|Angiotensin-Converting Enzyme Inhibitors||Benazepril (Lotensin)|
|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)|
|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.
Nicardipine sustained release
Nifedipine long acting (Procardia XL)
|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.