Chapter 8: Antihypertensive Drugs Prof.R.D.Ye 2012-10-08
Chapter 8: Antihypertensive Drugs Prof. R.D. Ye 2012-10-08
Definition: Systolic BP≥140mmHg or Diastolic BP≥90mmHg Diagnosis is based on multiple (>3)measurements,on different days For patients having diabetes or chronic kidney disease(high-risk group), diagnosis of hypertension is made with BP>130/80 mmHg
Definition: Systolic BP 140 mm Hg or Diastolic BP 90 mm Hg • Diagnosis is based on multiple ( 3) measurements, on different days • For patients having diabetes or chronic kidney disease (high-risk group), diagnosis of hypertension is made with BP 130/80 mmHg
Classification and management of BP for adults Category Systolic Diastolic Lifestyle Initial drug modification therapy Normal <120 and <80 Encourage Not needed No,or treat Pre-hypertension 120-139 or 80-89 Yes Compelling indications Stage 1 hypertension 140-159 or 90-99 Yes Diuretic,ACEI,ARB,B-blocker,CCB, Combination;compelling indications Stage 2 hypertension ≥160 or ≥100 Yes Two-drug combo(diuretic and ACEl, or ARB or B-blocker or CCB; Also treat compelling indications Based on 7th Report of the Joint National Committee on Detection,Evaluation,and Treatment of High BP(JNC 7) Diuretic here means thiazide-type;ACEI,ACE inhibitor;ARB,angiotensin receptor blocker;B-blocker,B-adrenergic receptor blocker;CCB,calcium channel blocker
Normal Pre-hypertension Stage 1 hypertension Stage 2 hypertension Category Systolic Diastolic < 120 120-139 140-159 160 and or or or < 80 80-89 90-99 100 Classification and management of BP for adults Based on 7th Report of the Joint National Committee on Detection, Evaluation, and Treatment of High BP (JNC 7) Lifestyle modification Encourage Yes Yes Yes Initial drug therapy Not needed No, or treat Compelling indications Diuretic, ACEI, ARB, -blocker, CCB, Combination; + compelling indications Two-drug combo (diuretic and ACEI, or ARB or -blocker or CCB; Also treat compelling indications Diuretic here means thiazide-type; ACEI, ACE inhibitor; ARB, angiotensin receptor blocker; -blocker, -adrenergic receptor blocker; CCB, calcium channel blocker
BP=CO x PVR CNS/sympathetic nerves Baroreceptor reflex arc Heart rate Aortic arch contractility carotid sinuses B1-AR Arterial Cardiac a1-AR Peripheral Blood output resistance 度 Pressure Stroke Baroreceptors Na/Ca2+ volume exchange Renin- angiotensin- Venules aldosterone Sodium/ capacitance volume
Peripheral resistance Baroreceptor reflex arc Sodium/ volume Venules capacitance Stroke volume Heart rate contractility Na+/Ca2+ exchange Reninangiotensinaldosterone Cardiac output Arterial Blood Pressure CNS / sympathetic nerves BP = CO PVR Aortic arch carotid sinuses 1-AR 1-AR Baroreceptors
BP=COx PVR and MAP=CO x TPR CO=cardiac output MAP=mean arterial pressure =(SBP-DBP)/3+DBP SBP systolic blood pressure DBP diastolic blood pressure TPR total peripheral resistance
BP = CO PVR MAP = CO TPR and CO = cardiac output MAP = mean arterial pressure = (SBP – DBP) / 3 + DBP SBP = systolic blood pressure DBP = diastolic blood pressure TPR = total peripheral resistance