Ọgwụ antihypertensive

Ọgwụ antihypertensive

Edemede bara uru? Kekọrịta na netwọk mmekọrịta:

Ọbara mgbali elu = systolic BP ³140 mmHg na/ma ọ bụ diastolic BP ³90 mmHg n'ihe ndị na-adịghị ewere ọgwụ antihypertensive.

Nhazi ọkwa ọbara mgbali elu, mm Hg.

1.      Diuretics
Mechanisms nke antihypertensive edinam diuretics

  1. Mwepụ nke sodium (chloride);
  2. Mmetụta vaskụla na-adabereghị na natriuresis.

Ndị isi dị iche iche nke diuretics:

  1. Thiazide na thiazide-dị ka diuretics;
  2. loop diuretics na
  3. Ihe diuretics na-egbochi potassium

Thiazide diuretics (TD) - ọgwụ mbụ antihypertensive na
1958, e mepụtara thiazide diuretic hydrochlorothiazide.
Na 1959 - thiazide dị ka chlorthalidone diuretic.
Na 1974 - thiazide dị ka diuretic indapamide.

Ọgbọ nke mbụ - usoro benzothiadiazine (hydrochlorothiazide) na phthalimidine (chlorthalidone)
Ọgbọ nke abụọ - ihe chlorbenzamide (indapamide).

Mmetụta na mgbochi maka iji thiazide diuretics
• Metabolic (biochemical): hypokalemia, hypomagnesemia na hyperuricemia, hyperglycemia.
• Mfu nke potassium na magnesium ion n'oge ọgwụgwọ na nnukwu doses nke thiazide diuretics kọwara site na omume nke ventricular arrhythmias (ọnwụ mberede na-enweghị potassium supplements)
• Mmetụta dị na ọgwụgwọ thiazide diuretics na ihe dịka 30-50% nke ndị ọrịa.
• Ugboro nke mmetụta na-adabere na dose nke ọgwụ.
• Mgbe ị na-eji nnukwu doses nke thiazide diuretics, ọ dị mkpa ịkagbu ha n'ihi mmepe nke mmetụta na 20-30% nke ikpe.
Thiazide diuretics na-abawanye mpụta nke potassium na magnesium ion ma n'otu oge ahụ na-ebelata mmịpụta nke uric acid.
Thiazide (na loop!) A na-egbochi diuretics na ndị ọrịa nwere hypokalemia (ihe na-erughị 3.5 mmol / l), gout na hyperuricemia (karịa 8.5 mg / dl na ụmụ nwoke na karịa 6.6 mg / dl n'ime ụmụ nwanyị).

Thiazide diuretics (ọkachasị na oke doses) nwere ike imebi metabolism nke carbohydrate, nke na-egosipụta onwe ya na mmụba nke glucose na haemoglobin glycosylated, yana nnabata nnabata nke glucose ọnụ na eriri afọ.
Hyperglycemia nke na-eme n'oge ọgwụgwọ thiazide diuretics anaghị erute uru ụlọ ọgwụ.
Mana n'ime ndị nwere ike ịnwụ, ọgwụgwọ diuretic thiazide ogologo oge dị ka ọ na-enye aka na mmepe nke ọrịa shuga mellitus.
N'oge ọgwụgwọ ya na thiazide diuretics, mkpokọta insulin na-abawanye, nke a kwenyere na ọ bụ nzaghachi nkwụghachi ụgwọ maka mbelata uche nke anụ ahụ dị n'akụkụ na-arụ ọrụ insulin.
Hyperinsulinemia nwere ike ime ka mmepe nke atherosclerosis dịkwuo elu na ndị ọrịa HD.

Mmetụta na-adịghị mma na metabolism
lipid
. A na-akpọkarị ya mgbe ejiri indapamide gwọọ ya.
Thiazide diuretics (n'adịghị ka loop na potassium-sparing diuretics) na-ebelata mpụta nke ion calcium na mmamịrị.
Mmetụta calcium na-echekwa thiazide na thiazide dị ka diuretics na-eme ka ha baa uru na ọgwụgwọ ọbara mgbali elu na ndị ọrịa nwere osteoporosis concomitant.
A na-enweta mmetụta diuretic kachasị site na obere doses nke TD dị obere.
Diuretic, ya mere mmetụta antihypertensive nke thiazide diuretics na-ebelata nke ukwuu na ndị ọrịa nwere ụkọ akụrụngwa (GFR erughị 30 ml / min).
N'ihi nke a, thiazide na thiazide dị ka diuretics adịghị atụ aro maka ọgwụgwọ ọbara mgbali elu n'ime ndị ọrịa nwere ọrụ akụrụ na-adịghị mma.

Hydrochlorothiazide (hypothiazid)
• Mmetụta diuretic na-apụta mgbe awa 2 gachara, na-eru nke kachasị mgbe awa 4 gachara ma na-ewe ihe dị ka awa 12. Na-enyere aka belata ọbara mgbali elu.
• Tụkwasị na nke ahụ, ọ na-ebelata polyuria na ndị ọrịa nwere ọrịa shuga insipidus (usoro nke ime ihe adịghị akọwapụta nke ọma).
• N'ọnọdụ ụfọdụ, na-ebelata nrụgide intraocular na glaucoma.
• N'ime afọ ndị na-adịbeghị anya, a naghị eji hydrochlorothiazide (HCTZ) mee ihe dị ka monotherapy. 
• N'ụzọ bụ isi, a na-eji ya mee ka ọrụ nke ọgwụ ndị ọzọ antihypertensive dị ntakịrị - 12.5-25 mg.
• Ngwakọta diuretic: triampur - HCTZ (12.5 mg) + triamterene (25 mg)
Mmetụta dị n'akụkụ.
• Site na usoro nri: ọgbụgbọ, ọgbụgbọ, afọ ọsịsa; adịkarịghị - pancreatitis.
• Site na usoro obi obi: orthostatic hypotension, tachycardia.
• Site n'akụkụ nke metabolism: hypokalemia, hypomagnesemia, hyponatremia, hypochloremic alkalosis, hyperuricemia, hypercalcemia.
• Site na usoro endocrine: hyperglycemia.
• Site na usoro hemopoietic: adịkarịghị - neutropenia, thrombocytopenia.
• N'akụkụ akụkụ nke ọhụụ: adịkarịghị - mmebi anya.
• Site n'akụkụ nke usoro nhụjuanya nke etiti na usoro nhụjuanya nke akụkụ: adịghị ike, ike ọgwụgwụ, dizziness, paresthesia.
• Mmeghachi omume nfụkasị: adịkarịghị - dermatitis nfụkasị ahụ.

Ntuziaka pụrụ iche
• Jiri nlezianya mee ihe na ndị ọrịa nwere gout na ọrịa shuga mellitus.
• N'ime ndị ọrịa nwere ụkọ akụrụngwa, ọ dị mkpa iji nlezianya nyochaa mkpokọta plasma nke electrolytes na CC.
• Mgbe ihe ịrịba ama nke ụkọ potassium pụtara, yana iji otu oge nke glycosides obi, GCS na ACTH, a na-egosi ọkwa nke nkwadebe potassium ma ọ bụ diuretics na-egbochi potassium.
• Maka iji ogologo oge eme ihe, ekwesịrị ịgbaso nri bara ụba na potassium.
• A naghị atụ aro iji diuretics na NSAID n'otu oge.
• GMPnews Portal: Ihe ize ndụ dị ukwuu nke ọrịa kansa anụ ahụ na-abụghị melanoma ka achọpụtara ọnụ ọgụgụ dị elu nke hydrochlorothiazide n'ọmụmụ ọrịa ọrịa abụọ dabere na data sitere na Ndekọ Ọrịa Cancer Mba Danish. Mmetụta fotosensitizing nke hydrochortiazide nwere ike ịbụ usoro enwere ike maka mmepe nke NMSC.

Ekwesịrị inye mmasị maka nhọrọ diuretic na thiazide na thiazide dị ka diuretics • Indapamide
na chlorthalidone egosipụtawo uru na mbenata ọnwụ cc n'ime ule ụlọ ọgwụ na-enweghị usoro . nwere ogologo oge ime ihe karịa HCTZ • Indapamide na chlorthalidone na-anabata nke ọma.


Chlorthalidone (oxodoline, apo-chlorthalidone)
• Na-ezo aka na diuretics nke ọkara irè. Mmetụta diuretic na-amalite mgbe awa 2 gachara, rute nke kachasị mgbe awa 12 gachara ma dịruo awa 72
• Mmetụta hypotensive na-amalite nke nta nke nta, na-eru oke mgbe izu 2-4 gachara. mgbe mmalite ọgwụgwọ.
• Na mgbakwunye, chlorthalidone na-akpata mbelata nke polyuria na ndị ọrịa nwere ọrịa shuga insipidus, ọ bụ ezie na akọwapụtabeghị usoro ya.
• Site na ọbara mgbali elu arterial - 25 mg 1 oge / ụbọchị
• Ọ bụrụ na ọ dị mkpa, enwere ike ịbawanye dose ahụ ruo 50-100 mg / s 
.
Chlorthalidone nwere uru n'ịchịkwa ọbara mgbali nke awa 24 ma e jiri ya tụnyere HCTZ - a na-achịkwa ọbara mgbali ka mma, ọkwa cholesterol na LDL dị ala, na ihe ize ndụ nke ọrịa obi na-agbadata nke ukwuu (site na 21%).
Ihe ndị a na data ndị ọzọ, karịsịa nsonaazụ nke ọmụmụ ALLHAT, kwere ka ndị ọkachamara America tụlee CTD diuretic kachasị mma na ọgwụgwọ ọbara mgbali elu.

Indapamide dị iche na thiazide diuretics ndị ọzọ n'ihi na ọ nwere mmetụta pere mpe na ọkwa potassium na uric acid.
N'oge ọgwụgwọ na indapamide, ọkwa glucose anaghị agbanwe agbanwe na mmetụta nke anụ ahụ dị n'akụkụ na-arụ ọrụ nke insulin adịghị enye nsogbu, yabụ ọ bụ diuretic kachasị mma maka ọgwụgwọ ọbara mgbali elu na ndị ọrịa nwere ọrịa shuga mellitus.
Indapamide dị iche na diuretics ndị ọzọ na nnabata ya nke ọma.
N'adịghị ka thiazide ndị ọzọ na thiazide dị ka diuretics, indapamide nwere mmetụta pere mpe na mkpokọta cholesterol na triglyceride ma na-abawanye ọkwa HDL ọbara ntakịrị
.

Mmetụta nke indapamide na arịa ọbara
• Mmetụta vasodilating kpọmkwem:
- na-ebelata ọdịnaya calcium intracellular, na-egbochi ịbanye calcium site na akpụkpọ ahụ ma pụọ ​​​​na ebe nchekwa intracellular nke sel anụ ahụ dị nro nke vaskụla vaskụla akwara
.
• Na-ebelata ngbanwe nke vaskụla pathological
• Njirimara Antioxidant
• Mmetụta mgbochi atherosclerotic 
• Thiazide na diuretics dị ka thiazide dị irè karịa ụmụ nwanyị nwere HD karịa ụmụ nwoke.
• N'ime ndị ọrịa agadi (karịa afọ 60) ha dị irè karịa ndị ọrịa na-eto eto.

Ya mere, thiazide na thiazide dị ka diuretics (ewezuga indapamide) adịghị mma maka ọgwụgwọ mbụ nke ọbara mgbali elu na ndị ọrịa nwere ọrịa shuga mellitus na ndị na-ebute mmepe ya, ya bụ, n'ime ndị nwere oke ibu ma ọ bụ na-egosi ọrịa shuga mellitus na ọrịa shuga mellitus. akụkọ ezinụlọ.

Diuretics loop na-eme mkpụmkpụ - mgbe nkwụsị nke mmetụta diuretic, ọnụego nke excretion nke ion sodium na-ebelata ruo n'ọkwa dị n'okpuru ọkwa mbụ, ya bụ. sodium njigide na-eme.
     Nke a bụ "mmeghachi azụ azụ" (ma ọ bụ nlọghachi azụ).
"Ihe ngosi nlọghachi" na-akọwa ihe kpatara diuretics loop na-eme mkpụmkpụ (dị ka furosemide na bumetanide) mgbe a na-ewere ya otu ugboro n'ụbọchị anaghị abawanye nsị sodium ion kwa ụbọchị ma ghara inwe mmetụta antihypertensive.

Diuretics loop nke na-eme ogologo oge (torasemide) anaghị ebute mmetụta nlọghachi, yabụ na-arụ ọrụ nke ọma na ọgwụgwọ ọbara mgbali elu karịa furosemide na bumetanide.
Torasemid (Diuver, Britomar, Trigrim) na dose nke 2.5 mg otu ugboro kwa ụbọchị anaghị akpata mmetụta diuretic akpọpụtara, yana ọbara mgbali na-agbada n'otu oge iji hydrochlorothiazide, chlorthalidone na indapamide.

Njirimara nke torasemide
• na-egbochi reabsorption nke Na + na Cl-in
• mgbago mgbago nke Henle;
• na-apụkarị (80%) site na imeju;
• nwere obere kaliuresis ma e jiri ya tụnyere ndị ọzọ loop diuretics;
• nwere ihe mgbochi aldosterone;
• nwere mmetụta vasodilator kpọmkwem;
• na-eme ka eriri akwara dị nro dị nro.

A na-emepụta beta-blockers
b-blockers dị ka ọgwụ antianginal, ma na mmalite 60s ọ bịara pụta ìhè na ha dị irè na ọgwụgwọ ọ bụghị naanị angina pectoris, kamakwa ọbara mgbali elu.
N'afọ 1964, e bipụtara akụkọ mbụ banyere iji propranolol na ndị ọrịa nwere GB,
yana mgbochi nke b1-adrenergic receptors, b-blockers nwere ike ma ọ bụ ghara igbochi b2-adrenergic receptors.
N'okwu nke mbụ, ha na-ekwu maka
  b-blockers na-abụghị ndị a na-ahọrọ, na nke abụọ - banyere ọgwụ ndị na-ahọrọ b1.
Mgbochi nke ndị na-anabata β1-adrenergic nwere mmetụta chrono-, dromo-, batmo- na inotropic adịghị mma.

Nhazi nke beta-blockers dabere na beta-1-selectivity na esịtidem sympathomimetic ọrụ (ISA):
Ndị na-abụghị ndị beta-blockers:
a) na-enweghị ICA: propranolol, nadolol (Korgard), sotalol, carvedilol (dilatrend, acridilol, atram, vedicardol). , carvedigamma, carvetrend, cardivas, coriol, talliton), proxodolol (albetor);
b) na ICA: oxprenolol, pindolol (whisken);
Wisken - n'ihi mmetụta na-akpali akpali nke akụkụ ahụ dị nro na ndị na-anabata β2-adrenergic, ọ nwere mmetụta vasodilating nke ụlọ ọgwụ.

Nhọrọ beta-blockers:
a) na-enweghị ICA: atenolol, esatenolol (estekor), betaxolol (lokren, betak), metoprolol (betalok zok, egilok C, metozok, vasocardin, corvitol, metocard, serdol, egilok, emzok), bisoprolol (aritel). , bidop, biol, biprol, bisogamma, bisocard, concor, corbis, cordinorm, coronal, lodoz), nebivolol (binelol, nebilet), esmolol (breviblok), talinolol (cordanum);
b) na ICA: acebutolol, celiprolol (celiprol) na-arụ ọrụ β2 a-rec.

b-blockers, na-egbochi ndị na-anabata b2-adrenergic nke mkpụrụ ndụ b-pancreatic, na-ebelata mmepụta insulin, nke na-esonyere mmụba nke ọkwa glucose basal.
Dị ka akụkọ ụfọdụ si kwuo, b-blockers, dị ka thiazide diuretics, na-abawanye ohere nke ịmalite ịmalite ọrịa shuga na ndị ọrịa nwere nsogbu.
Ya mere, a naghị atụ aro ndị na-egbochi b-blockers (karịsịa ndị na-abụghị ndị a na-ahọrọ) dị ka ọgwụ antihypertensive nke mbụ n'ime ndị ọrịa nwere nsogbu mmepe nke ọrịa shuga mellitus, ya bụ, na ndị ọrịa nwere oke ibu na akụkọ ihe mere eme ezinụlọ nke ọrịa shuga mellitus.

Mkpọkọta glucose sitere na imeju na nzaghachi nke hypoglycemia bụ ndị na-anabata β2-adrenergic bụ ndị na-akwado ya.
Yabụ, mmeghachi omume hypoglycemic na insulin ma ọ bụ ọgwụ antidiabetic nke ọnụ na ndị ọrịa nwere ọrịa shuga mellitus na ọgwụgwọ nke ndị na-egbochi b1 bụ ihe na-adịkarị obere karịa na ọgwụgwọ nke ọgwụ anaghị ahọpụta.

b1-selective blockers:
 dị nchebe n'ime ndị ọrịa nwere ọrịa mgbochi mkpali na-
akawanye njọ n'ime ọbara lipid na glucose metabolism ruo n'ókè dị nta karịa
omume antihypertensive na-abụghị nhọrọ nke a na-apụta karịa omume nke b-blockers na-abụghị nhọrọ.

Dabere na solubility na abụba na mmiri, a na-ekewa b-blockers n'ime otu atọ:
1) lipophilic (betaxolol, carvedilol, metoprolol, propranolol);
2) hydrophilic (atenolol, nadolol, sotalol);
3) amphophylic.

Lipophilic b-blockers na-abanye ngwa ngwa na ihe fọrọ nke nta ka ọ bụrụ kpam kpam (karịa 90%) na tract gastrointestinal.
Na-emekarị ha metabolized na imeju (80-100%). Ekwesịrị iburu nke a n'uche na ọrụ imeju na-adịghị mma.
Ekwesịrị ibelata doses ma ọ bụ ugboro ole lipophilic b-blockers na ndị agadi agadi, ndị ọrịa nwere imeju imeju ma ọ bụ CHF, yana mgbe ejiri ya na ọgwụ na-egbochi ọrụ enzymes imeju.

Contraindications maka nhọpụta:

Zuru oke:

• Bradycardia (obi na-erughị 50 kwa nkeji), hypotension
• Ọrịa sinus ọrịa
• Atrioventricular block II-III ogo, sinoauricular ngọngọ
• Decompensated obi nkụda mmụọ
• Ọrịa na-adịghị ala ala obstructive pulmonary ọrịa, bronchial ụkwara ume ọkụ.

Onye ikwu:

Oge ngwụcha nke ọrịa Raynaud na ọrịa vaskụla na-ekpochapụ ọrịa vaskụla
• Ọrịa shuga mellitus na-emebi emebi (ihe ize ndụ nke hypoglycemia)
• Ime na
ịmụ nwa • Vasospastic angina
• Dyslipidemia • nkụda mmụọ
.

N'ihi ihe ndị a nke acebutolol, bisoprolol na celiprolol, ojiji ha na-akacha mma na ndị ọrịa agadi, bụ ndị na-enwekarị imeju na akụrụ na-adịghị arụ ọrụ.

Ngosipụta maka idepụta β-blockers dị ka ọgwụ antihypertensive nke mbụ:
• Angina pectoris • Infarction
myocardial gara aga
• CHF
• Tachyarrhythmias
• Glaucoma
• Ime ime .

2.      Calcium antagonists (calcium channel blockers)
A na-ekewa ndị na-emegide calcium ụzọ atọ dị mkpa dabere na nhazi kemịkal:

  1. Phenylalkylamine mmepụta (verapamil, gallopamil);
  2. Ihe mgbarụ Benzothiazepine (diltiazem)
  3. Dihydropyridine mmepụta - nifedipine, amlodipine (Norvasc, Normodipin, Cardilopin), S (-) amlodipine (Escordicor) Isradipine (Lomir) Nitrendipine (Octidipine, Bypress), Nimodipine (Nimotop), Felodipine (Plendil, Felodipine), Nisoldipine (Sicordipine), lacidipine (lacipil, sakur), lercanidipine (lerkamen, zanidip), wdg.

Ihe ngosi maka nhọpụta nke ndị na-emegide calcium:
• angina pectoris;
• Vasospastic angina;
• ọbara mgbali elu akwara;
• Supraventricular tachycardia (ma e wezụga dihydropyridines): verapamil na diltiazem na-ebelata ọnụ ọgụgụ obi, na-egbochi ọrụ nke sinus na AV nodes;
• Ọrịa Raynaud.
Verapamil na diltiazem nwere mmetụta ino-, chrono- na dromotropic na-adịghị mma, i.e. ike ibelata myocardial contractility, ibelata ọnụego obi na ngwa ngwa atrioventricular conduction.
Ya mere, verapamil na diltiazem bụ nkewa dị ka "cardioselective" ma ọ bụ "bradycardic" (obi na-ebelata) calcium antagonists.

Nifedipine na ihe ndị ọzọ dihydropyridine dị iche na verapamil na diltiazem na vasoselectivity ka ukwuu.
Ha anaghị enwe mmetụta dị ukwuu n'ụlọ ọgwụ na ọrụ nke oghere sinus na nhazi nke atrioventricular.
N'oge ọgwụgwọ ya na ihe ndị na-emepụta dihydropyridine, ọnụọgụ obi anaghị agbanwe agbanwe, mana ọ nwere ike ịbawanye n'ihi mmeghari nke sistemu ọmịiko-adrenal na nzaghachi na mgbasawanye dị nkọ nke akwara sistem.
A na-akpọ Nifedipine, amlodipine, felodipine, na ihe ndị ọzọ dihydropyridine dị ka "vasoselective" (vasoseelecting) ma ọ bụ "vasodilating" (vasodilating) calcium antagonists.

Ọdịmma nke calcium antagonists nke ọgbọ mbụ - verapamil, nifedipine na diltiazem - bụ obere oge nke edinam (T1 / 2 ọ dịghị ihe karịrị 3 awa), na-achọ 3-4 ugboro n'ụbọchị. Nri nke ndị na-emegide calcium na-eme mkpụmkpụ na-esonyere ya na nnukwu ọnụọgụ ọgwụgwọ plasma nke ọgwụ, na-akpata "ọnụ ọnụ" na "na-agbada", na enweghị ntụkwasị obi nke mmetụta vasodilating.
A maara na mmetụta niile nke ndị na-emegide calcium na-adabere na dose ma na-apụta na njedebe kachasị. Site na usoro onunu ogwu a, a naghị anabata ha nke ọma yana ọtụtụ mgbe ndị ọrịa na-akwụsị ị drinkụ ya, ọkachasị ọgwụ ndị otu dihydropyridine.
Dabere na data sitere na nnwale ndị a na-achịkwaghị achịkwa nke gụnyere ndị ọrịa nwere nnukwu myocardial infarction, a na-anabatakarị na vasoselective calcium antagonists, n'adịghị ka ọgwụ cardioselective, enweghị mmetụta cardioprotective, ya bụ. ha anaghị ebelata mmepe nke myocardial infarction myocardial ugboro ugboro na ọnwụ obi na mberede.

Otu ihe onwunwe nke ndị na-emegide calcium bụ lipophilicity, nke na-akọwa nnabata ha dị mma na tract gastrointestinal (90-100%) na naanị ụzọ ikpochapụ ahụ bụ metabolism na imeju.

Calcium antagonists na-akpata:
• regression nke ekpe ventricular hypertrophy na ọbara mgbali elu,
• nwere antianginal,
• cardioprotective,
• renoprotective,
• mmetụta antiatherogenic (plasma membrane stabilization, nke na-egbochi ntinye na ntinye nke free cholesterol n'ime mgbidi arịa, na-ebelata ike nke mgbidi arịa. macrophages iji weghara LDL),
• gbochie nchịkọta platelet.

Isi mmetụta nke calcium antagonists

  1. Mmetụta ndị metụtara vasodilation (isi ọwụwa, dizziness, flushing, palpitations, peripheral edema, transient hypotension) na ihe ndị ọzọ e ji mara nke dihydropyridine dị mkpụmkpụ na-eme ihe;
  2. Mmetụta ino-, chrono- na dromotropic na-adịghị mma dị na verapamil na, n'ókè dị nta, diltiazem, n'ihi nke a na-egbochi iji calcium antagonists na nnukwu systolic systolic ventricular aka ekpe (ejection ejection na-erughị 30%), ọrịa sinus na-arịa ọrịa na. mgbochi nke atrioventricular II-III Art.;
  3. Ọrịa eriri afọ (afọ ntachi, afọ ọsịsa, ọgbụgbọ, ọgbụgbọ, wdg), a na-ahụkarị na ndị agadi agadi na ọgwụgwọ verapamil;
  4. Mmetụta metabolic (dịka ọmụmaatụ, na-akawanye njọ nke metabolism carbohydrate n'oge ọgwụgwọ nke nifedipine) na
  5. Mmetụta metụtara pharmacokinetic na pharmacodynamic mmekọrịta nke calcium antagonists na ọgwụ ndị ọzọ (dịka ọmụmaatụ, digoxin, theophylline, rifampicin, b-blockers, vasodilators, wdg).

Calcium antagonists bụ naanị otu klas nke ọgwụ mgbochi hypertensive nke mmetụta ya adịghị ebelata mgbe ejiri ya na ọgwụ mgbochi mkpali na-abụghị steroidal. Ya mere, ndị na-emegide calcium na-adabara karịsịa maka ọgwụgwọ ogologo oge nke ọbara mgbali elu na ndị ọrịa nwere OA, ọrịa ogbu na nkwonkwo, wdg.

3.      Angiotensin-converting enzyme inhibitors
Renin, enzyme proteolytic, na-etolite na sel nke juxtaglomerular ngwa nke akụrụ, nke nwere baroreceptors na-anabata ịgbatị mgbidi nke afferent arterioles nke renal glomerulus.
Mbelata nrụgide arteriole (dịka ọmụmaatụ, na hypovolemia jikọtara ya na mfu ọbara ma ọ bụ ịba ụba ọsụsọ) na-akpali renin secretion, nke bụ eleghị anya usoro nchebe evolushọn maka ịnọgide na-enwe ọbara mgbali.
Njikọ na-esote na RAAS bụ angiotensinogen, nke bụ glycoprotein arụpụtara n'ime imeju ma zoo n'ime ọbara.
 Renin na-ekewa angiotensinogen n'ime ụmụ irighiri ihe abụọ, nke buru ibu, angiotensin I, na-atụgharị ya site na angiotensin-converting enzyme (ACE) na angiotensin II.

Angiotensin II bụ peptide nwere ụdị ọrụ dị iche iche nke usoro ndu, yana na mbụ - ihe kachasị ike vasoactive.
Angiotensin II na-akpali secretion nke aldosterone site na adrenal glomerular oyi akwa, nke na-akwalite sodium reabsorption na nephron tubules, na-abawanye na olu nke mmiri (n'ime arịa, mgbe ahụ na interstitium), ya mere na-abawanye na ọbara mgbali.

Site na igbochi ọrụ nke angiotensin I-converting enzyme, ndị na-egbochi ACE na-ebelata nguzobe nke angiotensin II ma mechaa mebie mmetụta obi na-akpata nke ịgbalite sistemu renin-angiotensin, gụnyere vasoconstriction arterial na secretion aldosterone.
Site na igbochi ọrụ kininase II, ndị na-egbochi ACE na-ebelata arụ ọrụ nke bradykinin na kinin ndị ọzọ ma na-enye aka na mkpokọta nke ihe ndị a na anụ ahụ na ọbara. Kinins naanị ma ọ bụ site na ntọhapụ nke prostaglandins E2 na I2 nwere mmetụta vasodilating na natriuretic.

Usoro ọrụ nke ndị na-egbochi ACE

Na mgbakwunye, ndị na-egbochi ACE, site na ibelata ntụgharị nke angiotensin I na angiotensin II, na-eduga n'ịbawanye ọdịnaya nke angiotensin I n'ọbara na anụ ahụ.
Mkpokọta nke angiotensin I na-enye aka na ntụgharị ya na-abawanye na angiotensin- (1-7), nke nwere mmetụta vasodilatory na natriuretic.
Ya mere, mmetụta antihypertensive nke ndị na-egbochi ACE na-ejikọta ya na mbelata nguzobe nke ihe vasoconstrictor (angiotensin II, yana norepinephrine, arginine-vasopressin, endothelin-1), yana mmụba na nguzobe ma ọ bụ mbelata nke mmebi ahụ. nke vasodilating bekee (bradykinin, angiotensin- (1-7), nitric oxide, prostaglandins).

Naanị ihe mgbochi ACE anọ (captopril, libenzapril, lisinopril na cenonapril) na-arụ ọrụ ndụ ozugbo.
Ndị na-egbochi ACE ndị ọzọ amaara bụ ihe na-adịghị arụ ọrụ, ma ọ bụ prodrugs.
Naanị mgbe nnabata na tract eriri afọ, n'ihi hydrolysis, ha na-aghọ diacid metabolites na-arụ ọrụ, dịka ọmụmaatụ, enalapril na-atụgharị na enalaprilat, fosinopril na fosinoprilat, wdg.
Ya mere, ndị na-egbochi ACE niile nwere ike kewaa ụzọ abụọ: 1) na-arụ ọrụ. ụdị onunu ogwu na 2 ) prodrugs.
Klas 1. Ọgwụ lipophilic
• Captopril (Capoten)
Klas II. Ọgwụ lipophilic
• Subclass II - ọgwụ ndị na-emekarị mkpochapụ gbasara akụrụ (karịa 60%): benazepril (lotensin), quinapril (accupro) perindopril (prestarium A, hypernic, perinpress, prenesa) cilazapril (inhibase, prilazid) enalapril, enalaprilat (zofenopril)
Subclass IIB - ọgwụ nwere isi ụzọ abụọ nke mkpochapụ: moexipril (moex), ramipril (tritace, amprilan, chartil, diaprel), fosinopril (monopril
) quadropril), trandolapril (hopten)
Klas III. Hydrophilic ọgwụ
Lisinopril (Irumed, Diroton, Dapril, Lysigamma, Sinopril) bụ ọgwụ nwere nnukwu nephro- na cardioprotective Njirimara.
Mmetụta antihypertensive a na-akpọkarị nke ndị na-egbochi ACE bụ ndị ọrịa nwere oke ọrụ nke sistemu renin-angiotensin-aldosterone.
Mana ndị na-egbochi ACE enweghị ike igbochi oke ọrụ nke RAAS, n'ihi na. Ihe ruru 70-80% nke angiotensin II na-arụ ọrụ n'ime akụkụ ahụ na anụ ahụ na-enweghị itinye aka na ACE site na enyemaka nke enzymes ndị ọzọ (chymase, cathepsin, wdg), na ọgwụgwọ nke ACE inhibitors, njikọ nke angiotensin II nwere ike ịgbanwe. site n'okporo ụzọ dabere na ACE gaa na ụzọ chymase.
 Nke a na-akọwa ohere nke "mgbanarị" mmetụta antihypertensive na ọgwụgwọ nke ACE inhibitors, karịsịa megide ndabere nke nri nnu dị elu, ma na-eje ozi dị ka ihe ndabere maka iji ọgwụ ndị na-egbochi ọrụ angiotensin II. , n'agbanyeghị ụzọ e si guzobe ya.

Dabere na oge mmetụta antihypertensive, enwere ike kewaa ndị inhibitors ACE n'ime otu atọ:

  1. Ọgwụ ndị na-adịghị adịte aka kwesịrị inye 2 ma ọ bụ 3 ugboro n'ụbọchị (dịka ọmụmaatụ, captopril).
  2. Ọgwụ nwere ogologo oge nke omume, nke a ga-ewererịrị ma ọ dịkarịa ala ugboro abụọ n'ụbọchị (zofenopril na enalapril).
  3. Ọgwụ na-eme ogologo oge nke na-enye njikwa ọbara mgbali elu elekere anya mgbe a na-ewere ya otu ugboro n'ụbọchị (quinapril, lisinopril, perindopril, ramipril, spirapril, trandolapril, fosinopril, wdg).

Ndị ọrịa na-anabatakarị ndị na-egbochi ACE.
Ndị ikom ọcha na-anabata ọgwụgwọ ogologo oge ACE inhibitor karịa ụmụ nwanyị ọcha, yana ndị ojii na ndị China.
• Mmetụta metụtara ya na iji ACE inhibitors: kpọmkwem na nke na-abụghị nke a kapịrị ọnụ.

Specific
• Ọrụ gbasara akụrụ arụrụ arụ na ọgwụgwọ ndị na-egbochi ACE na-adịkarị na ndị ọrịa nwere ọrịa akụrụ ma ọ bụ nke zoro ezo, gụnyere ọnya abụọ nke akwara akụrụ.
• hyperkalemia dị ịrịba ama (> 5.5 mEq / L) bụ ihe a na-adịghị ahụkebe n'oge ọgwụgwọ na ndị na-egbochi ACE na ndị ọrịa nwere ọrụ gbasara akụrụ nkịtị (0%-6%).
Na mgbakwunye na ọdịda akụrụ, ihe ndị dị ize ndụ maka mmepe hyperkalemia na ndị ọrịa na-anata ndị na-egbochi ACE bụ ojiji nke potassium salts, potassium-sparing diuretics (amiloride, spironolactone, triamterene) na ọgwụ mgbochi mkpali na-abụghị steroidal (indomethacin, diclofenac). sulindac).
• N'aka nke ọzọ, ijikọ aka nke loop na thiazide diuretics na-ebelata ohere nke ịmalite hyperkalemia n'oge ọgwụgwọ ACE inhibitors 
• Ụkwara akọrọ, dị ka akwụkwọ akụkọ si kwuo, na-eme na ọgwụgwọ nke ACE inhibitors ugboro 1 ruo 48. %
Ugboro ụkwara n'oge ọgwụgwọ ya na ndị na-egbochi ACE na-adabere na mmekọahụ na agbụrụ nke ndị ọrịa.
• Dịka ọmụmaatụ, ụkwara na-ejikọta ACE inhibitor na-adịkarị na ụmụ nwanyị karịa ụmụ nwoke (ihe dịka 7: 3 ratio).
• Ndị na-adịghị ese anwụrụ nwere ihe dị ka okpukpu abụọ ugboro ụkwara ka ndị na-ese anwụrụ.
• Dịka ụfọdụ nlebanya siri kwuo, perindopril na fosinopril adịchaghị ebute mmepe ụkwara akọrọ karịa captopril, lisinopril na enalapril.
• Angioedema (Quincke's edema) bụkwa ihe na-emetụtakarị ndị na-egbochi ACE.
• Ọ na-apụta obere oge karịa ụkwara akọrọ - na 0.1-0.5% nke ikpe, mana angioedema, n'adịghị ka ụkwara, nwere ike ibute ndụ ndị ọrịa egwu ozugbo.
Mmetụta ndị na-adịghị akọwapụta nke ndị na-egbochi ACE gụnyere mgbakasị uto, leukopenia (neuropenia), rashes anụ ahụ, ọrịa dyspeptik, yana ikpe dịpụrụ adịpụ nke mmebi akụrụ na imeju na mmepe nke anaemia.

A naghị
atụ aro ka iji ACE inhibitors dị ka ọgwụ antihypertensive maka akwara akwara nke akụkụ abụọ, stenosis nke akwara nke naanị akụrụ na-arụ ọrụ, ọdịda akụrụ siri ike (ọkwa creatinine karịa 300 μmol / l ma ọ bụ 3.5 mg / dl), hyperkalemia siri ike ( n'elu 5.5 mmol / l), n'oge ime na n'oge ọ bụ nwata, nakwa dị ka onye hypersensitivity nke otu ọgwụ (akọrọ ụkwara ma ọ bụ angioedema na akụkọ ihe mere eme).

Site na iji nlezianya dị ukwuu, ekwesịrị iji ndị na-egbochi ACE na ndị ọrịa na-ekpochapụ atherosclerosis nke akwara akwara nke ala nsọtụ (n'ihi nchikota atherosclerotic ọnya nke akụkụ akwara na akwara), atherosclerosis na-agbasa na ọnya nke akwara obi na carotid, na-agafeghị oke. ọdịda akụrụ, hyperkalemia na-agafeghị oke (site na 5 ruo 5, 5 meq / l), ịba ọcha n'anya na-adịghị ala ala ma ọ bụ imeju imeju, yana ụmụ nwanyị na-amụ nwa (na-eburu n'uche mmetụta ọjọọ ọgwụ nwere ike ime na mmepe intrauterine nke nwa ebu n'afọ. ).

4.      Angiotensin II antagonists (AT1 receptor blockers)
Na omume nke AII na arịa ọbara, a na-ekewa usoro abụọ - pressor na depressor.
A na-emegharị usoro pressor site na mmetụta nke AII na ụdị 1 ndị na-anabata ya ma na-eduga na vasoconstriction, sodium na njigide mmiri, mmụba nke ọrụ ọmịiko, mbelata ụda vagal, mmụba cell, na mmetụta inotropic dị mma.
Mmetụta ịda mbà n'obi nke AII na-enweta site na mkpali nke ndị na-anabata ụdị 2, nke na-eduga na vasodilation, karịsịa nke a na-akpọ na arịa ụbụrụ na akụrụ, mmetụta natriuretic, mmetụta antiproliferative, ịgbalite nke kininogen, ntọhapụ nke nitric oxide na prostaglandin I2.

A na-enye usoro dị irè karị na nke akọwapụtara maka igbochi oke ọrụ nke sistemu renin-angiotensin na AH site na otu ọgwụ - angiotensin II receptor blockers (ARBs) ma ọ bụ AT1-angiotensin receptor blockers (sartans)
Sartans nwere ọtụtụ ihe dị mkpa.
Nke mbụ, ndị na-egbochi AT1-angiotensin na-anabata nke ọma karịa ndị na-egbochi ACE, na-ebelata mmetụta obi obi nke ịgbalite sistemu renin-angiotensin .
Ebe ndị na-egbochi ACE na-eme naanị otu ụzọ maka imepụta angiotensin II, ndị na-egbochi ndị na-anabata AT1-angiotensin na-arụ ọrụ dị ka angiotensin II antagonists, n'agbanyeghị otú e si emepụta angiotensin II.
Ya mere, ndị na-egbochi ndị na-anabata AT1-angiotensin na-enye nkwụsị zuru oke na nhọrọ nke usoro renin-angiotensin.

Nke abuo, omume nke sartans dị kpọmkwem karịa omume nke ndị na-egbochi ACE.
N'ihi enweghị mmetụta na usoro bradykinin-kallikrein-kinin, isi ihe dị iche iche nke ARB bụ nchekwa dị elu na ọnụ ọgụgụ dị nta nke mmetụta ndị yiri placebo. Enweghị ụkwara na ọnụọgụ mmeghachi omume nfụkasị ahụ bụ uru zuru oke nke sartans karịa ndị na-egbochi ACE.
Usoro ọgwụgwọ antihypertensive nke AT1-angiotensin receptor blockers jikọtara ya na mbelata mmetụta nke angiotensin II (na angiotensin III), nke ndị na-anabata AT1-angiotensin na-akwado ya.
Na mgbakwunye, mgbochi nke ndị na-anabata angiotensin II na-eduga na mbelata nke nzuzo nke aldosterone, mbelata nke reabsorption nke sodium na mmiri na akụkụ dị nso nke tubules gbasara akụrụ.
Sartans na-egbochi naanị ndị na-anabata AT1 ka ha na-ejigide ikike nke na-ekesa AT II ka ha na ndị na-anabata AT2 na-emekọrịta ihe, nke na-esonyere vasodilation, mgbochi proliferation ma na-akwalite mmetụta organoprotective ndị ọzọ, na nke a, n'aka nke ya, na-egbochi ọganihu nke ọrịa ahụ.
Site na igbochi ndị na-anabata AT1, ndị na-egbochi AT1-angiotensin na-ebelata akwara arterial vasoconstriction nke angiotensin II (na angiotensin III), na-ebelata nrụgide hydraulic na renal glomeruli, yana belata nzuzo nke aldosterone, arginine-vasopressin, endothelin-1 na norepinephrine.
Site na iji ogologo oge, AT1-angiotensin receptor blockers na-ebelata mmetụta proliferative nke angiotensin II n'ihe metụtara cardiomyocytes na mkpụrụ ndụ akwara dị nro nke mgbidi vaskụla, yana sel mesangial na fibroblasts.

Losartan (Cozaar, Lorista, Lozap, Blocktran)
• Valsartan (Diovan, Valsacor, Valz)
• Irbesartan (Aprovel)
• Candesartan (Atakand)
• Eprosartan (Teveten)
• Telmisartan (Micardis)
• Olmesartan (Benikar, Cardosal)
• Azmilartan (edarbi)
————————————————————
• Prodrugs Prodrugs
include:
• Losartan - metabolized in the liver, only 14% is converted to the active metabolite,
• Candesartan, olmesartan na azilsartan - hydrolysis na eriri afọ tract.

Sartans nwere nnukwu ihe akaebe maka cerebroprotection, nephroprotection na mbelata ihe ize ndụ nke nsogbu obi.
Ọnụ ọgụgụ dị ukwuu nke ọmụmụ ihe a na-achịkwa egosiwo ike ha ọ bụghị nanị iji belata ọnụ ọgụgụ nke mmepe na ọganihu nke mmebi akụkụ ahụ a na-atụ anya (mbelata hypertrophy ventricular aka ekpe, mbelata na ịdị njọ nke microalbuminuria na proteinuria, na-ebelata ọnụ ọgụgụ nke ọdịda nke ọrụ akụrụ). , cerebroprotection), kamakwa iji gbochie mmebi akụkụ ahụ.
• Otu n'ime akụkụ dị mkpa akọwapụtara nke ọgwụ maka ojiji nke sartans bụ mbelata nke ụdị ọrịa shuga mellitus nke 2.
• Achọpụtala mmetụta ndị a nke ọma maka telmisartan (ONTARGET, 2008), irbesartan (IRMA, 2001; IDNT, 2003), valsartan (NAVIGATOR, 2010), nnukwu doses nke losartan (RENAAL, 2001; RASS, 2009).
• Maka ọgwụ atọ - losartan, valsartan na candesartan - edebanye aha CHF dị ka ihe ngosi maka ojiji.
 N'otu oge ahụ, CHF bụ ihe mgbochi maka ịde telmisartan
• N'ime ndị ọrịa nwere nnukwu ihe ize ndụ nke ịmalite CVC, a na-egosi ọkwa telmisartan ọbụlagodi na ọbara mgbali elu dị elu. N'ime ARB niile, ọ bụ naanị telmisartan ka egosiri iji belata ihe omume CV niile yana nnabata ọgwụgwọ dị mma.
• Telmisartan nwere ọkara ndụ kachasị ogologo (ihe karịrị awa 20) n'etiti ndị sartan niile, nke na-enye ndị ọrịa si na otu "ndị na-abụghị dipper" kwaga n'ìgwè "dipper" dị mma karị, na-enwe obere ihe ize ndụ nke ọbara mgbali elu. n'isi ụtụtụ na mbelata ihe ize ndụ nke ọrịa strok .
• Telmisartan na-ebelata LVH nke ọma karịa ọgwụ antihypertensive ndị ọzọ
• Nephroprotection
• Na-ebelata nguzogide insulin .

Telmisartan nyere aka ọ bụghị naanị na mmụba nke paramita anthropometric, kamakwa na mbelata ọnụọgụ na olu nke abụba ahụ
Mgbe atụnyere telmisartan na sartan ndị ọzọ, uru ya na ibelata ọkwa triglyceride na ịbawanye ọkwa HDL gosipụtara
mmetụta Uricosuric
Mbelata ọrụ RAAS. na SNS

Azilsartan (Edarbi)
Ọmụmụ nnwale egosila na Edarbi® na-ejikọ ndị na-anabata angiotensin.

ọzọ ike

karịa ARB ndị ọzọ (olmesartan, telmisartan, valsartan).
Nke a na-akọwa ngwa ngwa, ogologo oge na mmetụta antihypertensive nke ọgwụ
Olmesartan nwere ọ bụghị naanị ezigbo antihypertensive nrụpụta, ikike ibelata akwara akwara, meziwanye ọrụ nke endothelium vaskụla, mana nwekwara ikike cerebroprotective.
Nke a na-enye anyị ohere ịkwado ọgwụ ahụ bụ isi maka ọgwụgwọ ndị agadi na-arịa ọbara mgbali elu, bụ ndị ọrụ nke ịnọgide na-arụ ọrụ ọgụgụ isi bụ otu n'ime ihe ndị dị mkpa
.

5.      α1-adrenergic receptor
blockers α-adrenergic receptor blockers na-anọchite anya otu ọgwụ dị iche iche nke ejirila kemgbe mmalite 1960 na-agwọ ụdị dị iche iche nke ọbara mgbali elu.

Nkewa nke α-adrenergic receptor
blockers α-adrenergic receptor blockers kewara ụzọ abụọ bụ isi:

  1. anaghị ahọpụta na
  2. a1-nhọpụta.

Ndị na-adịghị ahọpụtara (phentolamine) na-ebelata mmetụta nke catecholamines na ma a1- na a2-adrenergic receptors, nhọrọ - nhọrọ na-egbochi mmetụta nke catecholamines na a1-adrenergic receptors nke arịa ọbara na akụkụ ndị ọzọ na anụ ahụ.
• prazosin - pratsiol, minipress, adverzuten,
• doxazosin - kamiren, cardura, tonocardin, artezin, doxaprostan)
• terazosin - cornam, setegis (BPH)
• tamsulosin - omnic (BPH)
Na mgbakwunye, ụfọdụ ọgwụ mgbochi hypertensive nwere a-adrenergic igbochi Njirimara. , nke na-abụghị nke otu a-blockers.
Ya mere, a hụrụ mmetụta mgbochi a1-adrenergic na b-blockers abụọ (carvedilol na proxodolol).

Mmetụta extravascular nke a1-adrenergic blockers bụ nnukwu mkpa ụlọ ọgwụ.
Ekwuputala na nhọrọ a1-adrenergic receptor blockers nwere ike imeziwanye ihe mejupụtara ọbara - ha na-ebelata ọdịnaya nke mkpokọta cholesterol n'ime ọbara n'ihi akụkụ atherogenic ya - LDL cholesterol ma n'otu oge ahụ na-abawanye ọkwa HDL. Ọdịnaya nke triglycerides na-ebelatakwa n'oge ọgwụgwọ a1-blockers.
Mmetụta nke a1-blockers na nchịkọta lipid ọbara na-apụta karịsịa na ndị ọrịa nwere atherogenic dyslipidemia.

a1-blockers na-abawanye mmetụta nke anụ ahụ na ọrụ nke insulin. Doxazosin, dịka ọmụmaatụ, na-ebute mbelata nke obere glucose basal (site na 7 mg/dl, ma ọ bụ 5%) yana insulin (site na 14 mmol/l, ma ọ bụ 17%) na ndị ọrịa nwere ọbara mgbali elu.
Nnyocha ụlọ ọgwụ abụọ egosila na a1-blockers (karịsịa doxazosin) na-egbochi nchịkọta platelet.

Ọnụnọ nke ndị na-anabata a1-adrenergic na akwara dị nro nke prostate na eriri afo na-arụ ọrụ dị ka ihe ndabere maka iji prazosin, na ndị ọzọ a1-adrenergic blockers na ndị ọrịa nwere hyperplasia prostate na-adịghị mma.

Ọchịchọ nke mmeghachi omume orthostatic, nke a na-ahụkarị na ndị agadi na ndị ọrịa nwere neuropathy mamịrị, bụ ihe mgbochi maka iji a1-blockers.
Site n'ibelata ọbara mgbali elu, a1-blockers na-eme ka mmeghachi omume nhụsianya nke sistem obi ọmịiko, nke na-egosipụta site na tachycardia.
Ya mere, a 1-blockers ekwesịghị iji a1-blockers na ndị ọrịa nwere ọrịa akwara obi na-arụ ọrụ angina na-enweghị nchịkwa nke b-blockers n'otu oge, nke na-egbochi ihe omume reflex tachycardia.

6.      Central sympatholytics
Hyperactivity nke SNS bụ otu n'ime isi usoro maka ịba ụba ọbara mgbali na prognostically adịghị mma akara na ndị ọrịa nwere ọbara mgbali elu.
Ihe dị ka 30% nke ndị ọrịa nwere GB na-egosi hyperactivity nke SNS, nke a na-egosipụta ọ bụghị naanị site na mmụba nke ọbara mgbali elu, kamakwa site na tachycardia, mmụba nke mmepụta obi, vasoconstriction akụrụ, njigide mmiri, na nguzogide insulin
• ọgbọ nke mbụ - methyldopa. (dopegyt), guanfacine (estulic), reserpine
• ọgbọ nke abụọ - clonidine (clophelin, hemiton)
• ọgbọ nke atọ (imidazoline agonists receptor) - moxonidine (cint, physiotens, moxogamma), rilmenidine (albarel).
Dị ka echiche nke oge a si dị, mmetụta antihypertensive nke moxonidine na rilmenidine dabeere na agonism megide ndị na-anabata I1-imidazoline nke neurons dị na ventrolateral nuclei nke medulla oblongata.
Site na ibelata hyperactivity SNS, ndị agonists ndị na-anabata I1-imidazoline na-ebelata ọbara mgbali ma belata ọnụ ọgụgụ obi.

Moxonidine na-ebelata ọrụ nke SNS ma si otú a na-eduga na mbelata ọbara mgbali.
Otu uru dị mkpa nke moxonidine bụ mmetụta dị mma na carbohydrate na lipid metabolism. Moxonidine na-abawanye mmetụta nke anụ ahụ na insulin site na imeziwanye usoro insulin dabere na ibuga glucose n'ime sel, na-ebelata ọkwa insulin, leptin na glucose n'ọbara, na-ebelata ọdịnaya nke triglycerides na acid fatty free, na-abawanye ọkwa nke HDL cholesterol. .
N'ime ndị ọrịa buru oke ibu, moxonidine na-eduga na mbelata ibu (MERSY).
Moxonidine nwere mmetụta organoprotective: ọ na-ebelata LVH, na-eme ka ọrụ diastolic nke obi dịkwuo mma, ọrụ ụbụrụ nke ụbụrụ, ma na-ebelata MAU.
Enwere ike igosi Moxonidine maka ọgwụgwọ ọbara mgbali elu na ndị ọrịa nwere MS ma ọ bụ ụdị ọrịa shuga 2 yana njikọ ACE inhibitors ma ọ bụ ARBs, calcium antagonists.

Contraindications na nhọpụta nke moxonidine na rilmenidine bụ:
• oké uche ịda mbà n'obi,
• sinus bradycardia (obi na-erughị 50 kwa nkeji),
• ọrịa sinus syndrome,
• atrioventricular ngọngọ II-III ogo,
• ọrịa imeju siri ike,
• nnukwu gbasara akụrụ ọdịda. .
N'ihi enweghị ahụmahụ ụlọ ọgwụ, a na-atụ aro ka ị ghara inye ụmụ nwanyị moxonidine na rilmenidine n'oge ime na nwa ara.

7.      Renin inhibitors
Aliskiren (rasilez) bụ onye na-egbochi ya kpọmkwem nke renin Renin
secretion site na akụrụ na ịgbalite RAAS na-eme na mbelata nke BCC na ọbara na-agbapụta ọbara site na usoro nzaghachi.
Renin na-arụ ọrụ na angiotensinogen, na-eme ka e guzobe decapeptide na-adịghị arụ ọrụ - angiotensin I (ATI), nke, site n'enyemaka nke ACE na, akụkụ ụfọdụ, na-enweghị òkè ya, na-agbanwe n'ime octapeptide angiotensin II (ATII).
ATII na-ebelata secretion renin site na usoro nzaghachi na-adịghị mma. Ọgwụ ndị na-egbochi RAAS (gụnyere renin inhibitors) na-ebelata nzaghachi na-adịghị mma, na-eduga na mmụba nkwụghachi ụgwọ na ntinye uche renin plasma.

Ọgwụgwọ ya na ndị na-egbochi ACE na ndị na-anabata angiotensin II na-abawanye ọrụ renin plasma, nke metụtara nnukwu ihe ize ndụ nke ọrịa obi na ndị ọrịa nwere ọbara mgbali elu na ndị ọrịa nwere ọbara mgbali elu.
Mgbe ị na-eji aliskiren dị ka monotherapy yana yana ọgwụ antihypertensive ndị ọzọ, a na-ewepụ nkwụsị nke nzaghachi na-adịghị mma, na-ebute mbelata ọrụ renin plasma (na ndị ọrịa nwere ọbara mgbali elu site na nkezi 50-80%), yana ATI. na ọkwa ATII,
na ọbara mgbali elu akwara mgbe ị na-eji Rasilez na dose nke 150 na 300 mg otu ugboro n'ụbọchị, enwere mbelata ogologo oge dabere na ọbara mgbali systolic na diastolic maka awa 24, gụnyere n'isi ụtụtụ.
Mgbe izu 2 gachara, enwere mbelata ọbara mgbali elu site na 85-90% nke kachasị, mmetụta hypotensive na-anọgide na ọkwa enwetara n'oge ogologo oge (ruo 1 afọ).
Mgbe a kwụsịchara ọgwụgwọ ya na Rasilez, a na-enwe nlọghachi ọbara nke nta nke nta na ọkwa mbụ ya n'ime izu ole na ole, na-enweghị mmepe nke ọrịa nkwụsị na mmụba nke ọrụ renin plasma.
N'izu 4 ka nkwụsị nke Rasilez gasịrị, ọbara mgbali na-anọgide na-adị ntakịrị ma e jiri ya tụnyere placebo.

Mgbe ị na-eji ọgwụ ahụ maka oge mbụ, ọ dịghị mmeghachi omume hypotensive (mmetụta nke mbụ dose) yana mmụba reflex nke obi na nzaghachi vasodilation.
Mgbe a na-eji Rasilez dị ka monotherapy yana yana ọgwụ antihypertensive ndị ọzọ, a na-ahụ mbelata ọbara mgbali elu na 0.1% na 1% nke ikpe, n'otu n'otu.
Usoro ọgwụgwọ ngwakọta na Rasilez na ndị na-egbochi ACE, ndị na-anabata angiotensin II, ndị na-egbochi ọwa calcium na diuretics bụ ndị ọrịa na-anabata nke ọma ma na-enye ohere iji nweta mbelata ọbara mgbali ọzọ.

Contraindications
• Ịrụ ọrụ gbasara akụrụ siri ike (serum creatinine> 150 μmol / l maka ụmụ nwanyị na> 177 µmol / l maka ụmụ nwoke na / ma ọ bụ ọnụego nzacha glomerular <30 ml / min).
• Ọrịa Nephrotic.
• ọbara mgbali elu nke renovascular.
• Usoro hemodialysis mgbe niile.
• Ọrụ imeju na-adịghị mma nke ukwuu
• Ụmụaka na ndị nọ n'afọ iri na ụma na-erubeghị afọ 18.
• Hypersensitivity na akụkụ nke ọgwụ.
• Site na ịkpachara anya, ekwesịrị ịnye ọgwụ ahụ maka ndị ọrịa nwere akwara akwara otu akụkụ ma ọ bụ nke abụọ ma ọ bụ stenosis nke akwara otu akụrụ, ọrịa shuga mellitus, BCC belatara, hyponatremia, hyperkalemia, ma ọ bụ ndị ọrịa mgbe a tụgharịrị akụrụ. Nchekwa nke Rasilez na ndị ọrịa nwere akwara akwara abụọ ma ọ bụ akwara akwara nke otu akụrụ emebeghị.

Mmetụta dị n'akụkụ
• A tụlere nchekwa nke Rasilez n'ime ihe karịrị ndị ọrịa 7800.
• Mgbe ị na-eji ọgwụ ahụ na dose nke ruru 300 mg, ngụkọta oge mmeghachi omume ọjọọ yiri nke ahụ mgbe ị na-eji placebo. Mmeghachi omume ọjọọ na-adịkarị nwayọọ, na-adịru nwa oge, na ọ dịkarịghị mkpa ka a kwụsị ọgwụgwọ ọgwụ. A na-ahụkarị afọ ọsịsa na ndị ọrịa na-agwọ Rasilez.
• Mgbe ị na-eji ọgwụ ahụ eme ihe, enweghi mmụba na ụkwara akọrọ, njirimara nke ndị na-egbochi ACE. Mmetụta nke ụkwara akọrọ n'oge ọgwụgwọ na Rasilez (0.9%) yiri nke ahụ mgbe ị na-ewere placebo (0.6%).
• Site na tract digestive: ọtụtụ mgbe - afọ ọsịsa.
• Mmeghachi omume dermatological: mgbe ụfọdụ - akpụkpọ anụ.
• N'akụkụ nke ụlọ nyocha: adịkarịghị - megide ndabere nke monotherapy, a hụrụ ntakịrị mbelata na mkpokọta hemoglobin na hematocrit (na nkezi site na 0.05 mmol / l na 0.16%, n'otu n'otu), nke na-achọghị ịkwụsị ọgwụgwọ. (mbelata mkpokọta hemoglobin na hematocrit na-ahụkwa site na iji ọgwụ ndị ọzọ na-emetụta RAAS, ọkachasị ndị na-egbochi ACE na ndị na-anabata angiotensin II), ntakịrị mmụba na mkpokọta potassium serum (0.9% ma e jiri ya tụnyere 0.6% mgbe ị na-ewere placebo). ).
• Enweghị mgbanwe dị ịrịba ama n'ụlọ ọgwụ na mkpokọta cholesterol, HDL, na triglycerides na-ebu ọnụ, glucose, ma ọ bụ uric acid.
• Mmeghachi omume nfụkasị: n'ọnọdụ ụfọdụ - angioedema.

Usoro ọgwụgwọ ngwakọta
• Jiri ọgwụ abụọ maka ọgwụgwọ mbụ ma ọ bụrụ na BP dị 20/10 mmHg karịa ebumnuche. Art. (ya bụ> 160/100 mmHg maka ndị ọrịa nwere ọbara mgbali elu na-enweghị mgbagwoju anya ma ọ bụ> 150/90 mmHg maka ndị nwere ọrịa shuga na ọrịa ndị ọzọ).
• Ọgwụgwọ nke ndị ọrịa nwere ọbara mgbali elu ọkwa 1 na-adịkarị mma ịmalite na monotherapy.
• Otú ọ dị, ihe àmà na-adịbeghị anya na-egosi na uru nke ọgwụgwọ nchịkọta mbụ nwere ike ịgbatị ndị ọrịa nwere ọbara mgbali elu ọkwa 1.

Mmetụta na-adịghị mma nke ọgwụ antihypertensive na ohere nke mkpochapụ ha

Nkwenye
Ebe ọ bụ na ọtụtụ ọgwụ antihypertensive nwere mmetụta ndị na-adabere na dose, monotherapy dị elu nwere ike ibute ihe ọjọọ.
N'ọnọdụ ndị dị otú a, iji belata mmeghachi omume ọjọọ na-adabere na dose, ọ ka mma iji obere ọgwụ mbụ yana ọgwụ antihypertensive ọzọ, ọbụlagodi na enweghị mbelata ọbara mgbali ọzọ.
Otu ihe atụ bụ iji ngwakọta dị ala nke ndị na-egbochi ACE na dihydropyridine CCB na ndị ọrịa na-etolite edema na nnukwu doses nke CCBs.

Nkwenye ọgwụgwọ
ogologo oge na ọgwụgwọ dị mkpa maka njikwa BP. Iji usoro ọgwụgwọ ngwakọta nwere ike ibelata nsogbu a site n'ibelata ọnụ ọgụgụ ọgwụ na ibelata ugboro ole ha na-eji.
Nnyocha e mere n'oge na-adịbeghị anya banyere ihe dị ka ndị ọrịa Kaiser Permanente (USA) 85,000 gosiri na nrapagidesi ike nke ndị ọrịa na ọgwụgwọ na-adabere na ọnụọgụ ọgwụ e nyere ha.

Ngwakọta ọgwụ dị mma • Diuretic
+ ACE inhibitor ma ọ bụ ARB
• Calcium antagonist (dihydropyridine) + BAB •
Calcium antagonist + ACE inhibitor ma ọ bụ ARB •
Calcium antagonist + diuretic Nchikota nke ACE inhibitors, AKs, ARBs nwere imidazoline agonists nnabata.



Uru nke nchikota a kapịrị ọnụ • Ọ
dị mfe ịdepụta na dose titration
• Ịbawanye nnabata onye ọrịa na ọgwụgwọ • Ike nke
mmetụta antihypertensive. Mwepụ nke ohere nke nchịkọta na-enweghị isi



ACE inhibitor + diuretic
Nchikota a kapịrị ọnụ:
• Co-Renitec - enalapril 20 mg + HCTZ 12.5 mg
• Enap H / NL - enalapril 10 mg + HCTZ 25/12.5 mg •
NoliprelA / Noliprel forte / NoliprelA bi-forte
5/5/10mg + indapamide 0.625/1.25/2.5 mg
• Enzix - 10 mg enalapril na 2.5 mg indapamide
• Enziks duo-forte - maka ọgwụgwọ ọbara mgbali elu arterial ogbo III, 20 mg enalapril + 2.5 mg nke indapamide n'ụtụtụ ka edepụtara ya. , na 20 mg ọzọ nke enalapril na mgbede.
Iruzid - lisinopril (irumed) + HCTZ
• Capozid - captopril 25 ma ọ bụ 50 mg + hydrochlorothiazide 15 ma ọ bụ 25 mg)
• Hartil D - ramipril + HCTZ

Angiotensin II receptor blockers + diuretic
Ngwakọta a kapịrị ọnụ:
• Gizaar - losartan 50 mg + HCTZ 12.5 mg •
Co-Diovan - valsartan 80 mg + HCTZ 12.5 mg  

Calcium antagonist + ACE inhibitor
Ngwakọta ejikọtara ọnụ
• ọnụnọ - amlodipine + perindopril A
• Equator - amlodipine + lisinopril
• Tarka - verapamil SR 180 mg + trandolapril 2 mg • Lotrel - amlodipine +
benazepril  •
Aegipres - amlodipine + Enanorm (nitrendipine + enalapril  • Triapin - ramipril + felodipine


Angiotensin II receptor blockers + calcium antagonist
Ngwakọta a kapịrị ọnụ:
• Exforge - valsartan + amlodipine
• Amzaar - amlodipine + losartan
• Twinsta - amlodipine + telmisartan

Calcium antagonist + beta-blocker
egosipụtara karịsịa na ndị ọrịa nwere ọrịa akwara obi
• Ike nke mmetụta antihypertensive na mbelata ọnụọgụ mmetụta n'ihi ihe omume multidirectional
• Nnukwu antihypertensive irè
Ngwakọta edozi:
Logimax - metoprolol succinate 47.5 + felodipine 5 mg.

Amlodipine + bisoprolol = Concor AM
• Bisoprolol: ezigbo arụmọrụ ogologo oge
yana profaịlụ nchekwa amụrụ nke ọma
• Amlodipine: arụmọrụ ogologo oge (n'ime awa 24) na data nchekwa ogologo oge.

Beta-blocker + diuretic
Nchikota a kapịrị ọnụ:
• Tenoric - atenolol 50 mg + chlorthalidone 12.5 mg
• Lopressor - metoprolol 50/100 mg + HCTZ 25/50 mg
• Viskaldix - pindolol 10 mg + clopamid 5 mg
• Lodoz - bisoprolol / 5 mg) na hydrochlorothiazide (6.25 mg)
Mmetụta na-adịghị mma na carbohydrate na lipid metabolism, ike belatara.

A na-atụle ohere nke iji ngwakọta atọ nke ọgwụ antihypertensive na ndị ọrịa na-enwetaghị ọbara mgbali elu mgbe ha na-eji usoro akụkụ abụọ.
Enwetala ọnụọgụ data zuru oke na-egosi ịdị irè na nnabata nke ọgwụgwọ ugboro atọ.
Akụkọ banyere iji ọgwụgwọ nchikota atọ emee laa azụ na 1960-1970s.
 Ọmụmụ ihe nkwado nke Veterans Affairs tụlere ịdị irè nke ngwakọta atọ nke reserpine, hydralazine, na HCTZ.
Ka ọ dị ugbu a, nkwenye nke mkpa ọ dị iji usoro ọgwụgwọ ugboro atọ dabere na nnukwu ọmụmụ ihe.

Ndụmọdụ RMOAG/VNOK maka nchọpụta na ọgwụgwọ ọbara mgbali elu na-ekwu na ndụmọdụ nke ịdepụta ọgwụgwọ antihypertensive ugboro atọ maka ọbara mgbali elu na-eguzogide ọgwụ; A na-amata ngwakọta nke akụkụ atọ ndị a dị ka ihe ezi uche dị na ya:
• ACE inhibitor + dihydropyridine AA + β-AB;
• ARB + ​​dihydropyridine AA + β-AB;
• ACE inhibitor + AK + diuretic;
• ARB + ​​AK + diuretic;
• ihe mgbochi ACE + diuretic + β-AB;
• ARB + ​​diuretic + β-AB;
• dihydropyridine AK + diuretic + β-AB.


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