抗高血压药_完整英文版ppt课件

Antihypertensivedrugs,hypertension,Meanarterialbloodpressureishigherthanthenormalrange,inthecaseofnottakingbloodpressuredrugs：Systolicbloodpressure18.7kPa(140mmHg)and（or）Diastolicbloodpressure12.0kPa(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:reninangiotensinaldosteronesystem,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%23weeksafterthemajorityofpatientsinmedicalworkCanbeusedforvarioushighbloodpressure(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；3CancausereflectiveheartrateshareReceptorblockers.,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、doxazosinReceptorblockers：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。ArteriovenousdiastolicPeripheralresistanceBloodpressure；Blockthereleaseofaldosteronewatersodiumretention；2.InhibitionofslowexcitationpeptidedegradationSlowexcitationpeptideconcentrationsintheblood: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,AngiotensinreceptorblockersARBAT1receptor:vascularsmoothmuscle,cardiacmuscle,brain,kidneyandsecretionofaldosteroneAdrenalzonacells-hasregulatingeffecttothestabilityofthecardiovascularfunction.losartan【Antihypertensivemechanism】SelectiveblockingAT1receptor:blockingangiotensinmediatedbloodvesselsShrinkage,aldosteronereleaseandpromotevascularsmoothmuscleproliferationandeffectPeripheralresistancePromotinguricacidexcretion,inhibitingrenaltubuleofuricacidabsorption,short,【Clinicalapplicationof】EachperiodhighbloodpressureStep-downfeatures:Theoralworkfast2.Theroletomaintainforalongtime:24hsmoothstep-down,36weeksformaximumeffect【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:AmediumtostrongantihypertensiveeffectDontaffectkidneyfunction,improvethelevelofreninLong-termusecanimprovelipidmetabolismBlock1receptoralpha,relievedysuriaprostatepatients,Clinicalapplication,CanbeseparatelyusedtreatmentofmildandmoderatehypertensionForelderlypatientswithhypertensioncombinedprostatichypertrophy,canimprovethesymptomsofdysuriaSeverehypertensionsharediureticandbetareceptorblockerscanenhancestep-downeffect,Adversereactions,Firstagentphenomenon:somepatientsforthefirsttime0.51hourafterthetreatmentcanappearorthostatichypotension,dizziness,sweating,heartpalpitationsandreactionLong-termusecancausewatersodiumretention,diuresismedicineca