Arterioles dilatation, drugs causing

This drug causes dilation of resistance vessels (arterioles) but not of capacitance vessels (venules). Minoxidil [mi NOX i dill] is administered orally for treatment of severe to malignant hypertension that is... 

FIGURE 41 -1. Calcium channel blockers inhibit the movement of caldum ions across the cell membrane. When calcium channels are blocked by drug molecules, musde contraction is decreased, causing the smooth musdes of the arteries and arterioles to dilate. 

The drugs of this class (hydralazine and sodium nitroprusside) lower arterial blood pressure primarily by direct spasmolytic action on smooth musculature of arterioles, which leads to a reduction of resistance of peripheral vessels by causing dilation. Diastolic pressure is usually lowered more than the systolic pressure. 

Drugs that potently dilate arterioles can cause a phenomenon known as coronary steal, whereby the increase in flow caused by the arteriolar dilation draws blood from unobstructed vessels and increases flow to areas already well perfused. This steals blood preferentially from vessels which may be obstructed (have lesser flow), and decreases perfusion in those areas which may already be ischemic. 

Hydralazine (apresoline) causes direct relaxation of arteriolar smooth muscle, possibly secondary to a fall in intracellular Ca concentrations. The drug does not dilate epicardial coronary arteries or relax venous smooth muscle. Hydralazine-induced vasodilation is associated with powerful stimulation of the sympathetic nervous system, likely due to baroreceptor-mediated reflexes, which results in increased heart rate and contractility, increased plasma renin activity, and fluid retention all of these effects counteract the antihypertensive effect of hydralazine. Although most of the sympathetic activity is due to a baroreceptor-mediated reflex, hydralazine may stimulate NE release from sympathetic nerve terminals and augment myocardial contractility directly. Most of hydralazine s effects are confined to the cardiovascular system the decrease in blood pressure after administration is associated with a selective decrease in vascular resistance in the coronary, cerebral, and renal circulations, with a smaller effect in skin and muscle. Because of preferential dilation of arterioles, postural hypotension is not common, and hydralazine lowers blood pressure equally in the supine and upright positions. 

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