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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, 2012,PHM142 Fall 2012 Instructor: Dr. Jeffrey Henderson,Measure of systoli
2、c and diastolic pressure Pressure against the blood vessels Proportional to blood flow Transport of nutrients and O2 Removal of waste and CO2 Distribution of Hormones,Blood Pressure,Blood pressure above 140/90 Risk increases with age 2011 44% men and women ages 45-64 2011 45% men and women ages 65+,
3、Hypertension,Blindness Stroke Heart attack Heart failure Kidney damage High salt diet Obesity Hereditary Stress,Dangers of Hypertension,Causes,Renin-Angiotensin Aldosterone System,Liver,A: Enalapril,ACE Inhibitors,Liver,B,A: Enalapril B: Esterase,ACE Inhibitors,Liver,B,A: Enalapril B: Esterase,ACE I
4、nhibitors,Liver,B,A: Enalapril B: Esterase,ACE Inhibitors,Liver,B,A: Enalapril B: Esterase,ACE Inhibitors,Liver,B,B: Esterase C: Enalaprilat,ACE Inhibitors,Action of Benazeprilat,ACE Inhibitors,Hypotension Chest pain Abdominal pain Anemia,Adverse effects,1% during clinical trials,1% during clinical
5、trials,Fatigue Headache Dizziness Nausea,Common in institutionalized elderly Orthostatic Hypotension baroreflex failure or volume depletion Systolic bp decrease 20mm Hg Diastolic bp decrease 10mm Hg Associated with hypertension, increased age and diabetes mellitus,Hypotension,Symptoms Blurred vision
6、, headache, nausea, dizziness Risks Increased incident of cerebral vascular disease Mild cardio-infarction Coronary heart disease Heart failure Cardio-vascular mortality,Orthostatic Hypotension,Non-Medicinal Consumption of salt Consumption of extra fluids Head of bed elevated Physical Activity Abdom
7、inal binder,Treatments,Medicinal Pyridostigmine (Mestinon) Fludrocortisone (Florinef) Midodrine (ProAmatine),Vasopressor Increases standing systolic bp Metabolite desglymidodrine 1-agonist Activation of -adrenergic receptors Arterial and venous vasoconstriction Elevates blood pressure,Midodrine,Cyto
8、sol,Nucleus,Midodrine Desglymidodrine Glycine,Desglymidodrine,Phospholipase C,1-adrenergic receptor s,Vasoconstriction Increase BP,Enzymatic cleavage,Increase in calcium,Supine hypertension Scalp paresthesias Pilomotor reactions (goosebumps) Urinary urgency Headaches,Adverse Effects,Summary,Hyperten
9、sion,Hypertension: BP 140/90 ACE converts angiotensin I (inactive) into angiotensin II (active) to increase blood pressure Angiotensin II is responsible for vasoconstriction, thirst, and releases aldosterone for retention of Na+ Majority of ACE inhibitors (Enalapril), when activated, bind by the car
10、bonyl group Enalaprilat (active form) inhibits ACE, which vasoconstriction, thirst, and stops the release of aldosterone,Hypotension,Systolic BP drop 20mm Hg or diastolic BP drop 10mm Hg Midodrine: major metabolite desglymidodrine which activates adrenergic receptors Vasopressor effect that causes a
11、ctivation and constriction of the arterial system,Ace Inhibitors. 09/15/12. . Adrenal Gland. . Barrios, V., Escobar, C., (2010). Antihpertensive and organ-protective effects of benazepril. Expert Review of Cardiovascular Therapy, 12, 1653-1724. Burt, V.L., Whelton, P., Roccella, E.J., Brown, C., Cut
12、ler, J.A., Higgins, M., Labarthe, D. (1995). Prevalence of hypertension in the US adult population. Hypertension, 25, 305-313. Canadian Health Measures Survey: Blood pressure in adults. 09/13/12. . eCPS. 09/15/12. . Figueroa, J.J., Basford, J.R., and Low, P.A., (2010). Preventing and treating orthos
13、tatic 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, 2010. 09/15/12. . Jabary, N.S., Sarabia, R., Sanchez, T., and Gordillo, R. (2007). Midodrine treatment in the management of severe
14、 orthostatic hypotension after hemangioblastoma surgery. Acta Neurochirurgica, 149, 303-306 Kaplan, N.M., & Victor, R.G. (2009). Kaplans Clinical Hypertension (10th ed.). Philadelphia: Wolters Kluwer Liver. 09/13/12. . Nature of Code Blood Vessels. 09/13/12. . Oldenburg, O., Kribben, A., Baumgart, D
15、., Philipp, T., Erbel, R., and Cohen, M. V., (2002). Treatment of orthostatic hypotension. Current Opinion in Pharmacology, 740-746 Perazella, M.A. (2003). Efficacy and safety of midodrine in the treatment of dialysis-associated hypotension. Expert Opinion Drug Safety, 2(1), 37-47 Sherwood, L. (2007
16、). Human Physiology (6th ed.). Belmont: Thomson Broks/Cole. Swann, P., Stehouwer, M., and Tukker, J., (1995). Molecular mechanism for the relative binding affinity to the intentinal peptide carrier. Comparion of three ACE-inhibitors: enalapril, enalaprilat, and isinopril. Biochimica et Biophysica Acta, 1236, 31-38.,References,