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ANTIHIPERTENSIVE

Definitie: medicamentele antihipertensive scad valorile tensiunii


arteriale, crescute in HTA, catre cele fiziologice. Mecanismele vizeaza
scaderea: fie a debitului cardiac fie a rezistentei periferice.
Definitie: hipertensiunea arteriala este cresterea constanta a tensiunii
arteriale sistolice (TAs) si/sau diastolice (TAd), la pacienti fara
tratament antihipertensiv, respectiv Tas 140 mmHg si/sau TAd 90
mmHg.
Clasificarea hipertensiunii
a) Clasificarea, functie de valorile TA max. (TAs) si TA min.
(TAd), in mmHg

b) Clasificarea stadiala O.M.S. (functie de stadiile de


afectare a unor organe):
Stadiul I, functional:
- cresteri tensionale moderate si temporare cu tulburari vasomotorii
(ameteli, dureri de cap etc);
- EKG normala;
- fara semne de afectare organica.
Stadiul II, organic:
- cresteri tensionale permanente;
- modificari de EKG;
- semne de afectare organica (cel putin unul) precum: hipertrofie
ventriculara stanga, tulburari renale).

Stadiul III, multiorganic:


- HTA severa permanenta;
- EKG modificata;
- afectari in majoritatea organelor vitale (insuficienta ventriculara
stanga, angina pectorala, infarct miocardic, AVC, retinopatie
hipertensiva etc).
c) Clasificare, functie de etiologie:
HTA esentiala (primara)
- este plurietiologica, datorata unor disfunctii complexe si relativ greu
de diagnosticat; cauze favorizante (factori de risc) sunt: antecedentele
familiale, arteroscleroza, obezitate, stres repetat, sedentarism,
fumatul/alcoolul (debutul la 25-55 ani);
HTA secundara
- este datorata unor patologii decelabile (boli
renale/hepatice/endocrine, diabet zaharat), sarcinii sau a unor
medicamente (AINS, anticonceptionale, corticosteroizi).
Farmacoterapia HTA este instituita in trepte (etape)
Etapa 1-a: monoterapie (HTA usoara)
- de prima alegere: diuretice (varstnici) sau beta-adrenolitice;
- de alternativa (in functie de bolnav si patologia asociata):
blocante ale canalelor de Ca++ (tip nifedipina);
alfa-adrenolitice (tip prazosin)
centrale (clonidina, reserpina)
inhibitori ai enzimei de conversie (IEC) (tip captopril sau
enalapril).
Etapa 2-a: asociere de 2 antihipertensive (HTA moderata)
- de prima alegere:
diuretic + beta-adrenolitic;
diuretic + IEC;
diuretic + alfa-adrenolitic;
diuretic + clonidina;
- de alternativa in functie de bolnav si patologia asociata: de ex.
blocante ale canalelor de Ca++ + IEC.
Etapa 3-a: asociere de 3 antihipertensive (HTA severa)
- de prima alegere: asocierea unui vasodilatator musculotrop (tip
dihidralazina);

- de alternativa in functie de bolnav alta asociere: de ex. un bolnav cu


tonus simpatic crescut, se adauga un al doilea simpatolitic (alfa
metildopa).

Clasificarea medicamentelor antihipertensive


Clasificarea, functie de mecanismele fiziopatogenice implicate in HTA,
la nivelul carora actioneaza:
A. Inhibitoare ale sistemului nervos vegetativ simpatic
(Simpatolitice);
- Centrale:
clonidina, moxonidina, rilmenidina;
alfa-metildopa, reserpina;
- Beta-adrenolitice:
neselective - propranolol, sotalol, tertatolol, carvedilol;
selective beta-1 atenolol, metoprolol, nebivolol,
betaxolol, bisoprolol, celiprolol, talinolol;
- Alfa-adrenolitice: prazosin, doxazosin, terazosin;
B. Vasodilatatoare
blocante ale canalelor de calciu:
tip nifedipina: nifedipina, nimodipina, nisoldipina,
nitrendipina, lacidipina, lecarnidipina, felodipina,
amlodipina;
tip diltiazem: diltiazem;
tip verapamil: verapamil, galopamil;
musculotrope: hidralazine, papaverina, nitroprusiat de sodiu;
C. Substante care interfera cu sistemul renina-angiotensina
aldosteron;
inhibitoare ale enzimei de conversie a angiotensinei
(IEC): captopril, lisinopril si prodroguri: enalapril, benazepril,
cilazapril, fodinopril, perindopril, quinapril, ramipril, trandolapril,
zofenopril;
antagonisti ai receptorilor AT-1 ai angiotensinei II:
candesartan, eprosartan, irbesartan, losartan, telmisartan,
valsartan.
D. Diuretice:
- tiazide si similare farmacologic: hidroclorotiazida, clortalion,
indapamid;
- de ansa: furosemid, bumetanid, acid etacrinic;
- antialdosteronice: spironolactona, amilorid, triamteren;
E. Alte mecanisme:

antagonisti ai serotoninei: ketanserin

DCI-uri Forme farmaceutice - Denumiri comerciale


SIMPATOLITICE
clonidinum compr. 0,15 mg: Clonidina
moxonidinum compr. film. 0,2/0,3/0,4 mg/ml: Moxonidina,
Moxogamma, Physiotens
rilmenidinum compr. 1 mg: Rilmenidina, Tenaxum
methyldopum compr. 250 mg: Dopegyt
propranololum compr. 10/40 mg, sol. orala: Propranolol, NPropranolol, Hemangiol
sotalolum compr. 80/160 mg: Sotalol, Sotagamma, Darob
carvedilolum compr. film. 3,125/6,25, 12,5/25 mg: Carvedilol,
Carvedigamma, Carveheal, Coryol, Dilatred, Gladycor,
Miocarvil, Talliton, Tedilol
metoprololum compr. elib. prel./film. 25/50/100/200 mg, sol.
inj./perf.: Betaloc Zok, Betaprol, Bloxan, Egilok, Metoprolol,
Metosuccinat
atenololum compr. 50/100 mg: Atenocor, Atenolol
bisoprololum compr. film. 2,5/5/10 mg: Bisoblok, Bisogamma,
Bisoprolol, Bisotens
betaxololum compr. film. 20 mg, pic. oft.: Betaxolol, Betac,
Betax, Betoptic, Lokren
nebivololum compr. film. 5 mg: Nebivolol, Dublock, Nebicard,
Nebilet, Nebinorm, Nolet, X-Pressol
doxazosinum compr. film. 1 mg, 4 mg: Doxazosin, Kamiren,
Cardura
prazosinum compr. 1/2 mg: Minipress
VASODILATATOARE
amlodipinum compr. 5/10 mg: Amlodipina, Almacor, Alneta,
Alotendin, Amlodigamma, Vazotal
felodipinum compr. elib. prel. 2,5/5/10 mg: Felodipin, Auronal,
Plendil, Sistar
lacidipinum compr. film. 2/4 mg: Lacipil

lercanidipinum compr. film. 10/20 mg: Lercanidipin, Leridip,


Lerpin, Pegfel
nifedipinum compr. elib. prel. 20/30 mg: Adalat, Nifedipin
nimodipinum compr. film. 30 mg, sol. perf.: Nimotop
nitrendipinum compr. 20 mg: Lusopress
verapamilum compr. film., caps., draj. 40/80 mg: Cordamil,
Isoptin, Verapamil
diltiazemum compr., caps. elib. prel. 60/90 mg: Diltiazem, Dilzem
SUBSTANTE CE INTERFERA CU SISTEMUL RENINAANGIOTENSINA
benazeprilum compr. film. 5/10/20 mg: Benazepril, Cibacen
captoprilum compr. 12,5/25/50 mg: Captopril
cilazaprilum compr. film. 0,5/1/2,5/5 mg: Pipredo
enalaprilum compr. 5/10/20 mg, sol. inj.: Enalapril, Enal, Enap,
Renitec
fosinoprilum compr. 10/20 mg: Fosinopril, Fosypril, Monopril,
Monotens,
lisinoprilum compr. 5/10/20/40 mg: Lisinopril, Lisigamma,
Lisiren, Ranolip, Tonolysin
perindoprilum compr. 2,5/4/5/8/10 mg: Prestarium
quinaprilum compr. film. 5/10/20 mg: Accupro, Pulsaren
ramiprilum compr. 1,25/2,5/5/10 mg: Ramipril, Amprigen,
Ampril, Hartil, Piramil, Ramiran, Tritace (+ hidroclortiazida)
trandolaprilum caps. 0,5/1/2/4 mg: Trandolapril, Gopten
zofenoprilum compr. film. 7,5/30 mg: Zofenopril, Zomen,
candesartanum compr. 4/816/32 mg: Atacand, Tandesar, Karbis
eprosartanum compr. film. 300/400/600 mg: Eprosartan, Teveten
irbesartanum compr. 75/150/300 mg: Irbesartan, Aprovel,
Atokken, Ifirmasta, Irbec, Irbegamma, Karvea
losartanum compr. film. 12,5/50/100 mg: Losartan, Cozaar,
Lodial, Lorista, Talosan
telmisartanum compr. 20/40/80 mg: Telmisartan, Kinzalmono,
Micardis, Milsertan, Pritor, Tanydon, Telmark, Telmotens, Tezeo
valsartanum compr. film. 40/60/80/160/320 mg: Valsartan,
Avassan, Diovan, Simaldoz, Valaric, Valcatuna, Valsacor,
Valsargamma, Vasopentol, Warota, Wenzell
DIURETICE
hydrochlorothiazidum compr. 25 mg: Nefrix
indapamidum compr. elib. prel. 1,5 mg: Indapamid, Belamid,
Diuremid, Iduren, Indapagamma, Rawel, Reditens, Serdimid,
Tertensif
furosemidum compr. 40 mg, sol. inj.: Furosemid, Diurex, Diocor,
Diurocard (cu spironolactona)

spironolactonum compr. film., caps. 25/50 mg: Spironolactona,


Alspiron, Verospiron