| Therapies for perioperative hypertension: pharmacodynamic considerations. | |
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MedLine Citation:
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PMID: 8480501 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Cardiac output (CO) and peripheral resistance (PR), the two major determinants of systemic arterial blood pressure (BP), are regulated principally by the adrenergic (ADR) and renin-angiotensin-aldosterone (RAA) systems. Antihypertensive medications ultimately decrease CO, PR, or both, by acting at various sites in the ADR and RAA pathways or affecting cardiovascular functions directly. Beta-ADR-receptor blockers decrease heart rate (HR) and stroke volume (SV) by preventing the cardiostimulating effects of catecholamines and inhibiting renin release. Alpha-ADR-receptor blockers prevent the vasoconstricting effects of catecholamines and reduce PR (afterload). Angiotensin-converting enzyme inhibitors (ACEI) block the formation of angiotensin, a potent peripheral vasoconstrictor and aldosterone releaser. Hence, ACEI cause a decrease in both PR and CO, the latter by preventing salt and water retention by aldosterone, thereby reducing plasma volume and venous return. Direct vasorelaxation and, thus, a fall in PR can be achieved by vasodilators. These include drugs (e.g. calcium antagonists) that prevent the entry of calcium ions into vascular smooth muscle cells, and others (e.g. nitrovasodilators) that boost the intracellular levels of vasodilating second messengers (e.g. cyclic GMP). Antihypertensives from different classes are often combined to improve the ratio between therapeutic and adverse effects. |
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Authors:
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R Levi |
Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S.; Review |
Journal Detail:
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Title: Acta anaesthesiologica Scandinavica. Supplementum Volume: 99 ISSN: 0515-2720 ISO Abbreviation: Acta Anaesthesiol Scand Suppl Publication Date: 1993 |
Date Detail:
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Created Date: 1993-05-27 Completed Date: 1993-05-27 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 0370271 Medline TA: Acta Anaesthesiol Scand Suppl Country: DENMARK |
Other Details:
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Languages: eng Pagination: 16-9 Citation Subset: IM |
Affiliation:
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Department of Pharmacology, Cornell University Medical College, New York, New York. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antihypertensive Agents
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therapeutic use* Drug Interactions Humans Hypertension / drug therapy* Intraoperative Complications / drug therapy* Postoperative Complications / drug therapy* |
| Grant Support | |
ID/Acronym/Agency:
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HL 34215/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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