Pharmacology for NEET-PG
Antihypertensive Drugs for NEET-PG
Antihypertensive pharmacology covers the major drug classes, their mechanisms, and the comorbidities that guide selection, and it is a dependable NEET-PG topic. Questions commonly present a patient with a coexisting condition and ask for the best or the contraindicated agent, so compelling indications and contraindications are the core deliverable. The main classes are diuretics, ACE inhibitors and ARBs, calcium channel blockers, beta-blockers, and specific agents used in pregnancy and hypertensive emergencies. Examiners emphasise ACE inhibitor cough and angio-oedema, the renal protective role of ACE inhibitors and ARBs in diabetes, calcium channel blocker peripheral oedema, and safe agents in pregnancy. Hypertensive emergency management with intravenous agents and the specific choice in phaeochromocytoma are recurring points. The topic connects to cardiology, nephrology, and obstetrics. Common traps include using ACE inhibitors in bilateral renal artery stenosis or pregnancy, giving non-selective beta-blockers before alpha-blockade in phaeochromocytoma, and forgetting that thiazides can worsen glucose, urate, and electrolyte profiles.
MedNext Academy | 3 min read
Antihypertensive Drugs for NEET-PG
Antihypertensive pharmacology covers the major drug classes, their mechanisms, and the comorbidities that guide selection, and it is a dependable NEET-PG topic. Questions commonly present a patient with a coexisting condition and ask for the best or the contraindicated agent, so compelling indications and contraindications are the core deliverable. The main classes are diuretics, ACE inhibitors and ARBs, calcium channel blockers, beta-blockers, and specific agents used in pregnancy and hypertensive emergencies. Examiners emphasise ACE inhibitor cough and angio-oedema, the renal protective role of ACE inhibitors and ARBs in diabetes, calcium channel blocker peripheral oedema, and safe agents in pregnancy. Hypertensive emergency management with intravenous agents and the specific choice in phaeochromocytoma are recurring points. The topic connects to cardiology, nephrology, and obstetrics. Common traps include using ACE inhibitors in bilateral renal artery stenosis or pregnancy, giving non-selective beta-blockers before alpha-blockade in phaeochromocytoma, and forgetting that thiazides can worsen glucose, urate, and electrolyte profiles.
Antihypertensive pharmacology covers the major drug classes, their mechanisms, and the comorbidities that guide selection, and it is a dependable NEET-PG topic. Questions commonly present a patient with a coexisting condition and ask for the best or the contraindicated agent, so compelling indications and contraindications are the core deliverable. The main classes are diuretics, ACE inhibitors and ARBs, calcium channel blockers, beta-blockers, and specific agents used in pregnancy and hypertensive emergencies. Examiners emphasise ACE inhibitor cough and angio-oedema, the renal protective role of ACE inhibitors and ARBs in diabetes, calcium channel blocker peripheral oedema, and safe agents in pregnancy. Hypertensive emergency management with intravenous agents and the specific choice in phaeochromocytoma are recurring points. The topic connects to cardiology, nephrology, and obstetrics. Common traps include using ACE inhibitors in bilateral renal artery stenosis or pregnancy, giving non-selective beta-blockers before alpha-blockade in phaeochromocytoma, and forgetting that thiazides can worsen glucose, urate, and electrolyte profiles.
Key points
- **First-line classes:** Thiazide-type diuretics, ACE inhibitors or ARBs, and calcium channel blockers are all first-line; the choice depends on age, ethnicity, and comorbidity.
- **ACE inhibitors:** Preferred in diabetes, heart failure, and chronic kidney disease with proteinuria; cause dry cough, hyperkalaemia, and angio-oedema.
- **ARBs:** Block the angiotensin receptor with similar benefits to ACE inhibitors but without the cough; still contraindicated in pregnancy.
- **Calcium channel blockers:** Amlodipine and nifedipine cause ankle oedema and flushing; verapamil and diltiazem slow the heart and can cause constipation.
- **Beta-blockers:** No longer routine first-line for uncomplicated hypertension but valuable in coronary disease, heart failure, and after myocardial infarction.
- **Pregnancy:** Labetalol, methyldopa, and nifedipine are preferred; ACE inhibitors and ARBs are contraindicated due to foetal renal injury.
- **Hypertensive emergency:** Intravenous labetalol, nitroprusside, nicardipine, or nitroglycerine are used with controlled, gradual pressure reduction.
- **Phaeochromocytoma:** Alpha-blockade with phenoxybenzamine must precede any beta-blocker to avoid unopposed alpha vasoconstriction.
- **Thiazide adverse effects:** Hypokalaemia, hyponatraemia, hyperuricaemia, hyperglycaemia, and hypercalcaemia are recognised metabolic effects.
- **Renal artery stenosis:** Bilateral renal artery stenosis is a contraindication to ACE inhibitors and ARBs because they can precipitate acute kidney injury.
- **Resistant hypertension:** Spironolactone is often the preferred add-on when blood pressure remains uncontrolled on three agents including a diuretic.
Frequently Asked Questions
Which antihypertensive is preferred in a diabetic patient?
An ACE inhibitor or ARB, because both lower blood pressure and slow diabetic kidney disease by reducing intraglomerular pressure and proteinuria.
Why are ACE inhibitors avoided in pregnancy?
They cross the placenta and impair foetal renal development, causing oligohydramnios and other harm. Labetalol, methyldopa, and nifedipine are used instead.
Why must alpha-blockade come before beta-blockade in phaeochromocytoma?
Blocking beta receptors first leaves alpha-mediated vasoconstriction unopposed, which can trigger a severe hypertensive crisis. Alpha-blockade is established first.
What causes the dry cough with ACE inhibitors?
Reduced breakdown of bradykinin and substance P in the airways. Switching to an ARB usually resolves the cough while keeping similar benefits.
Continue reading
NEET-PGComplete NEET-PG guide
Review the exam pattern, preparation and resources.
Practise Pharmacology for NEET-PG
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
See plans