Mainly affects large and medium-sized arteries (increased collagen fibers, hyalinization, calcification)

Risk factors: smoking, hyperlipidemia, hypertension, diseases causing secondary hypertension (DM, hyperinsulinemia, hyperthyroidism, nephrotic syndrome), genetic factors, gender and age

Injury-response theory: LDL penetrates into the subendothelial space and is engulfed by macrophages to form foam cells (macrophage-derived); SMC enters to form foam cells (myocyte-derived foam cells); cholesterol crystallizes

Pathological changes

benign hypertension

Malignant hypertension: fibrinoid necrosis of arterioles, proliferative arteriolar sclerosis

installment

Organ disease

Acute infective endocarditis: pyogenic bacteria (Staphylococcus aureus)

Subacute infective endocarditis: viridans streptococci can cause localized or diffuse glomerulonephritis and Osler's nodes

Mitral valve stenosis: the main cause is rheumatic fever, the valve is fish-shaped, and there is a rumble-like murmur in the apical area. In the late stage, it becomes a "pear-shaped heart"

Mitral regurgitation: consequence of rheumatic endocarditis, systolic blowing murmur

Aortic stenosis: the heart becomes shoe-shaped

Aortic regurgitation: diastolic wind-like murmur, patients may have carotid pulse, water pulse, water pipe shooting sound and capillary pulse.

Neuro-humoral regulatory mechanisms (RAAS, sympathetic-adrenomedullary system, natriuretic peptide system)

The heart itself compensates (accelerated HR, cardiac tensogenic dilation, enhanced myocardial contractility, ventricular remodeling: concentric hypertrophy, pressure load, eccentric hypertrophy, volume load)

Extracardiac compensation: increased blood volume, blood flow redistribution

Decreased myocardial contractile function: changes in myocardial contraction-related proteins (denaturation, necrosis), myocardial energy metabolism disorders (energy generation, energy reserves, energy utilization), myocardial excitation-contraction coupling disorders (sarcoplasmic reticulum calcium transport dysfunction, extracellular Calcium ion influx disorder, troponin and calcium ion binding disorder)

Myocardial diastolic dysfunction: active diastolic dysfunction (insufficient ATP supply), passive diastolic dysfunction (reduced ventricular compliance)

Uncoordinated diastolic and systolic activities of various parts of the heart

Ia (sodium ion blocking drug)

Ib (beta blocker drug)

Ic (drug that prolongs action potential duration, potassium ion blockade)

ID (calcium channel blocker)

ACEI (Puri): protects the heart, kidneys, and blood sugar, reverses cardiovascular remodeling (preferred), causes irritating dry cough, hyperkalemia (not combined with potassium-sparing diuretics), angioedema, severe renal failure, and bilateral Renal artery stenosis, contraindicated in pregnant women

AT1-R (-) (Satan): No dry cough, can promote uric acid excretion

A (ACEI, ARB) Pril, Sartan

B (β-receptor blocker) Lorol: patients with angina pectoris and tachycardia; young people with hypertension

C (calcium channel blocker) dipine

D (diuretics): reduce blood volume in the early stage, relax smooth muscles in the later stage, and inhibit sodium and calcium exchange

Central antihypertensive drugs: excite α2 receptors on the postsynaptic membrane of the nucleus tract solitarius in the dorsal medulla, and imidazoline I1 receptors in the ventrolateral region of the rostral medulla.

Cardiac glycosides: positive inotropy, negative frequency, negative conduction, oxygen-reducing sodium-potassium ATPase, treatment of atrial fibrillation and atrial flutter ADR: gastrointestinal reactions (most common), central nervous system reactions (visual disturbance, redness) (indications for drug withdrawal), sinus tachycardia (indications for drug withdrawal), bradycardia, atrioventricular block (rescued by atropine), sinus tachycardia, ventricular fibrillation (rescued by phenytoin)

Statins (lowering TC LDL) HMG-CoA reductase Myalgia, myositis, rhabdomyolysis Not suitable for use by pregnant women and patients with abnormal liver and kidney function

Cholestyramine: Promote Ch consumption, reduce lipid absorption, gastrointestinal symptoms, hyperchloraemia

Fibrates: Comprehensive reduction of blood lipids. Rhabdomyolysis (combined with statins), pregnant women and children, and those with renal insufficiency are prohibited.

Nitroglycerin dilates blood vessels and can cause reflex hypertension (combined with propranolol). Nifedipine is suitable for variant angina.