Anti hypertensive agents:
1. ACE-inhibitor
2. Angiotensin receptor blocker
3. Calcium channel blocker
4. Diuretics
5. Beta blocker
6. Others
?Alpha blocker
?Combined alpha, beta blocker
?Centrally acting antihypertensive agents
?Direct vasodilators
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General guideline of initiating antihypertensive agents
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Drugs and dosage
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Contraindications and adverse effects
ACE-inhibitor
Contraindication
?Pregnancy
?Bilateral renal artery stenosis
?Serum creatinine increased >30% within 2 months of starting ACE inhibitor
Adverse effect
?Dry cough
?Angioedema (rare)
?May cause deterioration in renal function in patient with renovascular disease or renal impairment
Angiotensin receptor blocker
Contraindication and adverse effect are similar to those of ACE-inhibitor except persistent dry cough is less problematic in ARB, therefore it is recommended in ACE-inhibitor intolerance patient
Calcium channel blocker
Adverse effect
?Initial tachycardia *Verapamil may cause bradycardia
?Headache
?Flushing
?Constipation
?Ankle edema
Diuretics
Contraindication
?Serum potassium of 5 and above (potassium sparing diuretics)
?Used with caution in patient with renal insufficiency due to risk of hyperkalemia (potassium sparing diuretics)
Adverse effect
?Hypokalemia
?Hyperkalemia (potassium sparing diuretics)
?Hyponatremia
?Hypomagnesemia
?Hyperglycemia
?Hyperuricemia - may precipitate acute attack in gout patient
?Hypercholesterolemia
Beta - blockers
Contraindication
?Obstructive airway disease
?Severe peripheral vascular disease
?Heart block
Adverse effect
?Dyslipidemia
?Masking of hypoglycemia
?Increase incidence of new onset diabetes mellitus
?Erectile dysfunction
?Bradycardia
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