Antihypertensive selectivity

Prazosin, a selective a -adrenoceptor antagonist, exerts its antihypertensive effect by blocking the vasoconstrictor action of adrenergic neurotransmitter, norepinephrine, at a -adrenoceptors in the vasculature (200,227,228). Prazosin lowers blood pressure without producing a marked reflex tachycardia. It causes arteriolar and venular vasodilation, but a significant side effect is fluid retention. Prazosin increases HDL cholesterol, decreases LDL cholesterol, and does not cause glucose intolerance. 

Side chain reaction in derivatives of compound 2 has largely been concerned with the production of compounds with pharmaceutical activity by reaction between chloroalkyl side chains in position 2 and suitable amines. A selection of such compounds are 224 (82JAP(K)206684), and 225 (81FRP2450259) both are antihypertensive. Use of a dichloromethyl side chain provides an unsaturated amine, as in compound 226 (81FRP2450259). 

Compounds which act as antagonists at the receptors for beta sympathetic transmitters (beta blockers) have gained very wide acceptance as antihypertensive agents. It was found subsequent to their introduction that there are two populations of beta receptors the beta-1 receptors are richest in the cardiovascular system whereas beta-2 receptors are mostly found in the bronchi. Lack of receptor-type specificity led to bronchial spasm in some asthmatic individuals on ingestion of the earlier beta blockers. Much of the work outlined below had as its goal the preparation of agents which showed selectivity for beta-1 receptors. 

Fenoldopam (76) is an antihypertensive renal vasodilator apparently operating through the dopamine system. It is conceptually similar to trepipam. Fenoldopam is superior to dopamine itself because of its oral activity and selectivity for dopamine D-1 receptors (D-2 receptors are as.sociated with emesis). It is synthesized by reduction of 3,4-dimethoxyphenylacetonitrile (70) to dimethoxyphenethylamine (71). Attack of diis last on 4-methoxystyrene oxide (72) leads to the product of attack on the epoxide on the less hindered side (73). Ring closure with strong acid leads to substituted benzazepine 74. O-Dealkylation is accomplished with boron tribromide and the catechol moiety is oxidized to the ortho-quinone 75. Treatment with 9NHC1 results in conjugate (1,6) chloride addition and the formation of fenoldopam (76) [20,21]. 

Diuretics are used in a variety of medical disorders. The primary health care provider selects the type of diuretic diat will most likely be effective for treatment of a specific disorder. In some instances, hypertension may be treated with the administration of an antihypertensive drug and a diuretic. The diuretics used for this combination tiierapy include the loop diuretics and the thiazides and related diuretics. The specific uses of each type of diuretic drug are discussed in the following sections. 

ATC C07AB05 S01ED02 Use selective P-adrenoceplor blocker, antihypertensive... 

Drug selection for the management of patients with hypertension should be considered as adjunctive to nonpharmacologic approaches for blood pressure lowering, and ultimately the attainment of target blood pressure in many cases maybe more important than the antihypertensive agent used. 

While the main goal of antihypertensive therapy is to achieve target blood pressures, the selection of agents for an individual should also account for certain special considerations and a patient s comorbidities. Specific antihypertensive therapy is warranted for certain patients with comorbid conditions that may elevate their level of risk for cardiovascular disease. 

Often used to augment blood pressure lowering, CCBAs are most commonly used as add-on therapy for patients who are in need of further blood pressure lowering above and beyond that afforded by diuretics or other antihypertensives. Nonetheless, they have demonstrated their efficacy in select patient populations as very effective blood pressure lowering agents. 

Apart from possible clinical differences between the P-block-ers approved for HF, selection of a p-blocker may also be affected by pharmacologic differences. Carvedilol exhibits a more pronounced blood pressure lowering effect and thus causes more frequent dizziness and hypotension as a consequence of its ar receptor blocking activity. Therefore, in patients predisposed to symptomatic hypotension, such as those with advanced LV dysfunction (LVEF less than 20%) who normally exhibit low systolic blood pressures, metoprolol succinate may be the most desirable first-line P-blocker. In patients with uncontrolled hypertension, carvedilol may provide additional antihypertensive efficacy. 

The renaissance of the Biginelli MCR can be attributed to the obtained pyrimidine derivatives, which show remarkable pharmacological activity. A broad range of effects, including antiviral, antitumor, antibacterial, anti-inflammatory as well as antihypertensive activities has been ascribed to these partly reduced pyrimidine derivatives [96], such as 9-117 and 9-118 (antihypertensive agents) [97] and 9-119 (ala-adrenoceptor-selective antagonist) [98] (Scheme 9.24). Recently, the scope of this pharmacophore has been further increased by the identification of the 4-(3-hydroxyphenyl)-pyrimidin-2-thione derivative 9-120 known as monastrol [98], a novel cell-permeable lead molecule for the development of new anticancer drugs. Monastrol appears specifically to affect cell division (mitosis) by a new mechanism,... 

Trequinsin 106, a selective phosphodiesterase-3 (PDE3) inhibitor <2005MI6412>, and actisomide 225 have been introduced into human therapy as antihypertensive and antiarrhythmic agents, respectively. 

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