Antihypertensive Drugs
Hypertension, or high blood pressure, is a major risk factor for heart attacks, strokes, heart failure and kidney disease. Lifestyle modifications like diet, exercise and reducing stress can help lower blood pressure, but often medications are also needed. Some of the most commonly prescribed antihypertensive drug classes include:
Angiotensin Converting Enzyme (ACE) Inhibitors: ACE inhibitors work by inhibiting the enzyme angiotensin converting enzyme. This decreases the production of angiotensin II, a potent vasoconstrictor that causes blood vessels to narrow. This leads to lower blood pressure by reducing peripheral vascular resistance. Examples include lisinopril, enalapril and ramipril.
Angiotensin Receptor Blockers (ARBs): Like ACE inhibitors, ARBs block the effects of angiotensin II but they work by blocking the receptor that angiotensin II binds to rather than inhibiting the enzyme. ARBs include losartan, valsartan and telmisartan. They are well-tolerated options for those who cannot tolerate ACE inhibitors due to cough or other side effects.
Calcium Channel Blockers: Calcium channel blockers inhibit the entry of calcium ions into smooth muscle cells of the heart and blood vessels. This reduces heart muscle contractions and causes blood vessels to dilate, lowering both systolic and diastolic blood pressure. Examples are amlodipine, diltiazem and verapamil.
Diuretics: Diuretics, or "water pills", work by increasing the excretion of sodium and water from the kidneys. This reduces blood volume and pressure. Common diuretics are thiazide diuretics such as hydrochlorothiazide and loop diuretics like furosemide.
Combination Drugs: For those unable to control their blood pressure with monotherapy, two-Cardiovascular Drugs combinations in a single pill can offer better blood pressure control. Examples are lisinopril/hydrochlorothiazide and valsartan/amlodipine.
Antianginal Drugs
Angina is chest pain or discomfort that occurs when the heart muscles don't get enough oxygen-rich blood. It's usually caused by coronary artery disease which narrows the arteries and decreases blood flow to the heart. Medications are commonly prescribed along with lifestyle changes and may include:
Nitrates: Nitrates like isosorbide dinitrate and nitroglycerin are vasodilators that dilate blood vessels and increase blood flow to the heart. They provide rapid but short-acting relief of angina symptoms. Patch and long-acting forms provide around-the-clock effects.
Beta Blockers: Beta blockers like metoprolol and carvedilol block the effects of epinephrine and norepinephrine on the heart. This decreases heart rate, blood pressure and oxygen demand, reducing angina episodes. They are also prescribed after heart attacks to prevent future heart attacks.
Calcium Channel Blockers: As mentioned above, calcium channel blockers widen blood vessels and increase blood flow to the heart, preventing episodes of chest pain from decreased oxygen supply. They are often used in those who cannot tolerate beta blockers.
Statins and Antiplatelet Drugs
Statins and antiplatelet drugs are commonly prescribed alongside cardiac medications to further reduce the risk of heart attacks and strokes. Statins lower "bad" LDL cholesterol and triglycerides while raising "good" HDL cholesterol levels. This retards the development of atherosclerotic plaques. Examples are atorvastatin and rosuvastatin.
Antiplatelet drugs inhibit platelet activation and aggregation, preventing dangerous clots from forming. Aspirin is the most commonly used antiplatelet medication, but newer P2Y12 receptor inhibitors like clopidogrel and ticagrelor provide stronger platelet inhibition. They are prescribed long-term after events like stents, heart attacks or strokes.
Emerging Cardiovascular Drugs
Research into novel targets and therapies continues to evolve treatment options. Some areas of interest include:
PCSK9 inhibitors: PCSK9 inhibitors like evolocumab and alirocumab dramatically reduce LDL cholesterol by blocking a protein that normally allows breakdown of LDL receptors. They provide LDL lowering exceeding statins alone.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors: Originally developed as diabetes medications, SGLT2 inhibitors like empagliflozin and canagliflozin lower cardiovascular and renal risks independent of glucose. Their mechanisms of action are not fully understood but may stem from effects on insulin sensitivity and cardiac fuel utilization.
GLP-1 receptor agonists: Injectable GLP-1 agonists like liraglutide were also first approved for diabetes but reduce heart attack and stroke risks in part by promoting weight loss and lowering blood pressure. Dual/triple drugs combining GLP-1, SGLT2 and other mechanisms into single oral agents hold promise.
Other novel targets: Drugs inhibiting proteins like cholesteryl ester transfer protein and microsomal triglyceride transfer protein that influence lipoprotein metabolism may offer new therapeutic strategies. Gene therapies also represent an emerging frontier to potentially cure genetic forms of cardiovascular diseases.
An array of effective cardiovascular drugs now exist to treat high blood pressure, angina, hyperlipidemia and other conditions lowering heart disease risk. striving to develop even better tolerated and more powerful therapies that will help many more live healthier and longer lives.
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