Taiwanese Antihypertensives classification抗高血壓藥品分類

• 300年前的人大概活到30歲，今日的平均壽命大大延長，有90%的人會得高血壓 。

• 目標:140/90(/80沒有evidence)

• 十法則:Jama:把高血壓的藥分成五類，一種藥可以下降10mmHg血壓，double dose也只能再下降2mmHg左右，要配伍另外一種藥。

定義

治療Hypertension的藥物

分類

• diuretics
• Sympathoplegic agents and related drugs
  • centrally acting sympathoplegic drugs
    • clonidine
    • guanidines
    • methyldopa
  • peripherally acting sympathoplegic drugs
    • autonomic ganglion blockers
    • adrenergic neuron-blocking agent
  • adrenoceptor anatagonist
• direct vasodilators
• agents blocking production or action of angiotensin
• 平肝息風藥:治療肝陽上亢造成的高血壓

JAMA把DM用高血壓藥分成五類

• ACEI
• ARB
• CCB
• diuretics
• Beta-blocker(pure antagonist)

ADR

• ADR以以下藥物族群分類，並以此選擇配伍對象
  • diuretics
  • centrally acting sympathoplegic drugs
  • autonomic ganglion blockers
  • adrenergic neuron-blocking agent
  • adrenoceptor antagonist: alpha-blocker
  • adrenoceptor antagonist: beta-blocker
  • direct vasodilators
  • agents blocking production or action of angiotensin

療程

• 國際guildline:JNC7
• RxT
  • now:先用A或B(ACEI or ARB)(不並用,monotherapy)，如果沒效加上C或D(CCB或diuretics, ditherapy)，還是沒效則A/B+C+D(tritherapy)。
  • Old:首選藥通常都是利尿劑，如果不是第一個藥通常也是第二個。但是這其實是美國政府考慮到經濟和保險業者而影響的結果，國考仍然寫利尿劑，但是
    • 年輕人:AB-ACEI和ARB
    • 老人:CD-CCB和利尿劑
• pregnancy-induced hypertension
  • 但是妊娠高血壓第一線用藥是methyldopa
  • preclapsia和eclapsia第一線用藥是hydralazine

延伸學習

• 高血壓
  • diuretics
  • centrally acting sympathoplegic drugs
  • autonomic ganglion blockers
  • adrenergic neuron-blocking agent
  • adrenoceptor anatagonist: alpha-blocker
  • adrenoceptor anatagonist: beta-blocker
  • direct vasodilators
  • agents blocking production or action of angiotensin
• 抗心絞痛
  • adrenoceptor anatagonist: beta-blocker
  • CCB
• CHF
  • diuretics
  • adrenoceptor anatagonist: beta-blocker
  • agents blocking production or action of angiotensin
• 慢性腎臟病
  • agents blocking production or action of angiotensin
• BPH
  • adrenoceptor anatagonist: alpha-blocker
• pulmonary artery hypertention肺動脈高血壓:最後會變成right heart dysfunction 摘自2013高雄榮總藥師再教育阮綜合醫院心臟內科林少琳醫師，studytogether整理，若有錯誤請不吝指正，謝~
  • CCB:diltiazem、nifedipine
    • use only when demostrated vasoreactivity in RHC(about 10% or less of patients)
    • only 50% of patients maintain response to CCB
    • titrate up to maximum tolerated dose
    • 配伍禁忌:systemic hypotention、FC IV patients、severe right heart failure
  • endothelin receptor antagonist(ETRA)(targets endothelin-1 receptor on endothelium and vascular smooth muscle):
    • bosentan(Tracleer)(recommended laboratory monitoring:liver function testing prior to initiation of treatment and monthly、hemoglobin(prior to initiation of treatment and "after 1 month, then every 3 month."))(teratogenic致畸胎、lower sperm)
    • ambrisentan(Letairis)(ET-A selective, relatively less increase in transaminase(GPT) than bosentan)(recommended laboratory monitoring:liver function testing prior to initiation of treatment and monthly)