BloodPressureandDrugsUniversityofToronto血壓和藥物課件

1、Blood Pressure and Drugs Sarah Fu (sarah.fumail.utoronto.ca)Meng Xue Shi (mengxue.shimail.utoronto.ca)Shuhua Situ (shuhua.situlmail.utoronto.ca)Monica Tran (mo.tranmail.utoronto.ca)Presentation Date: Friday, September 21, 2019PHM142 Fall 2019Instructor: Dr. Jeffrey Henderson第1頁，共23頁。Measure of systo

2、lic and diastolic pressurePressure against the blood vesselsProportional to blood flowTransport of nutrients and O2Removal of waste and CO2Distribution of HormonesBlood Pressure第2頁，共23頁。Blood pressure above 140/90Risk increases with age2019 44% men and women ages 45-642019 45% men and women ages 65+

3、Hypertension第3頁，共23頁。BlindnessStrokeHeart attackHeart failureKidney damageHigh salt dietObesityHereditaryStressDangers of HypertensionCauses第4頁，共23頁。Renin-Angiotensin Aldosterone System第5頁，共23頁。LiverA: EnalaprilACE InhibitorsHHA第6頁，共23頁。LiverBA: EnalaprilB: EsteraseACE InhibitorsHHA第7頁，共23頁。LiverBA:

4、 EnalaprilB: EsteraseACE InhibitorsHHA第8頁，共23頁。LiverBA: EnalaprilB: EsteraseACE InhibitorsHHA第9頁，共23頁。LiverBA: EnalaprilB: EsteraseACE InhibitorsHHA第10頁，共23頁。LiverBB: EsteraseC: EnalaprilatACE InhibitorsHHCH第11頁，共23頁。Action of BenazeprilatACE InhibitorsHHH第12頁，共23頁。第13頁，共23頁。第14頁，共23頁。HypotensionChe

5、st painAbdominal painAnemiaAdverse effects1% during clinical trialsFatigueHeadacheDizzinessNausea第15頁，共23頁。Common in institutionalized elderlyOrthostatic Hypotension baroreflex failure or volume depletionSystolic bp decrease 20mm HgDiastolic bp decrease 10mm Hg Associated with hypertension, increase

6、d age and diabetes mellitus Hypotension 第16頁，共23頁。Symptoms Blurred vision, headache, nausea, dizziness RisksIncreased incident of cerebral vascular disease Mild cardio-infarction Coronary heart disease Heart failure Cardio-vascular mortality Orthostatic Hypotension第17頁，共23頁。Non-MedicinalConsumption

7、of salt Consumption of extra fluidsHead of bed elevatedPhysical Activity Abdominal binder Treatments Medicinal Pyridostigmine (Mestinon)Fludrocortisone (Florinef)Midodrine (ProAmatine)第18頁，共23頁。VasopressorIncreases standing systolic bp Metabolite desglymidodrine1-agonist Activation of -adrenergic re

8、ceptors Arterial and venous vasoconstrictionElevates blood pressure Midodrine 第19頁，共23頁。CytosolNucleusMidodrine Desglymidodrine Glycine Desglymidodrine Phospholipase C1-adrenergic receptor sVasoconstriction Increase BPEnzymatic cleavageIncrease in calcium第20頁，共23頁。Supine hypertension Scalp paresthes

9、ias Pilomotor reactions (goosebumps)Urinary urgency Headaches Adverse Effects 第21頁，共23頁。SummaryHypertensionHypertension: BP 140/90ACE converts angiotensin I (inactive) into angiotensin II (active) to increase blood pressureAngiotensin II is responsible for vasoconstriction, thirst, and releases aldo

10、sterone for retention of Na+Majority of ACE inhibitors (Enalapril), when activated, bind by the carbonyl groupEnalaprilat (active form) inhibits ACE, which vasoconstriction, thirst, and stops the release of aldosteroneHypotensionSystolic BP drop 20mm Hg or diastolic BP drop 10mm HgMidodrine: major m

11、etabolite desglymidodrine which activates adrenergic receptorsVasopressor effect that causes activation and constriction of the arterial system 第22頁，共23頁。Ace Inhibitors. 09/15/12. .Adrenal Gland. .Barrios, V., Escobar, C., (2019). Antihpertensive and organ-protective effects of benazepril. Expert Re

12、view of Cardiovascular Therapy, 12, 1653-1724.Burt, V.L., Whelton, P., Roccella, E.J., Brown, C., Cutler, J.A., Higgins, M., Labarthe, D. (2019). Prevalence of hypertension in the US adult population. Hypertension, 25, 305-313.Canadian Health Measures Survey: Blood pressure in adults. 09/13/12. .eCP

13、S. 09/15/12. .Figueroa, J.J., Basford, J.R., and Low, P.A., (2019). Preventing and treating orthostatic hypotension: As easy as A, B, C. Cleveland Clinic Journal of Medicine, 7(5), 298-306 High blood pressure, by age group and sex. 09/15/12. .Hypertension in Canada, 2019. 09/15/12. .Jabary, N.S., Sa

14、rabia, R., Sanchez, T., and Gordillo, R. (2019). Midodrine treatment in the management of severe orthostatic hypotension after hemangioblastoma surgery. Acta Neurochirurgica, 149, 303-306 Kaplan, N.M., & Victor, R.G. (2009). Kaplans Clinical Hypertension (10th ed.). Philadelphia: Wolters KluwerLiver

15、. 09/13/12. .Nature of Code Blood Vessels. 09/13/12. .Oldenburg, O., Kribben, A., Baumgart, D., Philipp, T., Erbel, R., and Cohen, M. V., (2019). Treatment of orthostatic hypotension. Current Opinion in Pharmacology, 740-746 Perazella, M.A. (2019). Efficacy and safety of midodrine in the treatment of dialysis-associated hypotension. Expert Opinion Drug Safety, 2(1), 37-47Sherwood, L. (2019). Human Physiology (6th ed.). Belmont: Thomson Broks/Cole.Swann, P., Stehouwer, M., and