Mechanism & Sites of Action
This class of drugs includes the oral vasodilators, hydralazine and minoxidil, which are used for long-term outpatient therapy of hypertension; the parenteral vasodilators, nitroprusside, diazoxide, and fenoldopam, which are used to treat hypertensive emergencies; the calcium channel blockers, which are used in both circumstances; and the nitrates, which are used mainly in angina (Table 11–3).
All the vasodilators that are useful in hypertension relax smooth muscle of arterioles, thereby decreasing systemic vascular resis-tance. Sodium nitroprusside and the nitrates also relax veins. Decreased arterial resistance and decreased mean arterial blood pressure elicit compensatory responses, mediated by baroreceptors and the sympathetic nervous system (Figure 11–4), as well as renin, angiotensin, and aldosterone. Because sympathetic reflexes are intact, vasodilator therapy does not cause orthostatic hypoten-sion or sexual dysfunction.
Vasodilators work best in combination with other antihyper-tensive drugs that oppose the compensatory cardiovascular responses.