Drugs on Hypertension

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TABLE OF CONTENTS:
ANTIHYPERTENSIVE DRUGS:3
OVERVIEW:3
HYPERTENSION:3
CLASSIFICATION OF BLOOD PRESSURE:4
REGULATION OF BLOOD PRESSURE:5
SITES AND EFFECTS OF ANTIHYPERTENSIVE DRUGS:6
DIURETICS:6
CENTRALLY ACTING DRUGS:10
ANGIOTENSIN INHIBITORS:11
SPECIFIC DRUGS:14
ANGIOTENSIN RECEPTORS BLOCKERS:14
DIRECT RENIN INHIBITOR:15
VASODILATORS:15
CALCIUM CHANNEL BLOCKERS:15
OTHER VASODILATORS:16
ANTI ANGINAL DRUGS:16
MECHANISM AND EFFECTS OF ANTIANGINAL DRUGS:17
TYPICAL ANGINA:18
VARIANT ANGINA:18
EFFICACY OF DRUG USED IN TREATMENT OF CORONARY HEART DISEASES20
TYPICAL ANGINA PECTORIS20
ANTI ISCHEMIC AGENTS20
PREVENTIVE AGENTS20
VASODILATORS:20
CALCIUM CHANNEL BLOCKERS:22
ADRENOCEPTOR ANTAGONISTS:25
MANAGEMENT OF ANGINA PECRORIS:26
DRUGS FOR HEART FAILURE:27
OVERVIEW:27
PATHOPHYSIOLOGY OF HEART FAILURE:28
MECHANISM AND EFFECT OF DRUG FOR HEART FAILURE:29

ANTIHYPERTENSIVE DRUGS:
OVERVIEW:
A
n estimated 50 million people in the united states have high blood pressure (hypertension) , commonly defined as a sustained systolic blood pressure of 140 mm hg or higher or a sustained diastolic pressure of 90 mm of hg or higher . Numerous studies have shown that untreated high blood pressure damages blood vessels, accelerates atherosclerosis, and produces left ventricular hypertrophy. The rate at which these changes occur is proportional to the severity of hypertension. Eventually, these abnormalities contributes to the development of ischemic heart disease, stroke, heart failure and renal failure , which are the most common cause of death in patients who are hypertensive. HYPERTENSION:

Over the past several decades, health professionals and public officials have increased their efforts to educate the public about the hazards of untreated hypertension and this has led to a significant increase in a number of hypertensive individuals who are aware of their conditions and treat it effectively via lifestyle modifications and pharmacologic agents. The effective treatment of high blood pressure appears to be one of the factors that has contributed to a nearly 60% reduction in the incident of stroke and at least a 50% reduction in the mortality rate from coronary artery disease since 1970. About 95% of the causes of hypertension are considered to be primary hypertension that cannot be attributed to a specific cause. The other 5% cases are classified as secondary hypertension, which results from an identifiable cause such as chronic kidney disease, pheochromocytoma (a tumor of adrenal medulla), or hyperaldosteronism. In some cases, secondary hypertension can be corrected by medicines or surgery. Although the cause of primary hypertension in any specific patient is usually unknown, numerous genetic and lifestyle factors are associate with it. These include obesity, lack of exercise, the so called metabolic syndrome (abnormal obesity, hyperlipidemia and insulin resistance), and dietary sodium intake by individuals with salt sensitivity, and excessive consumption of alcohol. In recent years the role of vascular endothelial cell dysfunction in the genesis and maintenance of hypertension has received increased attention. The endothelial is an important regulator of smooth muscle tone via synthesis and release of several relaxing factors, including nitric oxide and prostacyclin, as well as vasoconstricting factor such as endothelin 1 and angiotensin 2. In addition to its vasoconstrictive effect angiotensin 2 produces vascular injury via activation of growth factor that cause vascular smooth muscle proliferation and hypertrophy as well as fibrotic changes in the vascular wall. Oxidative stress and other pathological stimuli appear to alter the ratio of endothelial relaxing factor and vasoconstrictive factor thereby contributing to the development of hypertension. Several antihypertensive drugs, including carvedilol and the angiotensin inhibitors, appear to...
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