抗高血压药-课件英文版.ppt

《抗高血压药-课件英文版.ppt》由会员分享，可在线阅读，更多相关《抗高血压药-课件英文版.ppt（51页珍藏版）》请在三一办公上搜索。

1、Antihypertensive drugs,hypertension,Mean arterial blood pressure is higher than the normal range,in the case of not taking blood pressure drugs：Systolic blood pressure 18.7kPa(140mmHg)and（or）Diastolic blood pressure 12.0kPa(90mmHg)Divided into primary hypertension（90%95%）And secondary hypertension,c

2、omplications,Heart failureCoronary heart disease(CHD)Cerebrovascular accidentRenal failure,Antihypertensive drugs,Reasonable application of antihypertensive drugs,Control of blood pressure,Delay the formation and development of atherosclerosis,Reduce the complications such as brain,heart and kidney,

3、Reduce the mortality rate,prolong life,Blood pressure,-The factors influencing blood pressure：Cardiac output:heart rate,myocardial contraction force,change of blood volume,etc.;Peripheral resistance:the length of the blood vessels and blood viscosity,blood vessels,radius,etc.-Nerve-fluid system on b

4、lood pressure regulation。,1.Nervous regulation:the sympathetic nervous system,Peripheral neurotransmitter release,The postsynaptic membrane receptor,Second,humoral regulation:renin angiotensin aldosterone system,Kidney adjacent ballBeside the machine,-R blockers,renin,Angiotensin original,angiotensi

5、n,invertase,ACEI,angiotensin,Small artery contraction,losartan,Aldosterone secretion,Water sodium retention,diuretic,(thiazides),Classification,DiureticThe sympathetic nervous depressants(1)central blood pressure medication(2)the ganglion block(3)noradrenaline can nerve endings block(4)the adrenalin

6、e receptor blockersAffect the renin-angiotensin system medicineA gleam of antihypertensives:diuretic,calcium antagonist medicine,beta receptor blockers and ACEI,Diuretic,On the basis of(a line)blood pressure medicationEffect in the thiazide diuretic is most commonly used,antihypertensive effect is m

7、ild,persistent,long-term application of no significant resistanceFeatures:Antihypertensive effect is weak,by an average of 10%2 3 weeks after the majority of patients in medical workCan be used for various high blood pressure(basic blood pressure medication)Mild-alone,medium and severe-shareCan make

8、 the elderly hypertension patients complicated with stroke,the incidence of left heart failure and mortality is left,Hydrochlorothiazide,Early antihypertensive mechanismWith sodium diuresis,reduce the extracellular fluid and blood volumeLong-term antihypertensive mechanismDiuretic row sodium to Na+l

9、eft aortic smooth muscle cell,cell Na+/Ca2+exchange left-intracellular Ca2+left,reduce vascular smooth muscle of norepinephrine(NE)reactivity,disadvantages:,-Blood K+、Na+、Mg2+-Blood total cholesterol,triglyceride,low density lipoprotein cholesterol(hdl-c)-Blood uric acid-Blood renin-Glucose toleranc

10、e(disabled)for diabetes patientsEffective diuretic(furosemide)used in hypertensive crisis and poor associated with chronic renal hypertension patients.,Hypertensive crisis Patients with high blood pressure in the short term,the blood pressure increased significantly,and appear have a headache,be agi

11、tated,palpitation,sweating,nausea,vomiting,or pale flush,blurred vision and other signs.Mechanism:hyperthyroidism and circulating catecholamines increased sympathetic nervous activity,Clinical application,A gleam of medicationApplication of the treatment for mild hypertension separatelyWith other an

12、tihypertensive drug treatment,severe hypertension,Effect of diuresis medicine of compound preparations with other drugs,Compound antihypertension tablet:give up ping,hydralazine,hydrochlorothiazideCompound apocynum tablet:guanidine b organism,hydralazine,hydrochlorothiazideJane chrysanthemum antihyp

13、ertension tablet:clonidine,hydrochlorothiazideCompound captopril tablets,enalapril and hydrochlorothiazideConstant dropping pills:clonidine,hydralazine,hydrochlorothiazide,Calcium antagonist medicine,Block L voltage dependent calcium channel-left intracellular Ca2+diastolic small arteryNifedipine gr

14、oup,horizon,lacidipine flat,amlodipine,Nifedipine,【Step-down characteristics】1 Buck degree was positively correlated with the original high blood pressure,with normal blood pressure has no obvious antihypertensive effect；2 Oral absorption is good,work fast:sublingual administering 1-5 minutes work-i

15、n the treatment of variant angina pectoris,hypertensive crisis.Oral 30 to 60 minutes work-treatment of mild and moderate hypertension；3 Can cause reflective heart rate share Receptor blockers.,Clinical application,Light,medium and severe hypertension treatment,Nitrendipine,Selectively ACTS on the pe

16、ripheral vascular,blocking its internal flow of calcium ions,relaxing smooth muscle,the dilate blood vessels and step-downWarm and lasting antihypertensive effect,applicable to various types of high blood pressure,Lacidipine,Is a potent calcium antagonists,significantly and the effect of selective c

17、alcium ion channels in vascular smooth muscle.Its main role is to expand peripheral artery,reduce peripheral vascular resistance and to lower blood pressureResistance to atherosclerosisUsed for mild and moderate hypertensionName of commodity:lacidipine,Amlodipine,More gentle,smooth effect lasting,co

18、nvenience of once-daily dosage,24 hours of stability control of high blood pressure and angina pectoris,good safety and tolerabilitySimilar drugs,only it can be used by patients with congestive heart failure safetyAlso has the role of atherosclerosis,Adrenaline receptor blockers,Receptor blockers：pr

19、azosin、terazosin、doxazosin Receptor blockers：prapranolol、atenolol、labetalol、carbedilol,Mechanism of action,Nonselective beta receptor blockers,mostly related with the beta blocker:Heart:myocardial contraction force is abate,slow heart rate,cardiac output decreasesKidney:reduce renin secretion,inhibi

20、t RAS on blood pressure regulationThe sympathetic nerve endings presynaptic membrane:inhibition of positive feedback,NA secretion declineCentral(hypothalamus and medulla oblongata):excitatory neuron activity is abate,peripheral sympathetic nerve tension by,vascular resistance decreasedIncrease the t

21、op ring element synthesis,Clinical application,Suitable for various high blood pressureWith high cardiac output or plasma renin levels has good effect on the high side of hypertensive patients,especially suitable for hypertensive patients with coronary heart disease,cerebrovascular diseaseDiuretic o

22、r pooling vasodilators can enhance curative effect,atenolol,Selective beta 1 receptor blockers,lack of internal to the sympathetic activityOral is used to treat various degree of high blood pressure,antihypertensive effect a longer duration,labetalol,、Receptor blockersApplicable to various degrees o

23、f hypertension and hypertensive emergency,gestational hypertension,pheochromocytoma,high blood pressure when anesthesia or surgery,carvedilol）,、Receptor blockersUsed in the treatment of mild and moderate hypertension with renal insufficiency,diabetes,high blood pressure patients,Renin angiotensin sy

24、stem depressants,ACEI：Captopril etc.AT1-resistance：Chlorine sand,valsartan,etc,【Antihypertensive mechanism】1.AngII Generate and function。Arteriovenous diastolic Peripheral resistance Blood pressure；Block the release of aldosterone water sodium retention；2.Inhibition of slow excitation peptide degrad

25、ation Slow excitation peptide concentrations in the blood:produce NO、PG2 Etc.血管扩张血压,Angiotensin converting enzyme inhibitors ACEI,captopril（A sulfhydryl propionic acid pulp）,【Function characteristics】1 orally active,work fast,antihypertensive effect of medium strong;2 without reflective heart rate,l

26、ong-term use without resistance,not easy to cause the electrolyte disorders;Three pairs of renal hypertensive effect is good,can treat refractory heart failure,【application】Each period high blood pressure.Important first-line drugs.Especially suitable for complicated with diabetes and insulin resist

27、ance and left ventricular hypertrophy,heart failure,acute myocardial infarction patients with high blood pressure,Angiotensin receptor blockers ARB AT1 receptor:vascular smooth muscle,cardiac muscle,brain,kidney and secretion of aldosterone Adrenal zona cells-has regulating effect to the stability o

28、f the cardiovascular function.losartan【Antihypertensive mechanism】Selective blocking AT1 receptor:blocking angiotensin mediated blood vesselsShrinkage,aldosterone release and promote vascular smooth muscle proliferation and effect Peripheral resistance Promoting uric acid excretion,inhibiting renal

29、tubule of uric acid absorption,short,【Clinical application of】Each period high blood pressureStep-down features:The oral work fast2.The role to maintain for a long time:24 h smoothstep-down,3 6 weeks for maximum effect【side effect】relatively less ACEI:Attracted less dry cough and angioneurotic oedem

30、a;But still can cause low blood pressure and high potassium.For patients with pregnancy.Promoting uric acid excretion,inhibiting renal tubule of uric acid absorption,short,Pharmacological effects,Diastolic small artery smooth muscle,reduce the peripheral vascular resistance,lower blood pressureWith

31、heart rate slows,decreased cardiac outputInhibit the secretion of gastrointestinal tract and movement and the protection of gastric mucosaBuck with sedationReduce intraocular pressure,do not affect the pupil and the adjustment of the lens,Pharmacological action and mechanism,Activate I1-imidazoline

32、receptor，Make the peripheral sympathetic activity decline,vasodilation,blood pressure dropsThe excited central postsynaptic membrane receptor alpha 2Lower levels of plasma renin and aldosteroneInhibit the secretion of gastrointestinal tract and movement and the protection of gastric mucosaStatic not

33、e clonidine can produce booster for a short period of time(associated with peripheral alpha 2 receptor excited),followed by a long period of time the step-down(central role).Oral with the central role of the dominant,the booster effect is not obvious,Clonidine,Process in the bodyAbsorption:oral abso

34、rptionDistribution:easy through the blood brain barrier,plasma protein combined rate of 30%Metabolism:50%in intrahepatic metabolismDischarge:metabolic product and prototype by renal excretion,Clinical application,First-line treatment invalid moderately high blood pressure,with thiazide diuretic or o

35、ther antihypertensive agents share can improve the curative effectRenal hypertensionPatients with high blood pressure of peptic ulcerPrimary open-angle glaucoma,Adverse reactions,Dry mouth,sleepiness,constipation,impotence,can happen occasionally bradycardiaWater sodium retentionDrug withdrawal synd

36、rome:a long-term drug withdrawal may suddenly appear have a headache,tremor,abdominal pain,sweating,heart palpitations and blood pressure surge.And long-term medication made the alpha 2 weeks the presynaptic membrane receptor sensitivity,negative feedback effect is reduced,sudden withdrawal,increase

37、d sympathetic nervous function is associated with increased NE release.Recovery for medicine or alpha receptor blockers(e.g.,phentolamine)can alleviate.Withdrawal should be gradually reduced,The other central blood pressure medication,methyldopaA medium to strong step-down,cardiovascular and output,

38、less influence renal blood flowSuitable for renal hypertension and moderate hypertensive patients with poor kidney function,often with thiazide diuretic sharemoxonidineFor Il receptor affinity is high,and the receptor is strong,biological t1/2 longer,once a day dosingSuitable for patients with mild

39、and moderate hypertensionOn the central and peripheral alpha 2 receptor function is weak,the calm,dry mouth greatly reduce adverse reactions,Vasodilation medicine,Directly to relax vascular smooth muscle,decrease peripheral resistance and blood pressure to dropLong-term use antihypertensive vasodila

40、tors has the following disadvantagesCan theexcited sympathetic nerve,reflective increase cardiac output,heart rate speed upIncrease of renin and aldosterone secretion,leading to water and sodium retentionA long time with easy toleranceWith a diuretic or adrenaline receptor blockers share can enhance

41、 curative effect,reduce adverse reactions,Sodium nitroprusside,Antihypertensive effects associated with an increased NO-GC-cGMP,can dilate blood vessels and inhibit platelet aggregationOf arterioles and venules vascular smooth muscle were diastolic function,antihypertensive effect strong,rapid and s

42、hortMainly used in the treatment of hypertensive crisis.Also used in congestive heart failure,acute myocardial infarction and controlling hypertension during anesthesiaBecause of excessive step-down can cause nausea,vomiting,sweating,restlessness,palpitations and headache,Ganglion block medicinemeca

43、mylamine【Function characteristics】Antihypertensive effect strong,quickly;2.Has inhibitory effect on both sympathetic and parasympathetic,adverse reactions,and the heavier,orthostatic hypotension;The parasympathetic ganglion block symptoms.3.Hypertensive crisis.,Prazosin,Process in the bodyAbsorption

44、:good oral absorption,first eliminate the obvious,bioavailability of 60%Distribution:the combination of plasma protein rate was 97%Metabolism:liver metabolismDischarge:most bile excretion,by a small number of urine,Pharmacological effects and mechanism of action,Alpha 1 receptors on postsynaptic mem

45、brane of vascular smooth muscle are highly selective blocking effectStep-down features:A medium to strong antihypertensive effectDont affect kidney function,improve the level of reninLong-term use can improve lipid metabolismBlock 1 receptor alpha,relieve dysuria prostate patients,Clinical applicati

46、on,Can be separately used treatment of mild and moderate hypertensionFor elderly patients with hypertension combined prostatic hypertrophy,can improve the symptoms of dysuriaSevere hypertension share diuretic and beta receptor blockers can enhance step-down effect,Adverse reactions,First agent pheno

47、menon:some patients for the first time 0.5 1 hour after the treatment can appear orthostatic hypotension,dizziness,sweating,heart palpitations and reactionLong-term use can cause water sodium retention,diuresis medicine can maintain its antihypertensive effect,reserpine【Antihypertensive mechanism】Re

48、duce catecholamine transmitter in the storage and releaseAnd the sympathetic nerve endings(peripheral and central adrenergic)vesicle membraneAmine pump combination,catecholamine neurotransmitter(NA,5-HT)synthesis,storage,reuptake left,the depletion of the neurotransmitters,the sympathetic nerve cond

49、uction left-vasodilation,BP leftCentral inhibition,composed,stable effect.,Phenylephrine can nerve endings blocker,Features:effective slow,gentle and lasting,【Clinical application】1 light,moderate to high blood pressure,it has been less used alone2 manic psychosis【Adverse reactions】The parasympathet

50、ic nerve excitement symptoms:nausea,vomiting,intestinal cramps and diarrhea,peptic ulcer 2 Central inhibition:calm,lethargy,depression。,Potassium channels are open,Promote the KATP open The cell membrane hyperpolarization The inflow Ca,The new concept of high blood pressure medication 1.The effectiv