(2) medication. According to the level of diastolic blood pressure, it is divided into mild, moderate and severe hypertension.
Mild: diastolic blood pressure 12.0 ~ 13.8 kPa (90 ~ 104 mm Hg); Moderate: diastolic blood pressure 13.9 ~ 15.2 kPa (105 ~1/4 mm Hg); Severity: Diastolic pressure is greater than 15.3 kPa (1 15 mm Hg). According to the degree of hypertension and the response to treatment, ladder therapy has been widely accepted at home and abroad.
Step 1: Suitable for mild to moderate hypertension. Diuretics are the first choice, and thiazide diuretics have a positive antihypertensive effect. However, potassium-deficient diuretics such as hydrochlorothiazide and furosemide are easy to cause potassium deficiency, and potassium-preserving diuretics such as spironolactone and triamterene are easy to cause high blood potassium, so they should not be used when there is renal insufficiency.
Step 2: Diuretics are added with beta blockers such as propranolol hydrochloride or sympathetic blockers such as reserpine, clonine or methyldopa, or calcium antagonists such as nifedipine. However, propranolol hydrochloride can prolong and inhibit hypoglycemia, promote heart failure, increase triglyceride and cause asthma, so it is not suitable for diabetes and hypertension. Reserpine is easy to cause depression in the elderly and is rarely used; Clonidine and nifedipine are commonly used. In addition, methyldopa can cause impotence and diabetic autonomic nervous system disorder, so it should be used with caution or forbidden.
Step 3: add hydralazine, prazosin or captopril. Prazosin is easy to cause postural hypotension, so diabetes complicated with postural hypotension is prohibited. Captopril, an angiotensin converting enzyme inhibitor, is a powerful antihypertensive drug with rapid onset and satisfactory antihypertensive effect. The usual dose is 25 ~ 100 mg per day, and renal insufficiency only needs 12.5mg three times a day.
Step 4: vasodilator minoxidil or captopril.
In short, long-term use of diuretics to reduce blood pressure is prone to hypokalemia and hyperuricemia, and affects glucose and lipid metabolism; Sympathetic nerve and adrenaline blockers are easy to cause impotence, depression and postural hypotension; Beta blockers can prolong and inhibit hypoglycemia, interfere with glucose and lipid metabolism, and promote asthma and heart failure, so the above antihypertensive drugs should not be used in diabetic hypertension. Calcium antagonists and angiotensin converting enzyme inhibitors are commonly used drugs in clinic. Calcium antagonists have few side effects, but may cause headache and facial flushing due to vasodilation. Angiotensin converting enzyme inhibitors such as captopril can increase serum potassium and creatinine, so clinical application should be paid attention to.
At present, there are some calcium antagonists, such as amlodipine besylate (luohuoxi), once a day, 5 ~10 mg each time; Angiotensin converting enzyme inhibitors also have sustained-release tablets, such as benazepril hydrochloride (Lotensin), daily 10mg, with good curative effect and significantly reduced side effects.