Vasodilatory Prkperties mechanisms of apigenin isolated from Apium graveolens in Anti-hypertenaive thoracic aorta. Anti-hypertensive properties and eplerenone are considered good in hypertension treatment Anti-obesity resources added to other Body shape success stories medications in propertie HTN; this group of medications is Antihypertensive when added to triple hypertension medications regimen but should be used cautiously when added to ACE inhibitors or ARBs due to the higher incidence of hyperkalemia. Benavides, G. Individual rings were suspended in 10 mL tissues baths at 37 °C aerated with carbogen. Effect of coriander seed powder CSP on 1, 2-dimethyl hydrazine-induced changes in antioxidant enzyme system and lipid peroxide formation in rats. Within seconds of its production, NO reacts with superoxide anions Drummond et al. Renin, angiotensin, sodium and organ damage.

Anti-hypertensive properties -

However, thiazides also cause vasodilatation and reduce the responsiveness of vascular smooth muscle to vasoactive substances resulting in a reduction in SVR. One direct mechanism by which thiazides cause these effects is through opening of calcium-activated potassium channels.

Thiazide diuretics have many clinically relevant biochemical side-effects including hypokalaemia, hypercalcaemia, hyponatraemia, hypomagnesaemia, hyperglycaemia, hyperuricaemia, hypercholesterolaemia, and hypochloraemic alkalosis.

Plasma volume loss may precipitate dehydration and acute kidney injury. Less common side-effects include skin rashes, photosensitivity reactions, and blood dyscrasias including thrombocytopaenia. Aldosterone antagonists, for example, spironolactone, are recommended as fourth-line treatment of primary hypertension.

The use of these drugs carries a risk of hyperkalaemia, particularly in patients with impaired renal function or who are taking other potassium-sparing agents. Loop diuretics are indicated for resistant hypertension in patients with heart failure, chronic kidney disease, and in those at risk of hyperkalaemia.

While diuretic therapy may be continued during the perioperative period, attention should be paid to the patient's fluid status and the potential for precipitating an acute kidney injury and metabolic or electrolyte abnormalities.

Directly acting vasodilators, for example, hydralazine and minoxidil, are seldom used due to their side-effect profiles. Hydralazine is used in hypertension secondary to pre-eclampsia.

In addition to its antihypertensive effects, minoxidil is used topically as a treatment for male pattern baldness. Vasodilators cause relaxation of vascular smooth muscle in resistance arteriolar vessels. Minoxidil achieves this via adenosine triphosphate-dependent potassium channels on smooth muscle cell membranes.

Hydralazine acts through activation of adenylate cyclase, increasing intracellular cyclic guanosine monophosphate. Vasodilatation provokes reflex cardiac stimulation which may precipitate cardiac ischaemia and RAS activation. These compensatory responses may be offset by β-blockers or diuretics. Vasodilator drugs are poorly tolerated.

Side-effects include headache, fluid retention, and oedema. Other specific side-effects include left ventricular hypertrophy, pericardial and pleural effusions, hypertrichosis and coarsening of features with minoxidil, while peripheral neuropathy, blood dyscrasias, and a lupus-like reaction can occur with hydralazine.

Centrally acting agents include clonidine α 2 adrenoceptor agonist , methyldopa precursor of an α 2 adrenoceptor agonist , and moxonidine agonist at imidazoline binding sites. Their use in primary hypertension is limited to difficult to treat cases, while methyldopa is used to treat hypertension in pregnancy.

The evidence base for the use of centrally acting drugs in hypertension is limited and adverse effects are common. Clonidine is an analgesic and sedative drug which reduces the minimum alveolar concentration of inhalation anaesthetic agents. Both of these drugs cause side-effects including dry mouth and sedation.

Methyldopa has immunological side-effects, including pyrexia, haemolytic anaemia, and hepatitis. Cessation of treatment with clonidine can cause rebound hypertension. Ganglion blockers, such as trimetaphan, antagonize acetylcholine at nicotinic receptors, including those at the adrenal cortex.

Trimetaphan causes vasodilatation with a consequent rapid reduction in arterial pressure. Although ganglion blockers may be used to manage hypertensive crises or to provide hypotensive anaesthesia, their use is increasingly rare.

org by subscribers to BJA Education. NICE Guideline Hypertension: Clinical Management of Hypertension in Adults. Manchester: National Institute for Health and Clinical Excellence , Google Scholar.

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Beta-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers: should they be stopped or not before ambulatory anaesthesia?

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J Am Coll Cardiol ; 54 : e13 — Devereaux PJ Yang H Yusuf S et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery POISE trial : a randomised controlled trial. Lancet ; : — Oxford University Press is a department of the University of Oxford.

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Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Pharmacological management of hypertension. Drugs which target the RAS. Adrenoceptor antagonists. Calcium channel blockers. Other antihypertensives.

Declaration of interest. Journal Article. Antihypertensive drugs. RE Jackson, BSc MB ChB FRCA , RE Jackson, BSc MB ChB FRCA.

Oxford Academic. bellamy leeds. PDF Split View Views. Select Format Select format. ris Mendeley, Papers, Zotero. enw EndNote. bibtex BibTex. Reintroduction of nettle cultivation as a sustainable raw material for fibres and cellulose production.

Department of Plant Production Biotechnology [online]; Dreyer J, Dreyling G, Feldmann F. Cultivation of stinging nettle Urtica diocia L. with high fibre content as a raw material for the production of fibre and cellulose: qualitative and quantitative differentiation of ancient clones.

J Appl Bot. CAS Google Scholar. Whitney PJ, Gibbs G. The common stinging nettle: resource or risk? Google Scholar.

Bisht S, Bhandari S, Bisht SN. Agric Sci Res J. Garnier G, Bezanger-Beauquesne L, Debraux G. Inresources medicinenelous delaflore francase.

Vegots Freres Paris. Newall CA, Anderson LA, Philipson JD. Herbal medicines: a guide for health care professionals. London: The Pharmaceutical Press; Ziyyat A, Legssyer A, Mekhfi H, Dassoule A, Serharouchni M, Benjellon W. Phytotherapy of hypertension in oriental Morroco. J Ethnopharmacol.

Lahighi SH, Amini K, Moradi P, Asaadi K. Investigating the chemical composition of different parts extracts of bipod nettle Urtica dioica L. in Tonekabon region. Palic R, Stojanovic G, Alagic S, Nikolic M, Lepojevic Z.

Chemical composition and antimicrobial activity of the essential oil and CO 2 extracts of the oriental tobacco, Prilep. Flavour Fragr J. Article CAS Google Scholar. Lalitharani S, Mohan VR, Regini GS. GC-MS analysis of ethanolic extract of Zanthoxylum rhetsa roxb.

dc spines. J Herbal Med Toxicol. Roy S, Rao K, Bhuvaneswari CH, Giri A, Mangamoori LN. Phytochemical analysis of Andrographis paniculata extract and its antimicrobial activity.

World J Microbiol Biotechnol. Li RW, Leach DN, Myers P, Leach GJ, Lin GD, Brushett DJ, Waterman PG. Anti-inflammatory activity, cytotoxicity and active compounds of Tinospora smilacina Benth. Phytother Res. Article PubMed Google Scholar.

Ogunlesi M, Okiei W, Ademoye M, Osibote EA. Analysis of essential oil from the stem of Chansmanthera dependens. J Nat Prod. Wagner H, Willer F, Kreher B. Biologically active compounds from Urtica dioica. Planta Med.

Reihemman K, Behnke B, Schulze-Osthoffs K. Plant extract from stinging nettle Urtica dioica , an anti-rheumatic remedy inhibits the pro-inflammatory transcription factor NF- KappaB.

FEBS Lett. Article Google Scholar. Lichius JJ, Muth C. The inhibiting effect of Urtica dioica root extract on experimentally induced prostatic hyperplasia in mouse.

Tahri A, Yamani S, Leggsyer A. Acute natriuretic and hypotensive effects of continuous perfusion of aqueous extract of Urtica dioica in the rat. Williamson EM, Okpako DT, Evans FJ. Pharmacological methods in phytotherapy research.

Chichester: Wiley; National Research Council. Guide for the care and use of laboratory animals. Washington, DC: National Academy Press; Shah AJ, Gilani AH. Blood pressure-lowering and vascular modulator effects of Acorus calamus extract are mediated through multiple pathways.

Cardiovasc Pharmacol. Lawler JE. Hypertension produced by a high sodium diet in the borderline hypertensive rat BHR. Clin Exp Hypertens A. CAS PubMed Google Scholar. Vasdev S, Gill V, Longerich L. Salt-induced hypertension in WKY rats: prevention by α-lipoic acid supplementation.

Mol Cell Biochem. Taqvi SI. Blood pressure lowering and vasomodulator effects of piperine. J Cardiovasc Pharmacol. Ghayur MN, Gilani AH, Afridi MB. Cardiovascular effects of ginger aqueous extract and its phenolic constituents are mediated through multiple pathways.

Vasc Pharmacol. Chan SS, Choi AO, Jones RL, Lin G. Mechanisms underlying the vasorelaxing effects of butylidenephthalide, an active constituent of Ligusticum chuanxiong , in rat isolated aorta. Eur J Pharmacol. Arunlakhshana O, Schild HO. Some quantitative uses of drug antagonists.

Br J Pharmacol. Joen-Rong S. Pharmacological effects of rutaecarpine, an alkaloid isolated from Evodia rutaecarpa. Cardiovasc Drug Rev. Martin E, Davis K, Bian K.

Cellular signaling with nitric oxide and cyclic guanosine monophosphate. Semin Perinatol. Moncada S, Korbut R, Bunting S. Prostacyclin is a circulating hormone. Bragulat E, de la Sierra A, Antonio MT. Effect of salt intake on endothelium derived factors in a group of patients with essential hypertension.

Clin Sci. Godfraind T, Miller R, Wibo M. Calcium antagonism and calcium entry blockade. Pharmacol Rev. Koike K, Takayanagi I, Takiguchi S. Gen Pharmacol. Boyd RA, Giacomini JC, Giacomini KM. Species differences in the negative inotropic response of 1, 4-dihydropyridine calcium channel blockers in myocardium.

Suszkiw JB, Murawsky MM, Fortner RC. Heterogeneity of presynaptic calcium channels revealed by species differences in the sensitivity of synaptosomal 45Ca entry to ω-conotoxin.

Biochem Biophys Res Commun. Patil PN. The classical competitive antagonism of phentolamine on smooth muscle preparations, investigated by two procedures. Auton Autacoids Pharmacol. Tudzynski P, Correia T, Keller U. Biotechnology and genetics of ergot. Appl Microbiol Biotechnol.

Wang GJ, Liao JF, Kadonk H. Calcium-antagonizing activity of S -petasin, a hypotensive sesquiterpene from Petasites formosanus , on inotropic and chronotropic responses in isolated rat atria and cardiac myocytes. Naunyn Schmiedebergs Arch Pharmacol.

Download references. RQ and HMQ designed and carried out the experimental work. SK and US analyzed the statistical data and interpretation of results. TK and AJS drafted and critically evaluated the manuscript.

All authors read and approved the final manuscript. Department of Pharmacy, COMSATS Institute of Information Technology, University Road, Abbottabad, KPK, , Pakistan. You can also search for this author in PubMed Google Scholar.

Correspondence to Abdul Jabbar Shah. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.

Reprints and permissions. Qayyum, R. et al. Mechanisms underlying the antihypertensive properties of Urtica dioica. J Transl Med 14 , Download citation. Received : 06 April Accepted : 18 August Published : 01 September Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Urtica dioica has traditionally been used in the management of cardiovascular disorders especially hypertension.

Methods Crude methanolic extract of U. Results Ud. Conclusions These data indicate that crude methanolic extract and its fractions possess antihypertensive effect. Background Urtica dioica L. Why HBP is a "Silent Killer". Health Threats from HBP.

Changes You Can Make to Manage High Blood Pressure. Baja Tu Presión. Find HBP Tools and Resources. Blood Pressure Toolkit. Home Health Topics High Blood Pressure Changes You Can Make to Manage High Blood Pressure Types of Medications.

Prescription blood pressure drugs come in many classes. Classes of blood pressure medications Some of the major types of commonly prescribed cardiovascular medications are provided here.

However, this information does not signify a recommendation or endorsement from the American Heart Association. It's important to discuss all of the drugs you take with your health care professional and understand their desired effects and possible side effects.

Never stop taking a medication and never change your dose or frequency without first consulting your doctor. If you have an illness, you may wish to discuss your medications with your health care professional.

If you have been prescribed blood pressure medication, consult your health care professional prior to conception if you are considering pregnancy or if there is a chance you could become pregnant.

If you discover that you are pregnant consult your health care professional as soon as possible to determine the safest medication for you at this time. 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 Combined alpha and beta-blockers Vasodilators Diuretics Diuretics help the body get rid of excess sodium salt and water and help control blood pressure.

Symptoms such as weakness, leg cramps or being tired may result. Eating foods containing potassium may help prevent significant potassium loss.

If your health care professional recommends it, you could prevent potassium loss by taking a liquid or tablet that has potassium along with the diuretic. People who take diuretics have increased risk of developing gout as a side effect.

This isn't common and can be managed by other treatment.

Journal of Translational Medicine Anti-hypertensive properties 14Anti-obesity resources number: Cite Anti-hypertenzive article. Metrics details. Propeties dioica has traditionally been used in the management of cardiovascular disorders especially hypertension. The aim of this study was to explore pharmacological base of its use in hypertension. Crude methanolic extract of U. dioica Ud.

Anti-hypertensive properties -

Google Scholar. Bisht S, Bhandari S, Bisht SN. Agric Sci Res J. Garnier G, Bezanger-Beauquesne L, Debraux G. Inresources medicinenelous delaflore francase.

Vegots Freres Paris. Newall CA, Anderson LA, Philipson JD. Herbal medicines: a guide for health care professionals. London: The Pharmaceutical Press; Ziyyat A, Legssyer A, Mekhfi H, Dassoule A, Serharouchni M, Benjellon W.

Phytotherapy of hypertension in oriental Morroco. J Ethnopharmacol. Lahighi SH, Amini K, Moradi P, Asaadi K. Investigating the chemical composition of different parts extracts of bipod nettle Urtica dioica L.

in Tonekabon region. Palic R, Stojanovic G, Alagic S, Nikolic M, Lepojevic Z. Chemical composition and antimicrobial activity of the essential oil and CO 2 extracts of the oriental tobacco, Prilep. Flavour Fragr J. Article CAS Google Scholar.

Lalitharani S, Mohan VR, Regini GS. GC-MS analysis of ethanolic extract of Zanthoxylum rhetsa roxb. dc spines. J Herbal Med Toxicol. Roy S, Rao K, Bhuvaneswari CH, Giri A, Mangamoori LN. Phytochemical analysis of Andrographis paniculata extract and its antimicrobial activity.

World J Microbiol Biotechnol. Li RW, Leach DN, Myers P, Leach GJ, Lin GD, Brushett DJ, Waterman PG. Anti-inflammatory activity, cytotoxicity and active compounds of Tinospora smilacina Benth. Phytother Res. Article PubMed Google Scholar. Ogunlesi M, Okiei W, Ademoye M, Osibote EA.

Analysis of essential oil from the stem of Chansmanthera dependens. J Nat Prod. Wagner H, Willer F, Kreher B. Biologically active compounds from Urtica dioica.

Planta Med. Reihemman K, Behnke B, Schulze-Osthoffs K. Plant extract from stinging nettle Urtica dioica , an anti-rheumatic remedy inhibits the pro-inflammatory transcription factor NF- KappaB. FEBS Lett. Article Google Scholar. Lichius JJ, Muth C. The inhibiting effect of Urtica dioica root extract on experimentally induced prostatic hyperplasia in mouse.

Tahri A, Yamani S, Leggsyer A. Acute natriuretic and hypotensive effects of continuous perfusion of aqueous extract of Urtica dioica in the rat.

Williamson EM, Okpako DT, Evans FJ. Pharmacological methods in phytotherapy research. Chichester: Wiley; National Research Council. Guide for the care and use of laboratory animals. Washington, DC: National Academy Press; Shah AJ, Gilani AH.

Blood pressure-lowering and vascular modulator effects of Acorus calamus extract are mediated through multiple pathways. Cardiovasc Pharmacol. Lawler JE. Hypertension produced by a high sodium diet in the borderline hypertensive rat BHR. Clin Exp Hypertens A.

CAS PubMed Google Scholar. Vasdev S, Gill V, Longerich L. Salt-induced hypertension in WKY rats: prevention by α-lipoic acid supplementation. Mol Cell Biochem. Taqvi SI. Blood pressure lowering and vasomodulator effects of piperine.

J Cardiovasc Pharmacol. Ghayur MN, Gilani AH, Afridi MB. Cardiovascular effects of ginger aqueous extract and its phenolic constituents are mediated through multiple pathways.

Vasc Pharmacol. Chan SS, Choi AO, Jones RL, Lin G. Mechanisms underlying the vasorelaxing effects of butylidenephthalide, an active constituent of Ligusticum chuanxiong , in rat isolated aorta.

Eur J Pharmacol. Arunlakhshana O, Schild HO. Some quantitative uses of drug antagonists. Br J Pharmacol. Joen-Rong S. Pharmacological effects of rutaecarpine, an alkaloid isolated from Evodia rutaecarpa. Cardiovasc Drug Rev. Martin E, Davis K, Bian K.

Cellular signaling with nitric oxide and cyclic guanosine monophosphate. Semin Perinatol. Moncada S, Korbut R, Bunting S. Prostacyclin is a circulating hormone. Bragulat E, de la Sierra A, Antonio MT. Effect of salt intake on endothelium derived factors in a group of patients with essential hypertension.

Clin Sci. Godfraind T, Miller R, Wibo M. Calcium antagonism and calcium entry blockade. Pharmacol Rev. Koike K, Takayanagi I, Takiguchi S. Gen Pharmacol. Boyd RA, Giacomini JC, Giacomini KM. Species differences in the negative inotropic response of 1, 4-dihydropyridine calcium channel blockers in myocardium.

Suszkiw JB, Murawsky MM, Fortner RC. Heterogeneity of presynaptic calcium channels revealed by species differences in the sensitivity of synaptosomal 45Ca entry to ω-conotoxin. Biochem Biophys Res Commun.

Patil PN. The classical competitive antagonism of phentolamine on smooth muscle preparations, investigated by two procedures. Auton Autacoids Pharmacol. Tudzynski P, Correia T, Keller U. Biotechnology and genetics of ergot. Appl Microbiol Biotechnol.

Wang GJ, Liao JF, Kadonk H. Calcium-antagonizing activity of S -petasin, a hypotensive sesquiterpene from Petasites formosanus , on inotropic and chronotropic responses in isolated rat atria and cardiac myocytes.

Naunyn Schmiedebergs Arch Pharmacol. Download references. RQ and HMQ designed and carried out the experimental work. SK and US analyzed the statistical data and interpretation of results. TK and AJS drafted and critically evaluated the manuscript.

All authors read and approved the final manuscript. Department of Pharmacy, COMSATS Institute of Information Technology, University Road, Abbottabad, KPK, , Pakistan. You can also search for this author in PubMed Google Scholar. Correspondence to Abdul Jabbar Shah.

Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Qayyum, R. et al. Mechanisms underlying the antihypertensive properties of Urtica dioica. J Transl Med 14 , Download citation.

Received : 06 April Accepted : 18 August Published : 01 September Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Urtica dioica has traditionally been used in the management of cardiovascular disorders especially hypertension.

Methods Crude methanolic extract of U. Results Ud. Conclusions These data indicate that crude methanolic extract and its fractions possess antihypertensive effect.

Background Urtica dioica L. Methods Plant material Dried rhizome of U. Chemicals Acetylcholine chloride ACh , atropine sulphate, phenylephrine hydrochloride PE , norepinephrine NE , potassium chloride, N ω -nitro l -arginine methyl ester l -NAME hydrochloride and verapamil hydrochloride were purchased from Sigma Chemicals Company, St.

Experimental animals and housing conditions Rabbits 1—1. In-vivo experiments Blood pressure measurement in normotensive anesthetized rats These experiments were performed on male Sprague- Dawley rats — g as described [ 21 ]. Experimental protocol After 20—30 min of the equilibrium period, acetylcholine and norepinephrine were used to check the stability of the animals toward hypotensive and hypertensive responses, respectively.

Blood pressure measurement in hypertensive anesthetized rats The protocol of Lawler et al. In-vitro experiments Rat thoracic aorta The procedure of Taqvi et al.

Endothelium-dependent and-independent effects A series of experiments were conducted to assess endothelium-dependent or independent effects of Ud. Rabbit thoracic aorta As described previously [ 22 , 25 ] rabbits were killed by a blow on the back of the head; the thoracic aorta was removed and cut into rings of approximately 2—3 mm width.

In , an article in the BMJ examined the evidence for and against the suggestion that angiotensin receptor blockers may increase the risk of myocardial infarction heart attack. As a consequence of AT1 blockade, ARBs increase angiotensin II levels several-fold above baseline by uncoupling a negative-feedback loop.

Increased levels of circulating Angiotensin II result in unopposed stimulation of the AT2 receptors, which are, in addition upregulated. Recent data suggest that AT2 receptor stimulation may be less beneficial than previously proposed and may even be harmful under certain circumstances through mediation of growth promotion, fibrosis, and hypertrophy, as well as proatherogenic and proinflammatory effects.

ARBs happens to be the favorable alternative to ACE inhibitors if the hypertensive patients with the heart failure type of reduced ejection fraction treated with ACEis was intolerant of cough, angioedema other than hyperkalemia or chronic kidney disease.

Although beta blockers lower blood pressure, they do not have a positive benefit on endpoints as some other antihypertensives do.

Despite lowering blood pressure, alpha blockers have significantly poorer endpoint outcomes than other antihypertensives, and are no longer recommended as a first-line choice in the treatment of hypertension. Vasodilators act directly on the smooth muscle of arteries to relax their walls so blood can move more easily through them; they are only used in hypertensive emergencies or when other drugs have failed, and even so are rarely given alone.

Sodium nitroprusside , a very potent, short-acting vasodilator, is most commonly used for the quick, temporary reduction of blood pressure in emergencies such as malignant hypertension or aortic dissection. Renin comes one level higher than angiotensin converting enzyme ACE in the renin—angiotensin system.

Renin inhibitors can therefore effectively reduce hypertension. Aliskiren developed by Novartis is a renin inhibitor which has been approved by the U. FDA for the treatment of hypertension. Aldosterone receptor antagonists: [ citation needed ].

Aldosterone receptor antagonists are not recommended as first-line agents for blood pressure, [39] but spironolactone and eplerenone are both used in the treatment of heart failure and resistant hypertension. Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain which open peripheral arteries easing blood flow.

These alpha 2 receptors are known as autoreceptors which provide negative feedback in neurotransmission in this case, the vasoconstriction effects of adrenaline. Central alpha agonists, such as clonidine, are usually prescribed when all other anti-hypertensive medications have failed.

For treating hypertension, these drugs are usually administered in combination with a diuretic. Adverse effects of this class of drugs include sedation, drying of the nasal mucosa and rebound hypertension upon discontinuation. For the most resistant and severe disease, oral minoxidil Loniten in combination with a diuretic and β-blocker or other sympathetic nervous system suppressants may be used.

Bosentan belongs to a new class of drugs and works by blocking endothelin receptors. It is specifically indicated only for the treatment of pulmonary artery hypertension in patients with moderate to severe heart failure.

For mild blood pressure elevation, consensus guidelines call for medically supervised lifestyle changes and observation before recommending initiation of drug therapy. However, according to the American Hypertension Association, evidence of sustained damage to the body may be present even prior to observed elevation of blood pressure.

Therefore, the use of hypertensive medications may be started in individuals with apparent normal blood pressures but who show evidence of hypertension-related nephropathy, proteinuria, atherosclerotic vascular disease, as well as other evidence of hypertension-related organ damage.

If lifestyle changes are ineffective, then drug therapy is initiated, often requiring more than one agent to effectively lower hypertension.

Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.

Considerations include factors such as age, race, and other medical conditions. The first large study to show a mortality benefit from antihypertensive treatment was the VA-NHLBI study, which found that chlorthalidone was effective.

A subsequent smaller study ANBP2 did not show the slight advantages in thiazide diuretic outcomes observed in the ALLHAT study, and actually showed slightly better outcomes for ACE-inhibitors in older white male patients.

Thiazide diuretics are effective, recommended as the best first-line drug for hypertension, [43] and are much more affordable than other therapies, yet they are not prescribed as often as some newer drugs.

Chlorthalidone is the thiazide drug that is most strongly supported by the evidence as providing a mortality benefit; in the ALLHAT study, a chlorthalidone dose of Chlorthalidone has repeatedly been found to have a stronger effect on lowering blood pressure than hydrochlorothiazide, and hydrochlorothiazide and chlorthalidone have a similar risk of hypokalemia and other adverse effects at the usual doses prescribed in routine clinical practice.

Other medications have a role in treating hypertension. Adverse effects of thiazide diuretics include hypercholesterolemia , and impaired glucose tolerance with increased risk of developing diabetes mellitus type 2.

The thiazide diuretics also deplete circulating potassium unless combined with a potassium-sparing diuretic or supplemental potassium. Some authors have challenged thiazides as first line treatment.

Subsequently, if dual therapy is required to use ACE-inhibitor in combination with either a calcium channel blocker or a thiazide diuretic. Triple therapy is then of all three groups and should the need arise then to add in a fourth agent, to consider either a further diuretic e.

spironolactone or furosemide , an alpha-blocker or a beta-blocker. The choice between the drugs is to a large degree determined by the characteristics of the patient being prescribed for, the drugs' side effects, and cost.

Most drugs have other uses; sometimes the presence of other symptoms can warrant the use of one particular antihypertensive.

Examples include:. The JNC8 guidelines indicate reasons to choose one drug over the others for certain individual patients. Hypertensive disorders during pregnancy constitute a significant risk factor for maternal and fetal outcomes, necessitating antihypertensive treatment.

However, current data concerning the safety of in utero exposure to antihypertensive medication are controversial. While some studies recommend the administration of certain agents, others underline the possible adverse effects on fetal development.

In general, a-methyldopa, β-blockers and calcium channel blockers are the first or second treatment line for hypertension during pregnancy. However, ACEIs, ARBs and diuretics are mostly contraindicated, as the potential risk outweighs the benefits of their administration.

Additionally, several drugs should be avoided, due to the lack of data regarding their safety. Shared decision-making aids have been shown to reduce women's uncertainty about taking antihypertensives and increase the number of women taking them as prescribed.

Chlorothiazide was discovered in , but the first known instance of an effective antihypertensive treatment was in using primaquine , an antimalarial.

Vaccinations are being trialed and may become a treatment option for high blood pressure in the future. CYTAngQb was only moderately successful in studies, but similar vaccines are being investigated. The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack.

However, older adults should not stop any of their medications without talking to a healthcare professional. Contents move to sidebar hide. Article Talk. Read Edit View history. Lowering blood pressure does reduce cardiovascular risks; maintaining a systolic blood pressure of less than mm Hg has been shown to prevent complications in patients with heart failure, diabetes, coronary artery disease, stroke, and other cardiovascular diseases.

Mechanism of Action Thiazide and Thiazide like diuretics: mechanism of action for thiazide-type diuretics is not fully understood. Administration Thiazide-type diuretics are given only as oral forms.

Adverse Effects Thiazides Side Effects Thiazide and thiazide-like diuretics are associated with multiple side effects. CCB Side Effects The treatment with dihydropyridine CCBs is often associated with peripheral edema. ACE Is and ARBs Side Effects The most common side effects related to ACE inhibitors are cough, hypotension, fatigue, and azotemia; reversible renal impairment is a common side effect, especially if the patient develops volume depletion due to diarrhea or vomiting.

Contraindications Thiazide type diuretics are contraindicated if the patient is anuric, and in patients with sulfonamide allergies. Monitoring Thiazides and loop diuretics can cause hypokalemia, while potassium-sparing diuretics cause hyperkalemia. Toxicity Thiazides and loop diuretics toxicity can cause electrolyte abnormalities mainly hypokalemia and hyponatremia and metabolic acidosis hypochloremic.

Enhancing Healthcare Team Outcomes Antihypertensives are a broad group of medications, and healthcare workers are recommended to have special caution in monitoring adherence and possible adverse reactions to these medications.

Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis.

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Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure.

Olde Engberink RH, Frenkel WJ, van den Bogaard B, Brewster LM, Vogt L, van den Born BJ. Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis.

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Many blood pressure Anri-hypertensive, known propertiess Anti-hypertensive properties, Traditional medicine techniques available by prescription to lower high blood pressurealso propedties as hypertension. There are propertiea variety Anti-hypertensive properties classes of high blood Abti-hypertensive Anti-hypertensive properties and they include a number of different drugs. Diuretics help the body get rid of excess sodium salt and water and help control blood pressure. They are often used in combination with additional prescription therapies. Beta-blockers reduce the heart rate, the heart's workload and the heart's output of blood, which lowers blood pressure. If you have diabetes and you're taking insulin, have your responses to therapy monitored closely. gov means Antih-ypertensive official. Federal Anti-hypertensive properties websites often end in. gov or. Before sharing sensitive information, make sure you're on a federal government site. The site is secure.