内科学：4. 高血压.pptVIP

医生在选择初始治疗和维持治疗药物时，需考虑： 患者既往使用某一特定种类抗高血压药物的效果 药物的疗效和耐受性，药物的花费 患者本人的心血管疾病危险因素 是否存在靶器官损害？有无心血管疾病、肾脏疾病和糖尿病？ 是否存在适宜使用或不适宜使用某一特定种类抗高血压药物的其他合并疾病 与治疗其他疾病所使用的药物发生相互作用的可能性 联合用药 药物的选择 预测2010-2030我国成人高血压患病率四种趋势： 如每年增长3%，20年后患病率超过40%；估计高血压患者将达4亿。 采取有效措施，假设患病率不变，如每年降低1% 或3%，20年后患病率降至18%或12%。 --NCCD Increase=3% No Change Reduction=1% Reduction=3% 高 血 压 患 病 率 (%) 高血压流行趋势预测 1/10万人 年 中国心脑血管病死亡率变化 及有效干预后的预测趋势 ↓拐点 谢谢 2013级 * Left, Insulin’s actions in normal humans. Although insulin causes a marked increase in sympathetic neural outflow, which would be expected to increase blood pressure, it also causes vasodilation, which would decrease blood pressure. The net effect of these two opposing influences is no change or a slight decrease in blood pressure. There may be an imbalance between the sympathetic and vascular actions of insulin in conditions such as obesity or hypertension. Right, Insulin may cause potentiated sympathetic activation or attenuated vasodilation. An imbalance between these pressor and depressor actions of insulin may result in elevated blood pressure. (From Anderson EA, Mark AL: Cardiovascular and sympathetic actions of insulin: The insulin hypothesis of hypertension revisited. Cardiovasc Risk Factors 3:159, 1993.) * FIGURE 37-10 ??Some of the factors involved in the control of blood pressure that affect the basic equation blood pressure = cardiac output (CO) × peripheral resistance (PR). (From Kaplan NM: Clinical Hypertension. 8th ed. Baltimore, Lippincott Williams Wilkins, 2002, p 63.) * ?Endothelium-derived vasoactive substances. Various blood- and platelet-derived substances can activate specific receptors (orange circles) on the endothelial membrane to release relaxing factors such as nitric oxide (NO), prostacyclin (PGI2), and an endothelium-derived hyperpolarizing factor (EDHF). Other contracting factors are released, such as endothelin-1 (ET-1), angiotensin (A), and thromboxane A2(TXA2), as well as prostaglandin H2(PGH2). ACE = angiotensin-conve