Resp高血壓2008

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Resp高血壓2008

  1. 1. Therapeutics of Cardiovascular Diseases Hypertension 2008 George Hsiao Institute of Pharmacology, TMU
  2. 2. Homeostasis <ul><li>各司其職、陰陽調和、不敢逾越 </li></ul><ul><li>Pathophysiological mechanisms </li></ul><ul><li>Search for treatments </li></ul><ul><li>Pharmacological mechanisms </li></ul>
  3. 3. <ul><li>Normal blood pressure is generally regarded as 120/80 mmHg (systolic pressure/diastolic pressure). </li></ul><ul><li>Hypertension is defined as a diastolic arterial pressure greater than 90 mmHg, or a systolic pressure greater than 140 mmHg. (criteria?) </li></ul><ul><li>The condition can be fatal if left untreated, as it greatly increases the risk of thrombosis, stroke, and renal failure. </li></ul>
  4. 4. <ul><li>Three factors determine blood pressure (BP). These are blood volume, cardiac output, and total peripheral vascular resistance (TPR). </li></ul><ul><li>BP = CO X TPR </li></ul><ul><li>C.O.- Heart, Kidney </li></ul><ul><li>T.P.R.- Vessels, Kidney </li></ul>
  5. 10. <ul><li>‘ Primary ’ or ‘ essential ’ hypertension accounts for 90-95% of all case of hypertension. This has no known cause, but it is associated with: </li></ul><ul><li>●     Age (40+). </li></ul><ul><li>●     Obesity. </li></ul><ul><li>●     Physical inactivity. </li></ul><ul><li>●     Smoking and alcohol consumption </li></ul><ul><li>●     Genetic predisposition </li></ul>(Multiple Genetic Dz)
  6. 11. <ul><li>‘ Secondary hypertension ’ accounts for the remaining 5-10% of cases of hypertension. The cause is usually one of the following: </li></ul><ul><li>●     Renal disease, which activates the RAA (renin-angiotensin-aldosterone) </li></ul><ul><li>●     Endocrine disease, e.g. phaeochromocytoma, epinephrine-secreting tumour of the adrenal medulla (epinephrine). </li></ul>
  7. 12. DM-Hypertension
  8. 15. <ul><li>Treatments of hypertension </li></ul><ul><li>(A) Vasodilators - </li></ul><ul><li>Angiotensin-converting enzyme inhibitors </li></ul><ul><li>(captopril, ramipril ) </li></ul><ul><li>Angitensin-II receptor antagonists </li></ul><ul><li>(losartan) </li></ul>
  9. 16. <ul><li>Calcium antagonists (nifedipine/verapamil) </li></ul><ul><li>Alpha 1 -adrenoceptor antagonists (prazosin) </li></ul><ul><li>K + channel openers (minoxidil) </li></ul><ul><li>Uncertain (hydralazine) </li></ul><ul><li>Nitric oxide (sodium nitroprusside, hypertension crises) </li></ul><ul><li>(B) Beta-adrenoceptor antagonists </li></ul><ul><li>(  -blocker: propranolol,  1-blocker:atenolol) </li></ul><ul><li>(C) Diuretic drugs </li></ul><ul><li>(hydrochlorothiazide, furosemide; </li></ul><ul><li>spironolactone, triamterene) </li></ul><ul><li>(D) Centrally acting agents (Alpha 2 -adrenoceptor agonists : clonidine) </li></ul>
  10. 18.  1 receptoer Prazosin (-) K + Minoxidil (+)
  11. 19. Serotonin Bradykinin
  12. 23. <ul><li>Angitensin-II receptor antagonists </li></ul><ul><li>(losartan) </li></ul>

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