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LodozKombinasi Ultra Low dose ; Bisoprolol + HCT 6,25mg

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Lodoz ; unik dan rasional

LODOZmengandung

Bisoprolol & Hydrochlorothiazide dalam

dosis subtherapeutik /ULTRA LOW-DOSEBisoprolol 2,5 mg ( dosis umum )

HCT 6,25 mg ( dosis umum )

Meningkatkan respond rate

Profile efek samping yang lebih baik

compliance/ kepatuhan pasien yang meningkat

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A Goal of AntihypertensiveTherapyBlood Pressure :Cardiac Output X Peripheral Resistance

Therefore, a primary goal of antihypertensivetherapy perhaps should be to reduce

sympathoadrenal activity and plasma

catecholamine levels - at the very least,antihypertensive drugs should not increase them.

Izzo Am J Hypertens 1989; 2: 305S- 312S

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Causes of Sympathetic NervousSystem (SNS) Activation

SNSActivation

GeneticFactors

AcutePhysicalStressors

Diet

PsychosocialStress

Heart

rate

Cardiac

output

Blood

pressure

Platelet

aggregation

Catecholamine levels

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-Antagonist may be either 1-cardioselective ornon-cardioselective (1- 2 antagonism).

Bradycardia

Negative inotropy

Less

bronchopasm

GOOD ANTIHYPERTENSIVE EFFECT

1-SELECTIVE

Metabolic

Fewer peripheral effects

Circulatory

NONSELECTIVE

(1-2)Similar cardiac and antihypertensive effects

More marked pulmonary and peripheral effects

Sinus rate Renin inhibiton

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Organ Receptor-subtype Physiological effect

Heart 1 >>>>2 Heart rate , contractility ,conduction velocity and automaticity

Gastro-intestinal tract 1 , 2 Smooth muscle tone Bronchial tract 2 Smooth muscle tone Uterus 2 Smooth muscle tone Blood vessel 2 Smooth muscle tone Kidney 1 Renin release Fat tissue 2 > 1 (2:1), (3) Lipolysis Pancreas (-cells) 2 , (3) Insulin release Liver 2 Glycogenolysis

Gluconeogenesis Skeletal muscle 2 Glycogenolysis

K+ uptake

Tremor

Thyroid gland 2 T4

T3

Distribusi & fungsi of -adrenoceptors

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Type II diabetes mellitus

Insulin resistance Insulin levels

Norepinephrine release

Ventikular

arrhythmias PRA Angiotensin II

1 stimulation-induced cardiacand coronary artery damage

( atheroma ) Blood pressure+ non-dipping

at night

Intra-giomerularpressure

+ nephroathy

PTA, plasma renin activity

Cruickshank JM. Hypertension and diabetes:a fateful alliance. Satellite Symposium from XXII Congress of the European Society

of Cardiology. Amsterdam, 26-30 August 2000

BENEFIT 1 SELECTIVEFOR DM HYPERTENSION

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AKTIFASI SISTEM. SYMPATIS

BISOPROLOL

RENAL HEART

( JUXTAGLOMEROLUS )( 1 ) ( 1 > 2 )

INCREASE RENIN HEART RATE

ANGIOTENSINOGEN INCREASEBLOOD PRESSURE

RENIN

ANGIOTENSIN I

ACE

ANGIOTENSIN I I

VASOKONTRIKSI RETENSI Na + H2 0

INCREASEBLOOD PRESSURE

Elevated HR is linked to or predicts :

Higher hypertensive risk Ischaemia in coronary disease

Coronary heart disease

Cardiovascular mortality

Palatini & Julius; J. Hypertens., 1997