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Antihypertensive drugs

Antihypertensive drugs. BACKGROUND. NBP 120-90/90-60mmHg, Affecting factors: Volume of blood, Cardiac Output, resistance of Arterioles HBP SBP>140/ DBP>90 mmHg Morbidity 30% CLASSES OF HYPERTENISON Essential hypertension Secondary hypertension. CLASSES OF DRUGS. DRUGS Targets

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Antihypertensive drugs

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  1. Antihypertensive drugs

  2. BACKGROUND • NBP 120-90/90-60mmHg, • Affecting factors: Volume of blood, Cardiac Output, resistance of Arterioles • HBP SBP>140/ DBP>90 mmHg • Morbidity 30% • CLASSES OF HYPERTENISON • Essential hypertension • Secondary hypertension

  3. CLASSES OF DRUGS • DRUGSTargets • Diuretics • Agents act on ANS. • Direct Vasodilators • CCB • RAS blockers (ACEI, AT1B) • Blood Volume • Cardiac Output • Resistance of Vessel • Arterioles • RAS • Neuroregulation

  4. Diuretics • Agents Furosemide (Lasix) thiazides • Mechanism • Blood Volume • Na Na Ca Ca • Na PGE2, Kinin • reactivity to vaso-excitor material(NA)

  5. Diuretics • Clinic uses • Alone: Mild hypertension • United: Mediate & serious • ADR • K Na • CE TG LDL • Renin activity

  6. RAS blockers • ACEI(…pril) • Captopril • Mechanism • Angiotensin Renin AI ACE AII • Bradykinin NO,EDHF Vasoconstriction Aldosterone Proliferation

  7. Renin angiotensin aldosterone system, RAAS AgⅠ BP↑ AgⅡ ACE aldosterone ↑ renin 降解产物 心室重构 血管重构 缓激肽 血管紧 张素原 BP↓

  8. RAS blockers • Clinic uses: hypertension & CHF • ADR • Hypotension • Dry Cough • Hyperkalaemia • Antagonists of AT1 • Losartan • AII: AT1-R, AT2-R

  9. ANS Blockers • Antagonists of β-R • Propranolol,Metoprolol, atenolol • Mechanism • Heart Rate Cardiac Output • Rinin, positive feedback-NA • Clinic uses • Mild-mediate hypertension • ADR constriction

  10. ANS Blockers • sympathetic nerve inhibitor 1.Central hypotensive drugs:clonidine 2.Ganglion blockers:mecamylamine 3.Drugs affecting NA stores or release • Reserpine; Quanethidine 4. Adrenoceptor blokers • Antagonists of α-R:Prazosin, Urapidil • Antagonists of α, β –R:Labetalol

  11. Calcium antagonists • Target at vascular smooth muscle • nifedipine • amlodipine • tetrandrine

  12. Direct Vasodilators • Sodium nitroprusside • Mechanism • NO • Pharmacokinetics(P.K.) • P.E. • Directly on a. & v. • Clinic uses Serious hypertension • ADR : hypotension, thiocyanate toxicity ivgtt only Rapid onset(<2min) Cease in 5 min

  13. Direct Vasodilators • Potassium Channel Openers • Pinacidil • Mechanism • K hyperpolarization • Ca • Clinic use mild-midiate hypertention • ADR edema

  14. Review & questions • Classes of antihypertensive • Agents & main mechanisms of each. • Serious hypertension use ____ first. • Common ADR of them is ____. • Mild hypertension use ___ first, if no use, add ___ /-------.

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