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Antihypertensives

Uses, Side Effects and Pharmacogenetics of Antihypertensive Drugs

By | Adverse Drug Reactions, Antihypertensives | No Comments

An antihypertensive drug is any agent that reduces blood pressure. There are many different classes and are used in certain situations. They are prescribed for hypertension and help prevent events like transient ischemic attacks (TIAs), strokes, and myocardial infarction.
 
Classes of antihypertensive drugs include:

  • Diuretics
  • Calcium channel blockers
  • ACE inhibitors – used to treat hypertension but act by inhibiting angiotensin converting enzyme. This reduces activity of the renin angiotensin aldosterone system and reduces blood pressure. One example is ramipril.
  • Angiotensin II receptor antagonists
  • Adrenergic antagonists
  • Benzodiazepines
  • Renin inhibitors
  • Aldosterone receptor antagonists
  • Endothelin receptor blockers
  • Thiazide diuretics – used to treat hypertension and edema. They work by inhibiting the sodium chloride symporter. The increase in fluid loss decreases blood volume and reduced blood pressure. An example is bendroflumethiazide.


 

Antihypertensive Drugs Side Effects

 
Thiazide diuretics like bendroflumethiazide cause a number of side effects. These include:

  • Syncope (fainting)
  • Hypotension (low blood pressure)
  • Glaucoma
  • Gastric irritation
  • Nausea/vomiting
  • Diarrhea
  • Constipation
  • Abdominal pain
  • Rash

 
Calcium Channel Blockers include drugs like isradipine and verapamil. Side effects include:

  • Headache
  • Dizziness
  • Lethargy
  • Hypotension (low blood pressure)
  • Edema (swelling)
  • Pharyngitis (sore throat)
  • Fatigue
  • Malaise
  • Rash
  • Scalp irritation
  • Sleep disturbance
  • Myalgia (muscle pain)
  • Allergic reactions
  • Hypersensitivity
  •  
    ACE inhibitors are also associated with a number of side effects. These include:

    • Hypotension
    • Angina pectoris (chest pain)
    • Postural hypotension
    • Nausea/vomiting
    • Diarrhea
    • Abdominal discomfort
    • Dyspepsia
    • Fatigue
    • Asthenia
    • Vertigo
    • Bronchitis
    • Cough
    • Depression
    • Anxiety
    • Nervousness
    • Restlessness
    • Headache
    • Dizziness
    • Syncope (fainting)
    • Muscle spasm
    • Myalgia (muscle pain)


     
    Angiotensin II receptor antagonists include drugs like losartan (Cozaar). Common side effects include:

    • Nasal congestion
    • Sinusitis
    • Abdominal pain
    • Nausea
    • Diarrhea
    • Dyspepsia (indigestion)
    • Back pain
    • Myalgia (muscle pain)
    • Dizziness
    • Headache
    • Vertigo
    • Chest pain
    • Hyperkalemia (high blood concentration of potassium)
    • Insomnia
    • Anemia

     
    Adrenergic receptor antagonists are also used as antihypertensives. Common side effects include (these occur in more than 1% of patients):

    • Hypotension (low blood pressure)
    • Raynaud’s syndrome (can result in cold extremities)
    • Fatigue
    • Sleep disturbances
    • Nightmares
    • Sleep disorder
    • Agitation
    • Somnolence (lack of energy)
    • Irritability

     
    Antianxiety medications such as benzodiazepines can be used to lower blood pressure. Side effects can include:

    • Irritability (33% more)
    • Anxiety
    • Depression
    • Confusion
    • Disinhibition
    • Derealization
    • Dream abnormalities
    • Fear
    • Drowsiness (77%)
    • Impaired coordination
    • Memory impairment
    • Lightheadedness
    • Insomnia
    • Headache
    • Cognitive disorder
    • Dysarthria
    • Abnormal involuntary movement
    • Somnolence
    • Ataxia (loss of control of body)
    • Balance disorder
    • Nervousness
    • Syncope (fainting)
    • Agitation
    • Paresthesia (pins and needles)
    • Tinnitus
    • Hypersomnia
    • Lethargy
    • Fatigue
    • Blurred vision
    • Decreased libido
    • Micturition difficulties (issues urinating)
    • Menstrual disorders
    • Increased libido
    • Decreased salivation
    • Constipation
    • Allergies
    • Tachycardia (increased heart rate)
    • Chest pains
    • Rigidity
    • Tremor
    • Muscular twitching
    • Increased/decreased appetite
    • Weight gain/loss

     

    Know Your Risks for Side Effects from Anihypertensive Medications with the Rxight® Genetic Test

     
    Most patients do not suffer adverse reactions when taking antihypertensives. However some patients may suffer from many side effects. This inter patient variability is explained by pharmacogenetics. Polymorphisms (variations) in the enzymes and receptors that interact with antihypertensives can increase the probability of patients developing side effects.
     
    Most antihypertensives are metabolized by the cytochrome P450 superfamily of enzymes (the specific isoenzymes will vary on class and drug). Polymorphisms in these enzymes have been shown in studies to increase the probability of developing side effects (Clinical Biochemist Reviews, “The Influence of Cytochrome P450 Pharmacogenetics on Disposition of Common Antidepressant and Antipsychotic Medications,” Feb 2006).
     
    Identifying these alleles can aid clinicians in prescribing antihypertensives and could reduce the risk of developing adverse reactions. MD Labs provides a genetic testing service, Rxight®, which sequences a number of genes to establish how patients are likely to respond to hundreds of medications, including most antihypertensives.

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