I. Diuretics 1. Clinical application in the 1950s. Mainly thiazides. Hydrochlorothiazide is commonly used in China. 2, antihypertensive mechanism: blood volume reduction, reduced cardiac output, extracellular fluid volume shrinkage, total peripheral resistance decreased, vascular sensitivity to elevating substances decreased. 3, disadvantages: cholesterol, triglycerides, blood glucose and uric acid increase. HDL-C, blood potassium decrease. Decreased insulin sensitivity. Decrease the dose (<25mg/day), the adverse effects will be reduced. 4. Advantages: cheap. Basic treatment of antihypertensive drugs. It is often missing when combined with drugs. Beneficial to osteoporosis. Antihypertensive and lipid-lowering on prevention of myocardial infarction trial (ALLHAT): the effect of lowering blood pressure and reducing complications compared with CCBs,ACEIs, there is more than ever. 5, other diuretics: furosemide: azotemia or uremia when applied. Aminoglutethimide, aminoclopramide: mostly used in combination with thiazide diuretics. Antiseptic: selected for patients with combined chronic heart failure. Second, β-blockers (BBs) 1, clinical application in the 1960s. 2, many varieties, the antihypertensive effect is basically similar. 3.Varieties with intrinsic sympathetic activity: small effect on blood lipids and heart rate. 4, bronchial asthma, bradycardia, heart block: prohibited. 5.Pheochromocytoma: cannot be applied alone. 6.Commonly used varieties: Atenolol, Medrolol, Bisoprolol, etc. 3.Calcium antagonists (CCBs) 1.Clinical application in the 70s. 2, no metabolic and electrolyte adverse effects. 3, antihypertensive mechanism: inhibition of calcium ions into the cell, intracellular calcium ion concentration decreases, vasodilation, total peripheral vascular resistance decreases. The representative drugs are divided into 3 major categories: 1. Phenylalkylamines Verapamil: Inhibits myocardial contraction and conduction. The antihypertensive effect is inferior to that of dihydropyridines. Effective for supraventricular arrhythmias. 2, benzothiazepines. Diltiazem: Inhibition of myocardial contraction and conduction is lighter than verapamil. Coronary heart disease, angina pectoris is effective. 3, dihydropyridine class. (1) The name ends with "diphenhydramine". (2) nifedipine: antihypertensive efficacy is certain. Some people think it will cause increased myocardial infarction, not recognized. (3) Many varieties: nifedipine, nicardipine, felodipine, amlodipine, lacidipine, etc. (4) Long-acting varieties are used. (5) Nicardipine is available as an injection for acute cases. IV. Angiotensin-converting enzyme inhibitors (ACEI) 1, clinical application in the 80s. 2.Cough is the main adverse effect. It is the reason why these drugs cannot be applied. 3, combined with heart failure, myocardial infarction, diabetes mellitus, preferred. 4, many varieties, antihypertensive effect, adverse reactions are similar. Each drug has pharmacological and pharmacokinetic characteristics. 5, renal artery stenosis (bilateral stenosis or isolated renal stenosis), hyperkalemia, women preparing for pregnancy is prohibited. 6. Most are precursor drugs. Transformed into active products in the liver to have a hypotensive effect. 7, many varieties, the name ends with "Pulley". 8. Captopril, Enalapril, Benazepril, Lenopril, Betopril, Cilazepril, Fosinopril, etc. V. Angiotensin II receptor antagonist (ARB) 1, the latest class of antihypertensive drugs. The first one is Crosartan, which was approved for marketing by the FDA in 1995. 3.Application indications and contraindications are the same as ACEIs. 4.It has the advantage of no adverse effects of cough. 5.New varieties keep appearing. Valsartan, Irbesartan, Candesartan, etc. VI. α-blockers 1.Phenobarbital, Phentolamine: Internal medicine treatment of pheochromocytoma. 2. α1-blockers: prazosin, terazosin, doxazosin, uradil, etc. Improve lipid metabolism and prostatic hyperplasia. The antihypertensive effect is not satisfactory. There is standing hypotension (first dose reaction). 3. Uladil is available as an injection for acute cases.