浙江大学医学院：《药理学 Pharmacology》课程教学资源（PPT课件）抗高血压药物（降压药）Antihypertensive Drugs

When tlood pressure s 12080 Pessure when cut pressure s greate records than 120 mm H? No bood fows thogh te wessel Inatable hound s peard When cutf prossure is betwen 120 and B0 nm Ho Antihypertensive Drugs 远t cu pressure Blood pressure 80mm地g Bled Flaws hres内hwd AAo sourit noru

Antihypertensive Drugs

Antihypertensive Drugs 0 Overview 0 Classification of antihypertensive drugs u Antihypertensive drugs o Rational application of antihypertensive drugs

Overview Classification of antihypertensive drugs Antihypertensive drugs Rational application of antihypertensive drugs Antihypertensive Drugs

A. Overview Hypertension essential hypertension secondary hypertension I Criterion of hypertension diastolic blood pressure >90 mmHg systolic blood pressure>140 mmHg

A. Overview Hypertension essential hypertension secondary hypertension Criterion of hypertension: diastolic blood pressure  90 mmHg systolic blood pressure  140 mmHg

A. Overview Major factors influencing blood pressure Arterial blood pressure tone Blood Heart ContractilityFilling volume rate pressure Venous tone Baroreceptors and sympathetic nervous system Renin-angiotention-aldosterol system (RAAS)

Major factors influencing blood pressure Arterial blood pressure Cardiac output Peripheral resistance   Venous tone Blood volume Filling pressure Heart Contractility rate arteriolar tone Baroreceptors and sympathetic nervous system Renin-angiotention-aldosterol system (RAAS) A. Overview

Arenas Normal arteriolar tone To capil anes Cross section Vasoconstriction o’ arteriole (increased cont acton of circular smooth muscle in the artero Heart contracting an a, which lea练to Caused by: (a creased resstance and decreased Oxygen(oJ row through the vessel) Carbon doxide (CoJ) and other metabolon I Sympathetic stimulaton Arenes Vasopressin angotensin目 fEE Caused by ttt土毛 co. and otne measues 4 Sympathetic stmulation Histamine release Heart relaxing and fillin Heat Peripheral resistance and vascular tone and elasticity

Peripheral resistance and vascular tone and elasticity

Collagenic op o plsgue wA wall d-ichcor Endosteum Arterial wall hypertrophy and sclerosis

Arterial wall hypertrophy and sclerosis

B Classification of Antihypertensive Drugs u Diuretics 0 Calcium channel blockers u Regin-angiotensin system inhibitors o Sympathetic inhibitors u Vasodilators

Diuretics Calcium channel blockers Regin-angiotensin system inhibitors Sympathetic inhibitors Vasodilators B. Classification of Antihypertensive Drugs

血管运动中枢 Vasomotor ceter Methyldopa Clonidine 交感神经末梢 Guanabenz Guanethidine Sites of Guanadrel action of 交感神经节 pathetic gangla the major r ol he Propranolol and classes of other B-blockers antihyperte s of vess Prazosin and hydralazine Verapami and oth Losartan and other a, blockers calcium chane nsive drugs Nitroprusside blockers REceptors of juxtaglomerular Kidney tub celis Pnad release renin Thiazides Propranolol and other B blockers 肾小球旁细胞 converting enzyme Alkire other ACE inhbitors

血管运动中枢 交感神经末梢 交感神经节 肾小球旁细胞 Sites of action of the major classes of antihyperte nsive drugs

C. Antihypertensive Drugs Diuretics 1. Pharmacologicaleffects ()Reducing plasma volume (cardiac output l) (2) Reducing Na*-Ca2* exchange in vascular smooth muscle cells(Ca2+i L, peripheral resistance l)

Diuretics 1. Pharmacological effects (1) Reducing plasma volume (cardiac output ) (2) Reducing Na+ -Ca2+ exchange in vascular smooth muscle cells (Ca2+ i , peripheral resistance  ) C. Antihypertensive Drugs

Thiazide diuretics Sodium water retention Nat- Ca2+ exchange 个 Cai 2+ Blood in vascular volume smooth muscle cels Peripheral Cardiac resistance output Decrease in blood pressure

Na+ -Ca2+ exchange , Ca2+ i  in vascular smooth muscle cells