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O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N Z ` 枛葺洙33PP` 13` 33洙33` Q_{熓览懐礻` 333f膒KN膩v稩` 枛j@v郓峥澄腑H>?" dd@,?n<d@ `7 `2@`7``2 n?" dd@   @@``PR    @ ` ` p>> | 餿 0 (  0鹇 0 <" 餒"0C 疒 0 餞Md" 餒"0C 鹇 0 <M"U_ 餒"0C 疒 0 餞Md">& 餒"0C 鹪 0 餘M"P 餒"0C 鹇 0 < M"p 餒"0C 瘙 0 C 饃*M?d?"bUv 餒"0C 痄 0 <2M #" `  M 餖US鸔dkY憦蚹Hrh槝7h_    0 05M "  M 饎8US鸔dkY憦蚹Hr噀,g7h_ ,{孨 ,{ N ,{踁 ,{擭  痨 0 6:M "]} M 餪*0痤 0 6M "] }  M 餬*0痤 0 6癙M "]T} M 餬*0養 0 s *師藿h ? 33洙3380___PPT10.(谐%  Blends   * " 4鹄 (  4鹞餞 + 4 "+餬餬 P@ 4# "Dwo餳 4 s *"PP饊 4 養d" P@餬餬 P 0  4# "Ny餳 4 s *"P  饊 4 養d"P 0 饅 4 <" a*餳 4 s *"黏 4  餱?d?"+)痍 4 養l`M ?#" ` p M 餖US鸔dkY憦蚹Hrh槝7h_  鹪 4 0糲M " `   M 餘US鸔dkY憦蚹HroRh槝7h_ 痧 4 6竑M "`p  M 餯* 0痱 4 6`rM "`p  M 餱*"0痱 4 6}M "` M 餱*"0養 4 s *師藿h ? 33洙3380___PPT10.(谐%* 饞 *(  饃  c $历 4 p  餽  S p罨 4 `    餒  0師藿h ? 秽33櫃櫶80___PPT10.竻0(0  饦0 0(  饃  c $;p 0  p 饃  c $&p 0  p 餒  0師藿h ? 秽33櫃櫶80___PPT10.箙皔 $饜(  $餢 $ 0A?wv餚 $ s *師藿h ?"` 秽33櫃櫶80___PPT10.騾嘀mg0  饦@0(  饃  c $7p 0  p 饃  c $訡p 0  p 餒  0師藿h ? 秽33櫃櫶80___PPT10.箙0莧M0  饦P0(  饃  c $業p 0  p 饃  c $lJp 0  p 餒  0師藿h ? 秽33櫃櫶80___PPT10.箙 G0  饦`0(  饃  c $hPp 0  p 饃  c $,Sp 0  p 餒  0師藿h ? 秽33櫃櫶80___PPT10.粎搓  饜(  餢  0A?,',餚  s *師藿h ?"` 秽33櫃櫶80___PPT10.騾腊380  饦p0(  饃  c $爨 0   饃  c $慊 0   餒  0師藿h ? 秽33櫃櫶80___PPT10.絽p伣S ,饜(  ,餢 , 0A?9餚 , s *師藿h ?"` 秽33櫃櫶80___PPT10.髤狅r87'i)A-y/15+3 u7? a9  ( 蟒鄥燆鵒h珣+'迟0郆 hp   Anti hypertensive Drugs iweiBlendspwei24Microsoft PowerPointgs @饠@#吳@瘃茥靻}G腁g     -- @ !--'33-- @ !40--'-55-- @ !4I--::-- @ !4J--@@-- @ !4K--GG-- @ !4L--MM-- @ !4M--UU-- @ !4N--\\-- @ !4O--dd-- @ !4P--ll-- @ !4Q--tt-- @ !4R--}}-- @ !4S--厖-- @ !4T--帋-- @ !4U--棗-- @ !4V--牋-- @ !4W--è-- @ !4X--鞍-- @ !4Y--父-- @ !4Z--靠-- @ !4[--破-- @ !4\--屯-- @ !4]--佑-- @ !4^--谮-- @ !4_--哌-- @ !4`--沣-- @ !4a--梃-- @ !4b--祆-- @ !4c--镲-- @ !4d--蝌-- @ !4e--貂-- @ !4f---- @ !4g---- @ !4h---- @ !4i---- @ !4j---- @ !4k---'-- @ !4.D---'--- @ !4DU---- @ !4DV--%-- @ !4DW--0-- @ !4DX--8-- @ !4DY--褹-- @ !4DZ--覫-- @ !4D[--訯-- @ !4D\--語-- @ !4D]--謆-- @ !4D^--譲-- @ !4D_--豷-- @ !4D`--趞-- @ !4Da--蹌-- @ !4Db--輰-- @ !4Dc--邤-- @ !4Dd--釡-- @ !4De--悭-- @ !4Df--瀣-- @ !4Dg--绱-- @ !4Dh--榛-- @ !4Di--肓-- @ !4Dj--烊-- @ !4Dk--钗-- @ !4Dl--鹪-- @ !4Dm--蛸-- @ !4Dn--艮-- @ !4Do--蹉-- @ !4Dp--麋-- @ !4Dq---- @ !4Dr---- @ !4Ds---- @ !4Dt---- @ !4Du---- @ !4Dv---- @ !4Dw---- @ !4Dx---- @ !4Dy---- @ !4Dz---- @ !4D{---- @ !4D|---'A .=<( 汉北Ё湝憫唵{{ppddYYNNCC88,,破浇吵煙敂墘~~ssgg\\QQFF:://行热靠抖ⅱ枛寣亖vvjj__TTHH==儋乙适亮父い櫃帋剟xxmmaaVVKK後圹栽烫妹梃沣苘照挝铑殚滗揶鬃篌镲觋骀噜鼢趑痧祆珑貂耨眄种蝌鲻_\`abMNOPQ/01230\W]X^HIJKL !"#$WRXYZCDE[GRSTUV>?@AB@MNOPQ/012345678HIJKL !"#$%&'()CDEFG>?@AB /0123456789:;<= !"#$%&'()*+,-.? ?'-- @ !s E--'--- @ !d"---- @ !d%-- -- @ !d+--"""-- @ !d0--$$$-- @ !d6--&&&-- @ !d=--(((-- @ !dB--***-- @ !dH--,,,-- @ !dM--...-- @ !dT--000-- @ !d\--222-- @ !d`--444-- @ !dh--666-- @ !dn--888-- @ !ds--:::-- @ !dz--<<<-- @ !d-->>>-- @ !d--@@@-- @ !d--BBB-- @ !d--DDD-- @ !d--FFF-- @ !d--HHH-- @ !d--JJJ-- @ !d--LLL-- @ !d--NNN-- @ !d--PPP-- @ !d--RRR-- @ !d--TTT-- @ !d--VVV-- @ !d--XXX-- @ !d--ZZZ-- @ !d--\\\-- @ !d--^^^-- @ !d--```-- @ !d--bbb-- @ !d--ddd-- @ !d--fff-- @ !d--hhh-- @ !d--jjj-- @ !d --lll-- @ !d--nnn-- @ !d--ppp-- @ !d--rrr-- @ !d!--ttt-- @ !d(--vvv-- @ !d---xxx-- @ !d3--zzz-- @ !d:--|||-- @ !d>--~~~-- @ !dE---- @ !dI--倐-- @ !dP--剟-- @ !dT--唵-- @ !d\--垐-- @ !d`--妸-- @ !dg--寣-- @ !dl--帋-- @ !dr--悙-- @ !dw--拻-- @ !d}--敂-- @ !d--枛-- @ !d--槝-- @ !d--殮-- @ !d--湝-- @ !d--灋-- @ !d--牋-- @ !d--ⅱ-- @ !d--い-- @ !d--Ζ-- @ !d--è-- @ !d---- @ !d---- @ !d---- @ !d--鞍-- @ !d--膊-- @ !d--创-- @ !d--抖-- @ !d--父-- @ !d--汉-- @ !d--技-- @ !d--揪-- @ !d--览-- @ !d--侣-- @ !d--哪-- @ !d--破-- @ !d$--热-- @ !d,--适-- @ !d3--烫-- @ !d;--挝-- @ !dB--行-- @ !dJ--乙-- @ ! dQ--栽-- @ !d\--种-- @ !dd--刎-- @ ! dk--谮-- @ !dv--苘-- @ ! d~--揶-- @ ! d--噜-- @ ! d--忖-- @ !d--滗-- @ !d--骀-- @ ! d--梃-- @ ! d--觋-- @ !d--祆-- @ !d--铑-- @ !d--痧-- @ !d--蝌-- @ !d--趑-- @ !d--鲻-- @ !d0---- @ !dF---- @ !!d`---- @ !)d---- @ !.d---'@Tahoma-. 33+2 EvAnti hypertensive Drugs %"""  " )""."System桤- DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饒饦D>  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions#Thiazide diuretics, such as hydrochlorothiazide [hye droe klor oh THYE a zide], lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellu- lar volume, resulting in a decrease in cardiac output and renal blood flow (Figure 19.6). With long-term treatment, plasma vol- ume approaches a normal value, but peripheral resistance decreases. Spironolactone [spye row no LAK tone], a potassium- sparing diuretic, is often used with thiazides. (A complete discus- sion of diuretics is found on p. 223.) $Z$) g xAE #$  饘 <$(  <餽 < S  0   餽 < S X  0   餒 < 0師藿h ? 33洙3380___PPT10.魠朽褚$  饘0@$(  @餽 @ S 三F 0  F 餽 @ S H浡 0   餒 @ 0師藿h ? 33洙3380___PPT10.鯀p $  饘@D$(  D餽 D S E 0   餽 D S 菻 0   餒 D 0師藿h ? 33洙3380___PPT10.鯀慄繷r G0oZ沑荿 ? 鐵骮( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饒饦D>  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppX Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).    !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<>?@ABCDEFGHIJKLMNOPQRSTUVWXY[\]^_`abcdefghijklmnopqrstuvwxyz{}~|^RRoot Entry崄d汷嗞)喱藯靻PicturesZCurrent User )SummaryInformation(ZCPowerPoint Document(=PuDocumentSummaryInformation8d/ 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` x餻饊85   ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N r9? 9谾 [( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 胀諟.摋+,04     在屏幕上显示31jdPuH A %Arial宋体Tahoma WingdingsBlendsAnti hypertensive Drugs OVERVIEW 幻灯片 3 幻灯片 4ETIOLOGY OF HYPERTENSION +MECHANISMS FOR CONTROLLING BLOOD PRESSURE 幻灯片 7TREATMENT STRATEGIES 幻灯片 9 DIURETICS Thiazide diuretics 幻灯片 12ActionsTherapeutic usesPharmacokineticsAdverse effects_缿,uweiwei#beta-ADRENOCEPTOR BLOCKING AGENTS Actions 幻灯片 19Therapeutic uses Therapeutic usesAdverse effectsACE INHIBITORS Actions:Therapeutic uses CALCIUM CHANNEL BLOCKERS Actions Therapeutic uses#CENT jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 886x kA$  饘@D$(  D餽 D S E 0   餽 D S 菻 0   餒 D 0師藿h ? 33洙3380___PPT10.鯀慄繷r7a靣 ? au( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饜馉HA  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppiAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic usesGin both the supine and standing positions; postural hypotension is rarely observed, except in elderly, volume-depleted patients. These agents counteract the sodium and water retention observed with other agents used in the treatment of hypertension useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. Thiazide diuretics are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionHPHHQ {H$  饘PH$(  H餽 H S 0柕 0   餽 H S x櫟 0   餒 H 0師藿h ? 33洙3380___PPT10.鯀悳+rTu" ? 0uN( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饜馉HA  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppDAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic uses4in both the supine and standing positions; postural hypotension is rarely observed, except in elderly, volume-depleted patients. These agents counteract the sodium and water retention observed with other agents used in the treatment of hypertension useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney function5P56tmH$  饘PH$(  H餽 H S 0柕 0   餽 H S x櫟 0   餒 H 0師藿h ? 33洙3380___PPT10.鯀悳+r妼3 ? f_( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饜馉HA  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppDAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic uses4in both the supine and standing positions; postural hypotension is rarely observed, except in elderly, volume-depleted patients. These agents counteract the sodium and water retention observed with other agents used in the treatment of hypertension useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney function5P56tmHr洠 ? wD( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饜馉HA  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ6JH$  饘PH$(  H餽 H S 0柕 0   餽 H S x櫟 0   餒 H 0師藿h ? 33洙3380___PPT10.鯀悳+rx| ? Tㄎ( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 鸢鹄XM  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppHAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ$?H PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44H  "beta-ADRENOCEPTOR BLOCKING AGENTS "beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. H4  $  饘`L$(  L餽 L S 4鹊 0   餽 L S 銵 0   餒 L 0師藿h ? 33洙3380___PPT10.鷧鳮$  饘pP$(  P餽 P S 愲 0   餽 P S L⒌ 0   餒 P 0師藿h ? 33洙3380___PPT10.麉嚅5`$  饘T$(  T餽 T S 斬M 0  M 餽 T S 苒M 0  M 餒 T 0師藿h ? 33洙3380___PPT10.鼌纼i$  饘X$(  X餽 X S * 0   餽 X S - 0   餒 X 0師藿h ? 33洙3380___PPT10.鼌r湮@遍蓦 5? 牢a( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 鸢鹄XM  ?饎b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁U 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppHAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS  Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. 0P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88$x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ$?H PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44H  "beta-ADRENOCEPTOR BLOCKING AGENTS "beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. H4  r? 咈v ( / 0      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQaSTUVWXYZ[\]^_bcdefghijklmnopqrstuvwxyz{|}~JFIF``C   $.' 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",#(7),01444'9=82<.342C 2!!22222222222222222222222222222222222222222222222222" }!1AQa"q2亼#B绷R佯$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz儎厗噲墛挀敃枟槞0DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 痄鹑\O  O鸢b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppLAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. 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O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4   痨`饇(  `餌 ` C A2餚 ` s *師藿h ?"` 33洙3380___PPT10.迒0#蓚rw)藽? S)XEj ( / 00DAria      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]_`abcdefghijklmnopqrstuvwxy{|}~lngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 80痂lZ   _疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppmAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, $CAdverse effects_Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. Patients should be tapered off of I-blocker therapy in order to avoid precipitation of arrhythmias.The I-blockers should be avoided in treating patients with asthma, congestive heart failure, and peripheral vascular disease. ``6lZ|$  饘d$(  d餽 d S t 0  t 餽 d S $t 0  t 餒 d 0師藿h ? 33洙3380___PPT10.迒r尞$  饘h$(  h餽 h S  $t 0  t 餽 h S l,t 0  t 餒 h 0師藿h ? 33洙3380___PPT10.邌訮$  饘l$(  l餽 l S T媡 0  t 餽 l S t 0  t 餒 l 0師藿h ? 33洙3380___PPT10.鄦牞7r擡0f2h^j? pE妉G( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 80痂lZ   _疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppJAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, $CAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. |$  饘l$(  l餽 l S T媡 0  t 餽 l S t 0  t 餒 l 0師藿h ? 33洙3380___PPT10.鄦牞7r蝜? 猯I\!( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` @8痧p]   !_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppWAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, $CAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. |ACE INHIBITORS "Actions: The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility. These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II v@J  ' $  饘p$(  p餽 p S (KS 0  S 餽 p S FS 0  S 餒 p 0師藿h ? 33洙3380___PPT10.鄦p俅r厧榀? a!( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` H餈瘌t`   !"_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, $CAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. |ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin IIH  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.$[3$  饘p$(  p餽 p S (KS 0  S 餽 p S FS 0  S 餒 p 0師藿h ? 33洙3380___PPT10.鄦p俅$  饘 t$(  t餽 t S 萢S 0  S 餽 t S 瑅t 0  t 餒 t 0師藿h ? 33洙3380___PPT10.釂 Tb\rQ B? -n#( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` P餒xc   !"#_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses  Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combina- tion with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z Zrl$  饘0x$(  x餽 x S 濑 0   餽 x S  0   餒 x 0師藿h ? 33洙3380___PPT10.鎲鄏-rⅫ? 娯牺#( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 RALLY-ACTING ADRENERGIC DRUGS actions 幻灯片 31test  已用的字体演示文稿设计模板 幻灯片标题 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` P餒xc   !"#_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 ppAnti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z $~ $  饘0x$(  x餽 x S 濑 0   餽 x S  0   餒 x 0師藿h ? 33洙3380___PPT10.鎲鄏-r "? 纩$'( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` h餪"l   !"#$%&_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp!Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. 6 M~$  饘@|$(  |餽 | S 5 0  5 餽 | S P5 0  5 餒 | 0師藿h ? 33洙3380___PPT10.鎲賘$  饘P$(  餽  S 滝5 0  5 餽  S p5 0  5 餒  0師藿h ? 33洙3380___PPT10.鑶餢s$  饘`$(  餽  S L 0   餽  S 碐 0   餒  0師藿h ? 33洙3380___PPT10.鑶P:2r-%0M?OkQ?  %桽 ,( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饃0%u!   !"#$%&'()_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp%Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actions Odiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$  饘p$(  餽  S P 0   餽  S  0   餒  0師藿h ? 33洙3380___PPT10.閱p|-$  饘$(  餽  S % 0   餽  S ( 0   餒  0師藿h ? 33洙3380___PPT10.閱蠮姚$  饘$(  餽  S 淛 0   餽  S `d5 0  5 餒  0師藿h ? 33洙3380___PPT10.閱p1r跾!0A? 稴m#,( / 00DArialngs埞埞-鸱0z[ 0D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 00DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饊8&x"   !"#$%&'()*_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp&Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actionsOdiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$testMWhy are Levodopa (L-dopa) and carbidopa applied cooperately to treat PD? (6) P  $  饘$(  餽  S 4 0   餽  S  ~ 0   餒  0師藿h ? 33洙3380___PPT10.陠`崄.r眴$⒊? 崋蔚$n.( / 00DArialngs埞埞-鸱0z[ 0"D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 0"0DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饊8&x"   !"#$%&'()*_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp!(Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actionsOdiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$testWhy are Levodopa (L-dopa) and carbidopa applied cooperately to treat PD? (6) What is mode of action of benzodiazepines? (4) According to opioid s action? Why was it thought to be a  catholicon at 19 s century? (6)ZZ  NE$  饘$(  餽  S 4 0   餽  S  ~ 0   餒  0師藿h ? 33洙3380___PPT10.陠`崄.r $? 娴$.( / 00DArialngs埞埞-鸱0z[ 0"D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 0"0DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饊8&x"   !"#$%&'()*_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp3(Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actionsOdiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$testWhy are Levodopa (L-dopa) and carbidopa applied cooperately to treat PD? (6) What is mode of action of benzodiazepines? (4) According to opioid s action? Why was it thought to be a  catholicon at 19 s century? (6)Zl  N1$  饘$(  餽  S 4 0   餽  S  ~ 0   餒  0師藿h ? 33洙3380___PPT10.陠`崄.r桄$p? 逆$.( / 00DArialngs埞埞-鸱0z[ 0"D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 0"0DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饊8&x"   !"#$%&'()*_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp3(Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  '  Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actionsOdiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$testWhy are Levodopa (L-dopa) and carbidopa applied cooperately to treat PD? (6) What is mode of action of benzodiazepines? (4) According to opioid s action? Why was it thought to be a  catholicon at 19 s century? (6)Zl  N1r? `F$.( / 00DArialngs埞埞-鸱0z[ 0"D媅SOalngs埞埞-鸱0z[ 0 DTahomags埞埞-鸱0z[ 0"0DWingdings埞埞-鸱0z[ 0 A .  @n?" dd@  @@`` 饊8&x"   !"#$%&'()*_疖b$;鏋"戂謕覦玩0 2$皼む绑$i,c┹n 2$*[,<耙3@*?戁UR$蜩麷葷HfB樼鮉榟本鎦R$魽7(86 腏eh"8 0咥臕@8  3簱蚌蕷;斍蕷;g4[d[d z[ 0揀ppp@ <4ddddL 0埞- 80___PPT10 pp3(Anti hypertensive Drugs   OVERVIEW Hypertension is defined as a sustained diastolic blood pressure greater than 90 mm Hg accompanied by an elevated systolic blood pressure (>140 mm Hg).   jcan lead to congestive heart failure, myocardial infarction, renal damage, and cerebrovascular accidents. O ETIOLOGY OF HYPERTENSION (more than 90% of patients have essential hypertension, a disorder of unknown origin affecting the blood pressure-regulating mechanism. Inheritance factors Environmental factors such as a stressful lifestyle, high dietary intake of sodium, obesity, *MECHANISMS FOR CONTROLLING BLOOD PRESSURE +) (In both normal and hypertensive individuals, cardiac output and peripheral resistance are controlled mainly by two overlapping control mechanisms: the baroreflexes mediated by the sym- pathetic nervous system, and the renin-angiotensin-aldosterone system, 7 TREATMENT STRATEGIES iMild hypertension can often be controlled with a single drug. More severe hypertension may require treatment with several drugs that are selected to minimize adverse effects of the combined regimen. Treatment is initiated with any of four drugs depending on the individual patient: a diuretic, a beta-blocker, an ACE inhibitor, or a calcium channel blocker. TjZ1 7 N   DIURETICS Diuretics are currently recommended as the first-line drug therapy for hypertension. Low-dose diuretic therapy is safe and effective in preventing stroke, myocardial infarction, congestive heart failure and total mortality.  Thiazide diuretics  ~All oral diuretic drugs are effective in the treatment of hypertension, but the thiazides have found the most widespread use. .P     %   Actions7hydrochlorothiazide lower blood pressure, initially by increasing sodium and water excretion. This causes a decrease in extracellular volume, resulting in a decrease in cardiac output and renal blood flow. With long-term treatment, plasma volume approaches a normal value, but peripheral resistance decreases. 88x  Therapeutic usesin both the supine and standing positions; postural hypotension is rarely observed. useful in combination therapy with a variety of other antihypertensive agents including beta-blockers and ACE inhibitors. are particularly useful in the treatment of black or elderly patients, and in those with chronic renal disease. Thiazide diuretics are not effective in patients with inadequate kidney functionZ?I PharmacokineticsThiazide diuretics can be administered orally. They induce considerable disturbances in electrolyte balance. For example, blood levels of K + and Mg ++ are reduced, and Ca ++ is retained by the body HAdverse effects3induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 44>  "beta-ADRENOCEPTOR BLOCKING AGENTS beta-Blockers and/or diuretics are currently recommended as first-line drug therapy for hypertension. These drugs are efficacious but have some contraindications. Actions The beta-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic outflow from the CNS and inhibit the release of renin from the kidneys, thus decreasing the formation of angiotensin II and secretion of aldosterone. >4  Therapeutic uses Subsets of the hypertensive population: The beta-blockers are more effective for treating hypertension in white than in black patients, and in young patients compared to the elderly. Conditions that discourage the use of beta-blockers (for example, severe chronic obstructive lung disease, chronic congestive heart failure, severe symptomatic occlusive peripheral vascular disease) are more commonly found in the elderly and in diabetics.] ZTherapeutic usesHypertensive patients with concomitant diseases: The beta-blockers are useful in treating conditions that may coexist with hypertension, such as supraventricular tachyarrhythmia, previous myocardial infarction, angina pectoris, DAdverse effects|Drug withdrawal: Abrupt withdrawal may cause rebound hypertension, probably as a result of up-regulation of beta-receptors. ACE INHIBITORS These drugs block the angiotensin converting enzyme that cleaves angiotensin I to form the potent vasoconstrictor, angiotensin II>  ' Actions:The ACE inhibitors lower blood pressure by reducing peripheral vascular resistance without reflexly increasing cardiac output, rate, or contractility.[4Therapeutic uses Like beta-blockers, ACE inhibitors are most effective in hypertensive patients who are white and young. However, when used in combination with a diuretic, the effectiveness of ACE inhibitors is similar in white and black hypertensive patients. Unlike beta-blockers, ACE inhibitors are effective in the management of patients with chronic congestive heart failure. ACE inhibitors are now a standard in the care of a patient following a myocardial infarction. Therapy is started 24 hours after the end of the infarction.  Z CALCIUM CHANNEL BLOCKERS ;Diphenylalkylamines: Benzothiazepines: Dihydropyridines: @Actions Calcium channel antagonists block the inward movement of calcium by binding to L-type calcium channels in the heart and in smooth-muscle of the coronary and peripheral vasculature. This causes vascular smooth muscle to relax, dilating mainly arterioles. &"   Therapeutic useshave an intrinsic natriuretic effect; therefore, they do not usually require the addition of a diuretic. are useful in the treatment of hypertensive patients who also have asthma, diabetes, angina, and/or peripheral vascular disease. $ !"CENTRALLY-ACTING ADRENERGIC DRUGS " Clonidine  "actionsOdiminishes central adrenergic outflow. Clonidine is used primarily for the treatment of mild to moderate hypertension that has not responded adequately to treatment with diuretics alone. does not decrease renal blood flow or glomerular filtration and therefore is useful in the treatment of hypertension complicated by renal disease. PP6'  c#  Clonidine is absorbed well after oral administration and is excreted by the kidney. Because it causes sodium and water retention, clonidine is usually administered in combination with a diuretic. Z6 z 9$testWhy are Levodopa (L-dopa) and carbidopa applied cooperately to treat PD? (6) What is mode of action of benzodiazepines? (4) According to opioid s action? Why was it thought to be a  catholicon at 19 s century? (6)Zl  N1r擣? pFu$Root Entry崄d汷嗞)@晤{D登PicturesZCurrent User 8SummaryInformation(ZC ^      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]_`abcdefghijklmnopqrstuvwxy{|}~|"R OD PRESSURE 幻灯片 7TREATMENT STRATEGIES 幻灯片 9 DIURETICS Thiazide diuretics 幻灯片 12ActionsTherapeutic usesPharmacokineticsAdverse effects _缿,u微软用户甠o(u7b#beta-ADRENOCEPTOR BLOCKING AGENTS Actions 幻灯片 19Therapeutic uses Therapeutic usesAdverse effectsACE INHIBITORS Actions:Therapeutic uses CALCIUM CHANNEL BLOCKERS Actions Therapeutic uses#CENT