College of Pharmacy
HelixTalk Episode #65 - Advanced hypertension ninja skills with some of the oldest BP meds
Date posted: August 15, 2017, 6:00 am
In this episode, we discuss three "older" antihypertensives that are not preferred first-line therapies: clonidine, methyldopa, and minoxidil. We outline why these agents are not first-line therapies and review their pharmacology and adverse effect profiles.
- The first-line therapies for hypertension (thiazides, calcium channel blockers, ACE inhibitors, and ARBs) are preferred options because we have good comparative data investigating long-term clinical outcomes for these drugs.
- Clonidine can cause sedation, dry mouth, impotence, and bradycardia. It is available as an oral tablet (typically taken twice a day) or a patch (replaced once weekly). Importantly, a patient may have rebound tachycardia, hypertension, and other withdrawal symptoms if clonidine is taken chronically and suddenly stopped.
- Methyldopa is one of three preferred antihypertensives for pregnant women. Nifedipine XL and labetalol are likely equally effective and safe, but may have a more favorable adverse effect profile for the mother.
- Minoxidil has a number of serious adverse effects as outlined in its boxed warnings, including the risk of tachycardia (causing angina), edema (requiring a concomitant loop diuretic), and pericardial effusion possibly resulting in tamponade (a medical emergency).
- Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003 Dec;42(6):1206-52.
- James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-20. doi: 10.1001/jama.2013.284427.
- Slim HB, Black HR, Thompson PD. Older blood pressure medications-do they still have a place? Am J Cardiol. 2011 Jul 15;108(2):308-16.
- McComb MN, Chao JY, Ng TM. Direct Vasodilators and Sympatholytic Agents. J Cardiovasc Pharmacol Ther. 2016 Jan;21(1):3-19.