antihypertensive agents抗高血压药.pptVIP

Antihypertensive Agents 抗高血压药 Problem Magnitude of Hypertensoin Hypertension (HTN) is the most common primary diagnosis in clinic. Worldwide prevalence estimates for HTN may be as much as 1 billion. More than 7.6million?deaths?worldwide per year are attributed to HTN. HTN is fast becoming a global epidemic, affecting Third World countries more than developed nations nowadays. Hypertension Types of Hypertension Primary HTN: also known as essential HTN. accounts for 95% cases of HTN. no universally established cause known. Secondary HTN: less common cause of HTN ( 5%). secondary to other potentially rectifiable causes. renal disease, endocrine disorders other identifiable causes Antihypertensive Agents The first-line drugs recommended by the WHO as the used in treatment of hypertension, the order is the following: Diuretics(Thiazides) effective in lowering blood pressure in most patients. employed alone for mild or moderate essential hypertension. used in combination with sympathoplegic and vasodilator drugs to treat severe hypertension The renin-angiotensin system inhibitors Angiotensin converting enzyme inhibitors (ACEI) Angiotensin Ⅱ receptor blockers The renin inhibitors Angiotensin converting enzyme inhibitors (ACEI) Captopril (卡托普利), Alacepril (阿拉普利), Enalapril (依那普利), Lisinopril (赖诺普利), Quinapril (喹那普利), Perindopril (培哚普利). 1. Mechanism of Action Competitive inhibition of angiotensin converting enzyme ang II , bradykinin . Pharmacological effects (1) Reduction in systemic arteriolar resistance, systolic, diastolic and mean arterial pressure. 2. Pharmacological effects (2) Regional hemodynamic effects: Increased regional blood flow in proportion to ang II sensitivity of the vascular bed Increased large artery compliance Cardiac output and heart rate unchanged (3) Aldosterone secretion reduced Clinical Uses One of the initial choices for monotherapy of mild to moderate hypertension Most effective in high renin hypertension Excell