Clonidine (Catapres, Catapresan), guanfacine (Estulic), and methyldopa (Aldomet) are the prototypes of centrally acting antihypertensive drugs. Clonidine and guanfacine are lipophilic drugs that readily penetrate into the brain, where they stimulate a-adrenergic receptors in the pontomedullary region. The stimulation of these central a-adrenergic receptors has been shown to activate an inhibiting neuron, which causes a reduction of peripheral sympathetic tone and a subsequent fall in arterial blood pressure and heart rate. Both a centrally initiated reduction of vagus reflex activity and the activation of presynaptic o s -adrenergic blocking agents in the heart may contribute to the bradycardia. Studies indicate that methyldopa also penetrates into the brain, where it is converted into a-methylnorepinephrine. This amine may stimulate the same central a-adrenergic receptors as those activated by clonidine, which will result in a hypotensive effect. Possibly, a-methyldopamine might also play a role. Accordingly, the modes of action of clonidine and a-methyldopa probably are very similar at a basic level. The central adrenergic receptors probably are located postsynaptically. Their receptor demand corresponds more closely to that of the a 2 -subtype. Central a,-adrenergic receptors might possibly play a part in the modulation of vagally induced baroreflex bradycardia. A discussion on the pharmacological basis of the side effects of the centrally acting antihypertensives has been limited to those adverse reactions that are somehow related to a-adrenergic receptors. Sedation, a common side effect, appears to be mediated by central a 2 -adrenergic receptors, at least in animal models. The withdrawal syndrome, observed on abrupt cessation of treatment with clonidine, apparently also involves a-adrenergic receptors; however, why methyldopa does not precipitate a withdrawal phenomenon in the same animal model where clonidine was studied cannot be explained at present. (Hypertension 6 (Suppl. II): 11-28-11-33, 1984) KEY WORDS • methyldopa • central hypotensive activity guanfacine • a-adrenergic receptors clonidine From the Division of Pharmacolherapy. University of Amsterdam. Plantage Muidergracht 24. 1018 TV Amsterdam. The Netherlands. Address for reprints: P. A. van Zwieten. Division of Pharmacotherapy. University of Amsterdam. Plantage Muidergracht 24. 1018 TV Amsterdam. The Netherlands. 11-28 by guest on July 2, 2015 http://hyper.ahajournals.org/ Downloaded from