第十六章 抗高血压药
第十六章 抗高血压药
HypertensionMain.complicationsofpersistentCategorysystolic,mmHgdiastolic,mmHgHighblood pressure140[6]>90[6]chronicrenal failure≥180≥110Hypertensiveurgency≥160[6]≤90Isolatedsystolichypertension
Hypertension
高血压的病理生理学变化交感张力增高血管收缩、心脏收缩力增强、水钠潴留RAAS兴奋性增加
高血压的病理生理学变化 交感张力增高 RAAS兴奋性增加 血管收缩、心 脏收缩力增强、 水钠潴留
遗传因素环境因素摄盐+大脑高级中枢失调平滑肌信号缺陷利 Na+自隐+交感神经兴奋血管收缩因子性生长因子醛固酮1肾素血管紧张素 ↑血管平滑肌生长和结构改变血管反应性 1钠水潴留平滑肌细胞肥大、增生血管收缩管腔狭窄血浆和细胞外液容积1血管壁增厚自动调节心输出量1外周阻力十HBP
遗传因素 环境因素 HBP
DASH膳食治疗ACTSAROUDietaryDASHTheApproachesEatingPlantoResearch has found that ciet affects the development of highblood pressure, or hypertenston (themedical term):Recentlytwo studios showed that following a particular eating plancalled the DASH eating plan-and reducing the amount ot sodiStopum consurmed lowers blood pressureWile each stop adlone lowers blooxd pressure, the combination of the cating plan and areduced sodium intakegives the biggestbenent and may helppreventthe developrnentHypertensionor high blood pressureThts fact sheet, basod on tho DASH research findings, tells about high blood pressuroand howtofollowtheDASHeatingplanand reduoetheamountofsoxdlumyouconsume.lt offers tips on how to start and stay on the eating plan, as well as a weekof menus and some recipes.Themnenus and rectpes aregiven for two levels of dailysodium consumpticn2,400milllgrams (theupper lemitofcurrentrecommendationsby the Fedkral Government's National High Blood Pressuxe Education Prograrn, otNHBPEP, and the amount used to figure food iabels Nutrition Facts Daily Value) and1.500milligramsThose with highi blood prere mayespectally benefitfrom following the eattng plarandreductngthersoxtium intake Butthe combinatton Isaheart-healthyrecipethatalladults can follow.NATIONALINSTITUTESQFHEALTHANDBLOO0NATIONAHEARLUNS
DASH膳食治疗 Dietary Approaches to Stop Hypertension
Preload血容量前负荷MyocardialStroke volume心输出量contractility静脉Cardiac output小静脉Afterload心脏Heart rate交感神经Meanarterial血管阻力++血容量pressureVascular tonePeripheralO0+Remodellingresistance血管收缩肾Vascular1血压↑structure肾素释放Rarefaction肾素血管紧张素醛固酮系统
第二节 常用抗高血压药物5血管紧张素转化酶抑制药农血管紧张素受体Ⅱ拮抗药钙通道阻滞药a利尿药肾上腺素受体拮抗药
血管紧张素转化酶抑制药 血管紧张素受体Ⅱ拮抗药 钙通道阻滞药 利尿药 肾上腺素受体拮抗药 第二节 常用抗高血压药物
肾素血管紧张素转化酶抑制药Renin-angiotensin-aldosterone systemLegendSympatheticSecretionfromactivityanorganStimulatorysignalNaKidneyInhibitory signalTubular Nat cl'KLungsLiverreabsorptionandKtct-ReactionSurface of pulmonaryexcretion.H,Oretentionandrenalendothelium:H20ActvetransportACEAdrenalgland:PassivetransportcortexAldosteroneAngiotensinAngiotensinIlAngiotensinogenWater and saltsecretionretention.Effectivecirculating volumeDecrease inReninincreases.Perfusionrenalperfusionof the juxtaglomerularArteriolar(juxtaglomerularapparatusincreases.vasoconstriction,apparatus)increaseinbloodpressureArteriole--..Kidney-ADHsecretion..Pituitary gland:2posteriorlobeCollecting duct:H.0H20reabsorption
肾素血管紧张素转化酶抑制药
ACEAng IAng I糜蛋白酶2交感张力增高激动血管上AT收缩血管心脏收缩力增加、心率增快；血管收缩醛固酮分泌增加2激活原癌基因水钠潴留血管平滑肌增生，血管重构；心肌细胞肥大血压升高，靶器官损害
心脏收缩力增加、心 率增快；血管收缩 1 收缩血管 2 血管平滑肌增生，血管重 构；心肌细胞肥大 3 水钠潴留 4 交感张力增高 激动血管上AT1 激活原癌基因 醛固酮分泌增加 AngⅠ AngⅡ ACE 糜蛋白酶 血压升高，靶器官损害
肝ACEI激肽原?肾激肽释血管紧张素原放酶肾素(-)缓激肽前列腺素11血管紧张素IACE1④（激肽酶Ⅱ）血管扩张11血管紧张素Ⅱ失活肽11心室/主动脉1肥厚醛固酮血压下降血管收缩11降低1顺应性外周阻力增加1水、钠1潴留1血压上升-图26-2ACEI对RAAS及激肽释放酶-激肽-前列腺素系统的影响