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The lifetime probability of receiving antihypertensive medication is estimated to be 60% for adults in the U.S.1 Therefore, antihypertensive medications are widely available. Several classes of drugs used to treat hypertension are reviewed in this chapter: diuretics, sympatholytic agents, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and vasodilators (Table 190-1). Calcium channel blockers and β-blockers are also used in the treatment of hypertension; treatment of toxicity from these agents is discussed elsewhere (see Chapter 189, Calcium Channel Blockers, and Chapter 188, β-Blockers). In 2008, the American Association of Poison Centers’ National Poisoning Data System received reports of 10,709 exposures to diuretics, 8816 exposures to sympatholytic agents, 15,131 exposures to ACE inhibitors, 7016 exposures to ARBs, 1815 exposures to vasodilators, and 3590 exposures to “antihypertensives.”2 No fatalities were reported for these agents or classes.

Table 190-1 Summary of Antihypertensive Drugs

For most of the agents discussed in this chapter, life-threatening toxicity is not expected in acute overdose. In nearly all cases, there is no specific therapy and good supportive care is adequate. The initial approach to the patient with potential overdose of an antihypertensive drug is fairly uniform. The airway should be secured as necessary, and IV access should be established. Patients should be attached to a cardiac monitor ...

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