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What is The anti-hypertensive agent of choice in pregnancy is and explain in detail?
Ans- A Labetalol Old guidelines: Methyl dopa New guidelines: PIH: Oral Labetalol Htn emerg: IV Labetalol HYPERTENSION Definition: Sustained elevation of blood pressure causing cardiovascular mortality. Regulation of BP: 1. Baroreceptors: regulate short term, movement to movement control of Blood pressure 2. RAAS System: Long term maintenance of Blood pressure Types: 1. PRIMARY: idiopathic or Essential hypertension Most common type No identifiable cause, A: associated with high Salt intake Low potassium High Na+/K+ ratio Low Mg and Ca B: RAAS activity can be low, normal or high T/t: JNC 8 criteria for HTN 2: SECONDARY: identifiable cause Like phaeochromocytoma, Hyperthyroidism, aortic dissection, Cushing syndrome etc T/t: management of specific cause. Drugs for HTN First line drugs (JNC 8 guidelines) 1. ACE inhibitors or AT1 receptor blockers (ARB): DOC for CKD + HTN DOC: HTN + Gout (Losartan) Telmisartan: HTN with DM (PPAR-gamma agonist) 2. CCB (DHP TYPE): Amlodipine, Nifedipine, Nimodipine (DOC: SAH, PVD) Nicardipine: DOC for HTN emergency 3. THIAZIDES DIURETICS (only long acting) Second line drugs 4. Beta blockers: Cardioselective : metoprolol, Nebivolol etc....DOC for HTN + Angina 5. Alpha blockers: Prazosin etc..DOC for HTN + BPH 6. Alpha + beta blockers. Labetalol: DOC in Pregnancy 7. Vasodilators Artery: Hydralazine, Minoxidil, Diazoxide Venous: Nitrates Combined: Nitroprusside (Fastest acting) 8. Potassium sparing diuretics: Spironolactone, Eplerenone (DOC: resistant hypertension) Others 8. Central sympatholytics (alpha 2 agonists): Clonidine, Alpha methyldopa (second line in pregnancy) 9. Ganglionic Blockers: Trimethaphan (Arterial surgeries) 10. Dopamine agonist: Fenoldopam 11. Renin inhibitors: Aliskiren 12. Release inhibitors: Guanethidine, Bretylium 13. Loop diuretics: Furosemide etc ...,,,,,.........,,,,,,..........,,,,,,.........,,,,,,....,,,,,. JNC-8 guidelines Mnemonic for antihypertensive drugs safe in pregnancy Better mother care during hypertensive pregnancy Better - beta blockers(cardioselective and labetalol) Mother - methyldopa Care- clonidine During - dihydropyridine calcium channel blockers Hypertensive - hydralazine Pregnancy - prazosin( alpha blockers)