Drugs of Choice for Hypertensive Crisis

Live healthy and long

Philippines  September 13 2015

What doctors prescribe for hypertension

A recent Acute Hypertensive Emergency makes one research on how to deal with one, and even examine the drugs being administered.  It is good we now have internet;  and that there are heart specialists the author knows of specialist from Philippine Heart Center.

The patient is in the province in her 60s and experienced shortness of breath, dizziness, general weakening of the body and chest pains (a heart attack?)  She was put on losartan (an angiotensin receptor blocker known for treating long term essential hypertension and that acts on kidney) a diuretic,  a digitalis and Vit B complex.  The family spent a good 5 figures for having her watched in a hospital and her bp remained unstable.  The chest pains and shortness of breath were still there.  BP shot up to 180/120 when the multivitamins was given.  (It has been stopped when the watcher noticed the causal effect)  The BP is now down to  120/90. 

Now the relatives are asking as to whether they would transport the patient from the island province to the city to have better medical care.  It would seem that the attending MD is a GP (he is?) considering the medication administered.  The cardiologist friend advised against the medical transport as the stress of travel might cause some complications for the patient.  The transport can only be carried out if:

1.  BP is stabilized at 110/80 for at least a weak;
2.  No more chest pains
3.  No more difficulty of breathing

Oral western drugs administered for hypertensive patients:

1.   Catapres -  Clonidine, a centrally acting adrenergic blocking agent that has other indications like ADH syndrome, insomnia,, opoid withdrawal.  Drug has been in existence for 40 years.  Does not look like a focused drug for me. Does not work well with vasodilators, glycosides, and beta blockers.

2,  Losartan - an angiotensin blocker works on kidney and is for long term use and may sometimes be with a thiazide diuretic.  Works well for patients under 55 of age.  Some familiar brands are Angiocard, Angizartan, Arbloc, Bepsar,, Combizar.  May cost P17 to Php 20 per tab.

3.  Metoprolol - a beta blocker that is good for post MI (Myocardial infarction) hypertension  with angina, and arrhythmia.  Contraindicated for type 2 and 3 block and bradycardia (with HR below 45) and may cause further weakening in some patients  But works well in lowering BP by lowering heart rate.  Some brands are Neobloc, Betaloc, Betazol, Cardiotab, Metobloc, Metostad, Metocare, Ziomed, Ritemed Metopolol.  (the cheapest)

4.  Amlodipine - is a calcium antagonist which prevents migration of calcium causing vasopression that causes elevation of blood pressure.  Can lower BP by as much as 11 to 15 mm HG. For stabilization of angina.  Popular brands are: Aforbes, Ambes, Ambisyl, Ambloc, Amlodine, , Amlogin,, Amvasc, Corvex, Vasalat, Vasocar.  Ritemed Amlodipine.  The cheapest at P8.10 per tablet. The original patent was held by Pfizer for Vasoprec

5.  Nifedipine -  brand names are Adalat and Procardia for long term treatment of hypertension and angina.  Ia also a calcium antagonist.  Brand names are Adalat, Calcibloc, Calcibloc and Nicardia.   Prices are from P18 to P30 / 10 mg. tablet with Unilab selling the lowest.