Drugs used to treat hypertension课件.ppt

Drugs used to treat hypertension Non-renal mechanisms – neuronal mechanisms ? sympathetic nervous system (continual background of vasoconstrictor tone), and – endocrine and autocrine/paracrine mechanisms (NO vs, endothelin) Clinically important consequences of hypertension (?end organ damage“) include damage both to large and small blood vessels as well as left-ventricular hypertrophy (increased arterial pressure causes an increased risk of arterial rupture and bleeding from a weak spot in the arterial wall) ! - preferable (to loop diuretics) for the treatment of  uncomplicated hypertension- given by mouth as a single morning dose- begin to act within 1-2 hours and work for 12-24 hours- treatment should be started using a low dose - useful in hypertensive patients with moderate or severe renal impairment, or in patients with hypertensive heart failure. - relatively short-acting (diuresis occurs over the 4 hours following a dose) ? used in hypertension if response to thiazides is inadequate Mechanism of action: - they inhibit the co-transport of Na+, K+ and Cl- - ? of Ca2+ and Mg2+ excretion - they have useful pulmonary vasodilating effects (unknown mechanism) Toxicity: the most important toxicities of the alpha-blockers are simple extensions of their a-blocking effects – type A adverse effects - the main manifestations are: - drowsiness, weakness, orthostatic hypotension (first dose – bedtime administration) - and for the nonselective agents, reflex tachycardia - in patients with coronary disease, angina may be precipitated by the tachycardia (less frequent in selective alpha1-blockers) - oral administration of any of these drugs can cause nausea, vomiting, diarrhoea - urinary incontinece - priapism, nasal congestion Clinical pharmacology of hypertension B) INDIRECT ACTING - CALCIUM CHANNEL-BLOCKING AGENTS 1. dihydropyridine (nifedipine, nicardipine, amlodipine) 2. diltiazem, verapamil they b