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Antihypertensivedrugshypertension◼Meanarterialbloodpressureishigherthanthenormalrange,inthecaseofnottakingbloodpressuredrugs：Systolicbloodpre

ssure≥18.7kPa(140mmHg)and（or）Diastolicbloodpressure≥12.0kPa(90mmHg)Dividedintoprimaryhypertension（90%~95%）And

secondaryhypertensioncomplications◼Heartfailure◼Coronaryheartdisease(CHD)◼Cerebrovascularaccident◼Renalfai

lureAntihypertensivedrugsReasonableapplicationofantihypertensivedrugsControlofbloodpressureDelaythefor

mationanddevelopmentofatherosclerosisReducethecomplicationssuchasbrain,heartandkidneyReducethemortalityrate,prolong

lifeBloodpressure-Thefactorsinfluencingbloodpressure：◼Cardiacoutput:heartrate,myocardialcontractionforce,changeofbloodvolume,etc.;◼Peripheralresi

stance:thelengthofthebloodvesselsandbloodviscosity,bloodvessels,radius,etc.-Nerve-fluidsystemonbloodpressureregulation。maincentreganglionVasculars

moothmuscleclonidine-methyldopaEplerenonemecamylamineReserpineguanethidinepropranolol1prazosin1labetalolhydralazine

sodiumnitroprussidenifedipineminoxidil1.Nervousregulation:thesympatheticnervoussystemPeripheralneurotransmitterreleaseThepostsynapticmembranerecepto

rSecond,humoralregulation:renin–angiotensinaldosteronesystemKidneyadjacentballBesidethemachine-RblockersreninAngiotensinoriginalang

iotensinⅠinvertaseACEIangiotensinⅡSmallarterycontractionlosartanAldosteronesecretionWatersodiumretentiondiuretic

(thiazides)Classification◼Diuretic◼Thesympatheticnervousdepressants◼(1)centralbloodpressuremedication◼(2)thegan

glionblock◼(3)noradrenalinecannerveendingsblock◼(4)theadrenalinereceptorblockers◼Affecttherenin-angiotensinsystemme

dicineAgleamofantihypertensives:diuretic,calciumantagonistmedicine,betareceptorblockersandACEIDiuretic◼Onthebasisof(aline)bloodpressuremedication◼

Effectinthethiazidediureticismostcommonlyused,antihypertensiveeffectismild,persistent,long-termapplicationofnosignificantresistance◼Features:

◼Antihypertensiveeffectisweak,byanaverageof10%◼2~3weeksafterthemajorityofpatientsinmedicalwork◼Canbeusedforvari

oushighbloodpressure(basicbloodpressuremedication)◼Mild-alone,mediumandsevere-share◼Canmaketheelderl

yhypertensionpatientscomplicatedwithstroke,theincidenceofleftheartfailureandmortalityisleftHydrochlorothiazide◼Earlyantihypertensivemechanis

m◼Withsodiumdiuresis,reducetheextracellularfluidandbloodvolume◼Long-termantihypertensivemechanism◼Diureticrowsodiu

mtoNa+leftaorticsmoothmusclecell,cellNa+/Ca2+exchangeleft->intracellularCa2+left,reducevascularsmoothmuscleofno

repinephrine(NE)reactivitydisadvantages:-↓BloodK+、Na+、Mg2+-↑Bloodtotalcholesterol,triglyceride,lowdensitylipoproteincholestero

l(hdl-c)-↑Blooduricacid-↑Bloodrenin-↓Glucosetolerance(disabled)fordiabetespatientsEffectivediuretic(furosem

ide)usedinhypertensivecrisisandpoorassociatedwithchronicrenalhypertensionpatients.◼Hypertensivecrisis◼Patientswithhighbloodp

ressureintheshortterm,thebloodpressureincreasedsignificantly,andappearhaveaheadache,beagitated,palpitation,sweating,nausea,vomiting,

orpaleflush,blurredvisionandothersigns.◼Mechanism:hyperthyroidismandcirculatingcatecholaminesincreasedsympatheticnerv

ousactivityClinicalapplication◼Agleamofmedication◼Applicationofthetreatmentformildhypertensionseparately◼Withotherantihypert

ensivedrugtreatment,severehypertensionEffectofdiuresismedicineofcompoundpreparationswithotherdrugs◼Compoundantihypertensiontablet:give

upping,hydralazine,hydrochlorothiazide◼Compoundapocynumtablet:guanidineborganism,hydralazine,hydrochlorothiazide◼Janechrysanthemuma

ntihypertensiontablet:clonidine,hydrochlorothiazide◼Compoundcaptopriltablets,enalaprilandhydrochlorothiazide◼Constantdroppingpills:clonidine,hydr

alazine,hydrochlorothiazideCalciumantagonistmedicineBlockLvoltagedependentcalciumchannel->leftintracellularCa2+diastolicsmal

larteryNifedipinegroup,horizon,lacidipineflat,amlodipineNifedipine【Step-downcharacteristics】1Buckdegreewaspositivelycorrelatedwiththeoriginalhighb

loodpressure,withnormalbloodpressurehasnoobviousantihypertensiveeffect；2Oralabsorptionisgood,workfast:sublingu

aladministering1-5minuteswork-inthetreatmentofvariantanginapectoris,hypertensivecrisis.Oral30to60minuteswork-treatmentofmildandmoderatehypert

ension；3Cancausereflectiveheartrate↑—shareReceptorblockers.Clinicalapplication◼Light,mediumandseverehy

pertensiontreatmentNitrendipine◼SelectivelyACTSontheperipheralvascular,blockingitsinternalflowofcalciumions,relax

ingsmoothmuscle,thedilatebloodvesselsandstep-down◼Warmandlastingantihypertensiveeffect,applicabletovarioustype

sofhighbloodpressureLacidipine◼Isapotentcalciumantagonists,significantlyandtheeffectofselectivecalciumionchannelsinva

scularsmoothmuscle.Itsmainroleistoexpandperipheralartery,reduceperipheralvascularresistanceandtolowerbloodpres

sure◼Resistancetoatherosclerosis◼Usedformildandmoderatehypertension◼Nameofcommodity:lacidipine◼Amlodipine◼More

gentle,smootheffectlasting,convenienceofonce-dailydosage,24hoursofstabilitycontrolofhighbloodpressureandanginapectoris,g

oodsafetyandtolerability◼Similardrugs,onlyitcanbeusedbypatientswithcongestiveheartfailuresafety◼Alsoh

astheroleofatherosclerosisAdrenalinereceptorblockers◼α１Receptorblockers：prazosin、terazosin、doxazosin◼βRecepto

rblockers：prapranolol、atenolol、labetalol、carbedilolMechanismofaction◼Nonselectivebetareceptorblockers,mostlyrelatedwiththebetablocker:◼Heart:my

ocardialcontractionforceisabate,slowheartrate,cardiacoutputdecreases◼Kidney:reducereninsecretion,inhibitRASonbloodpressureregulation◼Thesympatheticn

erveendingspresynapticmembrane:inhibitionofpositivefeedback,NAsecretiondecline◼Central(hypothalamusandmedullaob

longata):excitatoryneuronactivityisabate,peripheralsympatheticnervetensionby,vascularresistancedecreased◼Increasethetopringelementsynth

esisClinicalapplication◼Suitableforvarioushighbloodpressure◼Withhighcardiacoutputorplasmareninlevelshasgoodeffectonthehighsideofhypertensivep

atients,especiallysuitableforhypertensivepatientswithcoronaryheartdisease,cerebrovasculardisease◼Diureticorpoolingva

sodilatorscanenhancecurativeeffectatenolol◼Selectivebeta1receptorblockers,lackofinternaltothesympatheticactivit

y◼Oralisusedtotreatvariousdegreeofhighbloodpressure,antihypertensiveeffectalongerdurationlabetalol◼α、βReceptorblocke

rs◼Applicabletovariousdegreesofhypertensionandhypertensiveemergency,gestationalhypertension,pheochromocytoma,highbloodpressur

ewhenanesthesiaorsurgerycarvedilol）◼α、βReceptorblockers◼Usedinthetreatmentofmildandmoderatehypertensionwithrenalinsufficien

cy,diabetes,highbloodpressurepatientsReninangiotensinsystemdepressantsACEI：Captopriletc.AT1-resistance：Chlorinesand,valsartan,etc【Antihyper

tensivemechanism】1.AngIIGenerateandfunction。－Arteriovenousdiastolic→Peripheralresistance↓→Bloodpressure↓；－Blockthereleaseofaldoste

ronewatersodiumretention；2.Inhibitionofslowexcitationpeptidedegradation↓Slowexcitationpeptideconcentrationsintheblood↑:produceNO、P

G2Etc.→血管扩张→血压↓AngiotensinconvertingenzymeinhibitorsACEIcaptopril（Asulfhydrylpropionicacidpulp）【Functioncharacteristics】◼1ora

llyactive,workfast,antihypertensiveeffectofmediumstrong;◼2withoutreflectiveheartrate,long-termusewithoutresistance,noteasytocausetheelectrolytedisor

ders;◼Threepairsofrenalhypertensiveeffectisgood,cantreatrefractoryheartfailure【application】Eachperiodhighbloodpressure.Importantfirst-linedr

ugs.Especiallysuitableforcomplicatedwithdiabetesandinsulinresistanceandleftventricularhypertrophy,heartfailure,acutemyocardi

alinfarctionpatientswithhighbloodpressureAngiotensinⅡreceptorblockersARBAT1receptor:vascularsmoothmuscle,cardiacmuscle,brain,kidneyandsecr

etionofaldosteroneAdrenalzonacells-hasregulatingeffecttothestabilityofthecardiovascularfunction.losartan【Antihypertensivemechanism】Sele

ctiveblockingAT1receptor:blockingangiotensinⅡmediatedbloodvesselsShrinkage,aldosteronereleaseandpromotevascularsmoothmuscleproliferationande

ffect→Peripheralresistance↓Promotinguricacidexcretion,inhibitingrenaltubuleofuricacidabsorption,short【Clinicalapplicationof】

EachperiodhighbloodpressureStep-downfeatures:1.Theoralworkfast2.Theroletomaintainforalongtime:24hsmoothstep-down,3~6weeksforma

ximumeffect【sideeffect】relativelylessACEI:Attractedlessdrycoughandangioneuroticoedema;Butstillcancauselowbloodpressureandhighpotassiu

m.Forpatientswithpregnancy.Promotinguricacidexcretion,inhibitingrenaltubuleofuricacidabsorption,shortPharmacologicaleffects◼Diasto

licsmallarterysmoothmuscle,reducetheperipheralvascularresistance,lowerbloodpressure◼Withheartrateslows,decreasedcardiacoutput◼Inhibitthesecre

tionofgastrointestinaltractandmovementandtheprotectionofgastricmucosa◼Buckwithsedation◼Reduceintraocularpressure,don

otaffectthepupilandtheadjustmentofthelensPharmacologicalactionandmechanism◼ActivateI1-imidazolinereceptor，M

aketheperipheralsympatheticactivitydecline,vasodilation,bloodpressuredrops◼Theexcitedcentralpostsynapticmembranereceptoralpha2◼Lowerlevelsofplasmaren

inandaldosterone◼Inhibitthesecretionofgastrointestinaltractandmovementandtheprotectionofgastricmucosa◼Staticnotec

lonidinecanproduceboosterforashortperiodoftime(associatedwithperipheralalpha2receptorexcited),followedbyalongperio

doftimethestep-down(centralrole).Oralwiththecentralroleofthedominant,theboostereffectisnotobviousClon

idine◼Processinthebody◼Absorption:oralabsorption◼Distribution:easythroughthebloodbrainbarrier,plasmaproteincombinedr

ateof30%◼Metabolism:50%inintrahepaticmetabolism◼Discharge:metabolicproductandprototypebyrenalexcretionClinicalapplicat

ion◼First-linetreatmentinvalidmoderatelyhighbloodpressure,withthiazidediureticorotherantihypertensiveagentssharecanimprovethecurativeeffect◼Re

nalhypertension◼Patientswithhighbloodpressureofpepticulcer◼Primaryopen-angleglaucomaAdversereactions◼Drymouth

,sleepiness,constipation,impotence,canhappenoccasionallybradycardia◼Watersodiumretention◼Drugwithdrawalsyndrome:along-termdrugwithdrawalmaysuddenly

appearhaveaheadache,tremor,abdominalpain,sweating,heartpalpitationsandbloodpressuresurge.Andlong-termmedicationmadethealpha2weeksth

epresynapticmembranereceptorsensitivity,negativefeedbackeffectisreduced,suddenwithdrawal,increasedsympatheticnervous

functionisassociatedwithincreasedNErelease.Recoveryformedicineoralphareceptorblockers(e.g.,phentolamine)canalleviate.Withdrawalsho

uldbegraduallyreducedTheothercentralbloodpressuremedication◼methyldopa◼Amediumtostrongstep-down,cardiovascularandoutput,lessinfluencerenalbloodflow

◼Suitableforrenalhypertensionandmoderatehypertensivepatientswithpoorkidneyfunction,oftenwiththiazidediuretics

hare◼moxonidine◼ForIlreceptoraffinityishigh,andthereceptorisstrong,biologicalt1/2longer,onceadaydosing◼Suitableforpatients

withmildandmoderatehypertension◼Onthecentralandperipheralalpha2receptorfunctionisweak,thecalm,drymouthgreatlyreduceadversereactionsVasodilationmed

icine◼Directlytorelaxvascularsmoothmuscle,decreaseperipheralresistanceandbloodpressuretodrop◼Long-termuseantihypertensiv

evasodilatorshasthefollowingdisadvantages◼Cantheexcitedsympatheticnerve,reflectiveincreasecardiacoutput,heartratespeed

up◼Increaseofreninandaldosteronesecretion,leadingtowaterandsodiumretention◼Alongtimewitheasytolerance◼Withadiureticoradrenalin

ereceptorblockerssharecanenhancecurativeeffect,reduceadversereactionsSodiumnitroprusside◼Antihypertensiveeffectsassociatedwithan

increasedNO-GC-cGMP,candilatebloodvesselsandinhibitplateletaggregation◼Ofarteriolesandvenulesvascularsmoothm

usclewerediastolicfunction,antihypertensiveeffectstrong,rapidandshort◼Mainlyusedinthetreatmentofhypert

ensivecrisis.Alsousedincongestiveheartfailure,acutemyocardialinfarctionandcontrollinghypertensiondurin

ganesthesia◼Becauseofexcessivestep-downcancausenausea,vomiting,sweating,restlessness,palpitationsandheadacheGanglionblockm

edicinemecamylamine【Functioncharacteristics】1.Antihypertensiveeffectstrong,quickly;2.Hasinhibitoryeffectonbothsympatheticandparasympathetic,

adversereactions,andtheheavier,orthostatichypotension;Theparasympatheticganglionblocksymptoms.3.Hypertensivecrisis.Prazosin–Processinthebody◼Absor

ption:goodoralabsorption,firsteliminatetheobvious,bioavailabilityof60%◼Distribution:thecombinationofplasmaproteinratewas97%◼Metabolism:livermetabolis

m◼Discharge:mostbileexcretion,byasmallnumberofurinePharmacologicaleffectsandmechanismofaction◼Alpha1receptorsonpostsynapticmembraneo

fvascularsmoothmusclearehighlyselectiveblockingeffect◼Step-downfeatures:◼Amediumtostrongantihypertensiveeffect◼D

on'taffectkidneyfunction,improvethelevelofrenin◼Long-termusecanimprovelipidmetabolism◼Block1receptoralpha,rel

ievedysuriaprostatepatientsClinicalapplication◼Canbeseparatelyusedtreatmentofmildandmoderatehypertension◼Forelderlypatientswithhypertensioncomb

inedprostatichypertrophy,canimprovethesymptomsofdysuria◼Severehypertensionsharediureticandbetareceptorblockerscanenhancestep-downeffectAdve

rsereactions◼Firstagentphenomenon:somepatientsforthefirsttime0.51hourafterthetreatmentcanappearorthostatichypotension,dizz

iness,sweating,heartpalpitationsandreaction◼Long-termusecancausewatersodiumretention,diuresismedicinecanmaint

ainitsantihypertensiveeffectreserpine【Antihypertensivemechanism】ReducecatecholaminetransmitterinthestorageandreleaseAndthes

ympatheticnerveendings(peripheralandcentraladrenergic)vesiclemembraneAminepumpcombination,catecholamineneurotransmitter(NA,5-HT)syn

thesis,storage,reuptakeleft,thedepletionoftheneurotransmitters,thesympatheticnerveconductionleft-vasodilation,BPleftCentralinhibition,composed,stabl

eeffect.PhenylephrinecannerveendingsblockerFeatures:effectiveslow,gentleandlasting【Clinicalapplication

】1light,moderatetohighbloodpressure,ithasbeenlessusedalone2manicpsychosis【Adversereactions】１Theparasympatheticne

rveexcitementsymptoms:nausea,vomiting,intestinalcrampsanddiarrhea,pepticulcer2Centralinhibition:calm,lethargy,depression。Pota

ssiumchannelsareopenPromotetheKATPopen→Thecellmembranehyperpolarization→TheinflowCa↓Thenewconceptofhighbl

oodpressuremedication1.Theeffectivetreatmentandlifelongtreatment2.Protecttargetorgans3.Smoothstep-down4.CombinationtherapyThemainpoints◼1.Diuretic,

pharmacologicalaction,mechanismofactionandclinicalapplication◼2.Thebetablockerdrugs:antihypertensiveef

fectandmechanismofaction◼3.TheangiotensinIconvertingenzymeinhibitionofmedicine◼(1)thepharmacologicaleffectsandmechanismofaction◼(2)theclinicalapplica

tionof◼(3)theadversereactions◼4.Chlorinesandtemple:pharmacologicaleffectsandmechanismofaction◼5.Calciumantago

nistmedicine:pharmacologicaleffects◼