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Classes of Blood Pressure Medications with Examples

by Pharmapproach
September 25, 2020
in Clinical Pharmacy
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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.

Contents

  • 1 Classes of blood pressure medications
    • 1.1 1. Angiotensin-Converting Enzyme Inhibitors (ACEIs)
    • 1.2 2. Beta-blockers (Beta-Adrenergic Blockers)
    • 1.3 3. Diuretics
    • 1.4 4. Angiotensin II receptor blockers (ARBs)
    • 1.5 5. Calcium channel blockers (CCBs)

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 nameCommon brand namesUsual dose range (mg/day)Daily frequency
BenazeprilLotensin10 – 401 or 2
CaptoprilCapoten12.5 – 1502 or 3
EnalaprilVasotec5 – 401 or 2
FosinoprilMonopril10 – 401
LisinoprilPrinivil, Zestril10 – 401
MoexiprilUnivasc7.5 – 301 or 2
PerindoprilAceon4 – 161
QuinaprilAccupril10 – 801 or 2
RamiprilAltace2.5 – 101 or 2
TrandolaprilMavik1 – 41

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 nameCommon brand namesUsual dose range (mg/day)Daily frequency
a.      Cardioselective beta-blockers
AtenololTenormin25 – 1001
BetaxololKerlone5 – 201
BisoprololZebeta2.5 – 101
Metoprolol tartrateLopressor100 – 4002
Metoprolol succinate extended
release
Toprol XL50 – 200

 

1
b.      Nonselective beta-blockers
NadololCorgard40 – 1201
PropranololInderal160 – 4802
Propranolol long actingInderal LA, Inderal XL, InnoPran XL80 – 3201
TimololBlocadren10 – 401
c.       Beta-blockers with intrinsic sympathomimetic activity
AcebutololSectral200 – 8002
CarteololCartrol2.5 – 101
PindololVisken10 – 602
d.       Mixed α- and β- blockers
CarvedilolCoreg12.5 – 502
Carvedilol phosphateCoreg CR20 – 801
LabetalolNormodyne, Trandate200 – 8002
e.        Cardioselective and vasodilatory beta-blockers
NebivololBystolic5 – 201

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 nameCommon brand namesUsual dose range (mg/day)Daily frequency
a.      Thiazide diuretics
ChlorthalidoneHygroton12.5–251
HydrochlorothiazideEsidrix, HydroDiuril, Microzide, Oretic12.5–501
IndapamideLozol1.25–2.51
MetolazoneZaroxolyn2.5–101
b.      Loop diuretics
BumetanideBumex0.5–42
FurosemideLasix20–802
TorsemideDemadex5–101
c.       Potassium-sparing diuretics
AmilorideMidamor5–101 or 2
Amiloride/ hydrochlorothiazideModuretic5–10/50–1001
TriamtereneDyrenium50–1001 or 2
Triamterene/ hydrochlorothiazideDyazide37.5–75/25–501

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 nameCommon brand namesUsual dose range (mg/day)Daily frequency
AzilsartanEdarbi40 – 801
CandesartanAtacand8 – 321 or 2
EprosartanTeveten600 – 8001 or 2
IrbesartanAvapro150 – 3001
LosartanCozaar50 – 1001 or 2
OlmesartanBenicar20 – 401
TelmisartanMicardis20 – 801
ValsartanDiovan80 – 3201

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 nameCommon brand namesUsual dose range (mg/day)Daily frequency
a.       Dihydropyridine
FelodipinePlendil5–201
IsradipineDynaCirc5–102
Isradipine SRDynaCirc SR5–201
Nicardipine SRCardene SR60–1202
AmlodipineNorvasc2.5–101
Nifedipine long-actingAdalat CC, Nifedical XL, Procardia XL10–401
b. Non-dihydropyridine
Diltiazem sustained releaseCardizem SR180–3602
Diltiazem sustained releaseCardizem CD, Cartia XT, Dilacor XR, Diltia XT, Tiazac, Taztia XT120–4801
Diltiazem extended releaseCardizem LA120–5401 (morning or evening)
Verapamil sustained releaseCalan SR, Isoptin SR, Verelan180–4801 or 2
Verapamil controlled onset, extended releaseCovera-HS180–420

 

1 (in the evening)
Verapamil chronotherapeutic oral drug absorption systemVerelan PM100–4001 (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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