高血压-课程中心.PPT

掌握高血压的诊断标准、危险分层和治疗原则。 熟悉降压药物的种类及特点；降压药物的选择和联合用药。 了解高血压的患病率、病因、发病机制和并发症；以及较常见的几种继发性高血压。 教学网站网址 《内科学》校级精品课程：0/kj/298/ 《内科学》省级精品课程：1/eln/200705111443400125/index.jsp?cosid=1033 “Hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it.” White PD, 1931 “高血压可能是一个重要的代偿机制，即使我们能够控制它，也不应该处理它。” “The greatest danger to a man with high blood pressure lies in its discovery, because then some fool is certain to try to reduce it.” Hay J, 1931 人类对高血压认识的历史 Definition of Hypertension Hypertension is a clinical syndrome, defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Hypertension should be considered a major risk factor for an array of cardiovascular and related disease as well as diseases leading to a marked increase in cardiovascular risk. 。 Etiology The pathogenesis of essential hypertension is multifactorial. Genetic factors play an important role. Children with one- or two-hypertensive parents have higher blood pressures. Environmental factors also are significant. Increased salt intake has long been incriminated as a pathogenic factor in essential hypertension. It alone is probably not sufficient to elevate blood pressure to abnormal levels; a combination of too much salt plus a genetic predisposition is required. Etiology Pathogenesis Sympathetic nervous system hyperactivity. It is most apparent in younger hypertensives, who may exhibit tachycardia and an elevated cardiac output. However, correlations between plasma catecholamines and blood pressure are poor. Pathogenesis Renin-angiotensin system. Renin acts on angiotensinogen to cleave of the ten-amino-acid peptide angiotensin I. This peptide is then acted upon by angiotensin-converting enzyme to create the eight-amino-acid peptide angiotensin II, a potent vasoconstrictor and a major stimulant of aldosterone release from the adrenal glands. Pathogenesis Defect of natriuresis. Hypertensive patients