Title Lijekovi za liječenje arterijske hipertenzije
Title (english) Drugs for treatment of arterial hypertension
Author Lucija Romić
Mentor Iveta Merčep (mentor)
Committee member Srećko Marušić (predsjednik povjerenstva)
Committee member Jasenka Markeljević (član povjerenstva)
Committee member Iveta Merčep (član povjerenstva)
Granter University of Zagreb School of Medicine (Department of Internal Medicine) Zagreb
Defense date and country 2019-07-12, Croatia
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Internal Medicine
Scientific / art field, discipline and subdiscipline BIOMEDICINE AND HEALTHCARE Clinical Medical Sciences Clinical Pharmacology and Toxicology
Abstract Arterijska hipertenzija najveći je javnozdravstveni problem, kako kod nas, tako i u svijetu. Definicija arterijske hipertenzije je vrijednost arterijskog tlaka iznad 140/90 mmHg. Klasifikacija arterijske hipertenzije, kao i potreba za uvođenjem terapije prema smjernicama Europskog društva za arterijsku hipertenziju i Europskog društva za kardiologiju iz 2007. godine zasniva se, ne samo na vrijednostima krvnog tlaka nego i na ukupnom KV riziku. Lijekove za liječenje arterijske hipertenzije možemo podijeliti u pet glavnih skupina: diuretici, β blokatori, blokatori kalcijskih kanala, ACE inhibitori i blokatori angiotenzinskih receptora. Diuretici su lijekovi koji smanjuju volumen ekstracelularne tekućine povećavanjem izlučivanja soli i vode putem bubrega, a za liječenje arterijske hipertenzije su najpogodniji tiazidski diuretici. Diuretici Henleove petlje se koriste u liječenju hipertoničara s kongestivnim zatajenjem srca i kroničnom bubrežnom bolešću. β blokatori su lijekovi koji se vežu selektivno na β-adrenergične receptore što rezultira blokadom β-adrenergične stimulacije u različitim organima, a imaju prednost u hipertoničara s anginom pektoris, zatajivanjem srca i nedavnim infarktom miokarda. Mehanizam djelovanja antagonista kalcija je vazodilatacija arteriola, a korisni su u stanjima poput angine pektoris, trudnoće i izolirane sistoličke hipertenzije kod starijih osoba. ACE inhibitori blokiraju angiotenzin konvertirajući enzim koji potiče pretvaranje angiotenzina I u angiotenzin II koji je jak vazokonstriktor. Povoljno djeluju na metabolizam glukoze, a posebno su korisni u liječenju hipertoničara sa kroničnom bubrežnom bolešću. Osnovni stav kod monoterapije nasuprot kombinacijskog liječenja jest taj da monoterapija može biti početno liječenje za blago povišen arterijski tlak u bolesnika s niskim ili umjerenim ukupnim kardiovaskularnim rizikom. Prednost bi trebalo dati kombinaciji dvaju lijekova u malim dozama kao prvom koraku u liječenju kada su početne vrijednosti arterijskoga tlaka u rasponu stupnjeva 2 i 3 hipertenzije, ili kad je ukupni kardiovaskularni rizik visok ili vrlo visok. Hipertenzivne krize dijele se na hipertenzivne emergencije koje se liječe intravenskom primjenom lijekova i na hipertenzivne urgencije koje se liječe peroralnom primjenom lijekova.
Abstract (english) Arterial hypertension is the biggest public health problem in Croatia and abroad. The definition of arterial hypertension is the value of the arterial pressure above 140/90 mmHg. Classification of arterial hypertension and the need to introduce therapy according to the 2007 European Society of Hypertension and European Society of Cardiology guidelines is based on, not only on blood pressure values, but also on total cardiovascular risk. The antihypertensive drugs can be divided into five major groups: diuretics, β blockers, calcium channel blockers, ACE inhibitors and angiotensin receptor blockers. Diuretics are drugs that decrease the volume of the extracellular fluid by increasing renal salt and water excretion and thiazide diuretics are the most appropriate for the treatment of arterial hypertension. Loop diuretics are used in the treatment of hypertensive patients with congestive heart failure and chronic kidney disease. β blockers are drugs that bind selectively to β-adrenergic receptors resulting in blockade of β-adrenergic stimulation in different organs, and have the advantage in hypertensive patients with angina pectoris, heart failure, and recent myocardial infarction. Mechanism of action of calcium antagonists is vasodilation, and they are useful in conditions such as angina pectoris, pregnancy and isolated systolic hypertension in the elderly. ACE inhibitors block angiotensin converting enzyme that promotes conversion of angiotensin I to angiotensin II which is a strong vasoconstrictor.They have a positive effect on glucose metabolism, and are especially useful in the treatment of hypertensive patients with chronic renal disease. The main standpoint of monotherapy versus combination therapy is that monotherapy may be an early treatment for slightly elevated arterial pressure in patients with low or moderate total cardiovascular risk. Preference should be given to the combination of the two drugs in small doses as the first step in treatment when the initial arterial pressure values range from degrees 2 and 3 to hypertension, or when the overall cardiovascular risk is high or very high. Hypertensive crises are divided into hypertensive emergencies that are treated by intravenous administration of drugs and in hypertensive urgency being treated by oral administration of drugs.
Keywords
arterijska hipertenzija
antihipertenzivi
monoterapija
kombinacijsko liječenje
hipertenzivna kriza
Keywords (english)
arterial hypertension
antihypertensives
monotherapy
combination therapy
hypertensive crisis
Language croatian
URN:NBN urn:nbn:hr:105:454382
Study programme Title: Medicine Study programme type: university Study level: integrated undergraduate and graduate Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resource Text
File origin Born digital
Access conditions Open access
Terms of use
Created on 2020-04-28 13:55:40