1

2

3

4

5

6

Coronary atherosclerosis/ Thrombous formationobstruction

ischemia

Compensatory /physiologic mechanisms -NO, bradykinin,histamin, thromboxane A2

-sympathetic activation, RAAS

Physiological changes: HR (oxygen demand) Vascular Resistances

DBP(coronary BF), SBP (wall tension)

Corornary atherosclerosis/ Thrombous formationobstruction

ischemia

7

CBF= Cerebral perfusion pressure (CPP) / cerbrovascular resistance (CVR)

CBF= 50 ml /100 g / min

CPP= MAP - ICP

AUTOREGULATION

If auto-reg is impaired and ICP is increase; small changes in MAP CPP

8

9

10

All-cause Mortality

11

Num

ber o

f R

CTs

Number of RCTs

0

1

2

3

4

5

65-6

7 68

-70

71-7

3 74

-76

77-7

9 80

-82

83-8

5 86

-88

89-9

1 92

-94

95-9

7 98

-00

01-0

3 04

-06

07-0

9

15 RCTS (N=869)

Hypertensive emergencies

0 2 4 6 8 10

ACE-inhibitors

B-blockers

Calcium CB

Nitrates

Alpha-1 blockers

Diuretics

Direct VD

Dopamine agonist

Class of Drug

Hypertensive emergencies

12

13

14

  Nitrates vs. dopamine agonist: decrease in SBP of 14 mm Hg

  CCB vs. ACE-I: decrease in DBP of 8 mm Hg

increase in HR of 22 bpm.   CCB vs. nitrates:

increase in HR of 11 bpm

15

16

17

18

19