Identify current drug therapies for hypertensive patients

Single-agent therapy is usually initiated; if this is ineffective, multiple agents may be prescribed. Multiple factors determine which agents are used, including race, gender, age, and comorbidities. For instance, black patients respond better to calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and p-blockers. p-Blockers are relatively contraindicated in patients with reactive airway disease, and patients with renal artery stenosis should not receive ACE inhibitors. Diuretics produce hypokalemia and hyperglycemia. p-Blockers are not particularly effective in elderly patients. Table 28-1 reviews commonly prescribed antihypertensive medications.

TABLE 28-1. COMMONLY PRESCRIBED ANTIHYPERTENSIVE MEDICATIONS

Class

Examples

Side Effects

Thiazide diuretics

Hydrochlorothiazide

Hypokalemia, hyponatremia,

hyperglycemia, hypomagnesemia,

hypocalcemia

Loop diuretics

Furosemide

Hypokalemia, hypocalcemia,

hyperglycemia, hypomagnesemia,

metabolic alkalosis

ß-Blockers

Propranolol,

Bradycardia, bronchospasm,

metoprolol, atenolol

conduction blockade, myocardial

depression, fatigue

a-Blockers

Terazosin, prazosin

Postural hypotension, tachycardia, fluid

retention

a2-Agonists

Clonidine

Postural hypotension, sedation,

rebound hypertension, decreases

MAC

Calcium channel

Verapamil, diltiazem,

Cardiac depression, conduction

blockers

nifedipine

blockade, bradycardia

ACE inhibitors

Captopril, enalapril,

Cough, angioedema, fluid retention,

lisinopril, ramipril

reflex tachycardia, renal dysfunction,

hyperkalemia

Angiotensin receptor

Losartan, irbesartan,

Hypotension, renal failure,

antagonists

candesartan

hyperkalemia

Vascular smooth

Hydralazine, minoxidil

Reflex tachycardia, fluid retention

muscle relaxants

Adapted from Morgan GE, Mikhail MS, Murray MJ: Clinical anesthesiology, ed 4, New York, 2005,

McGraw-Hill, Chapter 20.

ACE, Angiotensin-converting enzyme; MAC, minimal alveolar concentration.

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