KARDIOVASKULER
ARIFAH SRI WAHYUNI
081329008616
Hypertension: A Significant CV and
Renal Disease Risk Factor
CAD
CHF
Stroke LVH
Blood
Pressure
Renal disease Morbidity
Disability
Peripheral vascular
disease
National High Blood Pressure Education Program Working Group. Arch Intern Med. 1993;153:186-208.
Regulation of Blood Pressure
• Main coordinating
center is in the
medulla oblongata
of the brain;
medullary
cardiovascular
control center
• Reflex control of
blood pressure
•Baroreceptor
reflex
Factors determining ABP :
■ BP depends on:
1. Cardiac output CO = SV X HR.
2. Peripheral resistance.
3. Blood volume.
Heart rate, stroke volume and cardiac output
The pulse rate is not the only way of measuring the heart.
Stroke volume is the amount of blood pumped
out of the left ventricle per beat.
Diuretics Vasodilators
• Sympatholytic drugs
RAAS
9
DIURETIC
• Adalah obat-obat yang bekerja pada ginjal untuk
meningkatkan ekskresi air dan Na.
CA
H2O + CO2 H2CO3 H2CO3– + H+
B. Penghambat karbonik anhidrase
• Carbonic Anhydrase Inhibitors
(Acetazolamide (Oral) ;
Dorsolamide (Ocular) ;
Brinzolamide (Ocular)
• Mekanisme aksi : Menurunkan
reabsorbsi bikarbonat pada tubulus
proksimal melalui inhibisi katalis
hidrasi CO2 dan reaksi dehidrasi.
Na+ yang meningkat akan dialirkan
nefron distal, meningkatkan
sekresi K
• ESO Acetazolamide: Sedasi,
Acidosis; Renal stone (Phosphate
and Calsium stone) ;
Hyperchloremia, hyponatremia dan
hypokalemia
Thiazide Diuretic
• (e.g.: Thiazides and Thiazide-
like (Indapamide; Metolazone)
• Mekanisme aksi : Menghambat
Na + melalui penghambatan Na+
/ Cl- cotransporter. Terjadi
peningkatan ekskresi Na+ / Cl-
yang disertai H2O, beban Na+
yang meningkat dalam tubulus
distal menstimulasi pertukaran
cotransporter
• ESO : hiponatremia,
hiperglikemia Bagaimana?
hypelipidemia dan
hyperurecemia
Mechanisms of Action: Loop diuretics
Obat ini bekerja dengan
menghambat reabsorpsi NaCl
dalam ansa Henle ascending.
Karena kapasitas absorpsinya yang
besar, maka menyebabkan diuresis
yang lebih besar.
Mekanisme Menghambat
kotransport Na+/K+/2Cl-
2. Side effects:. 3. Therapeutic Uses
a) Edema
Ototoxicity; Hypokalemic
metabolic alkalalosis; b) Acute renal failure
hypocalcemia (hypercalceuria)
and hypomagnesemia; c) Hyperkalemia
hypochloremia; Hypovolemia; d) Hypercalcemia
hyperuricemia (How?);
hypersensitivity reactions.
Potassium-Sparing Diuretics
e.g : amiloride, triamterene, and spironolactone.
Termasuk diureik lemah, aksinya pada saluran
pengumpulcollecting ducts.
5. Contraindications : Hypersensitivity
6. Therapeutic Considerations
• no reflex tachycardia; small 1st dose;
• tidak mengganggu toleransi latihan
• dapat untuk pasien : diabetes, asthma, and/or
hypercholesterolemia
• mild to moderate hypertension
• Sering dikombinasi dengan diuretic, antagonist
4. Adverse Effects
impotence; bradycardia;
fatigue; exercise intolerance;
5. Contraindications
asthma; diabetes; bradycardia;
hypersensitivity
VASODILATOR
Vasodilators
Drugs: hydralazine (Apresoline); minoxidil (Loniten);
nitroprusside (Nipride); diazoxide (Hyperstat I.V.);
fenoldopam (Corlopam)
1. Site of Action- vascular smooth muscle
2. Mechanism of action nitroprusside
NO
fenoldopam
DA
Na+ Ca++ K+ minoxidil
diazoxide
Ca++
hydralazine
Vasodilators, Cont
3. Effect on cardiovascular system vasodilation, decrease TPR
4. Adverse Effects
reflex tachycardia
Increase SymNS activity (hydralazine, minoxidil,diazoxide)
lupus (hydralazine) hypertrichosis (minoxidil)
cyanide toxicity (nitroprusside)
5. Therapeutic Considerations
nitroprusside- iv only
hydralazine- safe for pregnancy
diazoxide- emergency use for severe hypertension
Uses: 1) Moderate hypertension when 1st line fails – with beta-blockers and
diuretics 2) Hypertension in Pregnancy, Dose 25-50 mg OD
Minoxidil :
0 Orally not used any more
0 Topically as 2-5% lotion/gel and takes months to get effects
0 Mechanism in hair growth:
0 Enhanced microcirculation around hair follicles and also by direct
stimulation of follicles
0 Alteration of androgen effect of hair follicles
0 More often in alopecia to promote hair growth
Vasodilators
Hdralazine Minoxidil Diazoxide Na
nitropruside
Contraindicated Contraindicated
in females in diabetic
The Renin-Angiotensin-Aldosterone (RAA) System
Β-BLOCKER
Angiotensin
converting
Blood Renin enzyme SPIRONOLACTON
(ACE)
ACE I
NA+ retention
Growth Vascular H2O retention
factor Sympathetic
smooth muscle K+ excretion
stimulation activation
constriction Mg+ excretion
ANTIHYPERTENSIVE DRUGS
Mechanism of action :
Block AT 1 receptors.
Advantages over ACEI :
They have no effect on bradykinin system: No cough,wheezing
or angioedema.
Complete inhibition of angiotensin action compared with ACEI
Losartan is the specific AT1 blocker
CALCIUM CHANNEL BLOCKERS
Calcium Channel Blockers - Classification
Inhibit calcium influx into arterial smooth muscles & cardiac muscles.
Dihydropyridine group (amlodipine, nifedipine) are more selective as
arteriodilators ( decreasing afterload)
Verapamil &Diltiazem are more selective as cardiac depressant (
decreasing C.O) .
CCB Site of Action
nifedipine
(and other
dihydropyridines)
CCB Action
Cardiovascular
• hypotension, palpitations & tachycardia
Gastrointestinal
• constipation & nausea
Other
• rash, flushing & peripheral edema