《药理学 Pharmacology》课程PPT教学课件：Antihypertensive Drugs

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Chapter 34 Antihypertensive Drugs

Antihypertensive Drugs Overview 0 Classification of antihypertensive drugs I 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

Classification of Antihypertensive Drugs by Their Primary Site or Mechanism of Action Diuretics( Chapter 29) 1. Thiazides and related agents(hydrochlorothiazide, chlorthalidone, etc 2. Loop diuretics(furosemide, bumetanide, torsemide, ethacrynic d 3.K+-sparing diuretics(amiloride, triamterene, spironolactone Sympatholytic Drugs(Chapters 9, 10, 34) 1. Centrally acting agents(methyldopa, clonidine, guanabenz, guanfacine) Noradrenergic 2. Adrenergic neuron blocking agents(guanadrel, reserpine) 3. B-Adrenergic antagonists(propranolol, metoprolol,etc nerve ending 4. a-Adrenergic antagonists(prazosin, terazosin, doxazosin blockers phenoxybenzamine, phentolamine) 5. Mixed adrenergic antagonists (labetalol, carvedilol Vasodilators( Chapter 34) 1. Arterial(hydralazine, minoxidil, diazoxide, fenoldopam 2. Arterial and venous(nitroprusside) Ca2t-Channel Blockers(Chapters 32, 34, 35)(verapamil, diltiazem nifedipine nimodipine, felodipine, nicardipine, isradipine, amlodipine) Angiotensin Converting Enzyme Inhibitors( Chapters 31, 32)(captopril, enalapril, lisinopril, quinapril, ramipril, benazepril, fosinopril moexipril, perindopril, trandolapril Angiotensin I1-Receptor Antagonists( Chapters 31, 34)(losartan, candesartan, irbesartan, valsartan, telmisartan, eprosartan)

Noradrenergic nerve ending blockers

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