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2. Classes of Antihypertensive Drugs
Aldosterone receptor antagonists (blockers)
Angiotensin II antagonists
Angiotensin-converting enzyme inhibitors
-Blockers
1-Selective
Nonselective
-Blockers
-1/-2
-1 predominant
/
Intrinsic sympathomimetic activity
Calcium channel antagonists
Nondihydropyridine
Dihydropyridine
Central 2 agonists
Direct renin inhibitors
Direct vasodilators
Diuretics
Thiazide-type
Loop-type
Potassium-sparing
Ganglionic blockers
Classes of Antihypertensive Drugs
There are currently 11 classes and more than 200 different drugs or combinations of drugs approved by the United States Food and Drug Administration to treat hypertension. This slide outlines the different classes of antihypertensive drugs and highlights the major pharmacological differences among drugs within each class when there is important heterogeneity within the class. On average, most antihypertensive drugs decrease systolic and diastolic blood pressures by about 10 mm Hg and 5 mm Hg, respectively, when administered as monotherapy. 2

3. Antihypertensive Drug Classes: Action Sites
Cardiac Output 
Blood
Pressure
Total Peripheral
Resistance =
-Blockers
Non-DHP
CCBs
Diuretics
-Blockers
ACE Inhibitors
AT1 Blockers
Direct renin inhibitors
1-Blockers
2-Agonists
All CCBs
Diuretics
Sympatholytics
Vasodilators
Antihypertensive Drug Classes
Antihypertensive Drug Classes: Action Sites
β-Blockers decrease blood pressure primarily by reducing cardiac output. They also decrease renal renin output and, thereby, angiotensin II-mediated vasoconstriction. Angiotensin-converting enzyme inhibitors, angiotensin type-1 blockers, direct renin inhibitors, 1-blockers, 2-agonists, sympatholytics, and vasodilators decrease blood pressure by reducing total peripheral resistance through various mechanisms. Calcium channel blockers can either affect total peripheral resistance (dihydropyridines) or can reduce both cardiac output and total peripheral resistance (nondihydropyridines). Diuretics initially reduce cardiac output by decreasing intravascular fluid volume; with continued therapy, however, they also reduce total peripheral resistance via vasodilation.
ACE = angiotensin-converting enzyme; AT1 = angiotensin type 1;
CCBs = calcium channel blockers; DHP = dihydropyridine 3

4. Summary
Drugs from 11 major classes have been approved by the United States Food and Drug Administration to treat hypertension
Many of these drugs have complementary effects to reduce blood pressure and prevent target organ damage
The goal of antihypertensive therapy is to use doses of drugs that effectively lower blood pressure while minimizing adverse effects
Combinations of drugs that have complementary actions – or allow the actions of one drug to offset the adverse effects of a second drug – are often required to achieve this goal
The dose-response relationship for a single drug may vary with the target organ-protective effect for which that drug is being prescribed
Summary 4