Topic overview

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Centrally acting α₂-agonists such as clonidine and methyldopa reduce sympathetic outflow, lowering systemic vascular resistance and heart rate. Their uses and adverse effects differ: clonidine is used in settings including hypertensive urgency, while methyldopa is preferred for hypertension in pregnancy. Aliskiren inhibits renin and suppresses the RAAS cascade, with contraindications and risks that require careful consideration. Endothelin receptor antagonists lower pulmonary vascular resistance; their use involves liver monitoring and pregnancy-safety precautions. Reserpine depletes monoamine stores and is limited by potentially serious toxicities. Across these agents, patient selection, awareness of rebound hypertension, and attention to orthostatic hypotension are central to safe use.