Regulation of Blood

Pressure

Regulation of Blood
Pressure

ANTIHYPERTENSIVE
DRUGS

1. DIURETICS
MoA and hemodynamic effect:
sodium and water retention
BP
PR
Pharmacological Effects:
Natriuretic (especially loop D.)
K+ excretion (esp. acetazolamide; except
K+-sparing D.)
Ca++ excretion (esp. loop D; except
Thiazide)
Water excretion (esp. loop D)

Proximal Tubule

Carbonic Anhydrase
Inhibitors

PK >> well absorbed after oral adm,

excretion by secretion in the proximal
tubule S2 segment.
PD >> depresses bicarbonate
reabsorption.
Indications >> glaucoma, acute
mountain sickness, urinary
alkalinization.

Loop of Henle

Loop Diuretics
Furosemid, bumetanid, torsemid,
ethacrynic acid
PK >> rapidly absorbed,
eliminated by tubular secretion
DI >> NSAIDs or probenecid >>
compete for weak acid secretion in
the proximal tubule.

Distal Convoluted
Tubule

Potassium-Sparing Diuretics
Spironolactone, amiloride,
triamterene
Na+ absorption (and K+ secretion)
at this site is regulated by
aldosterone.
MoA >> bind to aldosterone
receptors

Side Effects:
Metabolic effects
Hipomagnesia
Hipovolemia
Hipokalemia
(
(esp. at

2. SYMPATHOLITICS
DRUGS
A. -BLOCKER (Prazosin, Terazosin,
Doxazosin)

B. -BLOCKER
MoA:
Activation
Activationof
of1
1
adrenoceptors
adrenoceptors

CO
CO

-adrenoceptor
-adrenoceptor
blockers
blockers

PR
PR

Renin
Renin

Angiotensin
Angiotensin IIII

Aldosterone
Aldosterone
Na and
and water
water
Na
retention
retention

Blood
Blood
volume
volume

BP

-BLOCKER AGENTS:

Non-selective: propanolol, nadolol,

carteolol
1 blokers (cardioselective): atenolol,
metoprolol (relative), betaxolol,
bisoprolol
Partial agonist (-blockers + ISA):
pindolol, acebutolol, penbutolol
-blockers with -blocker effect:
labetalol & carvedilol

INDICATION:
HT dgn tachyaritmia, history of MI, AP,

C. CENTRALLY ACTING ADRENERGIC

D
Metildopa
Clonidine

3. VASODILATORS
Nitroprusside

A1. Hidralazine
Dilatasi arteri & arteriol (bukan
vena)
Resistensi perifer & reflex HR
& CO.
E.S: sakit kepala, anorexia,
palpitasi,
sweating, & flushing
A2. Minoxidil
Indikasi: HT sedang-berat; sering
Dilatasi arteriole (bukan
kombinasi
venule)
dgn diuretik dan -blocker
Indication: HT berat HT

B. HIPERTENSI EMERGENCY
TD diastolik > 150 mmHg atau
>130 mmHg dg komplikasi :
- Encephalopathy
- Cerebral hemorrhage
- Left ventricular failure
- Aortic stenosis
Tuj Th/ : dgn cepat TD
Obat : Sodium Nitroprusside (iv)
dan
Diazoxide (direct acting
arteriolar

C. Calcium Channel Blockers

Mekanisme :
- Menghambat influx Ca++ ke dlm
sel otot polos vasc. tonus &
resistensi vask
BP (vasodilator)
- Efek natriuretik intrinsik
-Indikasi :
HT dgn asthma, diabetes,
angina, dan peny vaskular
perifer

Obat CCB:
1. Dihydropyridine:
Nifedipine
- Isradipine
Nicardipine
- Nisoldipine
Amlodipine
- Felodipine
Nimodipine (cerebral
vasodilator)

2. Verapamil
3. Diltiazem

4. INHIBITORS OF
ANGIOTENSIN
A. ACE-INHIBITOR

-Captopril - Fesinopril
-Enalapril - Moexipril
-Lisinopril - Quinopril
-Benazepril - Ramipril (long acting)

B. ANGIOTENSIN REC-BLOCKING
AGENT
1. Angiotensin Type 1 (AT1) Rec
Blocking Agents:
- Losartan
- Valsartan
2. Analog and competitive Inhibitor of
AT II : - - Saralasin

4A. ACE INHIBITOR

Efek Farmakologi:

BP
-SekresiAldosteron Retensi Na+Air &
Retensi K+
-Bradikinin Vasodilatasi (enalapril:
bradykinin )
-Vasodilator
Preload CO

Efek Samping:
- Hipotensi berat setelah dosis awal
- ARF (khususnya pada stenosis ginjal)??
- Hiperkalemia
- Dry cough
- Angioedema
- Mempengaruhi sensasi rasa/pengecap
- Alergi skin rash, drug fever
-VR

4B. (AT1) Receptor Blocking

Agents
(Losartan and Valsartan).
Efek pada metabolisme
bradykinin (selective blockers)
Losartan: efek urikosurik (+)
Analog & competitive
Inhibitor of AT II :
(Saralasin)
Antagonis & agonis AT II
lemah,
efeknya:
unpredictable

KombinasiAntiHT