The 2014 US Guidelines for Adult Hypertension Treatment (JNC8) recommend four categories of antihypertensive drugs: thiazide diuretics, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB) and calcium channel antagonists (CCB).
Among them, ACEI and ARB drugs play a very important role in the treatment of hypertension. From the doctor’s point of view, they are [precision guided weapons] among antihypertensive drugs. The functions of these two drugs are somewhat similar. Let’s introduce them together.
- ACEI antihypertensive drugs are usually named after [XX], such as captopril, enalapril, fosinopril, lisinopril, peridopril, etc. ARB is usually called [sartan] antihypertensive drugs, including telmisartan, losartan, valsartan, candesartan, irbesartan, etc.
Precision guided hypotension
The antihypertensive effect of these two drugs is related to [angiotensin]. It is not difficult to see from the name that this thing makes blood vessels tense and is directly related to the contraction of blood vessels and the increase of blood pressure.
Under normal conditions, angiotensin is like a signal directing vasoconstriction, which has very important physiological functions, such as maintaining blood pressure and tissue blood supply when blood volume is insufficient. However, under pathological conditions, the signal will become too much, too strong, or too messy, leaving blood vessels at a loss. It is strange that blood vessels are highly nervous every day and do not produce hypertension!
How do these two drugs deal with angiotensin?
A simple understanding of ACEI is to prevent the generation of angiotensin, so blood vessels will not be tense. ARB, on the other hand, steals a beam for a column, allowing a fake to occupy the signal receiver of angiotensin. The signal cannot be transmitted, and of course the blood vessels will not be nervous.
It can be seen that ACEI and ARB are actually two checkpoints on a road. ACEI is in the front and ARB is in the back, both of which are anti-angiotensin. It seems that the effect of using the two together is more effective, but it is not. When using ACEI, 99% of the signals have been blocked, and at the risk of side effects of more than one drug, ARB is too uneconomical to solve the 1% leakage.
Protect the heart and kidneys
On the premise of suffering from hypertension, ACEI or ARB should be used first if there are the following conditions.
- Heart problems such as ventricular hypertrophy, cardiac enlargement and cardiac hypofunction; Diabetes mellitus; Urine protein positive caused by minor renal dysfunction.
ACEI and ARB can prolong the life span of patients with heart failure, especially ACEI, which is superior to other vasodilators and cardiotonic drugs in protecting cardiac function by reducing the production of angiotensin II at the source. The combination of ACEI and diuretics is a very important treatment scheme for hypertension with heart failure.
ARB has more advantages in controlling urinary protein positive caused by hypertensive nephropathy or diabetic nephropathy.
It should be noted that some patients may have intolerable dry cough when taking ACEI. At this time, ARB should be changed in time to effectively solve this problem.
Good antihypertensive weapons also have side effects.
Any drug will have side effects while producing therapeutic effects, ACEI and ARB are no exception.
In addition to the dry cough mentioned above, the side effects of ACEI may also cause the increase of serum creatinine, the increase of blood potassium, the decrease of liver function, angioneurotic edema and the impact on fetal development.
So some people cannot use ACEI drugs:
- Patients with kidney diseases who already have elevated serum creatinine before taking the drug cannot use it. Patients with hyperkalemia cannot use it when the blood potassium is not controlled at a safe level. People with poor liver function need to be cautious. Pregnant women are forbidden.
Except that ARB rarely causes dry cough, other side effects are similar to ACEI, but ARB has the risk of granulocytopenia and rhabdomyolysis. If problems are found by blood routine examination during taking ARB, or muscle soreness occurs, you must see a doctor in time.
Combination of drugs is a good partner.
At the beginning of the article, several kinds of antihypertensive drugs are mentioned. If these antihypertensive drugs are used in combination with appropriate schemes, they will sometimes have better effects. The same is true for ACEI and ARB drugs, which are good partners for combined use with various antihypertensive drugs.
- Combined with diuretics, it is suitable for hypertension complicated with heart failure, simple systolic hypertension and hypertension in the elderly. With calcium channel antagonists (CCB, Dipine antihypertensive drugs) in combination, It is suitable for patients with hypertension nephropathy, hypertension complicated with coronary heart disease, hypertension complicated with atherosclerosis, The effective control rate of blood pressure can reach more than 80% when the two drugs are combined, and some side effects of dipine antihypertensive drugs can be relieved at the same time. It is very suitable for hypertension with myocardial infarction, hypertension with heart failure, hypertension with tachycardia when used together with receptor blockers.
A good union, like the best partner, can produce twice the result with half the effort!
To learn about other antihypertensive drugs, please click on the following link:
> > Dipine, the most widely used antihypertensive drug
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