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Antihypertensive Update

by Becky Sisk, PhD, RN

(c) 2002

Six types of medications are used for hypertension:

 

Diuretics

Diuretics prevent the reabsorption of sodium in the kidneys. Sodium is thereby excreted, along with water. Excretion of sodium and water results in decreased plasma volume, decreased cardiac output, and decreased pressure in the arterial system. 

 

Thiazide diuretics act on the cortical area of the ascending tubule of the kidney. Loop diuretics act on the medullary portion of the ascending tubule. 

 

Side effects of diuretics are potassium loss (potassium is excreted along with sodium and water), weakness, fatigue, muscle cramping,  and nausea. Potassium sparing diuretics are often given to prevent potassium loss. People on thiazide or loop diuretics should drink a glass of orange juice or eat a banana daily to replace lost potassium.

 

Common thiazide diuretics are:

  • Chlorthalidone(Hygroton), 12.5-50 mg/day

  • Chlorothiazide (Diuril),
    Hydrochlorothiazide (Hydrodiuril, Esidrix), 12.5-50 
    mg/day

  • Metolazone (Zaroxolyn), 2.5-10 mg/day

Common loop diuretics are:

  • Bumetanide(Bumex), 0.5-4 mg/2-3 times a day

  • Ethacrynic acid (Edecrin), 25-100 mg/2-3 times a day 

  • Furosemide (Lasix), 40-240 mg/2-3 times a day

Common potassium sparing diuretics are:

  • Amiloride HCl (Midamor), 5-10 mg/day

  • Spironolactone (Aldactone), 25-100 mg/day

  • Triamterine (Dyrenium), 25-100 mg/day

Adrenergic Inhibitors

Adrenergic inhibitors reduce the effects of the sympathetic nervous system (SNS), lowering the pulse and peripheral vascular resistance. There are several types of adrenergic inhibitors. 

 

Peripheral agents deplete catecholamines in the peripheral sympathetic fibers and block the release of norephinephrine release from the SNS nerve endings. Side effects of peripheral agents are nasal congestion, sedation, depression, peptic ulcer, and impotence. Examples include:

  • Triamterine (Dyrenium), 25-100 mg/day

  • Guanethidine monosulfate (Ismelin), 10-150 mg/daily

  • Reserpine (Serpasil), 0.05-0.25 mg/day

Central alpha-agonists dilate peripheral arterioles and venules. Side effects are sedation, dry mouth, and bradycardia. Examples include:

  • Clonidine hydrochloride (Catapres), 0.2-1.2 mg/2-3 times a day

  • Methyldopa (Aldomet), 500-3,000 mg/2 times a day

Alpha-blockers depress the vasomotor and cardiac centers, decreasing peripheral vascular resistance and pressure. Side effects are postural hypotension, headache, fatigue, stuffy or blocked nose, impotence, and dizziness. Examples include:

  • Doxazosin mesylate (Cardura), 1-16 mg/day

  • Prazosin HCl (Minipress), 2-30 mg/2-3 times a day

  • Terazosin HCl (Hytrin), 1-20 mg/day

Beta-blockers block SNS beta-adrenergic receptors, thereby decreasing the pulse and blood pressure. Side effects are bronchospasm, bradycardia, heart failure, dizziness, dyspnea, impaired peripheral circulation, insomnia, fatigue, decreased exercise tolerance, and sexual dysfunction. Beta-blockers are contra indicated in the elderly or people with diabetes, because they exacerbate heart failure and impaired peripheral circulation. Examples are:

  • Metoprolol tartrate (Lopressor), 50-300 mg/2 times a day

  • Nadolol (Corgard), 40-320 mg/day

  • Propranolol HCl (Inderal), 40-480 mg/2 times a day or ( Inderal LA), 40-480 mg/day

Direct Vasodilators

Direct vasodilators relax the peripheral vascular smooth muscles. Side effects are headache, fluid retention, and tachycardia. Examples include:

  • Hydralazine HCl (Apresoline), 50-300 mg/2 times a day

  • Minoxidil (Loniten), 5-100 mg/day

Calcium Blockers

Calcium blockers promote vasodilation by blocking calcium ions from crossing cell membranes in arterial smooth muscles and myocardium. Side effects are headache, flushing of the face, gingival hyperplasia, edema, and palpitations. Examples include:

 

  • Diltiazem HCl (Cardizem SR), 120-360 mg/2 times a day

  • (Cardizem CD), 120-360 mg/day

  • Isradipine (DynaCirc), 5-20 mg/2 times a day

  • (DynaCircCR), 5-20 mg/day

  • Nifedipine (Procardia XL), 30-120 mg/day

ACE Inhibitors

ACE inhibitors interfere with the conversion of angiotensin I to angiotensin II, thereby blocking the release of aldosterone, which conserves sodium and water. Side effects are dry cough, dizziness, postural hypotension, funny taste in the mouth, and a skin rash. Examples include:

  • Benazepril HCl (Lotensin), 5-40 mg/1-2 times a day

  • Captopril (Capoten), 25-150 mg/2-3 times a day

  • Enalapril maleate (Vasotec), 5-40 mg/1-2 times a day

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers interfere with the renin-angiotensin system. Side effects are angioedema, hyperkalemia, and dizziness. Examples include

  • Losartan potassium (Cozaar), 25-100 mg/1-2 times a day

  • Valsartan (Diovan), 80-320 mg/day

  • Irbesartan (Avapro), 150-300 mg/day

Dual-acting medications are also available for hypertension:

 

Beta-adrenergic blockers and diuretics

  • Lopressor HCT - Metoprolol tartrate, 50 or 100 mg and hydrochlorothiazide, 25 or 50 mg 

  • Inderide - Propranolol hydrochloride, 40 or 80 mg and hydrochlorothiazide, 25 mg 

ACE inhibitors and diuretics

  • Lotensin HCT - Benazepril hydrochloride, 5, 10, or 20 mg and hydrochlorothiazide, 6.25, 12.5, or 25 mg 

  • Capozide - Captopril, 25 or 50 mg and hydrochlorothiazide, 15 or 25 mg 

Angiotensin II receptor antagonists and diuretics

  • Hyzaar - Losartan potassium, 50 mg and hydrochlorothiazide, 12.5 mg 

  • Calcium antagonists and ACE inhibitors

  • Lotrel - Amlodipine besylate, 2.5 or 5 mg and benazepril hydrochloride, 10 or 20 mg 

  • Teczem - Diltiazem hydrochloride, 180 mg and enalapril maleate, 5 mg 

Other combinations

  • Combipres - Clonidine hydrochloride, 0.1, 0.2, or 0.3 mg and chlorthalidone, 15 mg

  • Aldoril - Methyldopa, 250 or 500 mg and hydrochlorothiazide, 15, 25, 30, or 50 mg

  • Ser-Ap-Es - Reserpine, 0.10 mg and hydralazine hydrochloride, 25 mg and hydrochlorothiazide, 15 mg 

  • Aldactazide - Spironolactone, 25 or 50 mg and hydrochlorothiazide, 25 or 50 mg 


Reference:

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI),  compiled by a national consensus group of the National 
High Blood Pressure Education Program (NHBPEP), National Heart,Lung, and Blood Institute (NHBLI), National Institutes of 
Health (1997): http://www.nhlbi.nih.gov/guidelines/

hypertension/jncintro.htm

 

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This article was taken from Volume 1, # 3 of the "Clinical Nursing Resources" newsletter.  To subscribe: