aceiandcardiovascular disease课件

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1、ACEI&CardiovasculardiseaseNeurohormonalActivationinMyocardialIschemicandHeartFailureAfterRemme.EurHeartJ.1998;19(SupplF):F62-F71.MyocardialischemiaRASactivationSystemicVasoconstrictionVasoconstrictionofcoronaryarteries(bothlargeandsmall)SNSactivationAdrenergictoneMVO2Renin-AngiotensinAldostero

2、neSystemcirculatinghormonalsystemlocalendogenoustissuehormonalsystemwithautocrineandparacrineeffectsneurotransmitterandneuromodulatorActionofAngiotensinIITISSUEAFFECTEDACTIONArteryStimulatescontraction,growthAdrenalStimulatessecretionofaldosteroneKidneyInhibitsreleaseofreninIncreasestubularreabsor

3、ptionofsodiumStimulatesvasoconstrictionReleaseprostaglandinsBrainStimulatesthirstandthereleaseofvaospressinSympatheticIncreasescentralsympatheticoutflownervousFacilitatesperipheralsympathetictransmissionsystemIncreasesadrenalreleaseofepinephrineHeartIncreasescontractilityandventricularhypertrop

4、hyGoodfriendetal.NEJM1996;334:1649-1654.CardioprotectiveEffectsofACEIRestoringthebalancebetweenmyocardialoxygensupplyanddemandReductioninLVpreloadandafterloadReductioninLVmassReductioninsympatheticstimulationBeneficialeffectonreperfusioninjury*EvaLonn,etal.Circulation1994;90(4):2056-69.*Notdemonstr

5、atedconclusivelyinhumansAngiotensinIAngiotensinII1.vasoconstriction(systemicandcoronary)2.sympatheticnervoussystem(centralandperipheral)ACEIVasculoprotectiveEffectsofACEIDirectantiatherogeniceffect*Antiproliferativeandantimigratoryeffectsonsmoothmusclecells,neutrophilsandmononuclearcellsImprovement

6、and/orrestorationofendothelialfunctionProtectionfromplaquerupture*AntiplateleteffectsEnhancementofendogenousfibrinolysis*AntihypertensiveeffectsImprovementinarterialcomplianceandtoneEvaLonn,etal.Circulation1994;90(4):2056-69.*NotdemonstratedconclusivelyinhumansUseofACEIintheManagementofCardiovascu

7、larDiseaseHypertensionSevereCHFModerateLVdysfunctionwithorwithoutMIHigh-riskpatientsformajorcardiovascularevents-receptorantagonists&HeartfailureHeartFailureSocietyofAmerica(HFSA)PracticeGuidelines.JCardia