Contents

Search

antihypertensive agent

Agents used in the control of blood pressure. Classification: 1) diuretics a) loop diuretics b) thiazide diuretics 2) sympatholytics a) adrenergic neuron inhibitor b) adrenergic receptor antagonist 1] alpha-adrenergic receptor antagonist (alpha blocker) 2] beta-adrenergic receptor antagonist (beta blocker) c) centrally-active alpha-adrenergic receptor agonist 3) vasodilator agents a) renin-angiotensin-aldosterone inhibitor 1] ACE inhibitors 2] ARBs 3] renin inhibitor 4] aldosterone antagonist c) calcium channel blockers d) nitrates e) others Benefit/risk: - no benefit to anti-hypertensive agents for treatment of mild hypertension [2] - 1 in 12 patients experience adverse drug effects from anti-hypertensive agents - antihypertensive use reduces incident dementia or cognitive impairment 7.0 vs 7.5% & cognitive decline: 20 vs 21% [5] - antihypertensive use does not change scores on the Mini-Mental State Examination, Trail Making Test, or Cognitive Abilities Screening Instrument [5] - RAAS inhibitors that cross the blood-brain barrier* may be linked to less memory decline [9] (see RAAS inhibitor) - number needed to treat (NNT) with anti-hypertensive agent(s) for systolic blood pressure of 170 mm Hg, non-smoking, without diabetes mellitus [3] - 238 men 50 years old to prevent 1 MI - 227 men 50 years old to prevent 1 stroke - 569 women 50 years old to prevent 1 MI - 310 women 50 years old to prevent 1 stroke - 101 men 65 years old to prevent 1 MI - 88 men 65 years old to prevent 1 stroke - 294 women 65 years old to prevent 1 MI - 120 women 65 years old to prevent 1 stroke - antihypertensive treatment associated with lower risk for cardiovascular events (9-11%) regardless of baseline blood pressure or cardiovascular disease, even at systolic blood pressures of < 120 mm Hg [7]* * apparently this would not apply to patients with HFpEF [[8] Dosage: - bedtime dosing may benefit patients who do not become hypotensive at night or have nocturnal falls due to orthostatic hypotension - ACE inhibitors, ARBs & calcium channel blockers with most evidence for benefit of bedtime dosing [1] - bedtime antihypertensive dosing may diminish cardiovascular risk [4] - morning vs night dosing with similar rates of cardiovascular outcomes [11] - Cochrane review unable to determine whether morning or evening dosing superior with respect to cardiovascular outcomes or adverse effects [13] Adverse effects: - no association of antihypertensives & falls in the elderly [6] - acute kidney injury (RR=1.2)* - hyperkalemia (RR=1.9)* - hypotension (RR=2.0) - syncope (RR=1.3) [6] - antihypertensives associated with increased MRI white matter hyperintensities [10] * risks magnified with medications affecting the renin-angiotensin-aldosterone system Notes: - substantial heterogeneity in blood pressure response to antihypertensives [12] - personalized therapy with potential to lower systolic blood pressure an additional 4.4 mm Hg [12]

Interactions

drug interactions drug adverse effects of antihypertensive agents

Related

antihypertensive agents & diabetes risk chronic hypertension hypertension (HTN, high blood pressure, HBP)

Specific

angiotensin II type 2 & 4 inhibiting agent angiotensin II type 2 & 4 stimulating agent diuretic rilmenidine sympatholytic; alpha & beta blockers; adrenergic neuron inhibitors; adrenolytic vasodilator agent

General

cardiovascular agent

Properties

References

  1. Prescriber's Letter 19(1): 2012 Timing of Antihypertensive Medications Detail-Document#: 280109 (subscription needed) http://www.prescribersletter.com
  2. The NNT: Anti-Hypertensive Treatment for the Primary Prevention of Cardiovascular Events In Mild Hypertension. http://www.thennt.com/nnt/anti-hypertensives-for-cardiovascular-prevention-in-mild-hypertension/
  3. The NNT: Blood Pressure Medicines for Five Years to Prevent Death, Heart Attacks, and Strokes. http://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/
  4. Hermida RC, Crespo JJ, Dominguez-Sardina M et al. Bedtime hypertension treatment improves cardiovascular risk reduction: The Hygia Chronotherapy Trial. Eur Heart J 2019 Oct 22; ehz754 PMID: 31641769 https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478 - Hermida RC, Ayala DE, Mojon A, Fernandez JR. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011 Dec;22(12):2313-21. Epub 2011 Oct 24. PMID: 22025630 Free PMC Article
  5. Hughes D, Judge C, Murphy R et al Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment. A Systematic Review and Meta-analysis. JAMA. 2020;323(19):1934-1944 PMID: 32427305 https://jamanetwork.com/journals/jama/fullarticle/2766163
  6. Albasri A, Hattle M, Koshiaris C et al. Association between antihypertensive treatment and adverse events: Systematic review and meta-analysis. BMJ 2021 Feb 10; 372:n189. PMID: 33568342 PMCID: PMC7873715 Free PMC article https://www.bmj.com/content/372/bmj.n189
  7. The Blood Pressure Lowering Treatment Trialists' Collaboration Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021. May 1. Volume 397, ISSUE 10285, P1625-1636 PMID: 33933205 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00590-0/fulltext
  8. Faselis C, Lam PH, Zile MR et al. Systolic blood pressure and outcomes in older patients with HFpEF and hypertension. Am J Med 2021 Apr 1; 134:e252. PMID: 33010225 https://www.amjmed.com/article/S0002-9343(20)30812-3/fulltext
  9. Pass W Memory benefit seen with antihypertensives crossing blood-brain barrier. Internal Medicine News. 2021. June 21. https://www.mdedge.com/internalmedicine/article/241878/neurology/memory-benefit-seen-antihypertensives-crossing-blood-brain
  10. Messerli FH, Bavishi C, Messerli AW, Siontis GCM On Cerebrotoxicity of Antihypertensive Therapy and Risk Factor Cosmetics. Eur Heart J. 2021;42(7):758-760. PMID: 33369623 https://www.medscape.com/viewarticle/948862
  11. Mackenzie IS et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): A prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022 Oct 22; 400:1417. PMID: 36240838 Free article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01786-X/fulltext
  12. Sundstrom J et al. Heterogeneity in blood pressure response to 4 antihypertensive drugs: A randomized clinical trial. JAMA 2023 Apr 11; 329:1160. PMID: 37039792 PMCID: PMC10091169 (available on 2023-10-11) https://jamanetwork.com/journals/jama/fullarticle/2803518
  13. Wu C, Zhao P, Xu P et al Evening versus morning dosing regimen drug therapy for hypertension. Cochrane Database Syst Rev. 2024 Feb 14;2(2):CD004184. PMID: 38353289 Review.

Component-of

antihypertensive combination