Antihypertensive Drugs | Academically

Antihypertensive Drugs

May 25, 2024 3 min read
Antihypertensive Drugs
According to WHO, hypertension is a major global health issue that affects an estimated 1.28 billion adults aged 30–79 years worldwide, with the majority residing in low- and middle-income countries.

Alarmingly, 46% of adults with hypertension are unaware they have the condition. Even among those diagnosed, less than half (42%) receive treatment, and only about 21% have their hypertension under control.

Hypertension is a common cardiovascular disease affecting the worldwide population. A persistent and sustained high blood pressure has damaging effects on the heart, brain, kidneys and eyes. Hypertension could be:

  • Primary or essential hypertension: It is the most common type. There is no specific underlying cause.
  • Secondary hypertension: It can be due to renal, vascular, endocrine disorders, etc.

As a leading cause of premature death worldwide, hypertension necessitates urgent attention and effective management strategies. One of the global health targets for noncommunicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030. 

In this blog, we discuss the classification of antihypertensive drugs and its role in managing and mitigating the risks associated with hypertension.

Classification of Antihypertensive Drugs

1. Angiotensin converting enzyme (ACE) inhibitors: Captopril, enalapril lisinopril, perindopril, ramipril, benazepril, fosinopril. 

2. Angiotensin II receptor blockers (ARBs): Losartan, candesartan, irbesartan, valsartan, telmisartan, olmesartan. 

3. Direct renin inhibitor: Aliskiren. 

4. Calcium channel blockers (CCBs): Diltiazem, verapamil, nifedipine, amlodipine, nicardipine, isradipine, felodipine, nitrendipine. 

5. Diuretics 

(a) Thiazides and related agents: Hydrochlorothiazide, chlorthalidone, indapamide. (b) Loop diuretics: Furosemide, bumetanide, torsemide. 

(c) Potassium-sparing diuretics: Amiloride, triamterene, spironolactone, eplerenone.

6. Sympatholytic agents 

(a) Centrally acting sympatholytics: Clonidine, alpha-methyldopa.

(b) Beta-Adrenergic blockers: Atenolol, metoprolol, esmolol, propranolol, betaxolol, cartel or, propranolol, timolol.

(c) Beta-Adrenergic blockers with ad al &-blocking activity: Labetalol, carvedilol.

smolol, betaxolol, carvedilol.

(d) Alpha-Adrenergic blockers: - Selective: Prazosin, terazosin, doxazosin. - Nonselective: Phenoxybenzamine, phentolamine. 

(e) Ganglion blocker: Trimethaphan. 

(f) Neurone blocker: Reserpine. 

7. Vasodilators 

(a) Arteriolar-dilators: Hydralazine, minoxidil, diazoxide, fenoldopam. 

(b) Primarily venodilator: Nitroglycerin. 

(c) Arteriolar and venodilator: Sodium nitroprusside.

Treatment of Hypertension

1. Non-pharmacological approaches helpful to control hypertension are weight reduction, sodium restriction, alcohol restriction, exercise, mental relaxation, cessation of smoking and consumption of potassium rich diet. 

2. Drug treatment: Selection of antihypertensive drugs in individual patients depends on: 

(i) comorbidity, 

(ii) associated complications, 

(iii) age, 

(iv) sex, 

(v) cost of the drug and 

(vi) concomitant drugs.

  • Preferred drugs for initial treatment of hypertension: ACE inhibitors, ARBs, CCBs and thiazides. 
  • Therapy usually started with a single agent.

Dosage and indication of hypertensive drugs

Hydrochlorothiazide12.5-25 mg OD oralMild Hypertension
Chlorthalidone12.5-25 mg OD oralMild Hypertension
Captopril12.5-75 mg BD oralMild to severe hypertension especially in diabetes
Enalapril2.5-40 mg OD oralMild to severe hypertension especially in diabetes
Lisinopril5-40 mg OD oralMild to severe hypertension especially in diabetes
Ramipril1.25 - 20 mg OD oralMild to severe hypertension especially in diabetes
Losartan25-50 mg OD or BD oral Mild to severe hypertension especially in diabetes
Propranolol10-120 mg, BDor QID oralMild to moderate hypertension 
Atenolol25-100 mg OD oralMild to moderate hypertension 
Prazosin1-10 mg BD oralMild to moderate hypertension 
Clonidine0.05-0.6 mg BDMild to moderate hypertension 
Sodium nitroprusside 0.25-1.5 mcg/kg/minute i.v. infusion in 5% dextroseHypertensive emergencies (hypertensive crisis)
Nifedipine SR30-90 mg OD oralMild to moderate hypertension 
Amlodipine2.5-10 mg OD oralMild to moderate hypertension 
Alpha-Methyldopa250 mg-2 g/day oralHypertension during pregnancy

Commonly used drugs for hypertension associated with the following conditions

Angina/Post MIBeta-Blockers

Congestive cardiac failure/Left 

ventricular failure

ACE inhibitors, loop diuretics and ARBs
Diabetes mellitus and diabetic nephropathyACE inhibitors, ARBs, CCBs
Bronchial asthma/COPDCalcium channel blockers (CCBs)
Hypertensive emergenciesSodium nitroprusside, labetalol, nitroglycerin
Benign prostatic hyperplasia (BPH)Selective a1-blocker
Pregnancya-Methyldopa, hydralazine, labetolol
  • Combination therapy is used in patients who do not respond to a single drug, and can be used as initial therapy in patients with high BP.  
  • Combination therapy: ACE inhibitors/ARBs with either thiazides/DHDs. If response is not satisfactory other antihypertensives can be added, eg. thiazides/DHPs with beta-blockers. ACE inhibitors are not to be combined withARBs.


Antihypertensive drugs is an important topic for many healthcare professionals, with numerous questions from this topic frequently appearing in competitive exams like the KAPS. 

For a thorough understanding of antihypertensive drugs and access to key exam questions, join Academically’s KAPS Exam Preparation Course. Our curriculum is tailored to help pharmacists pass the exam on their first attempt.

KAPS Exam Preparation Course

To learn more about the course and the exam, fill out this form to receive expert guidance.

Dr. Indu K
Dr. Indu K
about the author

Dr. Indu K is a dentist with one year of clinical experience. She seamlessly transitioned into content writing three years ago. Her passion lies in making complex medical information accessible to everyone. She uses her unique blend of medical knowledge and exceptional writing skills to bridge the gap between healthcare and the general audience.