American Society of Hypertension Self-Assessment Guide
Basic Science: Pharmacology of antihypertensive drugs

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Drugs Causing Hypertension or Contributing to Loss of BP Control

There are a number of drugs that can cause significant BP elevations in otherwise normotensive individuals. There are also numerous clinically important interactions between antihypertensive and other drugs that result in loss of BP control, although the pharmacologic mechanisms underlying these effects vary.

Each of the four major classes of steroid hormones, corticosteroids, mineralocorticoids, anabolic steroids, and estrogenic steroids, has been reported to raise BP; the first two classes by

Drugs or Drug Interactions Producing Hypotension

All antihypertensive drugs may cause hypotension if given in high enough doses or when combined with other drugs that exaggerate their effect. Alpha blockers like prazosin and terazosin can cause orthostatic hypotension, especially in older individuals with impaired autonomic function, when given in high doses at the initiation of therapy. Even the selective α1d antagonists like tamsulosin can cause orthostatic changes. These drugs are less likely to cause a precipitous fall in BP if the dose

Drug Interactions That Reduce Adverse Effects

Thiazide diuretics are among the most commonly prescribed antihypertensive agents, yet they frequently produce hypokalemia, which has been implicated in renal interstitial fibrosis with deterioration in renal function and in impaired glucose tolerance with progression to overt diabetes mellitus. Combining an ACEI, ARB, or direct renin inhibitor with a thiazide reduces the incidence of hypokalemia, in part because of the reduction in aldosterone production by renin–angiotensin system blockers.

Adverse Drug Effects and Adverse Drug–Drug Interactions

Certain adverse drug effects such as non-productive cough or angioedema with ACEIs can occur in the absence of interactions with other drugs and appear to be dose–independent. A dose–dependent interaction of hydralazine with the enzymes responsible for its acetylation rather than with another drug is associated with the development of lupus–like syndrome. Individuals who are genetically slow acetylators are more likely to develop positive antinuclear antibody and lupus–like syndrome sooner and

Drug–Disease Interactions

Diuretics, particularly thiazides, antagonize the excretion of uric acid and can precipitate gouty attacks in susceptible individuals. They also increase the risk of developing glucose intolerance and, ultimately, overt diabetes mellitus. Conversely, the development of new onset diabetes is reduced by ACEIs, ARBs, and sustained-release verapamil compared with treatment with diuretics. For many years, it has been recommended that beta blockers, particularly those exhibiting significant beta2

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This article is part of the American Society of Hypertension Self-Assessment Guide series. For other articles in this series, visit the JASH home page at www.ashjournal.com.

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