一线抗高血压药物.pptVIP

* * * JNC7及中国：Goal blood pressure for patients: Adults 140 / 90 mmHg; With diabetes or renal disease: 130 / 80 mmHg; JNC8：60y 目标值为150/90，60y目标值140/90 黑人低肾素型高血压常见而白人高肾素型常见。 * * * * * BMI:身体质量指数 the Dietary Approaches to Stop Hypertension (DASH) diet 1 cup=240 ml * * 国外约1/4-1/3的原发性高血压患者是低肾素型，老年高血压80%是低肾素型，我国的低肾素型高血压也占多数。 * * * * 进入细胞的钾离子和氯离子可通过各自的离子通道进入细胞间隙和血液 * * 作用温和、持久，无明显耐受性；2.小剂量单用即可降压(12.5mg), 超过25mg降压作用不一定↑。 * 噻嗪类利尿药抑制胰岛beta细胞功能（可能与低血钾有关），引起血糖升高；抑制肝脏磷酸二脂酶，引起高脂血症。 * * * 黑人肾素途径往往较弱。 * * * * * * * 抑制交感神经活性(交感中枢、压力感受器、外周交感末梢突触前膜β2） * The blockade of beta2 receptors in the body by beta blockers can induce hypoglycemia or low blood sugar. Beta2 receptors normally induce glucose production by stimulating breakdown of glucose stores in the liver and delivering that glucose to the system. When this process is blocked, low blood sugar may occur. When the body glucose gets too low, it normally stimulates the sympathetic nervous system to increase the heart rate as a signal that glucose needs to be replenished. Your palms may get sweaty and you might also feel a little shaky. This response is blocked with the use of beta-blockers and hypoglycemia may go unnoticed until it is too late. This is particularly problematic in diabetics. In a 2010 review article published in “Current Medical Research and Opinion“(Fonseca VA, /doi/pdf/10.1185/03007990903533681), hyperglycemia or high blood glucose was noted to occur in patients taking non-vasodilating beta blockers, or nonselective beta blockers such as atenolol and metoprolol. These beta blockers were associated with worsening glucose and cholesterol control. In contrast, vasodilating beta blockers or selective beta blockers such as carvedilol, labetalol and nebivolol had a more favorable effect on glucose and cholesterol control. * * * * * 可乐定也可激活外周交感神经突触前膜alpha2A受体，抑制NE释放。但大剂量可激活外周血管的α2B受体，收缩血管，降压作用减弱 * TNS:孤束核 RVLM:延髓吻端腹外侧区 * * * * * 狼疮样反应与乙酰化产物蓄积有关 * * ? receptor blockers B Therapeutic uses 高血压: 各型高血压 - 一线抗高血压药