THERAPEUTIC NDICATIONS APPROVED CALCIUM CHANNEL BLOCKERS HYPERTENSION rapamil Diltiazem Nifedipine Felodipine Isradipine Amlodipine Nicardipine ANGINA VerapamilDiltiazem Nifedipine Amlodipine Nicardipine SUPRAVENTRICULAR TACHYARRHYTHMIA apamil Diltiazem SAFE IN MILD-TO MODERATE CHF Felodipine Isradipine Amlodipine SAFE WITH DItiazem Nifedipine Felodipine Isradipine Amlodipine Nicardipine B-BLOCKERS KEY: Drug Drug Approved Indication Use with caution
C. Antihypertensive Drugs Hemodynamic Effects of Long-Term Administration of Antihypertensive Agents HEART CARDIAC TOTAL PERIPHERAL PLASMA PLASMA RENIN RATE OUTPUT RESISTANCE VOLUME ACTIVITY Diuretics Sympatholytic agents Centrally acting Adrenergic neuron blockers a-Adrenergic antagonists B-Adrenergic antagonists No iSat ISA Arteriolar vasodilators ↓← Ca T-channel blockers ACE inhibitors ATRA tISA, intrinsic sympathomimetic activity. ACE, angiotensin converting enzyme. ATRA, angiotensin Il-receplor antagonist.unchanged " Changes are indicated as follows: t, increased; 4, decreased;-t, increased or no change;-+, decreased or no change;
C. Antihypertensive Drugs
C. Antihypertensive Drugs Renin-angiotensin system inhibitors ACEIS: captopril卡托普利 enalapril依那普利 AT1 receptor antagonists: losartan氯沙 Renin inhibitors: enalkiren依那吉仓
Renin-angiotensin system inhibitors ACEIs: captopril 卡托普利, enalapril 依那普利 AT1 receptor antagonists：losartan 氯沙坦 Renin inhibitors: enalkiren 依那吉仑 C. Antihypertensive Drugs
23456789「101121314 AngiotensInogen NH2-Asp-Arg-Val-Tyr-lle-His-Pro-Phe- His-Leu vallle-His-Ser-R (Renin AnglotensIn I NH2-Asp Arg-Val-Tyr-lle-His-ProlPhe His Leu-COQH aAP画 .[des-Asp]Anglotensin NH2-Arg-Val-Tyr-lle- His-Pro-PheaHis-Leu-COOH mACE■画a Angiotensin ll NH2-Aspr Arg-Val-Tyr-lle-His-ProuPhe-COOH (AP 1■■■■■■■■ AngiotensinⅢ NH2-Arg-Val-Tyr-lle-His-Pro-Phe- COOH ■■■■国■画■■国■■■画画■ angiotensin(1-7) Asp-Arg-Val-Tyr-lle-His-Pro-COOH AP)Aminopeptidase Endopeptidases Angiotensin (24.15;241;2426) Converting Enzyme Prolylcarboxypeptidase
A MACULA DENSA (MD) PATHWAY NSAIDS Delivery or/(+)NacI Reabsorption Tubular Reabsorption NacltoMD Macula Densa (Gl2/PGE2 k+) Proximal Tub INTRARENAL BARORECEPTOR PATHWAY RENIN NEGATIVE RELEASE FEEDBACK +)、h Blood Pressure Pre- glomerular Vessels Ang ll Fomation/) B-ADRENERGIC RECEPTOR PATHWAY ARTERIAl Activation of Activation +) BLOOD Sympathet 阝1 Adrenergic of AT1R) PRESSURE Tone Receptors on JGCs LONG LOOP NEGATMVE FEEDBACK Major pathways modulating renin release Macula densa Cell Juxtaglomerular Cell Ad ATP (+) (+)lnw=ADO y COX-2 Expression upregulated by