Pharmacologic Management

of Hypertension
7. Alpha 1 blockers
8. Central alpha2 Agonist
9. Direct Vasodilators

Ramos, Celber Vic. B

Alpha 1 blockers
Drugs

MOA

Drug of
choice
for/indicat
ion

Prazosin AlphaHypertensi
(Minipres adrenergic
on
s)
blockade leads BPH
decrease
Terazosin to
(Hytrin) systemic
vascular
Doxazosi resitance.
n
Results
in
(Cardura) decreased BP

Dose

Route

Initialmaximum

2-20 mg (23/day)

PO

1-10 mg (12/day)

PO

1-16 mg (1)

PO

Central alpha2 Agonist

Drugs

Methyldop
a
(Aldomet)

MOA

Drug of
choice
for/indicatio
n

Dose
Initialmaximum

Rout
e

Act as alpha2
agonists to reduce
sympathetic tone
Clonidine to peripheral
(Catapres) structures
(decreasing
peripheral
resistance, HR,
and plasma renin
activity)

Hypertension 250-1000
CHF
mg (2)

PO

Hypertension 0.1-0.6 mg
As effective
(2)
as
methyldopa
but requires
smaller dose
CHF

PO

Guanabenz
(Wytensin)

Hypertension
Often
combinned

PO

Direct Vasodilators
1. ARTERIAL VASODILATORS
Drugs

Hydralazi
ne
(Apresoli
ne)

MOA

Arterial smooth muscle

relaxation and
vasodilation (probably
through action on cAMP
and Calcium)

Drug of
choice
for/indicatio
n

Hypertensi
on
CHF

Minoxidil Inhibits
Hypertensi
(Loniten) Phosphodiesterase
on
leading to increase level Alopecia
of cAMP, which through
calcium modulation leads
to arterial smooth
muscle relaxation and
vasodilation

Dose

Route

Initialmaximum

10-50 mg
at 30 min
intervals

25-100
(2/day)

PO
IM
IV

PO
Topical

Direct Vasodilators
2. Arterial and Venous
Vasodilators
Drugs
MOA
Drug of
Nitroglyceri
n
(Nitro-Bid,
Nitro-Dur,
Nitrogard)

Converted to nitric
oxide intracellularly,
which activates
guanylate cyclase,
leading to the following
cascade of events:

Sodium
Nitroprussi
Leading to increase in
de
(Nitropress cGMP
Causing
, Nipride)
dephosphorylation of
myosin light chain
Leading to relaxation

Dose

choice
for/indicati
on

Initialmaximum

Acute
hypertensi
ve
emergenci
es
CHF

Initial 5
ug/min
then
titrate by
5 ug/min
at 3-5 min
intervals
Max: 1020 ug/min
Initial: 0.3
(ug/kg)/mi
n
Max: 10

Route

Subling
al
PO, IV,
Ointmen
t or

patche
s

IV

References
Harrisons Principles of Internal
Medicine 18th edition. Longo et.al
Goodman & Gilmans Manual of
Pharmacology and Therapeutics by
Brunton et.al
Basic and Clinical Pharmacology 10th
edition by Bertram G. Katzung