Surveys show that the prevalence of hypertension among residents over the age of 18 in my country is as high as 27.9, that is, approximately one in every four adults has hypertension.
Moreover, most patients with hypertension need to take medication for life. Therefore, it is very important for patients with hypertension to understand the mechanism of action of various antihypertensive drugs, suitable groups of people, and possible side effects. This allows everyone to have a basic judgment on their own situation after taking the medicine. If there is an adverse reaction to the medicine, it can be discovered in time and dealt with accordingly, which will also be better for blood pressure control and physical health!
Article source: Drug Review Center
Commonly used clinical antihypertensive drugs include thiazide diuretics, dihydropyridine calcium channel blockers (CCB), angiotensin-converting enzyme Inhibitors (ACEI), angiotensin II receptor antagonists and beta-blockers. The five categories of antihypertensive drugs have their own action characteristics, strong indications and adverse reactions.
1. Thiazide diuretics
1. Representative drugs: hydrochlorothiazide, indapamide.
2. Mechanism of action: Natriuretic and diuretic, reducing blood volume.
3. Strong indications: elderly hypertension, simple systolic hypertension, salt-sensitive hypertension, refractory hypertension, etc.
4. Side effects:
●Hypokalemia: main symptoms include nausea, anorexia, physical weakness, listlessness, mental confusion, etc.
- Reducing sodium intake can alleviate hypokalemia.
●Hyperuricemia: severe cases can cause gout.
——If the blood uric acid level is ≥480 μmol/L, it is recommended to switch to other antihypertensive drugs.
●Photosensitivity reaction: can cause rash.
——Patients taking thiazide diuretics and their compound preparations should avoid direct sunlight.
2. Dihydropyridine calcium channel blockers
1. Representative drugs: amlodipine, felodipine sustained-release tablets, nifedipine controlled-release tablets
2. Mechanism of action: It dilates blood vessels and lowers blood pressure by blocking calcium ion channels on vascular smooth muscle cells.
3. Strong indications: elderly patients with hypertension, simple systolic hypertension, patients with stable angina, coronary or carotid atherosclerosis and peripheral vascular disease.
4. Side effects
●Ankle edema: It is related to the dosage. Elevating the foot can reduce the symptoms of edema.
——If edema persists, other antihypertensive drugs should be replaced; the combined use of prici/sartan antihypertensive drugs can reduce the symptoms of edema.
●Gingival hyperplasia: Nifedipine, amlodipine, felodipine, etc. can all cause gingival hyperplasia.
——Maintaining oral hygiene can reduce the incidence of gum hyperplasia.
●Stubborn constipation.
—-like reaction of dihydropyridine calcium channel blockers.
3. Angiotensin-converting enzyme inhibitors
1. Representative drugs: enalapril, benazepril, perindopril, etc.
2. Mechanism of action: Inhibits angiotensin-converting enzyme, blocks the production of renin angiotensin II, inhibits the degradation of kininase and exerts antihypertensive effects.
——Restricting salt or adding diuretics can increase the antihypertensive effect of prici antihypertensive drugs.
3. Strong indications: patients with chronic heart failure, cardiac insufficiency after myocardial infarction, prevention of atrial fibrillation, diabetic nephropathy, non-diabetic nephropathy, metabolic syndrome, proteinuria or microalbuminuria.
4. Side effects
●Dry cough: About 30 patients can suffer from persistent dry cough, which is often aggravated after lying down. Female patients are more likely to develop dry cough.
——Preliminary antihypertensive drugs may cause dry cough, and those who cannot tolerate them can be replaced with Sartan antihypertensive drugs.
4. Angiotensin II receptor inhibitors
1. Representative drugs: losartan, valsartan, irbesartan, etc.
2. Mechanism of action: Blocks angiotensin II receptor (type 1) to exert antihypertensive effect.
3. Strong indications: Those who cannot tolerate the antihypertensive drugs of the Prilim type can choose Sartan antihypertensive drugs.
4. Side effects
●Back pain: Sartan antihypertensive drugs can cause back pain. Clinical trial results show that valsartan causes back pain in 1.6 cases and joint pain in 1.0 cases.
——Different Sartan antihypertensive drugs have different incidence rates of adverse reactions in the musculoskeletal system. When musculoskeletal pain occurs while taking a sartan antihypertensive drug, another sartan can be tried.
5. Beta blockers
1. Representative drugs: metoprolol, bisoprolol, etc.
2. Mechanism of action: Inhibits over-activated sympathetic nerve activity, inhibits myocardial contractility, slows down the heart rate and exerts antihypertensive effects.
3. Strong indications: patients with tachyarrhythmia, coronary heart disease, and chronic heart failure.
4. Side effects
●Pulse and slowed heartbeat: Beta blockers vary greatly among individuals, and patients should monitor their heart rate.
——For patients with hypertension and coronary heart disease, while controlling blood pressure, the resting heart rate should be slowed down to 50 to 60 beats/min.
●Rebound phenomenon: Sudden withdrawal of medication can cause severe angina pectoris and even sudden cardiac death.
——The dose must be gradually reduced under the guidance of a doctor, and the entire withdrawal process should take at least 2 weeks.