ANTIHIPERTENSIVE

Definitie: medicamentele antihipertensive scad valorile tensiunii

arteriale, crescute in HTA, catre cele fiziologice. Mecanismele vizeaza
scaderea: fie a debitului cardiac fie a rezistentei periferice.
Definitie: hipertensiunea arteriala este cresterea constanta a tensiunii
arteriale sistolice (TAs) si/sau diastolice (TAd), la pacienti fara
tratament antihipertensiv, respectiv Tas ≥ 140 mmHg si/sau TAd ≥ 90
mmHg.

Clasificarea hipertensiunii

a) Clasificarea, functie de valorile TA max. (TAs) si TA min.

(TAd), in mmHg

b) Clasificarea stadiala O.M.S. (functie de stadiile de

afectare a unor organe):

Stadiul I, functional:
- cresteri tensionale moderate si temporare cu tulburari vasomotorii
(ameteli, dureri de cap etc);
- EKG normala;
- fara semne de afectare organica.

Stadiul II, organic:

- cresteri tensionale permanente;
- modificari de EKG;
- semne de afectare organica (cel putin unul) precum: hipertrofie
ventriculara stanga, tulburari renale).
Stadiul III, multiorganic:
- HTA severa permanenta;
- EKG modificata;
- afectari in majoritatea organelor vitale (insuficienta ventriculara
stanga, angina pectorala, infarct miocardic, AVC, retinopatie
hipertensiva etc).

c) Clasificare, functie de etiologie:

HTA esentiala (primara)

- este plurietiologica, datorata unor disfunctii complexe si relativ greu
de diagnosticat; cauze favorizante (factori de risc) sunt: antecedentele
familiale, arteroscleroza, obezitate, stres repetat, sedentarism,
fumatul/alcoolul (debutul la 25-55 ani);
HTA secundara
- este datorata unor patologii decelabile (boli
renale/hepatice/endocrine, diabet zaharat), sarcinii sau a unor
medicamente (AINS, anticonceptionale, corticosteroizi).

Farmacoterapia HTA este instituita in trepte (etape)

Etapa 1-a: monoterapie (HTA usoara)

- de prima alegere: diuretice (varstnici) sau beta-adrenolitice;
- de alternativa (in functie de bolnav si patologia asociata):
 blocante ale canalelor de Ca++ (tip nifedipina);
 alfa-adrenolitice (tip prazosin)
 centrale (clonidina, reserpina)
 inhibitori ai enzimei de conversie (IEC) (tip captopril sau
enalapril).

Etapa 2-a: asociere de 2 antihipertensive (HTA moderata)

- de prima alegere:
 diuretic + beta-adrenolitic;
 diuretic + IEC;
 diuretic + alfa-adrenolitic;
 diuretic + clonidina;
- de alternativa in functie de bolnav si patologia asociata: de ex.
blocante ale canalelor de Ca++ + IEC.

Etapa 3-a: asociere de 3 antihipertensive (HTA severa)

- de prima alegere: asocierea unui vasodilatator musculotrop (tip
dihidralazina);
- de alternativa in functie de bolnav alta asociere: de ex. un bolnav cu
tonus simpatic crescut, se adauga un al doilea simpatolitic (alfa
metildopa).

Clasificarea medicamentelor antihipertensive

Clasificarea, functie de mecanismele fiziopatogenice implicate in HTA,

la nivelul carora actioneaza:

A. Inhibitoare ale sistemului nervos vegetativ simpatic

(Simpatolitice);
- Centrale:
 clonidina, moxonidina, rilmenidina;
 alfa-metildopa, reserpina;
- Beta-adrenolitice:
 neselective - propranolol, sotalol, tertatolol, carvedilol;
 selective beta-1 – atenolol, metoprolol, nebivolol,
betaxolol, bisoprolol, celiprolol, talinolol;
- Alfa-adrenolitice: prazosin, doxazosin, terazosin;
B. Vasodilatatoare
- blocante ale canalelor de calciu:
 tip nifedipina: nifedipina, nimodipina, nisoldipina,
nitrendipina, lacidipina, lecarnidipina, felodipina,
amlodipina;
 tip diltiazem: diltiazem;
 tip verapamil: verapamil, galopamil;
- musculotrope: hidralazine, papaverina, nitroprusiat de sodiu;
C. Substante care interfera cu sistemul renina-angiotensina
– aldosteron;
- inhibitoare ale enzimei de conversie a angiotensinei
(IEC): captopril, lisinopril si prodroguri: enalapril, benazepril,
cilazapril, fodinopril, perindopril, quinapril, ramipril, trandolapril,
zofenopril;
- antagonisti ai receptorilor AT-1 ai angiotensinei II:
candesartan, eprosartan, irbesartan, losartan, telmisartan,
valsartan.
D. Diuretice:
- tiazide si similare farmacologic: hidroclorotiazida, clortalion,
indapamid;
- de ansa: furosemid, bumetanid, acid etacrinic;
- antialdosteronice: spironolactona, amilorid, triamteren;
E. Alte mecanisme:
 - antagonisti ai serotoninei: ketanserin

DCI-uri – Forme farmaceutice - Denumiri comerciale

SIMPATOLITICE
clonidinum – compr. 0,15 mg: Clonidina
moxonidinum – compr. film. 0,2/0,3/0,4 mg/ml: Moxonidina,
Moxogamma, Physiotens
rilmenidinum – compr. 1 mg: Rilmenidina, Tenaxum
methyldopum – compr. 250 mg: Dopegyt
propranololum – compr. 10/40 mg, sol. orala: Propranolol, N-
Propranolol, Hemangiol
sotalolum – compr. 80/160 mg: Sotalol, Sotagamma, Darob
carvedilolum – compr. film. 3,125/6,25, 12,5/25 mg: Carvedilol,
Carvedigamma, Carveheal, Coryol, Dilatred, Gladycor,
Miocarvil, Talliton, Tedilol
metoprololum – compr. elib. prel./film. 25/50/100/200 mg, sol.
inj./perf.: Betaloc Zok, Betaprol, Bloxan, Egilok, Metoprolol,
Metosuccinat
atenololum – compr. 50/100 mg: Atenocor, Atenolol
bisoprololum – compr. film. 2,5/5/10 mg: Bisoblok, Bisogamma,
Bisoprolol, Bisotens
betaxololum – compr. film. 20 mg, pic. oft.: Betaxolol, Betac,
Betax, Betoptic, Lokren
nebivololum – compr. film. 5 mg: Nebivolol, Dublock, Nebicard,
Nebilet, Nebinorm, Nolet, X-Pressol
doxazosinum – compr. film. 1 mg, 4 mg: Doxazosin, Kamiren,
Cardura
prazosinum – compr. 1/2 mg: Minipress

VASODILATATOARE
amlodipinum – compr. 5/10 mg: Amlodipina, Almacor, Alneta,
Alotendin, Amlodigamma, Vazotal
felodipinum – compr. elib. prel. 2,5/5/10 mg: Felodipin, Auronal,
Plendil, Sistar
lacidipinum – compr. film. 2/4 mg: Lacipil
lercanidipinum – compr. film. 10/20 mg: Lercanidipin, Leridip,
Lerpin, Pegfel
nifedipinum – compr. elib. prel. 20/30 mg: Adalat, Nifedipin
nimodipinum – compr. film. 30 mg, sol. perf.: Nimotop
nitrendipinum – compr. 20 mg: Lusopress
verapamilum – compr. film., caps., draj. 40/80 mg: Cordamil,
Isoptin, Verapamil
diltiazemum – compr., caps. elib. prel. 60/90 mg: Diltiazem, Dilzem

SUBSTANTE CE INTERFERA CU SISTEMUL RENINA-

ANGIOTENSINA
benazeprilum – compr. film. 5/10/20 mg: Benazepril, Cibacen
captoprilum – compr. 12,5/25/50 mg: Captopril
cilazaprilum – compr. film. 0,5/1/2,5/5 mg: Pipredo
enalaprilum – compr. 5/10/20 mg, sol. inj.: Enalapril, Enal, Enap,
Renitec
fosinoprilum – compr. 10/20 mg: Fosinopril, Fosypril, Monopril,
Monotens,
lisinoprilum – compr. 5/10/20/40 mg: Lisinopril, Lisigamma,
Lisiren, Ranolip, Tonolysin
perindoprilum – compr. 2,5/4/5/8/10 mg: Prestarium
quinaprilum – compr. film. 5/10/20 mg: Accupro, Pulsaren
ramiprilum – compr. 1,25/2,5/5/10 mg: Ramipril, Amprigen,
Ampril, Hartil, Piramil, Ramiran, Tritace (+ hidroclortiazida)
trandolaprilum – caps. 0,5/1/2/4 mg: Trandolapril, Gopten
zofenoprilum – compr. film. 7,5/30 mg: Zofenopril, Zomen,
candesartanum – compr. 4/816/32 mg: Atacand, Tandesar, Karbis
eprosartanum – compr. film. 300/400/600 mg: Eprosartan, Teveten
irbesartanum – compr. 75/150/300 mg: Irbesartan, Aprovel,
Atokken, Ifirmasta, Irbec, Irbegamma, Karvea
losartanum – compr. film. 12,5/50/100 mg: Losartan, Cozaar,
Lodial, Lorista, Talosan
telmisartanum – compr. 20/40/80 mg: Telmisartan, Kinzalmono,
Micardis, Milsertan, Pritor, Tanydon, Telmark, Telmotens, Tezeo
valsartanum – compr. film. 40/60/80/160/320 mg: Valsartan,
Avassan, Diovan, Simaldoz, Valaric, Valcatuna, Valsacor,
Valsargamma, Vasopentol, Warota, Wenzell

DIURETICE
hydrochlorothiazidum – compr. 25 mg: Nefrix
indapamidum – compr. elib. prel. 1,5 mg: Indapamid, Belamid,
Diuremid, Iduren, Indapagamma, Rawel, Reditens, Serdimid,
Tertensif
furosemidum – compr. 40 mg, sol. inj.: Furosemid, Diurex, Diocor,
Diurocard (cu spironolactona)
spironolactonum – compr. film., caps. 25/50 mg: Spironolactona,
Alspiron, Verospiron