WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Fathima et al.

World Journal of Pharmacy and Pharmaceutical Sciences

SJIF Impact Factor 6.041

Volume 6, Issue 01, 443-464

Review Article

ISSN 2278 – 4357

ANTI-HYPERTENSIVE DRUGS ADVERSE DRUG REACTIONS AND ITS MANAGEMENT Masrath Fathima* and Zainab Mahveen India.

Article Received on 07 Nov. 2016,

ABSTRACT According to the World Health Organization (WHO) definition, an

Revised on 28 Nov. 2016, Accepted on 18 Dec. 2016

adverse drug reaction (ADR) is ‗a response to a drug that is noxious

DOI: 10.20959/wjpps201701-8388

and unintended and occurs at doses normally used in human for the prophylaxis, diagnosis, and treatment of disease, or for modification of

*Corresponding Author

physiological function. Hypertension is a chronic disease condition

Masrath Fathima

which is considered to be one of the major cardiovascular risk factor.

India.

Antihypertensive drugs are frequently associated with adverse drug reactions (ADRs) that may limit treatment options and reduce patient adherence, which may hinder blood pressure control. Hypertensive patients often have concomitant disease condition such as hyperlipidaemia, impaired glucose metabolism and renal impairment, leading to an increased rate of Cardio Vascular morbidity and mortality. Therefore, a comprehensive management of both hypertension as well as concomitant Cardio Vascular Disease risk factors is critical when treating hypertensive patients. For the treatment of hypertension a wide range of anti-hypertensive agents are available as single or combination therapy to achieve a target blood pressure in individual patient. KEYWORDS: Introduction of hypertension, treatment of hypertension, Adverse drug reactionand its management, discussion, conclusion, reference. INTRODUCTION Hypertension is the medical condition where the systolic blood pressure is more than 140 mm Hg and the diastolic blood pressure is more than 90 mm Hg. It is a chronic disease which is considered to be one of the major public health problems and a significant cardiovascular risk factor. According to the World Health Organization (WHO), each year, at least 7.1 million people die as a result of increased blood pressure. Hypertensive patients often have concomitant disease condition such as hyperlipidaemia, impaired glucose metabolism and www.wjpps.com

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renal impairment, leading to an increased rate of Cardio Vascular morbidity and mortality. For the treatment of hypertension, a broad range of antihypertensive medications are currently available. Antihypertensive drugs are frequently associated with adverse drug reactions (ADRs) that may limit treatment options and reduce patient adherence, which may hinder blood pressure control. Beta-blockers provoked psoriasis, calcium channel blockers induced gingival hyperplasia, peripheral oedema, Angiotensin Converting Enzyme inhibitors produced ankle oedema and thiazide diuretics produced hyponatremia, hyperglycaemia are some of the rare and serious Adverse Drug Reaction occurred in patients treated with these drugs. Therefore, a comprehensive management of both hypertension as well as concomitant Cardio Vascular Disease risk factors is critical when treating hypertensive patients. Among the most important and most widely used drugs are thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin II receptor antagonists and beta blockers. TYPES OF HYPERTENSION There are mainly two types of hypertension recognised. Depending on the type of hypertension, the cause could be known or unknown. It is suspected that hypertension results from a combination of factors related to genetics, diet, and lifestyle. 1. PRIMARY HYPERTENSION Also known as essential hypertension, is the most common type of hypertension. With this type of hypertension, there is no single identifiable cause for high blood pressure. Instead, hypertension occurs because of genes, diet, and lifestyle. You may be able to keep your hypertension under control in order to reduce stress levels.they are as follows 

Diet



Reducing



salt intake



exercising

2. SECONDARY HYPERTENSION With this type of high blood pressure, the cause is apparent and can be an underlying condition. It results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension. Hypertension can also be caused by endocrine conditions, such

as Cushing'ssyndrome, hyperthyroidism, hypothyroidism, acromegaly,

and pheoch-

romocytoma. Other causes of secondary hypertension include obesity, sleep apnoea,

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World Journal of Pharmacy and Pharmaceutical Sciences

pregnancy, excessive eating of liquorice, excessive drinking of alcohol, and certain prescription medicines, herbal remedies and drugs. Arsenic exposure through drinking water has been shown to correlate with elevated blood pressure and some conditions during pregnancy can cause secondary hypertension. 

There are four types of hypertension that are less commonly used. They are as follows:

1. MALIGNANT HYPERTENSION In malignant hypertension, high blood pressure occurs suddenly and drastically i,e If your diastolic pressure goes over 130, you may have malignant hypertension. A person might experience numbness in the body as well as vision problems, extreme fatigue, confusion, anxiety, and seizures. Malignant hypertension is reversible when the underlying condition is cured. Malignant hypertension is very rare and affects both children and adults. Pregnant women are also at risk. Heart damage is a possibility with this type of hypertension. 2. RESISTANT HYPERTENSION Resistant hypertension is unresponsive to strong medications. In any case, treatments for resistant hypertension have been developed to keep the condition under control. Hypertension is called resistant if three medications fail to successfully treat the condition. At least four medications may be necessary to treat resistant hypertension. Resistant hypertension may have a genetic component and is more common in people who are older, obese, female, African American, or have an underlying illness, such as diabetes or kidney disease. 3. ISOLATED SYSTOLIC HYPERTENSION This type of hypertension is a result of old age and a poor diet. Normal blood pressure is considered under 120/80. With isolated systolic hypertension, the systolic pressure rises above 140, while the lower number stays near the normal range, below 90. This type of hypertension is most common in people over the age of 65 and is caused by the loss of elasticity in the arteries. The systolic pressure is much more important than the diastolic pressure when it comes to the risk of cardiovascular disease for an older person. Risk factors include old age, obesity, using tobacco products, and having diabetes.

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World Journal of Pharmacy and Pharmaceutical Sciences

4. WHITE COAT HYPERTENSION The term "white coat hypertension" comes from the well-studied phenomena that patients may have high blood pressure when taken at their doctor's office or a clinic but have normal blood pressure when taken at home. OVERVIEW The drug therapy for hypertension should be individualized. Important considerations in planning drug therapy are whether the patient has multiple medical problems and what impact drug therapy will have on the patient’s quality of life. Demographic factors, cultural implications, the ease of medication administration and cost are other important considerations. There are essentially seven main categories of pharmacologic drugs: diuretics, adrenergic drugs, vasodilators, ACE inhibitors, ARBs, CCBs, and direct renin inhibitors. Because all antihypertensive drugs (with the exception of diuretics) have some vasodilator action, and are also called direct vasodilators to differentiate them Drugs in these classes may be used either alone or in combination. GOAL BP VALUES RECOMMENDED BY THE JOINT NATIONAL COMMITTEE (JNC) IN 2003 AND AMERICAN HEART ASSOCIATION (AHA) IN 2007. JNC7 

AHA

Most patients for general prevention: