Correlation between mechanistic biotransformation and biochemical toxicology of some antihypertensive drugs

Mechanistic biochemistry (consideration of metabolism in the context of knowledge of contemporary biochemistry) was applied to propanolol (1), hydrochlorothiazide (2), hydralazine (3), and triamterene (4), representative of the main types of anti-hypertensive drugs in common use. Three routes of metabolism, that is, acetylation, generation of free radicals (leading to peroxidation of lipids), and osazone formation were considered in relation to the structures of these drugs. The possibility that acetylation can lead to hepatic toxicity, lipid peroxidation to membrane lesion, and osazone formation to glucose and energy depletion was highlighted. Hydralazine, with its potential for osazone formation and great susceptibility to acetylation and free radical formation, was judged most capable of giving rise to these side effects, in agreement with reported toxicity. Triamterene was judged less susceptible than hydralazine to acetylation and free radical formation, and hydrochlorothiazide even less so. Propanolol is immune to any of these consequences.