Drugs acting on the heart: antihypertensive drugs

Abstract

Antihypertensive drugs are used commonly in anaesthesia and intensive care medicine. Patients might require antihypertensive drugs before surgery for the treatment of essential hypertension, pre-eclampsia or, occasionally for conditions such as phaeochromocytoma; during surgery as part of a deliberate hypotensive anaesthetic technique; or to reduce postoperative cardiovascular complications. Here, we discuss the physiology of blood pressure control, the pharmacology of antihypertensive drugs, current guidelines, and practical applications of antihypertensive therapy.Keywords antihypertensive agents; autonomic nervous system; blood pressure; hypertension; renin-angiotensin system; vasomotor system Introduction Arterial pressure is modulated by the interaction among vessel tone, blood volume, and cardiac function, which are regulated by local and nervous mechanisms. Local mechanisms include metabolites that influence vascular tone and blood flow within tissues. Nervous mechanisms control the distribution of blood throughout the body, as well as coordination of cardiac output, heart rate, and contractility. The autonomic nervous system (ANS) is controlled by centres in the spinal cord, brainstem and hypothalamus, which are influenced by higher centres. The renin-angiotensin system (RAS) affects vascular tone and excretion of sodium and water in response to changes in circulating volume and arterial pressure. Blood pressure can be manipulated by drugs acting at several of these sites (Figure 1).

Pharmaceutical Composition of Hydrochlorothiazide:β-Cyclo-dextrin: Preparation by Three Different Methods, Physico-Chemical Characterization and In Vivo Diuretic Activity Evaluation

“…In developed countries, heart disease and stroke are the first and the third-ranked causes of morbidity and mortality, respectively [ 1 ]. Pharmacological treatment of hypertension consists in the use of drug therapies including association or not of diuretics, beta-blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor (AT1) antagonist (ARA) [ 1 , 2 , 3 , 4 ].…”

Pharmaceutical Composition of Valsartan: β-Cyclodextrin: Physico–Chemical Characterization and Anti-Hypertensive Evaluation

“…Hypertension is one of the most prevalent chronic adult illnesses today and cannot be cured, but it can be controlled. The pharmacological treatment for control of hypertension utilizes various drug therapies, single doses or associations of diuretics, beta-blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor (AT1) antagonist (ARA) [ 1 , 2 ]. Valsartan (VAL, Figure 1 ) is one of the angiotensin II receptor (AT1) antagonists recommended for treatment of hypertension, post-myocardial infarction or congestive heart failure.…”

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“…Although, a plethora of therapeutically effective categories of antihypertensive agents are available including single doses or associations of diuretics, calcium channel blockers, beta-blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor (AT1) antagonist (ARA) [2][3] . Problem associated with these therapeutic moieties and conventional delivery systems affect their utility and patient compliance.…”