Methyldopa is an aromatic-amino-acid decarboxylase inhibitor in animals and in man. Methyldopa is a medication that has been used to treat high blood pressure since the 1960s. Methyldopa is indicated in the treatment of moderate to severe hypertension, including that complicated by renal disease. Only methyldopa, the L-isomer of alpha-methyldopa, has the ability to inhibit dopa decarboxylase and to deplete animal tissues of norepinephrine. D-isomer is relatively inactive. In man the antihypertensive activity appears to be due solely to the L-isomer, which became generally known as methyldopa (Aldomet). About twice the dose of the racemate (Methyldopa anhydrous, (±)-; DL-alpha-methyldopa) is required for equal antihypertensive effect. Racemic alpha-methyldopa was shown to be much less effective or ineffective for the treatment of hypertension. The comparative study of the hypotensive effect of L-alpha-methyl-dopa (L-isomer) versus the racemic form was performed. The short-term hypotensive effects of the racemic form and the L-isomer of alpha-methyl-dopa were compared in 13 hospitalized patients with arterial hypertension. After a placebo period the active preparations in a fixed dose of 1.5 g daily were administered for three-day periods separated by a second placebo period of three days, the sequence of the active drugs being alternated. Both substances were shown to exert significant hypotensive effects. The L-isomer produced significant blood-pressure reductions irrespective of whether or not it was given first, whereas the racemic form was effective only when given first. The blood-pressure levels obtained with the L-isomer were throughout lower than those with the racemic form. Methyldopa is a centrally acting antihypertensive agent. It is metabolized to alpha-methylnorepinephrine in the brain, and this compound is thought to activate central alpha-2 adrenergic receptors

Urapidil is an anti-hypertensive agent approved in Europe for the treatment of the corresponding disease. The drug acts by activating 5HT1a receptor and inhibiting alpha1-adrenergic receptors.

Guanoxan is 2-guanidinomethylbenzo-1,4-dioxan. It acts as a blocker of alpha-2 adrenoceptors. The clinical use of this drug has been in the treatment of hypertension. Both systolic and diastolic pressures are lowered in the lying and standing positions.

Dihydralazine is a compound with antihypertensive properties and is in clinical trials, where is studied its effect on kidney function and hormones in healthy individuals.

Guanazodine is a new antihypertensive drug. Guanazodine caused a sustained decrease in the systemic blood pressure of spontaneously hypertensive rats, renal hypertensive dogs and normal cats. No tachyphylaxis developed when the drug was administered orally. The heart rate decreased. Guanazodine relaxed the cat nictitating membrane, attenuated the positive chronotropic response to sympathetic nerve stimulation in anesthetized dogs and in isolated rabbit aorta to transmural electrical stimulation. Guanazodine potentiated the pressor response to noradrenaline but attenuated the response to tyramine in anesthetized cats. It may be concluded that the hypotensive effect of guanazodine is related to adrenergic neuron blocking action, the noradrenaline-depleting action in peripheral tissues is similar to the effect of guanethidine and bethanidine. However, this drug is less potent than guanethidine. Toxicity and side effects appear to be less with guanazodine than with guanethidine and bethanidine.

Picodralazine is a peripheral vasodilator, sympatholytic agent exerting antihypertensive properties.

Moxonidine is a second-generation, centrally acting antihypertensive drug with a distinctive mode of action. Moxonidine activates I1-imidazoline receptors (I1-receptors). Imidazoline I1-receptor agonism represents a new mode of antihypertensive action to inhibit peripheral alpha-adrenergic tone by a central mechanism. Adrenaline, noradrenaline and renin levels are reduced, a finding consistent with central inhibition of sympathetic tone. Moxonidine acts centrally to reduce peripheral sympathetic activity, thus decreasing peripheral vascular resistance. In patients with mild to moderate hypertension, moxonidine reduces blood pressure (BP) as effectively as most first-line antihypertensives when used as monotherapy and is also an effective adjunctive therapy in combination with other antihypertensive agents. It improves the metabolic profile in patients with hypertension and diabetes mellitus or impaired glucose tolerance, is well tolerated, has a low potential for drug interactions and may be administered once daily in most patients. Moxonidine is a good option in the treatment of patients with mild to moderate hypertension, particularly as adjunctive therapy in patients with the metabolic syndrome.

Guanoclor is an anti-hypertensive agent developed by Pfizer Ltd. (U.K.). It seems to be effective in various types of hypertension (unknown aetiology, renal, and malignant). It affects both systolic blood-pressure and diastolic blood-pressure. It is an adrenergic neurone-blocking agent, which also interferes with noradrenaline synthesis by inhibition of the enzyme dopamine beta-hydroxylase. Clinical use of the compound was first reported by Lawrie et al. (1964), who achieved satisfactory blood-pressure control in 60% of their cases with guanoclor alone, and in a further 18% with the addition of a thiazide diuretic. They also noted a significant reduction in urinary noradrenaline levels during guanoclor administration. Guanochlor has an affinity for the Na+/H+ exchanger ranging between 0.5 uM and 6 uM in different systems and is more potent than amiloride in all systems studied. It is suggested that guanochlor recognizes a binding site on the Na+/H+ exchanger that is distinct from the amiloride binding site.

Guanoxabenz is an antihypertensive drug that was in clinical use in the 1980s. It acts as a selective agonist of alpha2A1 and alpha2B1 adrenergic receptors. Guanoxabenz is the main metabolite of the FDA-approved drug guanabenz.

Endralazine (6-benzoyl-3-hydrazino-5,6,7,8-tetrahydropyrido-(4,3-c)-pyridazine mesylate) is a peripheral vasodilator drug, which acts by direct relaxation of the smooth muscle fibres of the peripheral arterial vessels. Endralazine has been used as an antihypertensive agent.