Snapshot A 54-year-old man presents to his primary care physician for an annual examination. In his previous visit, he was diagnosed with hypertension. In today's visit, his blood pressure has not improved given his difficulty to adhere to a diet with more fruits and vegetables and exercise. His medical history is significant for type II diabetes mellitus and he is currently taking metformin. Physical examination is remarkable for a blood pressure of 152/99 mmHg and mildly decreased vibration and proprioception sense in his lower extremities. He is started on lisinopril. Introduction Antihypertensive medications are used to manage hypertension in patients where conservative measures are ineffective there are four commonly used antihypertensive medications diuretics login to view 2 more bullets sympatholytics login to view 2 more bullets vasodilators login to view 3 more bullets renin-angiotensin-aldosterone inhibitors login to view 3 more bullets Diuretics Medications thiazides mechanism of action login to view 2 more bullets potassium-sparing diuretics mechanism of action login to view 1 more bullet Note that loop diuretic abuse can result in an increased sodium and potassium level in the urine Sympatholytics Medications β-blockers mechanism login to view 2 more bullets notes login to view 3 more bullets e.g., metoprolol α-blockers mechanism login to view 6 more bullets Vasodilators Medications hydralazine mechanism login to view 1 more bullet note login to view 1 more bullet minoxidil mechanism login to view 1 more bullet calcium channel blockers mechanism login to view 1 more bullet can result in peripheral edema login to view 1 more bullet Renin-Angiotensin-Aldosterone Inhibitors Medications angiotensin-converting enzyme (ACE) inhibitors mechanism login to view 4 more bullets notes login to view 5 more bullets angiotensin receptor blockers (ARBs) mechanism login to view 1 more bullet notes login to view 1 more bullet Antihypertensives in Pregnancy Medication options used to manage hypertension in pregnancy include hydralazine labetalol methyldopa nifedipine Antihypertensives in Hypertensive Emergencies Nitroprusside mechanism arteriolar and venous dilation via cGMP notes is metabolized into cyanide, which can potentially lead to cyanide poisoning Fenoldopam mechanism a peripheral dopamine-1 receptor agonist notes maintains renal perfusion while the blood pressure is being decreased login to view 1 more bullet Nicardipine and clevidipine mechanism decreases cardiac and vascular calcium influx Labetalol mechanism α- and β-blocker Antihypertensive Medications That Address Comorbid Conditions Individualizing Antihypertensive TherapyConditionAntihypertensive MedicationBenign prostatic hyperplasiaα-blockersEssential tremorβ-blockerHyperthyroidismβ-blockerMigraineβ-blockerCalcium channel blockerOsteoporosisThiazide diureticsRaynaud phenomenonDihydropyridine calcium channel blocker