At present, there are about 5 categories of commonly used antihypertensive drugs, and some are compound preparations with various effective ingredients. Today, I would like to give you a brief introduction. I hope you have some understanding of the drugs you are taking.
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Diuretic
Diuretics, a classic antihypertensive drug, are suitable for patients with more salt intake, elderly hypertension, simple systolic hypertension, accompanied by heart failure and lower limb edema, and are also one of the basic drugs for refractory hypertension.
Commonly used drugs:
Diuretics commonly used to control blood pressure are mainly thiazide diuretics, such as hydrochlorothiazide. In addition, there is indapamide, which has similar effects to hydrochlorothiazide.
Small doses of thiazide diuretics (such as hydrochlorothiazide 6.25 ~ 25mg) have little effect on metabolism, and can significantly increase the antihypertensive effect when combined with other antihypertensive drugs (especially ACEI or ARB, such as enalapril, valsartan, etc.).
Adverse reactions:
The adverse reactions of these diuretics are hypokalemia and hyperuricemia. Weak fatigue, abdominal distension and palpitation occur. In order to avoid adverse reactions, these drugs are usually used in small doses.
Patients taking such drugs can use low sodium salt with high potassium content instead of common salt when necessary, and can also eat more potassium-rich foods such as bananas, oranges and green leafy vegetables.
Diuretics are not recommended for gout patients.
Potassium-preserving diuretic:
Potassium-preserving diuretics such as amiloride and aldosterone receptor antagonists (such as spironolactone) can sometimes be used to control blood pressure. Sodium drains without increasing potassium excretion. There is a risk of hyperkalemia when combined with other antihypertensive drugs with potassium preservation effect, such as ACEI or ARB. Therefore, if spironolactone is used to reduce blood pressure, enalapril and valsartan are not recommended to be used at the same time.
Long-term application of spironolactone may lead to adverse reactions such as male breast development.
Calcium antagonist
Calcium antagonist is a widely used antihypertensive drug. It is suitable for elderly hypertension, simple systolic hypertension, carotid intima-media thickening or plaque, stable angina pectoris, stroke and peripheral vascular diseases.
Commonly used drugs
Commonly used long-acting calcium antagonists include: nifedipine controlled-release tablets, nifedipine sustained-release tablets III, amlodipine, levamlodipine, felodipine, lacidipine;
Medium-acting calcium antagonist: usually taken twice a day in the morning and evening, commonly used are nitrendipine and nifedipine sustained-release tablets (I, II);
Short-acting calcium antagonist: usually 2-3 times/day, such as nifedipine.
The drugs mentioned above are dihydropyridine calcium antagonists, which can be used in basically all hypertension patients.
Adverse reaction
Individual patients will have headache, facial flushing, lower limb edema, palpitation and other adverse reactions. Patients with lower limb edema, combined application of small dose diuretics or ACEI/ARB drugs can reduce lower limb edema.
A few patients will have oral problems such as gingival hyperplasia. Reminding patients to pay attention to oral hygiene can effectively prevent or reduce the degree of gingival hyperplasia.
Short-acting preparations, such as nifedipine, can cause tachycardia, so medium-acting preparations, such as sustained-release tablets or controlled-release tablets of nifedipine, are generally selected.
For patients with heart failure, faster basic heart rate or arrhythmia, it is better not to use dihydropyridine calcium antagonists alone.
Other
Non-dihydropyridine calcium antagonists mainly include verapamil and diltiazem, which can also be used to reduce blood pressure, but their application is not so extensive. The side effects are that these two drugs may affect cardiac function and cause arrhythmia.
Before using such drugs, electrocardiogram examination should be carried out, and electrocardiogram should be reexamined after 2 ~ 6 weeks of medication.
ACEI and ARB
ACEI: Angiotensin converting enzyme inhibitor
It is suitable for patients with diabetes, chronic kidney diseases (except severe renal insufficiency), heart failure, cardiac insufficiency after myocardial infarction, prevention of atrial fibrillation, obesity and stroke.
Commonly used drugs
Long-acting drugs include benazepril, fosinopril, perindopril, ramipril and imidapril.
Enalapril is the main medium-effect drug.
Short-acting drugs mainly include captopril, which is usually used 2-3 times/day if taken for a long time in order to reduce blood pressure quickly when blood pressure increases.
Adverse reaction
The most common adverse reaction of this kind of drug is dry cough, which is generally not very serious. If you can’t stand it, you can change dressings. After dressing change, dry cough will disappear.
When individuals, especially the elderly, take this kind of medicine for the first time, hypotension may occur if the dosage is too large, so they usually take it at a small dosage. According to the antihypertensive effect, gradually adjust the dosage.
Very few patients with allergic constitution will suffer from swollen mouth and tight throat (vascular edema) after taking it. This is a relatively serious allergic reaction, which requires immediate treatment in hospital and the use of antiallergic drugs.
Pregnancy, hyperkalemia or double renal artery stenosis, and hypertension patients with angioedema in the past are forbidden to use such drugs. Other patients need regular reexamination of blood potassium and creatinine when applying them.
ARB: Angiotensin II Receptor Antagonist
It is roughly the same as ACEI and its applicable population, especially suitable for patients with obvious dry cough with ACEI drugs.
Commonly used drugs: losartan, valsartan, irbesartan, telmisartan, candesartan and olmesartan.
Receptor blocker
Receptor blockers mainly reduce blood pressure and heart protection by slowing down heart rate and reducing myocardial oxygen consumption. They are more suitable for young and middle-aged patients with fast heart rate, and are more suitable for patients with coronary heart disease, angina pectoris, myocardial infarction and chronic heart failure.
Commonly used drugs
Long-acting drugs: Bisoprolol and metoprolol sustained-release tablets, usually once per day.
Medium-and short-acting drugs: metoprolol tablets, carvedilol, aroprolol, atenolol, etc.
Adverse reaction
Common adverse reactions mainly include fatigue, cold limbs, bradycardia, etc.
It should be noted that if bradycardia occurs during taking the medicine and the medicine cannot be stopped suddenly, the heart rate will obviously increase (rebound phenomenon) after stopping the medicine, and the patient will feel flustered. If there is coronary heart disease in the past, sudden withdrawal of drugs will induce angina pectoris attacks. If there is discomfort, slowly and gradually reduce the drug dose before stopping the drug.
Patients with glucose and lipid metabolism abnormalities such as diabetes and hyperlipidemia generally do not choose receptor blockers first, and highly selective receptor blockers (such as bisoprolol and metoprolol) can be selected when necessary;
Receptor blockers are forbidden in patients with asthma or high atrioventricular block, and should be used with caution in patients with chronic obstructive pulmonary disease and heart rate less than 60 beats/minute.
Combined medication
When the antihypertensive effect of one drug is not good, the combination of multiple drugs can be adopted. For patients with high blood pressure, the combination of drugs will also be directly used to control blood pressure.
Doctors generally give priority to the combination of the two drugs, such as:
- Calcium antagonist + ACEI or ARBACEI or ARB + diuretic Calcium antagonist + receptor blocker Calcium antagonist + diuretic
If the control is not good, three drugs can be combined: calcium antagonist + ACEI or ARB + diuretic.
Fixed ratio compound preparation
Even if a drug contains a variety of effective ingredients, it is also a way of combining drugs. It is usually composed of two low-dose antihypertensive drugs with different mechanisms of action. For hypertension patients, it is more convenient to take.
The new type of preparation mainly includes:
- ACEI + thiazide diuretics; ARB + thiazide diuretics, such as valsartan + hydrochlorothiazide; Dihydropyridine calcium channel blockers + ARB, such as valsartan + amlodipine tablets; Dihydropyridine calcium channel blockers + receptor blockers; Thiazine diuretics + potassium-preserving diuretics.
The antihypertensive drugs and medication schemes introduced above are not good or bad, only suitable or inappropriate. For patients, they can not only effectively reduce blood pressure, but also protect organs such as heart, brain, lung and kidney, which is the appropriate drug.