(精编)【高血压英文教学精品课件】 Drugs used to treat hypertension.pptVIP

B) INDIRECT ACTING - CALCIUM CHANNEL-BLOCKING AGENTS 1. dihydropyridine (nifedipine, nicardipine, amlodipine) 2. diltiazem, verapamil they block voltage-dependent ?L-type“ calcium channels ? relaxation of smooth muscle ? vasodilation ? reduce peripheral vascular resistance ? reduction of BP negatively inotropic drugs they differ in selectivity for calcium channels in vascular smooth muscles and cardiac tissues - orally active ? suitable for long-term use 3. Vasodilators DIHYDROPYRIDINES (nifedipine, nicardipine) - evoke vasodilatation resulting in sympathetic reflex activation, - relatively selective for vascular smooth muscle (arterial) amlodipine, lacidipine, isradipine, felodipine – 2nd generation - longer duration of action – once daily - do not reduce myocardial contractility – do not produce clinical deterioration in heart failure nimodipine – preferentially acts on cerebral arteries – prevention of vascular spasm following aneurysmal subarachnoid haemorrhage Indication: all grades of essential hypertension alone (nifedipine, amlodipine) in patients with mild hypertension for patients in whom thiazide diuretics and b-blockers are contraindicated combinations angina (with beta-blockers) 3. Vasodilators verapamil, diltiazem - effects on the voltage-dependent channels in cardiac conducting tissue - vasodilatation it also blocks Ca2+ entry in gastrointestinal smooth muscle and consequently causes constipation 3. Vasodilators Drug Effect on heart rate Adverse effects Nifedipine ? Headache, flushing, ankle swelling Amlodipine ? Ankle swelling Nimodipine ± Flushing, headache Diltiazem ± Generally mild Verapamil ? Constipation, marked negative inotropic action Adverse effects of calcium channel-blocking agents Calcium channel blockers do not affect concentrations of plasma cholesterol or triglycerides, or extracellular calcium homeostasis. 3. Vasodilators 4. Angiotensin-converting enzyme inhibitors (ACEI), blockers of AT1 rc