CARDIOVASCULAR-RENAL DRUGS

Antihypertensive Agents

A 35-year-old man presents with a blood pressure of
150/95mmHg. He has been generally healthy, is sedentary,
drinks several cocktails per day, and does not smoke
cigarettes. He has a family history of hypertension, and his
father died of a myocardial infarction at age 55. Physical
examination is remarkable only for moderate obesity.
Total cholesterol is 220, and high-density lipoprotein
(HDL) cholesterol level is 40 mg/dL. Fasting glucose is
105 mg/dL. Chest x-ray is normal. Electrocardiogram
shows left ventricular enlargement.
How would you treat this patient?
The strong family history suggests that this patient has
essential hypertension.
Diagnosis: Stage 1 hypertension 150/90mmHg



Data interpretation:
Total cholesterol: 220mg/dL. (borderline)
Normal: 150-250 mg/dL
Ideal for HPN pt. is 150 or bellow since his father died of CAD.
HDL: 40mg/dL (low normal)
Normal: 35 to 80 mg/Dl
Ideal for HPN pt. is HDL 60 mg/dL or higher for protection against heart
disease.
Fasting Glucose: 105 mg/dL
Normal: 70 to 110 md/dL
Impaired fasting glucose: 111 to 125 mm/dL
Indicative of DM: 126 mg/dL & above



ECG- Left Ventricular hypertrophy
Thickening of myocardium of left ventricle
Due to uncontrolled HPN
Moderate obesity

Recommendation:
The patient needs more screening procedure like:
Complete lipid panel: Total cholesterol, LDL (low-density lipoprotein), the
"bad cholesterol, HDL (high-density lipoprotein), the "good cholesterol,
Triglycerides, fat in blood
SGPT & SGOT (liver)
Serum electrolytes (Potassium)
Creatinine (kidney)




Initial management:

Diet & lifestyle modification

Low salt, avoiding processed foods & eating a diet
rich in fruits, vegetables, and low-fat dairy products
Moderation of alcohol intake (no more than two
drinks per day)
Aerobics & Brisk walking only, no running due to
Obesity
Treatment
DIURETICS
Thiazides: Hydrochlorothiazide
MOA: Blocks Na/Cl transporter in renal distal convoluted
tubule
Effects: Reduce blood volume and poorly understood
vascular effects
Always check for patients Serum
electrolytes(Potassium)

Treatment

ANGIOTENSIN-CONVERTING ENZYME (ACE)
INHIBITORS
Captopril
MOA: inhibit the converting enzyme peptidyl dipeptidase that
hydrolyzes angiotensin I to angiotensin II Inhibit angiotensin
converting enzyme
Effects: Reduce angiotensin II levels, reduce vasoconstriction and
aldosterone secretion, increase bradykinin
ANGIOTENSIN RECEPTOR BLOCKERS (ARBs)
Losartan
MOA: Blocks angiotensin II type 1 (AT 1 ) receptor
Effects: Same as ACE inhibitors but no increase in bradykinin

Between ACE & ARB, the drug of choice will be ARB. ARB has
lesser side effects like coughing
They both have cardiac remodelling action & prevents further
cardiac enlargement

Living the DREAM!