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  • A Goal of Anti Hypertensive Therapy2

    Încărcat de

    Isak Lambas
    12 vizualizări8 pagini
    "Primary goal of antihypertensive therapy perhaps should be to reduce sympathoadrenal activity and plasma catecholamine levels," says dr. Izzo. Catecholamine levels Heart rate cardiac output Blood pressure Platelet aggregation GOOD ANTIHYPERTENSIVE EFFECT Sinus rate Negative inotropy 1-SELECTIVE Less bronchopasm Metabolic Fewer peripheral effects More marked pulmonary and peripheral effects.

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    "Primary goal of antihypertensive therapy perhaps should be to reduce sympathoadrenal activity and plasma catecholamine levels," says dr. Izzo. Catecholamine levels Heart rate cardiac output Blood pressure Platelet aggregation GOOD ANTIHYPERTENSIVE EFFECT Sinus rate Negative inotropy 1-SELECTIVE Less bronchopasm Metabolic Fewer peripheral effects More marked pulmonary and peripheral effects.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PPT, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    12 vizualizări8 pagini

    A Goal of Anti Hypertensive Therapy2

    Încărcat de

    Isak Lambas
    "Primary goal of antihypertensive therapy perhaps should be to reduce sympathoadrenal activity and plasma catecholamine levels," says dr. Izzo. Catecholamine levels Heart rate cardiac output Blood pressure Platelet aggregation GOOD ANTIHYPERTENSIVE EFFECT Sinus rate Negative inotropy 1-SELECTIVE Less bronchopasm Metabolic Fewer peripheral effects More marked pulmonary and peripheral effects.

    Drepturi de autor:

    Attribution Non-Commercial (BY-NC)
    Descărcați ca PPT, PDF, TXT sau citiți online pe Scribd
    Indicator pentru conținut neadecvat
    din 8

    Lodoz

    Kombinasi Ultra Low dose ; Bisoprolol + HCT 6,25mg

    Lodoz ; unik dan rasional


    LODOZ mengandung Bisoprolol & Hydrochlorothiazide dalam

    dosis subtherapeutik /ULTRA LOW-DOSE


    Bisoprolol 2,5 mg ( dosis umum )

    HCT 6,25 mg ( dosis umum )

    Meningkatkan respond rate Profile efek samping yang lebih baik

    compliance/ kepatuhan pasien yang meningkat

    A Goal of Antihypertensive Therapy


    Blood Pressure : Cardiac Output X Peripheral Resistance Therefore, a primary goal of antihypertensive

    therapy perhaps should be to reduce


    sympathoadrenal activity and plasma catecholamine levels - at the very least, antihypertensive drugs should not increase them.
    Izzo Am J Hypertens 1989; 2: 305S- 312S

    Causes of Sympathetic Nervous System (SNS) Activation


    Diet Genetic Factors

    SNS Activation
    Psychosocial Stress

    Acute Physical Stressors

    Catecholamine levels

    Heart rate

    Cardiac output

    Blood pressure

    Platelet aggregation

    GOOD ANTIHYPERTENSIVE EFFECT

    Sinus rate

    Renin inhibiton
    Bradycardia

    Negative inotropy

    1-SELECTIVE
    Less bronchopasm Metabolic Fewer peripheral effects Circulatory Similar cardiac and antihypertensive effects More marked pulmonary and peripheral effects

    NONSELECTIVE (1-2)

    -Antagonist may be either 1-cardioselective or non-cardioselective (1- 2 antagonism).

    Distribusi & fungsi of -adrenoceptors


    Organ Heart Gastro-intestinal tract Bronchial tract Uterus Blood vessel Kidney Fat tissue Pancreas (-cells) Liver Skeletal muscle Receptor-subtype 1 >>>>2 1 , 2 2 2 2 1 2 > 1 (2:1), (3) 2 , (3) 2 2 Physiological effect Heart rate , contractility , conduction velocity and automaticity Smooth muscle tone Smooth muscle tone Smooth muscle tone Smooth muscle tone Renin release Lipolysis Insulin release Glycogenolysis Gluconeogenesis Glycogenolysis K+ uptake Tremor T4 T3

    Thyroid gland

    Type II diabetes mellitus Insulin resistance


    Insulin levels

    BENEFIT 1 SELECTIVE FOR DM HYPERTENSION

    Norepinephrine release

    Ventikular arrhythmias

    PRA

    Angiotensin II

    1 stimulation-induced cardiac and coronary artery damage ( atheroma )


    PTA, plasma renin activity

    Blood pressure + non-dipping at night

    Intra-giomerular pressure + nephroathy

    Cruickshank JM. Hypertension and diabetes:a fateful alliance. Satellite Symposium from XXII Congress of the European Society of Cardiology. Amsterdam, 26-30 August 2000

    AKTIFASI SISTEM. SYMPATIS


    BISOPROLOL
    RENAL
    ( JUXTAGLOMEROLUS ) ( 1 )

    HEART
    (1>2)

    INCREASE RENIN

    HEART RATE

    ANGIOTENSINOGEN RENIN ANGIOTENSIN I ACE ANGIOTENSIN I I

    INCREASE BLOOD PRESSURE

    Elevated HR is linked to or predicts : Higher hypertensive risk Ischaemia in coronary disease Coronary heart disease Cardiovascular mortality
    Palatini & Julius; J. Hypertens., 1997

    VASOKONTRIKSI

    RETENSI Na + H2 0

    INCREASE BLOOD PRESSURE

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