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Digne-Malcolm H, Frise MC, Dorrington KL. How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure. Front Physiol. 2016;7:320doi: 10.3389/fphys.2016.00320.
Digne-Malcolm, H., Frise, M. C., & Dorrington, K. L. (2016). How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure. Frontiers in physiology, 7320. https://doi.org/10.3389/fphys.2016.00320
Digne-Malcolm, Holly, et al. "How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure." Frontiers in physiology vol. 7 (2016): 320. doi: https://doi.org/10.3389/fphys.2016.00320
Digne-Malcolm H, Frise MC, Dorrington KL. How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure. Front Physiol. 2016 Jul 29;7:320. doi: 10.3389/fphys.2016.00320. eCollection 2016. PMID: 27524972; PMCID: PMC4965470.
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Front Physiol. 2016 Jul 29;7:320. doi: 10.3389/fphys.2016.00320. eCollection 2016.

How Do Antihypertensive Drugs Work? Insights from Studies of the Renal Regulation of Arterial Blood Pressure.

Frontiers in physiology

Holly Digne-Malcolm, Matthew C Frise, Keith L Dorrington

Affiliations

  1. Medical Sciences Division, University of Oxford Oxford, UK.
  2. Department of Physiology, Anatomy and Genetics, University of Oxford Oxford, UK.
  3. Department of Physiology, Anatomy and Genetics, University of OxfordOxford, UK; Nuffield Department of Anaesthetics, John Radcliffe HospitalOxford, UK.

PMID: 27524972 PMCID: PMC4965470 DOI: 10.3389/fphys.2016.00320

Abstract

Though antihypertensive drugs have been in use for many decades, the mechanisms by which they act chronically to reduce blood pressure remain unclear. Over long periods, mean arterial blood pressure must match the perfusion pressure necessary for the kidney to achieve its role in eliminating the daily intake of salt and water. It follows that the kidney is the most likely target for the action of most effective antihypertensive agents used chronically in clinical practice today. Here we review the long-term renal actions of antihypertensive agents in human studies and find three different mechanisms of action for the drugs investigated. (i) Selective vasodilatation of the renal afferent arteriole (prazosin, indoramin, clonidine, moxonidine, α-methyldopa, some Ca(++)-channel blockers, angiotensin-receptor blockers, atenolol, metoprolol, bisoprolol, labetolol, hydrochlorothiazide, and furosemide). (ii) Inhibition of tubular solute reabsorption (propranolol, nadolol, oxprenolol, and indapamide). (iii) A combination of these first two mechanisms (amlodipine, nifedipine and ACE-inhibitors). These findings provide insights into the actions of antihypertensive drugs, and challenge misconceptions about the mechanisms underlying the therapeutic efficacy of many of the agents.

Keywords: antihypertensive drugs; diuretics; hypertension; renal circulation; vasodilator agents

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