抗高血壓藥-英文版

Antihypertensivedrugshypertension■

Meanarterialbloodpressureis

higherthan

the

normal

range,in

the

case

of

nottaking

blood

pressure

drugs

:Systolic

blood

pressure≥18.7kPa(140mmHg)and(or)Diastolic

blood

pressure≥12.0kPa(90mmHg)Dividedintoprimaryhypertension(90%~

95

%)

And

secondary

hypertensioncomplications■

Heart

failure■

Coronary

heart

disease(CHD)■

Cerebrovascular

accident■

Renal

failureAntihypertensivedrugsReasonable

application

ofantihypertensivedrugsReducethecomplications

suchas

brain,heart

and

kidneyanddevelopment

ofatherosclerosisReduce

themortalityrate,prolonglifeDelay

theformationControlbloodpressureofBloodpressure-

Thefactorsinfluencingbloodpressure:■

Cardiac

output

:heart

rate,myocardial

contractionforce,change

of

blood

volume,etc.;■Peripheral

resistance:the

length

of

the

bloodvessels

and

blood

viscosity,blood

vessels,radius,etc.-Nerve

-

fluid

system

onbloodpressureregulation

。clonidine

mecamylaminea-methyldopa

Reserpine

Eplerenone

guanethidineThepostsynaptiCmembranereceptorβpropranolola1

prazosinα?β

labetalol1.Nervousregulation:thesympatheticnervoussystemhydralazinesodiumnitroprusside

nifedipineminoxidilmain_

ganglion-centrePeripheralneurotransmitterreleaseVascularsmoothmuscleB-

-R

blKidneyadjacentbal]SmallarterylosartanAldosteroneSecond,humoral

regulation:renin-angiotensinaldosteronesystemgiotcontractionsecretion→WaterBesidethemachineAngioten(

originalsodium

retentiondiuretic(thiazides)asegiotensinI]ClassificationDiureticThesympatheticnervousdepressants(1)centralbloodpressuremedication(2)theganglionblock(3)noradrenaline

can

nerve

endings

block(4)the

adrenaline

receptor

blockersAffecttherenin-angiotensinsystemmedicineAgleamofantihypertensives:diuretic,calcium

antagonistmedicine,betareceptorblockersandACEIDiureticOn

the

basis

of

(a

line)blood

pressure

medicationEffect

in

the

thiazide

diuretic

is

most

commonly

used,antihypertensive

effect

is

mild,persistent,

long-termapplication

of

no

significant

resistanceFeatures:Antihypertensive

effect

is

weak,by

an

average

of

10%2～3

weeks

after

the

majority

ofpatientsin

medical

workCan

be

used

for

various

high

blood

pressure

(basic

blood

pressure

medication)

Mild

-alone,medium

and

severe

-shareCan

make

theelderly

hypertension

patientscomplicated

withstroke,theincidenceof

left

heart

failure

and

mortality

is

leftHydrochlorothiazide■

Early

antihypertensive

mechanism■With

sodium

diuresis,reduce

theextracellular

fluid

and

blood

volume■Long-termantihypertensivemechanism■

DiureticrowsodiumtoNa+left

aortic

smooth

muscle

cell,cell

Na+/Ca2+exchange

left-

>intracellular

Ca2

+left,reduce

vascularsmooth

muscle

of

norepinephrine(NE)

reactivitydisadvantages:-↓BloodK+、Na+

、Mg2+-↑Blood

total

cholesterol,triglyceride,low

density

lipoprotein

cholesterol(hdl-c)-個Blooduric

acid-個Bloodrenin-↓Glucose

tolerance(disabled)for

diabetespatientsEffectivediuretic

(furosemide)usedin

hypertensivecrisis

and

poor

associated

with

chronic

renalhypertension

patients.■HypertensivecrisisPatients

with

high

blood

pressure

in

the

shortterm,the

blood

pressure

increased

significantly,andappear

have

a

headache,be

agitated,palpitation,sweating,nausea,vomiting,or

pale

flush,blurred

vision

and

other

signs.Mechanism:hyperthyroidism

and

circulating

catecholamines

increased

sympatheticnervousactivityClinicalapplication■Agleam

ofmedication■Application

ofthe

treatment

for

mild

hypertension

separately■With

other

antihypertensive

drug

treatment,

severehypertensionEffectofdiuresismedicineofcompound

preparationswith

other

drugsCompoundantihypertensiontablet:giveupping,hydralazine,hydrochlorothiazide■

Compoundapocynumtablet:guanidineborganism,hydralazine,hydrochlorothiazide■

Janechrysanthemumantihypertensiontablet:clonidine,hydrochlorothiazid

e■

Compoundcaptopriltablets,enalapriland

hydrochlorothiazidem

Constant

dropping

pills:clonidine,hydralazine,hydrochlorothiazideCalciumantagonistmedicineBlock

L

voltage

dependent

calcium

channel->leftintracellular

Ca2+diastolic

small

arteryNifedipinegroup,horizon,lacidipine

flat,amlodipineNifedipine【Step-downcharacteristics】1Buck

degree

was

positively

correlated

with

the

original

high

bloodpressure,with

normal

blood

pressure

has

no

obviousantihypertensive

effect

;2

Oral

absorption

is

good,work

fast:sublingual

administering

1-5

minutes

work

-in

the

treatment

of

variant

angina

pectoris,hypertensive

crisis.Oral

30

to

60

minutes

work

-treatment

ofmild

andmoderate

hypertension

;3

Can

cause

reflective

heart

rate

↑—shareβ

Receptor

blockers.Clinicalapplication■

Light,mediumandseverehypertension

treatmentNitrendipineSelectively

ACTS

on

the

peripheral

vascular,blocking

its

internal

flow

of

calcium

ions,relaxingsmoothmuscle,thedilatebloodvessels

and

step-downWarm

and

lasting

antihypertensive

effect,applicable

to

various

types

ofhigh

bloodpressureLacidipine■Is

a

potent

calcium

antagonists,significantly

and

the

effectofselective

calcium

ion

channels

in

vascular

smooth

muscle.Its

main

role

is

to

expand

peripheral

artery,reduceperipheral

vascular

resistance

and

to

lower

blood

pressure■Resistance

to

atherosclerosis■

Used

for

mild

and

moderate

hypertension■Name

of

commodity:lacidipineAmlodipineMore

gentle,smooth

effect

lasting,convenience

of

once-daily

dosage,24

hours

of

stability

control

ofhigh

blood

pressure

and

angina

pectoris,goodsafety

and

tolerabilitySimilar

drugs,only

it

can

be

used

by

patients

withcongestive

heart

failure

safety■Also

has

the

role

ofatherosclerosis■

βReceptorblockers:prapranolol

、atenolol、

labetalol、

carbedilol■

Q?Receptorblockers:

prazosin

、terazosin、doxazosinAdrenaline

receptor

blockersMechanism

of

action■

Nonselective

beta

receptor

blockers,mostly

related

with

the

beta

blocker:■Heart

:myocardial

contraction

force

is

abate,slow

heart

rate,cardiacoutput

decreases■

Kidney:reduce

renin

secretion,inhibit

RAS

on

blood

pressureregulation■

The

sympathetic

nerve

endings

presynaptic

membrane:inhibitionofpositive

feedback,NA

secretion

decline■

Central

(hypothalamus

and

medulla

oblongata):excitatory

neuron

activity

is

abate,peripheral

sympathetic

nerve

tension

by,vascular

resistance

decreased■IncreasethetopringelementsynthesisClinicalapplication■

Suitable

for

various

high

blood

pressure■With

high

cardiac

output

or

plasma

renin

levels

hasgood

effect

on

the

high

side

ofhypertensive

patients,

especially

suitable

for

hypertensive

patients

withcoronary

heart

disease,cerebrovascular

diseaseDiuretic

or

pooling

vasodilators

can

enhance

curativeeffectatenolol■

Selective

beta1

receptor

blockers,lackof

internal

tothe

sympathetic

activity■Oral

is

used

to

treat

various

degree

of

high

bloodpressure,antihypertensive

effect

a

longer

durationlabetalol■

a

、β

Receptor

blockers■Applicable

to

various

degrees

ofhypertension

andhypertensiveemergency,gestationalhypertension,pheochromocytoma,high

blood

pressure

whenanesthesiaor

surgerycarvedilol)■a

、β

Receptor

blockers■Used

in

the

treatment

ofmild

and

moderatehypertension

with

renal

insufficiency,diabetes,highblood

pressure

patientsReninangiotensinsystem

depressantsACEI:Captopriletc.LAT1-resistance:

Chlorinesand,valsartan,etcAngiotensin

converting

enzyme

inhibitors

ACEIcaptopril(A

sulfhydrylpropionic

acid

pulp

)【

Antihypertensivemechanism】1.AngI

Generate

and

function

。2.Inhibitionofslow

excitationpeptidedegradation」Slo

wexcitationpeptideconcentrationsintheblood1:produceNO

、

PG2

Etc.血管擴張→血壓—Arteriovenousdiastolic→Peripheralresistance↓→BloodpressureJ;—Blockthereleaseofaldosterone

watersodium

retention

;【

Function

characteristics

】■1

orally

active,work

fast,antihypertensive

effect

ofmedium

strong;■2without

reflective

heart

rate,long-term

use

withoutresistance,not

easy

to

cause

the

electrolyte

disorders;m

Three

pairs

of

renal

hypertensive

effect

is

good,can

treatrefractory

heart

failure【

application

】Eachperiodhighbloodpressure.Importantfirst-line

drugs.Especiallysuitableforcomplicatedwithdiabetes

andinsulinresistanceandleftventricularhypertrophy,heartfailure,acutemyocardialinfarctionpatientswithhighbloodpressureAngiotensin

II

receptor

blockers

ARBAT1receptor:vascular

smooth

muscle,cardiac

muscle,brain,

kidney

and

secretion

ofaldosteroneAdrenal

zona

cells

-has

regulating

effect

to

the

stability

of

thecardiovascular

function.losartan【Antihypertensive

mechanism

】Selective

blocking

AT1

receptor:blocking

angiotensin

Imediated

blood

vesselsShrinkage,aldosterone

release

and

promote

vascular

smoothmuscleproliferation

and

effect→Peripheral

resistance↓Promoting

uric

acid

excretion,inhibiting

renal

tubule

ofuric

acidabsorption,short【Clinicalapplicationof

】Eachperiod

high

bloodpressureStep-down

features:1.

The

oral

work

fast2.The

role

to

maintain

for

a

long

time:24

h

smoothstep-down,3～6

weeks

for

maximum

effect【

side

effect

】

relatively

less

ACEI:Attracted

less

dry

cough

and

angioneurotic

oedema;But

still

can

cause

low

blood

pressure

and

high

potassium.Forpatientswithpregnancy.Promoting

uric

acid

excretion,inhibiting

renal

tubule

ofuric

acidabsorption,shortPharmacologicaleffects■Diastolic

small

artery

smoothmuscle,reducetheperipheral

vascular

resistance,lower

blood

pressure■With

heart

rate

slows,decreased

cardiac

output■

Inhibit

the

secretion

ofgastrointestinal

tract

and

movementand

the

protection

ofgastric

mucosa■Buck

with

sedation■Reduce

intraocular

pressure,do

not

affect

the

pupil

and

the

adjustment

of

the

lensPharmacologicalactionandActivateI?-imidaihna

i

ceptor,Make

theperipheralsympatheticactivitydecline,vasodilation,

bloodpressuredrops■

’The

excited

central

postsynaptic

membrane

receptor

alpha

2

Lower

levels

ofplasma

renin

and

aldosterone■Inhibit

the

secretion

ofgastrointestinal

tract

and

movement

andthe

protection

ofgastric

mucosaStatic

note

clonidine

can

produce

booster

for

a

short

period

oftime(associated

with

peripheral

alpha

2

receptor

excited),followedby

a

long

period

of

time

the

step-down(central

role).Oral

withthe

central

role

ofthe

dominant,the

booster

effect

is

not

obviousresmenzomeClonidine■

Process

in

the

body■Absorption:oralabsorptionDistribution:easy

through

the

blood

brainbarrier,plasma

protein

combined

rate

of

30%■Metabolism

:50%in

intrahepatic

metabolism■

Discharge:metabolic

product

and

prototype

by

renal

excretionClinicalapplicationFirst-line

treatment

invalid

moderately

high

blood

pressure,with

thiazide

diuretic

or

otherantihypertensive

agents

share

can

improve

thecurative

effect■

Renal

hypertension■

Patients

with

high

blood

pressure

ofpeptic

ulcer■

Primary

open-angle

glaucomaAdversereactionsDrymouth,sleepiness,constipation,impotence,can

happen

occasionally

bradycardiaWater

sodium

retentionDrug

withdrawal

syndrome:a

long-term

drug

withdrawal

may

suddenly

appear

have

a

headache,tremor,abdominal

pain,sweating,heartpalpitations

and

blood

pressure

surge.And

long-term

medication

made

the

alpha

2weeksthepresynapticmembrane

receptor

sensitivity,negativefeedback

effect

is

reduced,sudden

withdrawal,increased

sympathetic

nervous

function

is

associated

with

increased

NE

release.Recovery

for

medicine

or

alpha

receptor

blockers

(e-g.,phentolamine)can

alleviate.

Withdrawalshouldbegraduallyreduced1The

other

central

blood

pressure

medication■

methyldopaA

medium

to

strong

step-down,cardiovascular

and

output,lessinfluence

renal

blood

flowSuitable

forrenalhypertension

andmoderatehypertensive

patients

with

poor

kidney

function,often

with

thiazide

diuretic

sharemoxonidinemFor

Il

receptor

affinity

is

high,and

the

receptor

is

strong,biologicalt1/2

longer,once

a

day

dosing■

Suitable

for

patients

with

mild

and

moderate

hypertensionOn

the

central

and

peripheral

alpha

2

receptor

function

is

weak,the

calm,dry

mouth

greatly

reduce

adverse

reactionsVasodilationmedicine■Directly

to

relax

vascular

smooth

muscle,decrease

peripheralresistance

and

blood

pressure

to

dropLong-term

use

antihypertensive

vasodilators

has

the

following

disadvantages■

Can

theexcited

sympathetic

nerve,reflective

increase

cardiac

output,heart

rate

speed

up■Increase

ofrenin

and

aldosterone

secretion,leading

to

water

andsodium

retention■A

longtimewitheasytolerance■

Withadiureticoradrenalinereceptorblockerssharecan

enhancecurative

effect,reduce

adverse

reactionsSodium

nitroprusside■

Antihypertensive

effects

associated

with

an

increased

NO-GC-cGMP,can

dilatebloodvessels

andinhibitplatelet

aggregation■

Of

arterioles

and

venulesvascular

smoothmusclewerediastolicfunction,antihypertensive

effect

strong,rapid

and

short■

Mainly

used

in

the

treatment

ofhypertensive

crisis.Also

used

incongestive

heart

failure,acute

myocardial

infarction

and

controlling

hypertension

during

anesthesia■

Because

of

excessive

step-down

can

cause

nausea,vomiting,sweating,

restlessness,palpitations

and

headacheGanglionblockmedicinemecamylamine【

Function

characteristics

】1.Antihypertensive

effectstrong,quickly;2.Hasinhibitory

effect

onboth

sympatheticand

parasympathetic,adverse

reactions,and

the

heavier,orthostatic

hypotension;The

parasympatheticganglion

block

symptoms.3.Hypertensivecrisis.Prazosin一ProcessinthebodyAbsorption:good

oral

absorption,firsteliminate

theobvious,bioavailabilityof

60%

Distribution:the

combination

of

plasmaprotein

rate

was

970%■Metabolism:livermetabolism■Discharge:most

bile

excretion,by

a

smallnumber

of

urinePharmacologicaleffectsandmechanism

of

action■Alpha1receptorsonpostsynapticmembraneof

vascularsmooth

muscle

are

highly

selective

blocking

effect

■Step-down

features:A

medium

to

strong

antihypertensive

effectDon't

affect

kidney

function,improve

the

level

of

renin■

Long-term

use

can

improve

lipid

metabolismBlock1

receptor

alpha,relieve

dysuria

prostate

patientsClinicalapplication■Can

be

separatelyusedtreatmentof

mild

andmoderatehypertensionmForelderlypatientswithhypertensioncombinedprostatic

hypertrophy,can

improve

the

symptomsof

dysuriaSeverehypertensionsharediureticandbetareceptorblockers

can

enhance

step-down

effectthe

firsttime0.51

hour

after

the

treatmentcan

appear

orthostatic

hypotension,dizziness,sweating,heart

palpitations

and

reaction■

Long-termusecancausewatersodiumretention,

diuresis

medicine

can

maintain

its