RT Book, Section A1 Gugelmann, Hallam Melville A1 DeRoos, Francis Jerome A2 Nelson, Lewis S. A2 Howland, Mary Ann A2 Lewin, Neal A. A2 Smith, Silas W. A2 Goldfrank, Lewis R. A2 Hoffman, Robert S. SR Print(0) ID 1163013522 T1 Miscellaneous Antihypertensives and Pharmacologically Related Agents T2 Goldfrank's Toxicologic Emergencies, 11e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259859618 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1163013522 RD 2024/10/13 AB Hypertension is one of the most prevalent chronic medical problems and one of the most readily amenable to pharmacotherapy. Antihypertensive pharamacotherapeutics were first used in the 1960s after two studies independently linked asymptomatic hypertension to significant adverse effects such as stroke, myocardial infarction (MI), and sudden death.74,92 The first antihypertensives used included centrally acting sympatholytics, direct vasodilators, sodium nitroprusside, and diuretics. Unfortunately, these often had significant adverse events, leading to the development of β-adrenergic antagonists, calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) (Table 61-1). This chapter reviews early antihypertensives, as well ACEIs, ARBs, and DRIs. In general, the majority of antihypertensives manifest clinical signs and symptoms in terms of the degree of hypotension produced. Particular attention will be placed on mechanisms of action and unique toxicologic considerations for each of these xenobiotics.