ALL INDIA INSTITUTE OF MEDICAL AND SCIENCE

NEW DELHI

2021-2022

Drug presentation on
Anti- hypertensive

Submitted to: Submitted by:

Mrs. Sibi Riju Priya Singh
Associate professor 1st year M. Sc Nursing
CON, AIIMS DELHI CON, AIIMS DELHI
ANTIHYPERTENSIVE DRUGS
INTRODUCTION
There are multiple classes of antihypertensive medications used for the treatment of HTN; the
most recommended classes used as first-line for treatment are: Diuretics. Calcium channel
blockers. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor
blockers (ARBs)
Hypertension-
Elevation of systolic and diastolic BP above 140/90 mm of hg. It is a common cardiovascular
entity.
Hypertension may be
 Primary(essential) hypertension – where the cause is not known
 Secondary hypertension- when it is secondary to other condition like renal, endocrine
or vascular disorders.

Classification
The classes of blood pressure medications include:
 Diuretics
 Beta-blockers
 ACE inhibitors
 Angiotensin II receptor blockers
 Calcium channel blockers
 Alpha blockers
 Alpha-2 Receptor Agonists
  Central agonists
 Peripheral adrenergic inhibitors
 Vasodilators

DIURETICS
 These are drugs which cause a net loss of Na+ and water in urine.
 There are several categories of diuretics. All diuretics increases the excretion of water
from body.
 The antihypertensive effect of diuretics is mild-BP falls by 15-20 mm of hg over 2-4
weeks.
How it works

Diuretics enhance the excretion of sodium and water resulting in

1. ↓Plasma volume → ↓ cardiac output → ↓BP

2. ↓Body sodium → relaxation of vascular smooth muscles(due to Na+ depletion in the
vascular smooth muscle) → ↓ PVR → ↓ BP
Examples-
 Thiazides: Hydrochlorothiazide, Chlorthalidone, Indapamide
 High ceiling: Furosemide
 K+ sparing: Spironolactone, Triamterene, Amiloride
Indication
 Edema
o Congestive heart failure
o Acute pulmonary edema
o Cirrhosis
o Nephrotic syndrome
 Hypertension
 Hypercalcemia
 Forced Diuresis
Side effect
 Excessive volume depletion
o Circulatory collapse
o Azotaemia and hyperuricemia
 Hypokalemia
o Cardiac arrythmias
 Hypocalcemia
  Hypomagnesemia
 Ototoxicity
Nursing responsibility-

 Take the tablets in the morning so increase urination will not disturb sleep.
 Measure and record weight to monitor fluid changes.
 Hypokalemia can occur with some diuretics, Arrange potassium rich diet or
supplemental potassium as needed.
 Instruct patient drug may be taken with food or meal if GI upset occur.
 Advice pts. That they may experience these side effects: increase volume and
frequency of urine, dizziness, feeling fainting on arising, drowsiness, sensitivity to
light, increase thirst.
 Instruct pt. to report wt. changes of more than 3 pounds in 1 day,swelling in ankles,
dizziness or cramps.

BETA BLOCKERS
Beta-blockers are drugs that can lower stress on the heart and blood vessels. They can also
help manage migraine, anxiety, tremor, and other conditions.
Other names for beta-blockers include beta-antagonists, beta-adrenergic blocking agents, and
beta-adrenergic antagonists.
Beta blockers are primarily prescribe to manage cardiovascular symptoms, such as angina
and high blood pressure.
Beta-blockers work by blocking the action of certain hormones in the nervous system, such
as adrenaline. By doing this, they help prevent the activation of the “fight-or-flight” stress
response.
Adrenaline and noradrenaline are hormones that prepare the muscles in the body for exertion.
This is a crucial part of responding to danger.
If the body releases high levels of adrenaline, a person may experience a rapid heartbeat, high
blood pressure, excessive sweating, anxiety, and heart palpitations.
Blocking the release of these hormones lowers stress on the heart and reduces the force of the
contractions of the heart muscle. In turn, it also takes pressure off the blood vessels in the
heart, the brain, and the rest of the body.
Beta-blockers also obstruct the production of angiotensin II, which is a hormone that the
kidneys produce. This relaxes and widens the blood vessels, easing the flow of blood through
them.
Mechanism of action

Block sympathetic function of heart by blocking beta receptor-

1. ↓ HR → ↓ CO → ↓BP
 2. ↓ myocardial contractility → ↓CO → ↓BP
Examples of beta blocker-
 Acebutolol (sectral)
 Atenolol (tenormin)
 Bisoprolol (zebeta)
 Metoprolol (lopressor, toprol XL)
 Nadolol (corgard)
 Propranolol (inderal)
 Sotalol (betapace)
 Carvedilol (coreg)
INDICATIONS
 Angina
 Congestive heart failure
 Hypertension, or high blood pressure
 Irregular heartbeat
 Myocardial infarction, or heart attack
 A rapid heartbeat, or tachycardia
 Coronary heart disease
SIDE EFFECTS
 slow heartbeat, or bradycardia
 low blood pressure
 cold feet and hands
 fatigue
 nausea and vomiting
 weakness and dizziness
 abdominal discomfort
 constipation
 sleeping difficulties and disturbances
 erectile dysfunction
  memory loss
 confusion
 fluid retention, or edema, which may occur when a person starts using carvedilol
Precaution-

 Teach pt. not to discontinue abruptly, because it may cause angina if stopped abruptly.
 Teach not to take OTC products.
 Teach pt. how to take BP at home.
 Instruct pt. to comply with wt. control, dietary adjustment, and modified exercise programs.
 Caution pt. to avoid hazardous activities as it may increase dizziness and drowsiness.
 Symptoms of hypoglycaemia may be masked in diabetic patients
 Teach pt. to take drugs as prescribed, not to double the dose,

ACE INHIBITORS
Angiotensin-converting-enzyme inhibitors are a class of medication used primarily for the
treatment of high blood pressure and heart failure. They work by causing relaxation of blood
vessels as well as a decrease in blood volume, which leads to lower blood pressure and
decreased oxygen demand from the heart.
Angiotensin-converting enzymes inhibitors (ACE Inhibitors) are antihypertensive agents
that act in the lungs to prevent the conversion of angiotensin I into angiotensin II, which is a
potent vasoconstrictor.
 Angiotensin-converting enzyme (ACE) inhibitors are medications that help relax the veins
and arteries to lower blood pressure. ACE inhibitors prevent an enzyme in the body from
producing angiotensin II, a substance that narrows blood vessels.
MECHANISM OF ACTION:
ACE inhibitors have two primary functions.
First, they decrease the amount of sodium retained in the kidneys. Secondly, they stop the
production of a hormone called angiotensin II.
This hormone usually causes blood vessels to narrow. When this hormone isn’t produced,
blood flows through the vessels more effectively. This helps the blood vessels to relax and
expand, which lowers blood pressure.
Side effects from ACE inhibitors are rare.
You may have a dry cough.
You may feel dizzy or lightheaded when you start taking these medicines, or if your provider
increases your dose. Standing up slowly from a chair or your bed may help. If you have a
fainting spell, call your provider right away.
Other side effects include:
  Headache
 Fatigue
 Loss of appetite
 Upset stomach
 Diarrhea
 Numbness
 Fever
 Skin rashes or blisters
 Joint pain
 If your tongue or lips swell, call your provider right away, or go to the emergency
room. You may be having a serious allergic reaction to the medicine. This is very
rare.
Interactions

 Allopurinol: increased risk for hypersensitivity

 NSAIDs: increased risk for decreased antihypertensive effects
Nursing responsibility-

 Teach pt. not to discontinue drugs, as the symptoms may not appear but the disease is
not cured.
 Avoid OTC drugs.
 Avoid Xanthenes such as coffee, tea, chocolate, cola etc.
 Rise slowly to avoid orthostatic hypotension.

 Not suitable during pregnancy

 The concomitant use of potassium supplements and potassium-containing salt substitutes is not
Recommended.
ANGIOTENSIN II RECEPTOR BLOCKERS
Angiotensin II receptor blockers help relax your veins and arteries to lower your blood
pressure and make it easier for your heart to pump blood.
Angiotensin is a chemical in your body that narrows your blood vessels. This narrowing can
increase your blood pressure and force your heart to work harder.
Angiotensin II receptor blockers block the action of angiotensin II. As a result, the
medication allows your veins and arteries to widen (dilate).

Example- Candesartan
 Irbesartan
  Losartan
 Olmesartan
 Valsartan
Side effects of angiotensin II blockers can include:
 Headache, nausea, diarrhea, Dizziness and back pain.
 Higher than normal potassium levels in the blood (hyperkalemia)
 Swelling of the skin due to a buildup of fluid (angioedema)
 Don't take angiotensin II receptor blockers if you're pregnant or plan to become
pregnant because the drugs can harm a developing fetus.
Interactions

 Phenobarbital, indomethacin, rifamycin: loss of effectiveness of ARBs

 Ketoconazole, fluconazole, diltiazem: decreased antihypertensive effects of
ARBs
Nursing responsibility-

 Teach pt. to avoid sunlight, wear sunscreen, photosensitivity may occur.

 Teach to comply to dosage schedule.
 Teach to inform about mouth scar, sore throat, swelling of hands, feet etc.
 Teach pt. to rise to sitting and standing position slowly to avoid orthostatic
hypotension.

 Not suitable during pregnancy

 Teach concomitant use of potassium supplements and potassium-containing salt substitutes is
not recommended
CALCIUM CHANNEL BLOCKERS
Calcium channel blockers, calcium channel antagonists or calcium antagonists are a group of
medications that disrupt the movement of calcium through calcium channels. Calcium
channel blockers are used as antihypertensive drugs, i.e., as medications to decrease blood
pressure in patients with hypertension. 
Calcium channel blockers are medications used to lower blood pressure. They work by
preventing calcium from entering the cells of the heart and arteries. Calcium causes the heart
and arteries to squeeze (contract) more strongly. By blocking calcium, calcium channel
blockers allow blood vessels to relax and open.
CCB are of two types-
1. Dihydropyridines- Blocks L type calcium in vascular smooth muscles.
Examples- Amlodipine, Felodipine, Nicardipine and Nifedipine
Side effects- Dizziness, headache, flushing, peripheral edema and gingival hyperplasia
2. Non-dihydropyridine- Blocks L type and T type calcium channel in both vascular smooth
muscles and cardiac cells(such as SA and AV node)
Causes→ ↓contractility, ↓HR, ↓conduction
Example- Diltiazem and Verapamil
Side effect- Bradycardia, constipation
Side effects
 Dizziness or lightheadedness
 Low blood pressure
 Heart rhythm problems
 Dry mouth
 Edema (swelling of ankles, feet, or lower legs)
 Headache
 Nausea
 Fatigue
 Skin rash
 Constipation or diarrhea
 Gastro-esophageal reflux disease (GERD)
Interactions

 Increased serum level and toxicity of cyclosporine if taken with diltiazem.

 Grapefruit juice can increase serum level and toxicity of calcium-channel
blockers.
Nursing responsibility-

 Caution pt. to avoid hazardous activities as it may increase dizziness and drowsiness.
 Instruct to limit caffeine consumption
 Avoid drinking large quantities of grapefruit juice
 Have high fibre diet and drink plenty of fluid to reduce the side effect of constipation

ALPHA BLOCKERS
Alpha blockers lower blood pressure by preventing a hormone called norepinephrine from
tightening the muscles in the walls of smaller arteries and veins. As a result, the blood vessels
remain open and relaxed. This improves blood flow and lowers blood pressure.
Because alpha blockers also relax other muscles throughout the body, these medications also
can help improve urine flow in older men with prostate problems.
Alpha blockers are either short-acting or long-acting. Short-acting medications work quickly,
but their effects last only a few hours. Long-acting medications take longer to work, but their
effects last longer. The alpha blocker that's best for you depends on your health and the
condition being treated.
Alpha blockers are also called alpha-adrenergic blocking agents, alpha-adrenergic
antagonists, adrenergic blocking agents and alpha-blocking agents.
Examples of alpha blockers used to treat high blood pressure include:

Doxazosin (Cardura)

Prazosin (Minipress)

Terazosin

SIDE EFFECTS:
When you start taking an alpha blocker, you might develop low blood pressure and dizziness,
which can make you faint when you rise from a sitting or lying position. As a result, the first
dose is often taken at bedtime.
Other side effects might include:

Dizziness

Headache

Pounding heartbeat

Weakness

Nursing responsibility-

 Take first dose at bedtime to avoid postural hypotension

 Teach to report excessive perspiration , dehydration, vomiting, diarrhea.
 Check BP regularly

VASODIALATORS
Vasodilators are medications that open (dilate) blood vessels. They affect the muscles in the
walls of the arteries and veins, preventing the muscles from tightening and the walls from
narrowing.
As a result, blood flows more easily through the vessels. The heart doesn't have to pump as
hard, reducing blood pressure.
Examples- Hydralazine and minoxidil.
Vasodilators are prescribed to prevent, treat or improve symptoms in a variety of conditions,
such as:
 High blood pressure

High blood pressure during pregnancy or childbirth (preeclampsia or eclampsia)

Heart failure

High blood pressure that affects the arteries in the lungs (pulmonary hypertension)

SIDE EFFECTS:
Direct vasodilators are strong medications that generally are used only when other
medications haven't controlled blood pressure adequately.
Side effects include:
Rapid heartbeat (tachycardia)

Heart palpitations

Fluid retention (edema)

Nausea

Vomiting

Headache

Excessive hair growth

Joint pain

Chest pain

Nursing responsibility-

 Should tell your doctor if you develop symptoms of arthritis, unexplained fever or tiredness
 Check bleeding time in individual with bleeding disorder.
 Take drugs with meal to avoid GI irritation.
 Advice to quite smoking to prevent excessive vasoconstriction.

Nurses’ responsibility
 Monitor BP periodically, note pulse its rate, rhythm, quality, and check apical and
radial pulse before administration of drug.
 Check for renal and liver function test before therapy begins and periodically
thereafter.
 Assess for edema in feet and legs daily, monitor I/O, weight daily.
 Monitor patient response to therapy through blood pressure monitoring.
 Monitor for adverse effects (e.g. hypotension, arrhythmias, renal failure, cough, and
pancytopenia).
 Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.
 Educate patient on importance of healthy lifestyle choices which include regular
exercise, weight loss, smoking cessation, and low-sodium diet to maximize the effect
of antihypertensive therapy.
 Administer drug on empty stomach one hour before or two hours after meal to ensure
optimum drug absorption.
 Monitor renal and hepatic function tests to alert doctor for possible development of
renal and/or hepatic failure as well as to signal need for reduced drug dose.
 Monitor for presence of manifestations that signal decreased in fluid volume
(e.g. diarrhea, vomiting, dehydration) to prevent exacerbation of hypotensive effect of
drug.
 Educate patient and family members about drug’s effect to the body and
manifestations that would need reporting to enhance patient knowledge on drug
therapy and promote adherence.
 Emphasize to the client the importance of strict adherence to drug therapy to ensure
maximum therapeutic effects.