BP=CO×PVR CNS/sympathetic nerves Baroreceptor reflex arc Heart rate Aortic arch contractility carotid sinuses 81-AR Peripheral a1-AR Arterial Cardiac Blood output resistance Pressure Stroke Na'/Ca2 volume exchange Renin- angiotensin- Venules aldosterone Sodium/ capacitance volume Factors affecting drug treatment of hypertension: Accuracy of diagnosis;severity of hypertension Etiology:Primary(essential hypertension)vs.secondary(10-15%patients) Identifiable causes of hypertension:Pheochromocytoma,renal artery constriction,Cushing's syndrome(hypercorticism)and Cushing's disease (over-production of ACTH).primary aldosteronism,thyroid or parathyroid disease,coarctation of the aorta Pre-existing risk factors and medical conditions(smoking,hyperlipidemia, diabetes,congestive heart failure,asthma,current medications) Individualization(age,gender,ethnicity);patient compliance Single drug(monotherapy)vs.multiple drug(polypharmacy) 33 Peripheral resistance Baroreceptor reflex arc Sodium/ volume Venules capacitance Stroke volume Heart rate contractility Na+/Ca2+ exchange Renin￾angiotensin￾aldosterone Cardiac output Arterial Blood Pressure CNS / sympathetic nerves BP = CO × PVR Aortic arch carotid sinuses β1-AR α1-AR Baroreceptors Factors affecting drug treatment of hypertension: • Accuracy of diagnosis; severity of hypertension • Etiology: Primary (essential hypertension) vs. secondary (10-15% patients) • Identifiable causes of hypertension: Pheochromocytoma, renal artery constriction, Cushing’s syndrome (hypercorticism) and Cushing’s disease (over-production of ACTH), primary aldosteronism, thyroid or parathyroid disease, coarctation of the aorta • Pre-existing risk factors and medical conditions (smoking, hyperlipidemia, diabetes, congestive heart failure, asthma, current medications) • Individualization (age, gender, ethnicity); patient compliance • Single drug (monotherapy) vs. multiple drug (polypharmacy)