual dose range (mg/day) Daily frequency
Azilsartan Edarbi 40 – 80 1
Candesartan Atacand 8 – 32 1 or 2
Eprosartan Teveten 600 – 800 1 or 2
Irbesartan Avapro 150 – 300 1
Losartan Cozaar 50 – 100 1 or 2
Olmesartan Benicar 20 – 40 1
Telmisartan Micardis 20 – 80 1
Valsartan Diovan 80 – 320 1

Some noted possible side effects of ARBs

  • Headache
  • Rash
  • Renal failure

5. Calcium channel blockers (CCBs)

These medications cause relaxation of cardiac and smooth muscle by blocking voltage-sensitive calcium channels, thereby reducing entry of extracellular calcium into cells. This leads to vasodilation and a corresponding reduction in blood pressure.

The dihydropyridine group work almost exclusively on L-type calcium channels in the peripheral arterioles and reduce blood pressure by reducing total peripheral resistance. In contrast, the effect of verapamil and diltiazem are primarily on the heart, reducing heart rate and cardiac output. Examples of calcium channel blockers include

Generic name Common brand names Usual dose range (mg/day) Daily frequency
a.       Dihydropyridine
Felodipine Plendil 5–20 1
Isradipine DynaCirc 5–10 2
Isradipine SR DynaCirc SR 5–20 1
Nicardipine SR Cardene SR 60–120 2
Amlodipine Norvasc 2.5–10 1
Nifedipine long-acting Adalat CC, Nifedical XL, Procardia XL 10–40 1
b. Non-dihydropyridine
Diltiazem sustained release Cardizem SR 180–360 2
Diltiazem sustained release Cardizem CD, Cartia XT, Dilacor XR, Diltia XT, Tiazac, Taztia XT 120–480 1
Diltiazem extended release Cardizem LA 120–540 1 (morning or evening)
Verapamil sustained release Calan SR, Isoptin SR, Verelan 180–480 1 or 2
Verapamil controlled onset, extended release Covera-HS 180–420

 

1 (in the evening)
Verapamil chronotherapeutic oral drug absorption system Verelan PM 100–400 1 (in the evening)

Some noted possible side effects of calcium channel blockers

Dihydropyridine

  • Flushing
  • Dizziness
  • Ankle swelling
  • Headache

Non-dihydropyridine

  • Dizziness
  • Bradycardia/heart block
  • Constipation ( verapamil only)

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