HERBAL ANTI HYPERTENSION DRUGS

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ABOUT AUTHORS:
Asha Kesari*, Pushpa Kumari Mahto, Shankheswari Kishan, Suranjeeta Singh
Department of Pharmaceutics,
Kanak Manjari Institute of Pharmaceutical Sciences,
Rourkela, Odisha
ashakeshri@yahoo.co.in

ABSTRACT
Hypertension or high blood pressure is a chronic medical condition in which the arterial blood pressure is elevated (normal blood pressure is 120/80 mm Hg). High Blood Pressure may lead to heart failure, stroke, coronary heart disease, kidney failure etc and may affect lungs, brain and heart. It is an important global problem and a very good percentage of people all over the world are affected by blood pressure. As there is no definite cure for this condition, hence controlling it is a big challenge. The main focus on BP management is to lower the elevated blood pressure and to prevent or reduce target organ damage. Although various antihypertensive drugs are available, they are usually associated with many sides –effects. The following article deals with the alternative measures used for lowering high blood pressure giving more importance on the various herbal drugs to be used as combination therapy.

REFERENCE ID: PHARMATUTOR-ART-2294

PharmaTutor (ISSN: 2347 - 7881)

Volume 2, Issue 12

Received On: 16/10/2014; Accepted On: 22/10/2014; Published On: 01/12/2014

How to cite this article: A Kesari, PK Mahto, S Kishan, S Singh; Herbal Anti Hypertension Drugs; PharmaTutor; 2014; 2(12); 49-61

INTRODUCTION
Hypertension refers to the prolonged and persistent elevation of blood pressure above the normal range. If not treated properly, hypertension can cause severe complications such as stroke, coronary heart disease and kidney failure.

Patients with hypertension must take antihypertensive drugs on a long-term basis. Although such drugs cannot give a radical cure, they can prevent heart failure, kidney failure and acute stroke induced by hypertension and delay the development of atherosclerosis by controlling the blood.(1)

Hypertension or high blood pressure is often called the” Silent killer”. “Silent” because it does not produce any significant recognizable symptoms and “killer” because even slightly high blood pressure can increase the risk of heart disease significantly.(2)

RISK FACTORS IN HYPERTENSIVE PATIENTS (3)
1. Smoking
2. Age (women older than 65 years and men older than 55 years of the age)
3. Diabetes
4. Dyslipidemia(↑LDL, ↓HDL, ↑TG)
5. Microalbuminuria or g.f.r < 60 ml/min
6. Family history of cardiovascular disease
7. Sex (men and postmenopausal women)
8. Obesity

PHARMACOLOGY OF ANTIHYPERTENSIVE AGENT (4)
Hypertension: systolic BP ≥140mmHg and/or diastolic≥90mmHg

Classification of hypertension for adults:

CATEGORY

SYSTOLIC(mmHg)


DIASTOLIC(mmHg)

Optimal  BP

<120

AND

<80

Normal BP

<130

AND

<85

High-normal BP

130-139

OR

85-89

Stage1(mild)

140-159

OR

90-99

Stage2(moderate)

160-179

OR

100-109

Stage3 (severe)

≥180

OR

≥110

DRUG TREATMENT FOR HYPERTENSION – FACTOR TO CONSIDER
1. Primary (essential hypertension) vs. secondary (10-15% patients
E.g-pheochromocytoma, renal artery constriction, Cushing’s syndrome
2. Diagnosis (based on separate office visits) and severity of hypertension
3. Individualization (age, gender, ethnicity) and patient compliance.
4. Pre-existing risk factors and medical conditions Smoking, hyperlipidmia, diabetes, CHF, asthma, current medication….
5. Single –drug therapy (mono therapy) vs. multiple drug therapy (poly pharmacy)

PRIMARY HYPERTENSION (ESSENTIAL HYPERTENSION)(5)
Essential hypertension is the most prevalent type of hypertension, affecting 90 to 95% of hypertensive patients. Although no direct cause has identified itself, there are many factors such as sedentary life, stress, visceral obesity, potassium deficiency, alcohol intake, and vitamin D deficiency that increase the risk of developing hypertension.

Risk also increases with aging, some inherited genetic mutations, and having a family history of hypertension. An elevation of renin, an enzyme secreted by the kidney, is another risk factor, as is sympathetic nervous system over activity.

Consuming foods that contain high fructose cron syrup may increase one’s risk of developing hypertension.

SECONDARY HYPERTENSION
This type is important to recognize since it is treated differently than essential hypertension, by treating the underlying cause of elevated BP. Hypertension results compromise or imbalance of pathophysiological mechanisms, such as the hormone regulating endocrine system, that regulate blood plasma volume and heart function.Some are common and well- recognized secondary causes such as Cushing’s syndrome, which is a condition where the adrenal glands overproduce the hormone cortisol.

MALIGNANT HYPERTENSION (6)
The term hypertensive emergency is primarily used as a specific term for a hypertensive crisis with a diastolic blood pressure greater than or equal to 120 mmHg and/ or systolic blood pressure greater than or equal to 180mmHg.Hypertensive emergency differs from hypertensive crisis in that, in the former,there is evidence of  acute organ damage.

A hypertensive emergency (formerly called “malignant hypertension”) is hypertension (high blood pressure)with acute impairment of one or more organ systems(especially the CNS, cardiovascular system and/or the renal system) that can result in irreversible organ damage. In a hypertensive emergency, the blood pressure should be slowly lowered over a period of minutes to hours with an antihypertensive agent.

PATHOPHYSIOLOGY (5)
The following three theories have been proposed to explain this:
1. Inability of the kidneys to excrete sodium, resulting in natriuretic factors such as atrial natriuretic factor being secreted to promote salt excretion with the side effect of raising TPR.
2. An overactive renin-angiotensin system leads to vasoconstriction and retention of sodium and water .The increase in blood volume leads to hypertension.
3. An overactive sympathetic nervous system, leading to increases stress responses.

It is also known that hypertension is highly heritable and Polygenic (caused by more than one gene) and a few candidates Genes have been postulated in the etiology of this condition.

HTN is a major independent risk factor for coronary artery disease, stroke, and kidney failure. Each increase of 20mmHg in systolic BP and 10mmHg in diasystolicBP, over the range of 115/75 to185/115 mmHg, doubles the risk of a fatal coronary event.

PRINCIPLE OF ANTIHYPERTENSION DRUGS (7)

Classes of antihypertension drugs
• Aldosterone receptors antagonists (blockers)
• Angiotensin II antagonists
• Angiotensin- converting enzyme inhibitor
• Alpha1 selective
• Non-selective
• Beta- blockers
• Beta-I/Beta-2
• Beta-1 predominant
• Alpha/Beta
• Intrinsic sympathomimtic activity
• Calcium channel antagonists
• non dihydropyridine
• Dihydropyridine
• Central Alpha2 agonists
• Direct renin inhibitors
• Direct vasodilators
• Diuretics
• Thiazide-type
• Loop-type
• Potassium –sparing
• Ganglionic blockers

COMMON HYPERTENSION DRUGS (8)


CLASS

TRADE

NAME

GENERIC   NAME

SIDE   EFFECTS

SPECIAL  MEASURES

AngiotensinII

 Receptors

Blockers

(ARBs)











Atacand

Atacand HCT

Avalide

Avapro

Benicar

Benicar HCT

Cozaar

Diovan

Diovan HCT

Exforge

Hyzaar

Micardis

Micardis HCT

Teveten

Teveten HCT

candesartan

candesartan+HCT

irbesartan+HCT

irbesartan

olmesartan

olmesartan+HCT

losartan

valsartan

valsartan+HCT

valsartan+amlodipine

losartan+HCT

telmisartan

telmisartan+HCT

eprosartan

eprosartan+HCT

1.Dizziness,

Lightheadededness

Or faintness upon

Rising

2. Physical problems:  Muscle cramps or weakness, back or legs pain, insomnia, irregular heartbeat or rapid or slow heartbeat.

3.Confusion

4.Severe vomiting or diarrhea

5.Cough

ARBs can be taken on an empty or full stomach.

Monitor B/P,CBC,electrolytes and renal function

Fall risk precaution especially early in therapy

INDICATIONS

Hypertension, alone or in combination with other antihypertensive drugs

Nephropathy in type IIdiabetes mellitus

Heart failure in combination with ACE inhibitor 

Reduce the risk of stroke

 

CLASS

TRADE  NAME

GENERIC   NAME

SIDE  EFFCT

SPECIAL MEASURE

AngiotensinConverting Enzyme Inhibitors

(ACEIs)

Accupril

Accuretic

Aceon

Altace

Capoten

Capozide

Lexxel

Lotensin

Lotensin HCT

Mavik

Monopril

Monopril HCT

Prinivil

Prinzide

Taka

Teczem

Uniretic

Univasc

Vaseretic

Vasotec

Zestoretic

Zestril

 Quinapril

Quinapril/HCT

Perindopril

Ramipril

Captopril

Captopril/HCT

Enalipril/felodipine

benazepril

benazepril/HCT

trandolapril

fosinopril

fosinopril/HCT

lisinopril

lisinopril/HCT

trandolapril/verapamil

enalapril/diltiazem

moexipril/HCT

moexipril

enalapril/HCT

enalaprilat

lisinopril/HCT

lisinopril

1.Cough

2.Red,itchy,skin rash

3.Dizziness,

Lightheadedness,

Or faintness upon

rising

4. Physical symptoms: sore throat, fever, mouth sores, chest pain, and swelling of feet, ankles and lower legs.

5. Swelling of the neck, face, and tongue.

6.High potassium levels

7.Kidney failure

8. Severe vomiting or diarrhoea.

Take on an empty stomach one hour before meals.

Do not use salt substitutes while taking ACE inhibitors.

Avoid NSAIDs like Aleve andMortin.

Fall risk precautions especially early in therapy.

Do not interrupt therapy without a MD order.

INDICATIONS

Hypertension, alone or in combination with other antihypertensive drugs.

Congestive heart failure in conjunction with diuretics.

Diabetes neuropathy.

Hypertension in the presence of kidney disease.

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