Update on Newer Antihypertensive Medicines

Chang Gyu Park

doi:10.5124/jkma.2010.53.8.717

J Korean Med Assoc > Volume 53(8); 2010 > Article

Park: Update on Newer Antihypertensive Medicines

Pharmacotherapeutics

Journal of the Korean Medical Association

Journal of the Korean Medical Association 2010; 53(8): 717-722.

Published online: July 30, 2010

DOI: http://dx.doi.org/10.5124/jkma.2010.53.8.717

Update on Newer Antihypertensive Medicines

Chang Gyu Park, MD

Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.

Corresponding author: Chang Gyu Park. packcg@kumc.or.kr

Received July 13, 2010 Accepted July 26, 2010

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The majority of hypertensive patients do not achieve target blood pressure for a variety of reasons, including insufficient medication, drug resistance, and noncompliance. There remains a significant need to develop new agents to better control hypertension. Nebivolol is a third-generation β-adrenergic receptor blocker which is very highly cardioselective and has direct vasodilator properties via stimulation of endothelial nitric oxide synthase activity. Aliskiren is the first orally active inhibitor of renin as an antihypertensive agent. It is associated with dose-related falls in blood pressure comparable to other major classes of antihypertensive drugs with a placebo level of side effects. Endothelin is a powerful vasoconstrictor peptide. An endothelin-receptor antagonist such as bosentan significantly lowered blood pressure in patients with essential hypertension. Vasopeptidase inhibitors inhibit neutral endopeptidase and angiotensin converting enzymes, but side-effects such as angio-oedema and cough remain to be overcome. AngQb vaccine in hypertensive patients showed a marked reduction in early morning blood pressure without serious adverse events.

Hypertension; Antihypertensives; Drug effects; Rennin-angiotensin system

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Figure 1

The renin_angiotensin system and the sites of inhibition by renin-inhibitors, angiotensin-converting enzyme inhibitors (ACEIs),angiotensin receptor blockers (ARBs), aldosterone-receptor blockers, and neutral endopeptidase (NEP) inhibitors. This figure was adapted from the reference 7.

Figure 2

The opposing effects of endothelin on endothelial and vascular smooth muscle cells are shown and are mediated by differential response to endothelin-receptor (ETA and ETB) stimulations. Endothelin-converting enzyme (ECE) is found on endothelial cells and is responsible for conversion of big endothelin-1 to endothelin-1, the predominant form of endothelin. This figure was adapted from the reference 7.