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Pharmacology of Hypertension and Hyperlipidemia

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Submitted By poch
Words 698
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Atenolol is a Beta adrenoceptor Antagonist which is more efficient in Blocking Beta 1 receptors. It is one of the most used drugs for treating hypertension since it is a cardioselective drug. It lowers the blood pressure and the heart rate and may be safe for asthmatics. The main indication is for angina pectoris, hypertension and arrhythmias. Its main action is to prevent sympathetic vasoconstriction and to reduce prostatic smooth muscle tone. One of the main problem with taking atenolol is that a daily dose is not sufficient and the behavior of the patient towards taking the drug continuously is dependent on this.
Doxazosin is an Alpha 1 Blocker. It selectively blocks alpha 1 receptors in arterioles and venules. It dilates both resistance and capacitance vessels which result in a reduction of arterial pressure. It produces less reflex tachycardia when lowering blood pressure. Retention of salt and water occurs with the intake of these drugs, so a diuretic must be taken in order to counteract these effects. Thiazide diuretics should not be given to patients with hyperlipidemia because it will just worsen the condition because thiazide diuretics deplete sodium and potassium (Ames).
Hydralazine dilates arterioles but not veins. The bioavailability is low with an estimation of 25% because it is rapidly metabolized by the liver during the first pass. It is mainly used in severe hypertension and works better in combination with Nitrates. It is effective in heart failure. It has a half-life of 1.5 to 3 hours but due to its binding to avascular tissue, the vascular effect is prolonged and is longer than the blood concentrations. The main adverse effect is headache, nausea, anorexia, palpitations, sweating and flushing. It is said that hydralazine had the ability to increase the turbulence of arteriole blood flow which could in turn result in the accumulation and production of atherosclerotic plaque.
Sertraline is a selective serotonin reuptake inhibitor (SSRI). It is an antidepressant drug which selectively blocks the Serotonin transporter (SERT). It exists as an isomer and is formulated in the racemic form. It is indicated for patients suffering from major depression, anxiety disorders, obsessive compulsive disorders and post-traumatic stress disorders. One of the adverse effects of this drug is weight gain. It is also associated with a discontinuation syndrome that manifests as dizziness and paresthesia that happens when the drug is discontinued for 1 to 2 days. This may be the reason why the patient has recently gained 9 pounds. Patient behavior is also a factor to be considered because the patient’s behavior in taking the drugs is crucial since Sertraline is known to cause a discontinuation syndrome.
Simvastatin is a structural analog of HMG-CoA. This is one of the most effective drugs in reducing LDL. It also reduces oxidative stress and vascular inflammation and increases the stability of atherosclerotic lesions. It is affected by the first pass effect through the liver ad is mainly excreted in bile. It causes partial inhibition in the enzyme HMG-CoA reductase which is needed for sterol synthesis which results into an impaired synthesis of isoprenoids. It is better to be taken during the evening because cholesterol synthesis happens at night. Simvastatin is a very potent competitive inhibitor, and doses at 80 mg may produce myopathy according to the FDA 2011. This may then interact with the hypertension that could cause serious complications and further progression of hypertension that could lead to a heart problem (Katzung et al., 2015).
Hyperlipidemia is prevalent in hypertension (Ames). Drug intake can be crucial as there are many drug to drug interactions. These should always be taken into consideration by the physician and should also prescribe proper dosing in relation to comorbidities that a patient may be suffering from. Behavior, specifically patient compliance, is also very crucial because there are adverse effects that may occur due to a missed dose or complete cease of intake due to temporary relief of symptoms may result into the progression of the disease.

REFERENCES:
Katzung, B., Masters, S. & Trevor, A. (2015). Basic & Clinical Pharmacology 12th edition.
Ames, RP. Hyperlipidemia in hypertension: causes and prevention. PubMed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1927888

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