Washington Manual of Medical Therapeutics
Other Antihypertensives
Other Antihypertensives is a topic covered in the Washington Manual of Medical Therapeutics.
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See Table 28-7.
Table 28-7: Other Antihypertensives
| Mechanism of Action | Potential Effects in Overdose | Potential Treatments | Comments | |
| Prazosin | α1 adrenergic blockade | Sedation, postural hypotension | Supportive, IV fluids, vasopressin/phenylephrine/norepinephrine | May cause priapism |
| Hydralazine | Interferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose |
| Minoxidil | ATP-K+ channel opening, NO-mediated vasodilation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose, direct myocardial toxicity in animal models |
| Nitroprusside | NO-mediated vasodilation | Hypotension, tachycardia, thiocyanate/cyanide toxicity | Discontinue offending agent. Consider sodium thiosulfate or hydroxocobalamin | Thiocyanate toxicity may occur due to impaired renal clearance |
| Thiazide diuretics | Primarily by inhibition of NaCl cotransporter in distal convoluted tubule | Altered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemia | Supportive (correction of electrolytes, volume status) | |
| Loop diuretics | Primarily by inhibition of Na-K-2Cl cotransporter in ascending loop of Henle | Altered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity | ||
| K+ sparing diuretics | Aldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene) | Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia) | ||
| ACE inhibitors | Inhibition of angiotensin converting enzyme | Sedation, hypotension | Supportive, IV fluids, vasopressors | Reports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock |
| ARBs | Inhibition of angiotensin type 1 receptor |
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See Table 28-7.
Table 28-7: Other Antihypertensives
| Mechanism of Action | Potential Effects in Overdose | Potential Treatments | Comments | |
| Prazosin | α1 adrenergic blockade | Sedation, postural hypotension | Supportive, IV fluids, vasopressin/phenylephrine/norepinephrine | May cause priapism |
| Hydralazine | Interferes with IP3-mediated Ca2+ release from sarcoplasmic reticulum → arteriolar relaxation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose |
| Minoxidil | ATP-K+ channel opening, NO-mediated vasodilation | Hypotension, tachycardia | Supportive, IV fluids, vasopressors | Myocardial ischemia reported in overdose, direct myocardial toxicity in animal models |
| Nitroprusside | NO-mediated vasodilation | Hypotension, tachycardia, thiocyanate/cyanide toxicity | Discontinue offending agent. Consider sodium thiosulfate or hydroxocobalamin | Thiocyanate toxicity may occur due to impaired renal clearance |
| Thiazide diuretics | Primarily by inhibition of NaCl cotransporter in distal convoluted tubule | Altered mental status, hypotension, electrolyte abnormalities, hyperuricemia, hyperglycemia | Supportive (correction of electrolytes, volume status) | |
| Loop diuretics | Primarily by inhibition of Na-K-2Cl cotransporter in ascending loop of Henle | Altered mental status, hypotension, electrolyte abnormalities (hypokalemia, hypomagnesemia), ototoxicity | ||
| K+ sparing diuretics | Aldosterone antagonists (spironolactone)/inhibition of epithelial sodium channel in collecting tubule (amiloride, triamterene) | Altered mental status, hypotension, electrolyte abnormalities (hyperkalemia) | ||
| ACE inhibitors | Inhibition of angiotensin converting enzyme | Sedation, hypotension | Supportive, IV fluids, vasopressors | Reports of success using angiotensin II in ACE-I overdose. Reports of success in using methylene blue with cardiogenic shock |
| ARBs | Inhibition of angiotensin type 1 receptor |
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Citation
Bhat, Pavat, et al., editors. "Other Antihypertensives." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. The Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602682/all/Other_Antihypertensives.
Other Antihypertensives. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602682/all/Other_Antihypertensives. Accessed April 1, 2023.
Other Antihypertensives. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602682/all/Other_Antihypertensives
Other Antihypertensives [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 April 01]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602682/all/Other_Antihypertensives.
* Article titles in AMA citation format should be in sentence-case
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ED - Dretler,Alexandra,
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PB - Wolters Kluwer Health
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