Beruflich Dokumente
Kultur Dokumente
Antihypertensives
Chris Hague, PhD
chague@u.washington.edu
References
http://www.americanheart.org/presenter.jhtml
?identifier=2152
http://www.nhlbi.nih.gov/health/dci/Diseases/
Hbp/HBP_WhatIs.html
Outline
1. Hypertension definitions
2. Diuretics
5. Sympatholytics
7. Direct vasodilators
Hypertension Stats
~1 in 3 adults have high BP in
USA
no symptoms!
Diagnosis
Hypertension: an elevation of arterial blood
pressure above an arbitrarily defined normal value
Causes of Hypertension
90-95%, cause unknown
secondary hypertension
kidney abnormalities
narrowing of arteries
Treatment goals
Short term goal
reduce blood pressure
Long term goal
•reduce mortality due to hypertension-induced
disease
•stroke
•retinopathy
Ways of lowering BP
Reduce cardiac output
Beta blockers
Ca2+ channel antagonists
Reduce plasma volume
Diuretics
Reduce Total Peripheral
Resistance
vasodilators
alpha1-adrenergic receptor
antagonists
ACE inhibitors MAP = CO X TPR
Summary of Drug Targets
Antihypertensive and Lipid-Lowering Treatment
to Prevent Heart Attack Trial (ALLHAT)
42,418 participants
Findings: Chlorthalidone is superior to an ACE inhibitor, a calcium
channel blocker and an alpha1-adrenergic antagonist in preventing one or
more CVD events.
http://www.nhlbi.nih.gov/health/allhat/index.htm
Thiazide Diuretics
mechanism of action
adjunct agent
cheap!
Drugs interacting with Renin-Angiotensin system
Losartan (Cozaar)
competitive antagonist
Valsartan (Diovan)
non-competitive
Candesartan (Atacand)
non-competitive
Irbesartan (Aprovel) Losartan
non-competitive
Therapeutic Uses
same uses as ACE inhibitors
no bradykinin effects
no cough
Mixed antagonism
inhibit vasoconstriction
Bretylium, Guanethidine
Reserpine