| Angiotensin Inhibitors | |||
| Angiotensin-Converting Enzyme Inhibitors | Benazepril (Lotensin)
Captopril Enalapril (Vasotec) Fosinopril Lisinopril (Zestril) Moexipril (Univasc) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) |
Inhibit ACE, reduce conversion of angiotensin I to angiotensin II (A-II). Inhibit A-II–mediated vasoconstriction. | Aspirin and NSAIDs may reduce drug effectiveness. Addition of diuretic enhances drug effect.
Should not be used with potassium-sparing diuretics. Can cause increase in serum creatinine. Inhibit breakdown of bradykinin, which may cause a dry, hacking cough that can occur at any point during treatment, even years later. Captopril may be given orally for hypertensive crisis. |
| Angiotensin II Receptor Blockers | Azilsartan (Edarbi)
Candesartan (Atacand) Eprosartan (Teveten) Irbesartan (Avapro) Losartan (Cozaar) Olmesartan (Benicar) Telmisartan (Micardis) Valsartan (Diovan) |
Prevent action of A-II and produce vasodilation and increased Na+ and water excretion. | Full effect on BP may not be seen for 3-6 wk. Do not affect bradykinin levels, therefore acceptable alternative to ACE inhibitors in people who develop dry cough.
In patients with kidney disease, ACE inhibitors and ARBs should not be used together due to adverse renal effects. |
| Renin Inhibitors | Aliskiren (Tekturna) | Directly inhibits renin, thus reducing conversion of angiotensinogen to angiotensin I. | May cause angioedema of the face, extremities, lips, tongue, glottis, and/or larynx.
Not to be used in pregnancy. |
| Calcium Channel Blockers | |||
| Non-Dihydropyridines | Diltiazem extended release (Cardizem LA)
Verapamil intermediate release (Calan) Verapamil long-acting (Covera-HS) Verapamil timed-release (Verelan PM) |
Inhibit movement of Ca++ across cell membrane, resulting in vasodilation
Cardioselective resulting in decrease in heart rate and slowing of AV conduction. |
Use with caution in patients with heart failure. Serum concentrations and toxicity of certain calcium channel blockers may be increased by grapefruit juice; avoid concurrent use.
Used for supraventricular tachydysrhythmias. Avoid in patients with second- or third-degree AV block or left ventricular systolic dysfunction. |
| Dihydropyridines | Amlodipine (Norvasc)
Clevidipine (Cleviprex) Felodipine Isradipine Nicardipine sustained release Nifedipine long acting (Procardia XL) Nisoldipine (Sular) |
Cause vascular smooth muscle relaxation resulting in decreased SVR and arterial BP. | More potent peripheral vasodilators. Clevidipine is for IV use only. Use of sublingual short-acting nifedipine in hypertensive emergencies is unsafe and not effective.
Serious adverse events (e.g., stroke, acute MI) have been reported. IV nicardipine available for hypertensive crisis in hospitalized patients. Change peripheral IV infusion sites every 12 hr. |
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