抗高血压药_课件英文版.ppt

Antihypertensivedrugs hypertension Meanarterialbloodpressureishigherthanthenormalrange inthecaseofnottakingbloodpressuredrugs Systolicbloodpressure 18 7kPa 140mmHg and or Diastolicbloodpressure 12 0kPa 90mmHg Dividedintoprimaryhypertension 90 95 Andsecondaryhypertension complications HeartfailureCoronaryheartdisease CHD CerebrovascularaccidentRenalfailure Antihypertensivedrugs Reasonableapplicationofantihypertensivedrugs Controlofbloodpressure Delaytheformationanddevelopmentofatherosclerosis Reducethecomplicationssuchasbrain heartandkidney Reducethemortalityrate prolonglife Bloodpressure Thefactorsinfluencingbloodpressure Cardiacoutput heartrate myocardialcontractionforce changeofbloodvolume etc Peripheralresistance thelengthofthebloodvesselsandbloodviscosity bloodvessels radius etc Nerve fluidsystemonbloodpressureregulation 1 Nervousregulation thesympatheticnervoussystem Peripheralneurotransmitterrelease Thepostsynapticmembranereceptor Second humoralregulation renin angiotensinaldosteronesystem KidneyadjacentballBesidethemachine Rblockers renin Angiotensinoriginal angiotensin invertase ACEI angiotensin Smallarterycontraction losartan Aldosteronesecretion Watersodiumretention diuretic thiazides Classification DiureticThesympatheticnervousdepressants 1 centralbloodpressuremedication 2 theganglionblock 3 noradrenalinecannerveendingsblock 4 theadrenalinereceptorblockersAffecttherenin angiotensinsystemmedicineAgleamofantihypertensives diuretic calciumantagonistmedicine betareceptorblockersandACEI Diuretic Onthebasisof aline bloodpressuremedicationEffectinthethiazidediureticismostcommonlyused antihypertensiveeffectismild persistent long termapplicationofnosignificantresistanceFeatures Antihypertensiveeffectisweak byanaverageof10 2 3weeksafterthemajorityofpatientsinmedicalworkCanbeusedforvarioushighbloodpressure basicbloodpressuremedication Mild alone mediumandsevere shareCanmaketheelderlyhypertensionpatientscomplicatedwithstroke theincidenceofleftheartfailureandmortalityisleft Hydrochlorothiazide EarlyantihypertensivemechanismWithsodiumdiuresis reducetheextracellularfluidandbloodvolumeLong termantihypertensivemechanismDiureticrowsodiumtoNa leftaorticsmoothmusclecell cellNa Ca2 exchangeleft intracellularCa2 left reducevascularsmoothmuscleofnorepinephrine NE reactivity disadvantages BloodK Na Mg2 Bloodtotalcholesterol triglyceride lowdensitylipoproteincholesterol hdl c Blooduricacid Bloodrenin Glucosetolerance disabled fordiabetespatientsEffectivediuretic furosemide usedinhypertensivecrisisandpoorassociatedwithchronicrenalhypertensionpatients HypertensivecrisisPatientswithhighbloodpressureintheshortterm thebloodpressureincreasedsignificantly andappearhaveaheadache beagitated palpitation sweating nausea vomiting orpaleflush blurredvisionandothersigns Mechanism hyperthyroidismandcirculatingcatecholaminesincreasedsympatheticnervousactivity Clinicalapplication AgleamofmedicationApplicationofthetreatmentformildhypertensionseparatelyWithotherantihypertensivedrugtreatment severehypertension Effectofdiuresismedicineofcompoundpreparationswithotherdrugs Compoundantihypertensiontablet giveupping hydralazine hydrochlorothiazideCompoundapocynumtablet guanidineborganism hydralazine hydrochlorothiazideJanechrysanthemumantihypertensiontablet clonidine hydrochlorothiazideCompoundcaptopriltablets enalaprilandhydrochlorothiazideConstantdroppingpills clonidine hydralazine hydrochlorothiazide Calciumantagonistmedicine BlockLvoltagedependentcalciumchannel leftintracellularCa2 diastolicsmallarteryNifedipinegroup horizon lacidipineflat amlodipine Nifedipine Step downcharacteristics 1Buckdegreewaspositivelycorrelatedwiththeoriginalhighbloodpressure withnormalbloodpressurehasnoobviousantihypertensiveeffect 2Oralabsorptionisgood workfast sublingualadministering1 5minuteswork inthetreatmentofvariantanginapectoris hypertensivecrisis Oral30to60minuteswork treatmentofmildandmoderatehypertension 3Cancausereflectiveheartrate share Receptorblockers Clinicalapplication Light mediumandseverehypertensiontreatment Nitrendipine SelectivelyACTSontheperipheralvascular blockingitsinternalflowofcalciumions relaxingsmoothmuscle thedilatebloodvesselsandstep downWarmandlastingantihypertensiveeffect applicabletovarioustypesofhighbloodpressure Lacidipine Isapotentcalciumantagonists significantlyandtheeffectofselectivecalciumionchannelsinvascularsmoothmuscle Itsmainroleistoexpandperipheralartery reduceperipheralvascularresistanceandtolowerbloodpressureResistancetoatherosclerosisUsedformildandmoderatehypertensionNameofcommodity lacidipine Amlodipine Moregentle smootheffectlasting convenienceofonce dailydosage 24hoursofstabilitycontrolofhighbloodpressureandanginapectoris goodsafetyandtolerabilitySimilardrugs onlyitcanbeusedbypatientswithcongestiveheartfailuresafetyAlsohastheroleofatherosclerosis Adrenalinereceptorblockers Receptorblockers prazosin terazosin doxazosin Receptorblockers prapranolol atenolol labetalol carbedilol Mechanismofaction Nonselectivebetareceptorblockers mostlyrelatedwiththebetablocker Heart myocardialcontractionforceisabate slowheartrate cardiacoutputdecreasesKidney reducereninsecretion inhibitRASonbloodpressureregulationThesympatheticnerveendingspresynapticmembrane inhibitionofpositivefeedback NAsecretiondeclineCentral hypothalamusandmedullaoblongata excitatoryneuronactivityisabate peripheralsympatheticnervetensionby vascularresistancedecreasedIncreasethetopringelementsynthesis Clinicalapplication SuitableforvarioushighbloodpressureWithhighcardiacoutputorplasmareninlevelshasgoodeffectonthehighsideofhypertensivepatients especiallysuitableforhypertensivepatientswithcoronaryheartdisease cerebrovasculardiseaseDiureticorpoolingvasodilatorscanenhancecurativeeffect atenolol Selectivebeta1receptorblockers lackofinternaltothesympatheticactivityOralisusedtotreatvariousdegreeofhighbloodpressure antihypertensiveeffectalongerduration labetalol ReceptorblockersApplicabletovariousdegreesofhypertensionandhypertensiveemergency gestationalhypertension pheochromocytoma highbloodpressurewhenanesthesiaorsurgery carvedilol ReceptorblockersUsedinthetreatmentofmildandmoderatehypertensionwithrenalinsufficiency diabetes highbloodpressurepatients Reninangiotensinsystemdepressants ACEI Captopriletc AT1 resistance Chlorinesand valsartan etc Antihypertensivemechanism 1 AngIIGenerateandfunction Arteriovenousdiastolic Peripheralresistance Bloodpressure Blockthereleaseofaldosteronewatersodiumretention 2 Inhibitionofslowexcitationpeptidedegradation Slowexcitationpeptideconcentrationsintheblood produceNO PG2Etc 血管扩张 血压 AngiotensinconvertingenzymeinhibitorsACEI captopril Asulfhydrylpropionicacidpulp Functioncharacteristics 1orallyactive workfast antihypertensiveeffectofmediumstrong 2withoutreflectiveheartrate long termusewithoutresistance noteasytocausetheelectrolytedisorders Threepairsofrenalhypertensiveeffectisgood cantreatrefractoryheartfailure application Eachperiodhighbloodpressure Importantfirst linedrugs Especiallysuitableforcomplicatedwithdiabetesandinsulinresistanceandleftventricularhypertrophy heartfailure acutemyocardialinfarctionpatientswithhighbloodpressure Angiotensin receptorblockersARBAT1receptor vascularsmoothmuscle cardiacmuscle brain kidneyandsecretionofaldosteroneAdrenalzonacells hasregulatingeffecttothestabilityofthecardiovascularfunction losartan Antihypertensivemechanism SelectiveblockingAT1receptor blockingangiotensin mediatedbloodvesselsShrinkage aldosteronereleaseandpromotevascularsmoothmuscleproliferationandeffect Peripheralresistance Promotinguricacidexcretion inhibitingrenaltubuleofuricacidabsorption short Clinicalapplicationof EachperiodhighbloodpressureStep downfeatures Theoralworkfast2 Theroletomaintainforalongtime 24hsmoothstep down 3 6weeksformaximumeffect sideeffect relativelylessACEI Attractedlessdrycoughandangioneuroticoedema Butstillcancauselowbloodpressureandhighpotassium Forpatientswithpregnancy Promotinguricacidexcretion inhibitingrenaltubuleofuricacidabsorption short Pharmacologicaleffects Diastolicsmallarterysmoothmuscle reducetheperipheralvascularresistance lowerbloodpressureWithheartrateslows decreasedcardiacoutputInhibitthesecretionofgastrointestinaltractandmovementandtheprotectionofgastricmucosaBuckwithsedationReduceintraocularpressure donotaffectthepupilandtheadjustmentofthelens Pharmacologicalactionandmechanism ActivateI1 imidazolinereceptor Maketheperipheralsympatheticactivitydecline vasodilation bloodpressuredropsTheexcitedcentralpostsynapticmembranereceptoralpha2LowerlevelsofplasmareninandaldosteroneInhibitthesecretionofgastrointestinaltractandmovementandtheprotectionofgastricmucosaStaticnoteclonidinecanproduceboosterforashortperiodoftime associatedwithperipheralalpha2receptorexcited followedbyalongperiodoftimethestep down centralrole Oralwiththecentralroleofthedominant theboostereffectisnotobvious Clonidine ProcessinthebodyAbsorption oralabsorptionDistribution easythroughthebloodbrainbarrier plasmaproteincombinedrateof30 Metabolism 50 inintrahepaticmetabolismDischarge metabolicproductandprototypebyrenalexcretion Clinicalapplication First linetreatmentinvalidmoderatelyhighbloodpressure withthiazidediureticorotherantihypertensiveagentssharecanimprovethecurativeeffectRenalhypertensionPatientswithhighbloodpressureofpepticulcerPrimaryopen angleglaucoma Adversereactions Drymouth sleepiness constipation impotence canhappenoccasionallybradycardiaWatersodiumretentionDrugwithdrawalsyndrome along termdrugwithdrawalmaysuddenlyappearhaveaheadache tremor abdominalpain sweating heartpalpitationsandbloodpressuresurge Andlong termmedicationmadethealpha2weeksthepresynapticmembranereceptorsensitivity negativefeedbackeffectisreduced suddenwithdrawal increasedsympatheticnervousfunctionisassociatedwithincreasedNErelease Recoveryformedicineoralphareceptorblockers e g phentolamine canalleviate Withdrawalshouldbegraduallyreduced Theothercentralbloodpressuremedication methyldopaAmediumtostrongstep down cardiovascularandoutput lessinfluencerenalbloodflowSuitableforrenalhypertensionandmoderatehypertensivepatientswithpoorkidneyfunction oftenwiththiazidediureticsharemoxonidineForIlreceptoraffinityishigh andthereceptorisstrong biologicalt1 2longer onceadaydosingSuitableforpatientswithmildandmoderatehypertensionOnthecentralandperipheralalpha2receptorfunctionisweak thecalm drymouthgreatlyreduceadversereactions Vasodilationmedicine Directlytorelaxvascularsmoothmuscle decreaseperipheralresistanceandbloodpressuretodropLong termuseantihypertensivevasodilatorshasthefollowingdisadvantagesCantheexcitedsympatheticnerve reflectiveincreasecardiacoutput heartratespeedupIncreaseofreninandaldosteronesecretion leadingtowaterandsodiumretentionAlongtimewitheasytoleranceWithadiureticoradrenalinereceptorblockerssharecanenhancecurativeeffect reduceadversereactions Sodiumnitroprusside AntihypertensiveeffectsassociatedwithanincreasedNO GC cGMP candilatebloodvesselsandinhibitplateletaggregationOfarteriolesandvenulesvascularsmoothmusclewerediastolicfunction antihypertensiveeffectstrong rapidandshortMainlyusedinthetreatmentofhypertensivecrisis Alsousedincongestiveheartfailure acutemyocardialinfarctionandcontrollinghypertensionduringanesthesiaBecauseofexcessivestep downcancausenausea vomiting sweating restlessness palpitationsandheadache Ganglionblockmedicinemecamylamine Functioncharacteristics Antihypertensiveeffectstrong quickly 2 Hasinhibitoryeffectonbothsympatheticandparasympathetic adversereactions andtheheavier orthostatichypotension Theparasympatheticganglionblocksymptoms 3 Hypertensivecrisis Prazosin ProcessinthebodyAbsorption goodoralabsorption firsteliminatetheobvious bioavailabilityof60 Distribution thecombinationofplasmaproteinratewas97 Metabolism livermetabolismDischarge mostbileexcretion byasmallnumberofurine Pharmacologicaleffectsandmechanismofaction Alpha1receptorsonpostsynapticmembraneofvascularsmoothmusclearehighlyselectiveblockingeffectStep downfeatures AmediumtostrongantihypertensiveeffectDon taffectkidneyfunction improvethelevelofreninLong termusecanimprovelipidmetabolismBlock1receptoralpha relievedysuriaprostatepatients Clinicalapplication CanbeseparatelyusedtreatmentofmildandmoderatehypertensionForelderlypatientswithhypertensioncombinedprostatichypertrophy canimprovethesymptomsofdysuriaSeverehypertensionsharediureticandbetareceptorblockerscanenhancestep downeffect Adversereactions Firstagentphenomenon somepatientsforthefirsttime0 51hourafterthetreatmentcanappearorthostatichypotension dizziness sweating heartpalpitationsandreactionLong termusecancausewatersodiumretention diuresismedicineca