European Journal of Clinical Pharmacology

, Volume 38, Supplement 2, pp S125–S128

Are different hemodynamic patterns of antihypertensive drugs clinically important?

  • S. Julius
Clinical Efficacy and Safety

DOI: 10.1007/BF01409481

Cite this article as:
Julius, S. Eur J Clin Pharmacol (1990) 38(Suppl 2): S125. doi:10.1007/BF01409481

Summary

Since vascular resistance is elevated in hypertension, it is suggested that vasodilators lower the blood pressure by a physiologic mechanism and therefore must be more useful than cardiac output-lowering drugs. This is not entirely correct. Drugs that lower cardiac output are also relative vasodilators, but the vasodilation occurs at a lower level of cardiac output. It is also not necessarily true that all vasodilators are good antihypertensive agents. The clinical profile of a vasodilator depends on its effect on the venous return, cardiac output, regional blood flow, renin-angiotensin system, and sympathetic reflexes. From the viewpoint of hemodynamics, an ideal antihypertensive drug is a vasodilator that does not excessively increase cardiac output, causes no fluid retention, does not induce a great deal of venodilation, and does not elicit substantial neurohumoral counterregulation. Angiotensin-converting-enzyme inhibitors, some calcium antagonists, and some combined alpha/beta-blocking agents come close to satisfying the hemodynamic definition of an ideal antihypertensive drug.

Key words

cardiac outputvascular resistanceblood pressure

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • S. Julius
    • 1
  1. 1.Division of Hypertension Department of Internal MedicineUniversity of Michigan Medical CenterAnn ArborUSA