Content

High blood pressure over a long period of time is called hypertension (or hypertension). In 90% of cases, arterial essential hypertension is diagnosed. In other cases, secondary arterial hypertension occurs. Treatment of hypertension requires a special regimen and a specific combination of drugs, this guarantees the effectiveness of treatment at different stages of the disease.

What is hypertension

A normal blood pressure is 120/70 (± 10 millimeters of mercury). The number 120 corresponds to systolic pressure (the pressure of blood on the walls of the arteries during heart contraction). The number 70 is diastolic pressure (blood pressure on the walls of the arteries during relaxation of the heart). With prolonged deviation from the norm, certain stages of hypertension are diagnosed:

Hypertension is a very common pathology. The reasons for its occurrence still remain unclear. Essential hypertension refers to a disease of unknown etiology. Secondary hypertension, which occurs in 10% of patients, includes:

• renal;
• endocrine;
• hemodynamic;
• neurological;
• stressful;
• hypertension in pregnant women;
• use of dietary supplements;
• taking contraceptive medications.

The human body has a system that regulates blood pressure. When blood pressure increases on the walls of large blood vessels, the receptors that are located in them are activated. They transmit nerve impulses to the brain. The control center for vascular activity is located in the medulla oblongata. The reaction is the dilation of blood vessels and a decrease in pressure. When the pressure decreases, the system performs the opposite actions.

An increase in blood pressure can be due to many reasons:

• obesity, overweight;
• kidney dysfunction;
• thyroid dysfunction;
• diabetes mellitus and other chronic diseases;
• magnesium deficiency;
• oncological diseases of the adrenal glands, pituitary gland;
• psychological stress;
• heredity;
• mercury, lead poisoning and other causes.

Existing theories about the causes of the disease have no scientific basis. Patients who are faced with this problem are forced to constantly resort to medications to alleviate their physical condition. Treatment for hypertension is aimed at reducing and stabilizing blood pressure, but does not eliminate the root cause.

Symptoms differ at different stages of the disease. A person may not feel the primary manifestations of pathology for a long time. Attacks of nausea, dizziness, and weakness are associated with overwork. Further observed: noise in the head, numbness of the limbs, decreased performance, memory impairment. With a prolonged increase in pressure, a headache becomes a constant companion. At the last stage of hypertension, dangerous complications can occur: myocardial infarction, ischemic stroke, damage to blood vessels, kidneys, and blood clots.

Treatment of arterial hypertension

All treatment methods that are aimed at treating arterial hypertension can be divided into groups: medicinal, non-medicinal, folk, complex. Any of the chosen treatment methods is aimed not only at normalizing pressure levels in the arteries. These are therapeutic measures that prevent irreversible changes in the muscle tissue of the heart and arteries, are designed to protect target organs, and include the elimination of risk factors that contribute to the development of the pathological condition.

Principles of treatment of hypertension

With the initial manifestations of the disease and in order to prevent it, you need to adhere to the general principles of treatment, which will help correct the condition and avoid exacerbation:

• reducing the consumption of table salt, it should not exceed 5 g per day (in severe conditions, complete desalting);
• correction of body weight in the presence of extra pounds, obesity;
• feasible physical activity;
• quitting smoking, drinking alcoholic and tonic drinks;
• the use of soothing herbal preparations and herbal preparations for excessive emotional excitability;
• limiting the influence of stress factors;
• night sleep 7, and preferably 8 hours;
• eating foods rich in potassium.

Standard of treatment

If arterial hypertension is diagnosed, the key to successful stabilization of the patient’s condition is constant medical supervision. Self-administration of tablets to lower blood pressure is unacceptable. It is necessary to know the strength and mechanism of action of the drug. When mild or borderline hypertension occurs, standard treatment is limited to reducing the amount of salt in the diet.

For severe forms of hypertension, drug therapy is prescribed. Strong drugs are Atenolol and Furosemide. Atenolol is a drug from the group of b-selective adrenergic blockers, the effectiveness of which has been tested by time. This remedy is relatively safe for patients with bronchial asthma, chronic bronchitis and other lung diseases. The drug is effective provided that salt is completely excluded from the diet. Furosemide is a proven diuretic. The dose of medication is determined by the doctor.

Drug treatment of hypertension

Therapeutic measures for the treatment of hypertension are prescribed taking into account laboratory test data, the individual characteristics of the patient’s condition, and the stage of development of the disease. The use of antihypertensive medications is justified in cases of prolonged disturbances in blood pressure and non-drug therapy methods have not yielded results.

Treatment regimens

To avoid complications with the functioning of the heart and other organs, drugs are prescribed to reduce blood pressure, taking into account pulse indicators:

Form of hypertension	Clinical picture	Medicines
With a high pulse	Pulse – 80 beats per minute, sweating, extrasystole, white dermographism	b-blockers (or Reserpine), Hypothiazide (or Triampur)
With a low pulse	Swelling of the face, hands, manifestations of bradycardia	Thiazide diuretics in three applications: single, intermittent, continuous.
No change in heart rate	Without pronounced edema, tachycardia, cardialgia	Angiotensin-converting enzyme blockers, thiazide diuretics, b-blockers
Severe course	Diastolic pressure above 115 mmHg	Optimal combination of 3-4 drugs

Modern drugs for the treatment of hypertension

Many patients are prescribed medications to treat hypertension that must be used continuously. The choice and use of medications must be taken very seriously. With improper therapy, complications develop: there is a high risk of heart attack and heart failure. All drugs that are used in treatment regimens can be divided into groups:

	Mechanism of action	Drug names
Angiotensin converting enzyme inhibitors (ACEIs)	Blocking the enzyme that converts angiotensin I to angiotensin II	Enap, Prerstarium, Lisinopril
Angiotensin II receptor inhibitors (sartans)	Indirect reduction of vasospasm due to effects on the renin-angiotensin-aldosterone system	Losartan, Telmisartan, Eprosartan
B-blockers	Have a vasodilating effect	Atenolol, Concor, Obzidan
Calcium channel blockers	Block the transfer of calcium into the cell, reduce energy reserves to the cell	Nifedipine, Amlodipine, Cinnarizine
Thiazide diuretics (diuretics)	Removes excess fluid and salt, prevents swelling	Hydrochlorothiazide, Indapamide
Imidazoline receptor agonists (AIRs)	Due to the connection of these substances with receptors in the brain and kidney vessels, the reabsorption of water and salt and the activity of the renin-angitensive system are reduced	Albarel, Moxonidine,

Combinations of antihypertensive drugs

The mechanism of action of antihypertensive drugs to lower blood pressure is different, so drug treatment of hypertension involves the use of combinations of medications. This is effective for complications of hypertension, damage to other organs, and renal failure. About 80% of patients require complex therapy. Effective combinations are:

• ACE inhibitor and calcium channel blocker;
• ACE inhibitor and diuretic;
• calcium antagonist and diuretic;
• alpha blocker and beta blocker;
• dihydropyridine calcium antagonist and beta blocker.

Irrational combinations of antihypertensive drugs

Combinations of drugs must be prepared correctly. Drugs for hypertension in the following combination do not have the desired therapeutic effect:

• dihydropyridine antagonist and non-dihydropyridine calcium blocker;
• beta blocker and ACE inhibitor;
• an alpha blocker in combination with other antihypertensive drugs (except a beta blocker).

Non-drug treatment

It is better to prevent any disease than to treat it. At the first appearance of surges in blood pressure, it is worth reconsidering your lifestyle in order to prevent the development of malignant hypertension. Non-drug treatment, despite its simplicity, is aimed at preventing the development of cardiovascular diseases. This set of measures is central to stabilizing the condition of those patients who are on long-term drug treatment.

Lifestyle change

Half of the patients diagnosed with the initial stages of hypertension manage to stabilize their condition at its first manifestations after adjusting their lifestyle. Strict adherence to a daily routine, sufficient time for rest and night sleep, balanced nutrition, physical activity, and getting rid of bad habits help reduce blood pressure.

Medical nutrition

The calorie content of a hypertensive menu should not exceed 2500 kcal. The daily diet includes 5 meals. Last dose 2 hours before going to bed. Food is steamed, boiled, baked and cooked without adding salt. The daily amount of liquid is about 1.5 liters. The ratio of proteins, carbohydrates, fats is 1:4:1. The diet should include foods rich in potassium, magnesium, and vitamins B, C, and P.

The permitted products include:

• rye and bran bread, crackers;
• lean soups;
• meat soups no more than 3 times a week;
• lean meat, fish;
• vegetable stews;
• porridge;
• fermented milk products;
• fruit casseroles;
• seafood;
• natural juices, weak tea with milk.

Physical activity

Strong physical activity is required for hypertension. It is worth giving preference to isotonic exercises. They accelerate blood circulation, activate lung function, and lower blood pressure. This is gymnastics aimed at the large muscles of the limbs. Walking, cycling, swimming, and light jogging are helpful. The ideal option is to exercise on a home gym. The optimal training regimen is 3-5 times a week.

Traditional medicine

Among the recipes of traditional medicine there are the simplest remedies aimed at stabilizing blood pressure. The most effective of them are:

• Flax seeds. Three tablespoons of seeds per day (can be crushed in a food processor) as an additive to salads and main courses normalizes fat metabolism, prevents vascular atherosclerosis, and stabilizes blood pressure.
• Red pine cones. An alcohol tincture is made from this plant material. Pine cones (collected in June-July) are poured into a liter jar, filled with vodka or alcohol and left for 2-3 weeks. Take 3 times a day before meals, 1 teaspoon.
• Garlic. Finely chop two cloves of garlic, add a glass of boiled water, and let it brew for 12 hours. The infusion is drunk and a new one is prepared. The course of treatment is 1 month, the infusion is consumed morning and evening.

Indications for hospitalization

Hypertension in severe forms is dangerous due to complications, so in some cases hospitalization is necessary:

1. A hypertensive crisis was diagnosed. This leads to a sharp deterioration in the patient’s general condition, poses a threat to his life, and there is a high risk of developing a heart attack or stroke. Urgent hospitalization is recommended.
2. Frequent surges in blood pressure occur, the cause of which is unclear and requires a comprehensive examination of the patient and identification of the diagnosis. The protocol for hospitalization does not provide for such cases, but there is a high risk of exacerbation of concomitant diseases.
3. In addition to high blood pressure, the patient is suspected of having heart disease, for example, angina pectoris.

High blood pressure is a reason to call an ambulance. Emergency doctors take effective therapeutic measures, as a result of which blood pressure and heart function indicators return to normal. In this case, there are no indications for hospitalization of the patient; then he can be treated on an outpatient basis to stabilize his condition. In other cases, if improvement cannot be achieved, he is hospitalized.

Treatment of hypertension with modern medications according to schemes and folk remedies

Anonymous 192

I was diagnosed with stage 2 arterial hypertension last year. At first, the treatment regimen changed, the main drug was the same - blood pressure lowering pills, but the dosage was changed. 5 mg is optimal, so I take it every morning, one tablet is enough to keep my blood pressure normal. Well, I buy herbs at the pharmacy, make mint tea, add it to tea... If you take care of your health, then stabilizing your blood pressure is quite possible.

3 days Answer

In recent years, hypertension has occupied a leading place among diseases of the heart and blood vessels. If previously elderly patients suffered from increased blood pressure, now the pathology is detected in young people. The long course of the disease leads to degenerative disorders in the tissues of the heart, kidneys, brain and organs of vision. The most dangerous complications of hypertension are myocardial infarction and cerebral stroke, which can lead to severe disability and death. The modern pharmacological industry produces a wide variety of drugs that help normalize the general condition of patients and improve the quality of life.

When is antihypertensive therapy administered?

Tablets for hypertension should be prescribed by a specialist after a comprehensive diagnosis, taking into account blood pressure numbers, the presence of concomitant diseases, contraindications, and the age of the patients. The combination of these components during therapy is of great importance for achieving positive results and maintaining health at the proper level. When the pressure rises to 140/90 mm Hg. Art. and above we can talk about the development of hypertension.

Risk factors for disease progression include:

• diabetes mellitus;
• hypercholesterolemia;
• obesity;
• physical inactivity;
• chronic stress;
• decreased glucose tolerance;
• bad habits;
• hereditary predisposition.

The onset of the disease begins with a periodic increase in blood pressure, usually against the background of a stressful situation. This causes headaches, drowsiness, weakness, and sometimes “floaters” flashing before the eyes. Often this condition is associated with overwork and does not seek medical attention. Over time, hypertension forms in the body the activation of compensatory reactions, which significantly smooth out the clinical picture. Patients no longer feel the pathological spasm of blood vessels, but the disease is constantly progressing.

Basic non-pharmacological measures for the treatment of hypertension

If episodes of hypertension are detected in the early stages, drug therapy is not prescribed. Improvement of the condition can be achieved by rational nutrition, physical exercise, giving up bad habits, and normalizing the work and rest regime. After a persistent increase in blood pressure occurs, it is recommended to take one drug under the constant supervision of a doctor. If monotherapy is ineffective, several antihypertensive drugs or tablets with a combined composition are prescribed.

Drugs affecting the reninangiotensin system

In the kidneys, when pressure decreases, the substance prorenin is produced, which, entering the bloodstream, is converted into renin, and after interacting with a special protein, it is synthesized into the inactive substance angiotensin 1. Under the influence of permissive factors, it reacts with angiotensin-converting enzyme (ACE) and acquires active properties - angiotensin 2. This substance has a vasoconstrictor effect, increases cardiac activity, promotes water retention in the body, and stimulates the centers of the sympathetic nervous system. Depending on the effect of the drug on a specific part of the reninangiotensin system, two groups of drugs are distinguished.

ACE inhibitors

The active substance in the medicine blocks the work of the enzyme of the same name. As a result, blood pressure and pulse normalize, the excitability of the nervous system decreases, and the removal of fluid from the body increases.

List of funds:

• captopril;
• ramipril;
• enalapril;
• quinopril;
• zofenopril.

The use of drugs is contraindicated in pregnancy, diabetes, severe autoimmune pathologies, renal and liver failure. Captopril is not used for long-term treatment of the disease, especially in elderly patients with symptoms of cerebral artery atherosclerosis. It is usually used to relieve hypertensive crises - a sharp increase in blood pressure. Every third patient experiences a dry cough while taking medications from this group. If a side effect occurs, the product must be replaced.

Sartans

The active substance in the drug blocks receptors sensitive to angiotensin 2. Sartans are new generation drugs that were created in the last decade. They gently normalize blood pressure in hypertension, do not cause withdrawal symptoms, and can have a therapeutic effect for several days.

List of funds:

• candesartan;
• losartan;
• valsartan;
• telmisartan.

Medicines are contraindicated during breastfeeding, pregnancy, in childhood, with significant fluid loss and increased potassium levels in the blood.

Valsacor is a modern drug for the treatment of hypertension from the sartan group

Calcium channel blockers

In the cell membrane of muscle fibers there are special channels through which calcium enters and causes their contractility. This leads to vasospasm and increased heart rate. Drugs in this group close the pathways for calcium to move into the cell, thereby causing a decrease in the tone of the vascular wall, a decrease in the pulse, and a decrease in the load on the myocardium.

List of funds:

• diltiazem;
• verapamil;
• nifedipine;
• amlodipine;
• diltiazem;
• nifedipine;
• lacidipine.

Medicines are prescribed for hypertension combined with angina pectoris and heart rhythm disturbances. Verapamil and diltiazem cause a decrease in heart rate. In recent years, nifedipine has ceased to be used in medical practice due to its short duration of action and the ability to cause side effects. Drinking tablets of this group is not recommended in old age, childhood and puberty, with liver failure, hypersensitivity to the active substance, acute myocardial infarction. At the beginning of treatment, swelling of the limbs may be observed, which usually disappears within a week. If edema persists for a long time, the drug must be replaced.

Beta blockers

In the tissues of the kidneys, bronchi, and heart there are beta receptors, which, when excited, can cause an increase in blood pressure. The hypotensive effect is achieved by combining the substance in the drug with these receptors, preventing biologically active substances from influencing their work. For hypertension, selective drugs are recommended that interact exclusively with myocardial receptors.

List of funds:

• bisaprolol;
• atenolol;
• metoprolol;
• carvedilol;
• nebivolol;
• Celiprolol.

The drugs are prescribed for resistant forms of hypertension, concomitant angina, cardiac arrhythmias, and previous myocardial infarction. Non-selective drugs such as carvedilol, nebivalol, celiprolol are not prescribed for diabetes mellitus or signs of bronchial asthma.

Nebilet controls not only blood pressure, but also heartbeat

Diuretics

Diuretics affect filtration in the glomeruli, promoting the removal of sodium from the body, which draws fluid with it. Thus, the effect of the drug is associated with the loss of water, which reduces the filling of the bloodstream and normalizes high blood pressure in hypertension.

List of funds:

• spironolactone;
• indapamide;
• hydrochlorothiazide (hypothiazide);
• triampur;
• furosemide

Diuretics are not prescribed for monotherapy; they are combined with drugs from other groups. Diuretics can remove potassium ions from sodium; in such cases, it is necessary to monitor the concentration of this chemical. Usually, when treating with such medications, you are additionally prescribed to drink potassium.

If potassium-sparing diuretics, such as spironoloctone and triampur, are used, replacement therapy will not be required. Furosemide is recommended for the relief of acute attacks, as it has a pronounced but short-lived effect. The drugs are contraindicated in cases of anuria, lactose intolerance, electrolyte imbalance, and severe diabetes mellitus.

Centrally acting drugs

Medicines in this group prevent overexcitation of the nervous system and normalize the functioning of the vasomotor center, which helps reduce high blood pressure.

List of funds:

• methyldopa;
• moxonidine;
• rilmenidine.

Tablets are prescribed to patients with emotional instability, as well as to patients under stress and increased excitability. Additionally, it is recommended to take tranquilizers, sleeping pills and sedatives.

If the first symptoms of hypertension occur, you should consult a specialist. After a comprehensive examination, the doctor will tell you what medications need to be used to normalize your overall health. He will correctly select a combination of medications and their dosage, prescribe the time for taking the pills and monitor their effectiveness. Only this approach can stop further progression of the pathology and eliminate the occurrence of severe consequences. To maintain health, self-medication is strictly contraindicated.

April 27, 2012

There are two approaches to the treatment of hypertension: drug therapy and the use of non-drug methods of reducing blood pressure.

Non-drug therapy for hypertension

If you carefully study the table “Risk stratification in patients with arterial hypertension”, you will notice that the risk of serious complications, such as heart attacks, strokes, is influenced not only by the degree of increase in blood pressure, but also by many other factors, for example, smoking, obesity, sedentary behavior life.

Therefore, it is very important for patients suffering from essential hypertension to change their lifestyle: quit smoking. start following a diet, and also select physical activities that are optimal for the patient.

It is necessary to understand that lifestyle changes improve the prognosis for arterial hypertension and other cardiovascular diseases no less than blood pressure that is ideally controlled with medications.

Quitting smoking

Thus, the life expectancy of a smoker is on average 10-13 years less than that of non-smokers, and the main causes of death are cardiovascular diseases and oncology.

When you quit smoking, the risk of developing or worsening heart and vascular diseases decreases within two years to the level of non-smokers.

Diet

Following a low-calorie diet with large amounts of plant foods (vegetables, fruits, greens) will reduce the weight of patients. It is known that every 10 kilograms of excess weight increases blood pressure by 10 mmHg.

In addition, eliminating cholesterol-containing foods from food will reduce blood cholesterol levels, the high level of which, as can be seen from the table, is also one of the risk factors.

Limiting table salt to 4-5 grams per day has been proven to reduce blood pressure levels, since with a decrease in salt content, the amount of fluid in the vascular bed will also decrease.

In addition, losing weight (especially waist circumference) and limiting sweets will reduce the risk of developing diabetes, which significantly worsens the prognosis of patients with arterial hypertension. But even in patients with diabetes, weight loss can lead to normalization of blood glucose.

Physical activity

Physical activity is also very important for patients with hypertension. During physical activity, the tone of the sympathetic nervous system decreases: the concentration of adrenaline and norepinephrine, which have a vasoconstrictive effect and increase heart contractions, decreases. And as is known, it is the imbalance in the regulation of cardiac output and vascular resistance to blood flow that causes an increase in blood pressure. In addition, with moderate exercise, performed 3-4 times a week, the cardiovascular and respiratory systems are trained: blood supply and oxygen delivery to the heart and target organs improves. In addition, physical activity coupled with diet leads to weight loss.

It is worth noting that in patients with low and moderate risk of cardiovascular complications, treatment of hypertension begins with the appointment of non-drug therapy for several weeks or even months (at low risk), the goal of which is to reduce abdominal volume (in men less than 102, in women less 88 cm), as well as eliminating risk factors. If there is no dynamics during such treatment, tablet drugs are added.

In patients with high and very high risk according to the risk stratification table, drug therapy should be prescribed already at the moment when hypertension is first diagnosed.

Drug therapy for hypertension.

The scheme for selecting treatment for patients with hypertension can be formulated in several theses:

• For patients with low and average risk, therapy begins with the prescription of one drug that lowers blood pressure.
• For patients with a high and very high risk of cardiovascular complications, it is advisable to prescribe two drugs in a small dosage.
• If target blood pressure (at least below 140/90 mmHg, ideally 120/80 or below) is not achieved in patients at low and moderate risk, it is necessary to either increase the dosage of the drug they are receiving or start giving a drug from another drug. groups in a small dose. In case of repeated failure, it is advisable to treat with two drugs from different groups in small dosages.
• If target blood pressure values ​​are not achieved in patients at high and very high risk, you can either increase the dosage of the patient's medications or add a third drug from a different group to the treatment.
• If, when blood pressure decreases to 140/90 or lower, the patient’s well-being worsens, it is necessary to continue taking the drugs at this dosage until the body gets used to the new blood pressure numbers, and then continue to reduce blood pressure to the target values ​​​​of 110/70-120 /80 mmHg

Groups of drugs for the treatment of arterial hypertension:

The choice of drugs, their combinations and dosage should be made by a doctor, and it is necessary to take into account the presence of concomitant diseases and risk factors in the patient.

Listed below are the main six groups of drugs for the treatment of hypertension, as well as absolute contraindications for drugs in each group.

• Angiotensin-converting enzyme inhibitors - ACE inhibitors: enalapril (Enap, Enam, Renitek, Berlipril), lisinopril (Diroton), ramipril (Tritace®, Amprilan®), fosinopril (Fosicard, Monopril) and others. Drugs in this group are contraindicated in case of high blood potassium, pregnancy, bilateral stenosis (narrowing) of renal vessels, angioedema.
• Angiotensin-1 receptor blockers - ARBs: valsartan (Diovan, Valsacor®, Valz), losartan (Cozaar, Lozap, Lorista), irbesartan (Aprovel®), candesartan (Atacand, Candecor). The contraindications are the same as for ACE inhibitors.
• β-blockers – β-AB: nebivolol (Nebilet), bisoprolol (Concor), metoprolol (Egilok®, Betalok®) . Drugs of this group cannot be used in patients with 2nd and 3rd degree atrioventricular block, bronchial asthma.
• Calcium antagonists - AK. Dihydropyridine: nifedipine (Cordaflex®, Corinfar®, Cordipin®, Nifecard®), amlodipine (Norvasc®, Tenox®, Normodipin®, Amlotop). Non-dihydropyridine: Verapamil, Diltiazem.

ATTENTION! Non-hydropyridine calcium channel antagonists are contraindicated in chronic heart failure and 2-3 degree atrioventricular block.

• Diuretics (diuretics). Thiazide: hydrochlorothiazide (Hypothiazide), indapamide (Arifon, Indap). Loop: spironolactone (Veroshpiron).

ATTENTION! Diuretics from the group of aldosterone antagonists (Veroshpiron) are contraindicated in chronic renal failure and high blood potassium.

• Renin inhibitors. This is a new group of drugs that have performed well in clinical trials. The only renin inhibitor currently registered in Russia is Aliskiren (Rasilez).

Effective combinations of drugs that lower blood pressure

Since patients often have to be prescribed two or sometimes more drugs that have a hypotensive (pressure-lowering) effect, the most effective and safe group combinations are given below.

• ACE inhibitor + diuretic;
• ACEI+AA;
• ARB+diuretic;
• BRA+AK;
• AA + diuretic;
• AK dihydropyridine (nifedipine, amlodipine, etc.) + β-AB;
• β-AB + diuretic:;
• β-AB+α-AB: Carvedilol (Dilatrend®, Acridilol®)

Irrational combinations of antihypertensive drugs

The use of two drugs of the same group, as well as combinations of drugs listed below, is unacceptable, since drugs in such combinations increase side effects, but do not potentiate the positive effects of each other.

• ACE inhibitor + potassium-sparing diuretic (Veroshpiron);
• β-AB + non-dihydropyridine AK (Verapamil, Diltiazem);
• β-AB+ is a centrally acting drug.

Combinations of drugs that are not found in any of the lists belong to the intermediate group: their use is possible, but it must be remembered that there are more effective combinations of antihypertensive drugs.

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No. 7. Centrally acting drugs for the treatment of arterial hypertension

You are reading a series of articles about antihypertensive (antihypertensive) drugs. If you want to get a more holistic view of the topic, please start at the beginning: an overview of antihypertensive drugs that act on the nervous system.

In the medulla oblongata (this is the lowest part of the brain) there is vasomotor (vasomotor) center. It has two departments - pressor And depressor. which increase and decrease blood pressure respectively, acting through the nerve centers of the sympathetic nervous system in the spinal cord. The physiology of the vasomotor center and the regulation of vascular tone is described in more detail here: http://www.bibliotekar.ru/447/117.htm(text from a textbook on normal physiology for medical universities).

The vasomotor center is important for us because there is a group of drugs that act on its receptors and thus reduce blood pressure.

Divisions of the brain.

Classification of centrally acting drugs

For drugs that act predominantly on sympathetic activity in the brain. include:

• clonidine (clonidine) ,
• Moxonidine (Physiotens) ,
• methyldopa(can be used in pregnant women),
• guanfacine ,
• guanabenz .

There are no pharmacies in Moscow and Belarus in the search methyldopa, guanfacine and guanabenza. but they are for sale clonidine(strictly according to the prescription) and moxonidine .

The central component of action is also present in serotonin receptor blockers. about them in the next part.

Clonidine (clonidine)

Clonidine (clonidine) inhibits the secretion of catecholamines by the adrenal glands and stimulates alpha 2 -adrenergic receptors and I 1 -imidazoline receptors of the vasomotor center. It reduces blood pressure (by relaxing blood vessels) and heart rate (heart rate). Clonidine also has hypnotic and analgesic effect .

Scheme of regulation of cardiac activity and blood pressure.

In cardiology, clonidine is used mainly for treatment of hypertensive crises. This drug is loved by criminals and... retired grandmothers. Attackers like to mix clonidine into alcohol and, when the victim “passes out” and is fast asleep, they rob fellow travelers ( Never drink alcohol on the road with strangers!). This is one of the reasons why clonidine (clonidine) has been available in pharmacies for a long time only with a doctor's prescription .

Popularity of clonidine as a remedy for arterial hypertension in grandmothers who are “clonidine addicts” (who cannot live without taking clonidine, like smokers without a cigarette) is due to several reasons:

1. high efficiency drug. Local doctors prescribe it for the treatment of hypertensive crises, as well as out of despair, when other drugs are not effective enough or the patient cannot afford it, but something needs to be treated. Clonidine reduces blood pressure even if other drugs are ineffective. Gradually, older people develop mental and even physical dependence on this drug.

sleeping pill (sedative) effect. They cannot sleep without their favorite medicine. Sedatives are generally popular among people; I previously wrote in detail about Corvalol.

anesthetic the effect also matters, especially in old age, when “ everything hurts ».

wide therapeutic interval(i.e. wide range of safe doses). For example, the maximum daily dose is 1.2-2.4 mg, which is as much as 8-16 tablets of 0.15 mg. Few blood pressure pills can be taken in such quantities with impunity.

cheapness drug. Clonidine is one of the cheapest drugs, which is of paramount importance for a poor pensioner.

Clonidine is recommended to be used only for the treatment of hypertensive crises. for regular use 2-3 times a day, it is undesirable, since rapid significant fluctuations in blood pressure levels are possible during the day, which can be dangerous for blood vessels. Basic side effects. dry mouth, dizziness and lethargy(not for drivers), development is possible depression(then clonidine should be discontinued).

Orthostatic hypotension (decrease in blood pressure in an upright body position) clonidine does not cause .

The most dangerous side effect of clonidine - withdrawal syndrome. Grandmothers who are clonidine addicts take many pills per day, bringing the average daily intake to high daily doses. But since the drug is purely prescription, it will not be possible to create a six-month supply of clonidine at home. If for some reason local pharmacies experience interruptions in the supply of clonidine. These patients experience severe withdrawal symptoms. Like a binge. Clonidine, which is absent in the blood, no longer inhibits the release of catecholamines into the blood and does not reduce blood pressure. Patients are worried agitation, insomnia, headache, palpitations and very high blood pressure. Treatment consists of the administration of clonidine, alpha-blockers and beta-blockers.

Remember! Regular taking clonidine should not be stopped abruptly. The drug needs to be discontinued gradually. replacing α- and β-blockers.

Moxonidine (Physiotens)

Moxonidine is a modern, promising drug that can be briefly called “ improved clonidine" Moxonidine belongs to the second generation of drugs acting on the central nervous system. The drug acts on the same receptors as clonidine (clonidine), but the effect on I 1 is imidazoline receptors much stronger than the effect on alpha2-adrenergic receptors. Due to stimulation of I 1 receptors, the release of catecholamines (adrenaline, norepinephrine, dopamine) is inhibited, which reduces blood pressure (blood pressure). Moxonidine maintains a reduced level of adrenaline in the blood for a long time. In some cases, as with clonidine, in the first hour after oral administration, before a decrease in blood pressure, an increase of 10% may be observed, which is due to stimulation of alpha1 and alpha2 adrenergic receptors.

In clinical studies Moxonidine reduced systolic (upper) pressure by 25-30 mmHg. Art. and diastolic (lower) pressure by 15-20 mm without developing drug resistance during 2 years of treatment. The effectiveness of treatment was comparable to a beta blocker atenolol and ACE inhibitors captopril and enalapril .

Antihypertensive effect Moxonidine lasts 24 hours, the drug is taken 1 time per day. Moxonidine does not increase blood sugar and lipid levels, and its effect does not depend on body weight, gender and age. Moxonidine reduced LVH ( left ventricular hypertrophy), which allows the heart to live longer.

The high antihypertensive activity of moxonidine made it possible to use it for the complex treatment of patients with CHF (chronic heart failure) with II-IV functional class, but the results in the MOXCON study (1999) were dismal. After 4 months of treatment, the clinical study had to be terminated early due to high mortality in the experimental group compared to the control group (5.3% vs. 3.1%). Overall mortality increased due to an increase in the incidence of sudden death, heart failure and acute myocardial infarction.

Moxonidine causes fewer side effects compared to clonidine. although they are very similar. In comparative cross A 6-week study of moxonidine with clonidine ( each patient received both compared drugs in random order) side effects led to treatment discontinuation in 10% of patients receiving clonidine, and only in 1.6% of patients. taking moxonidine. More often disturbed dry mouth, headache, dizziness, fatigue or drowsiness .

Withdrawal syndrome was observed on the first day after discontinuation of the drug in 14% of those receiving clonidine, and only in 6% of patients receiving moxonidine.

Thus it turns out:

• clonidine is cheap, but has many side effects,
• moxonidine It costs significantly more, but is taken once a day and is better tolerated. It may be prescribed if drugs from other groups are not effective enough or are contraindicated.

Conclusion. if financial situation allows, between clonidine And moxonidine for continuous use, it is better to choose the latter (once a day). Clonidine should be taken only in case of hypertensive crises; it is not a drug for every day.

Treatment of arterial hypertension

What methods are used to treat arterial hypertension? In what cases is hospitalization necessary for hypertension?

Non-drug methods for treating arterial hypertension

• Low-calorie diet (especially if you are overweight). With a decrease in excess body weight, a decrease in blood pressure is observed.
• Limit salt intake to 4 - 6 g per day. This increases sensitivity to antihypertensive therapy. There are “substitutes” for salt (potassium salt preparations - sanasol).
• Inclusion in the diet of foods rich in magnesium (legumes, millet, oatmeal).
• Increased physical activity (gymnastics, measured walking).
• Relaxation therapy, autogenic training, acupuncture, electrosleep.
• Elimination of harmful substances (smoking, drinking alcohol, taking hormonal contraceptives).
• Employment of patients taking into account his illness (exclusion of night work, etc.).

Non-drug treatment carried out in mild forms of arterial hypertension. If after 4 weeks of such treatment the diastolic pressure remains 100 mmHg. Art. and higher, then switch to drug therapy. If diastolic pressure is below 100 mmHg. Art. then non-drug treatment is continued for up to 2 months.

In persons with a complicated medical history, with left ventricular hypertrophy, drug therapy is started earlier or combined with non-drug therapy.

Drug treatments for arterial hypertension

There are many antihypertensive drugs. When choosing a drug, many factors are taken into account (gender of the patient, possible complications).

• For example, centrally acting drugs that block sympathetic influences (clonidine, dopegit, alpha-methyl-DOPA).
• Women in menopause, when there is low renin activity, relative hyperaldosteronism, and a decrease in progesterone levels, often experience hypervolumic states and develop “edematous” hypertensive crises. In such a situation, the drug of choice is a diuretic (saluretic).
• There are powerful drugs - ganglion blockers, which are used to relieve a hypertensive crisis or together with other antihypertensive drugs in the treatment of malignant hypertension. Ganglion blockers should not be used in elderly people who are prone to orthostatic hypotension. When administering these drugs, the patient must remain in a horizontal position for some time.
• Beta-blockers provide a hypotensive effect by reducing cardiac output and plasma renin activity. In young people they are the drugs of choice.
• Calcium antagonists are prescribed when hypertension is combined with coronary heart disease.
• Alpha adrenergic blockers.
• Vasodilators (eg minoxidil). They are used in addition to the main therapy.
• Angiotensin-converting enzyme inhibitors (ACEIs). These drugs are used for all forms of hypertension.

When prescribing drugs, the condition of the target organs (heart, kidneys, brain) is taken into account.

For example, the use of beta-blockers in patients with renal failure is not indicated, since they impair renal blood flow.

There is no need to strive to quickly reduce blood pressure, as this can lead to a deterioration in the patient’s well-being. Therefore, the drug is prescribed starting with small doses.

Treatment regimen for arterial hypertension

There is a treatment regimen for arterial hypertension: at the first stage, beta-blockers or diuretics are used; at the second stage “beta-blockers + diuretics”, it is possible to add an ACE inhibitor; in case of severe hypertension, complex therapy is carried out (possibly surgery).

Hypertensive crisis often develops when treatment recommendations are not followed. During crises, the most commonly prescribed drugs are clonidine, nifedipine, captopril.

Indications for hospitalization

• Clarification of the nature of arterial hypertension (if it is impossible to perform studies on an outpatient basis).
• Complication of arterial hypertension (crisis, stroke, etc.).
• Refractory arterial hypertension that does not respond to antihypertensive therapy.

The answer to this question is simple:

Point one: in order to meaningfully understand this issue, you need to graduate from medical school. After this, one can theoretically assume that drug A in patient X with one “bouquet” of diseases will work better than drug B in patient Y with a different “bouquet”, however:

Point two: for each patient, the strength of the effect of any drug and the level of side effects are unpredictable and all theoretical discussions on this topic are meaningless.

Point three: drugs within the same class, subject to therapeutic doses, usually have approximately the same effect, but in some cases - see point two.

Point four: to the question “what is better - watermelon or pork cartilage?” different people will answer differently (There are no comrades according to taste). Also, different doctors will answer questions about medications differently.

How good are the newest (new, modern) drugs for hypertension?

I am publishing the dates of registration in Russia of the “newest” drugs for hypertension:

Edarbi (Azilsartan) - February 2014

Rasilez (Aliskiren) - May 2008

Evaluate the degree of “newness” yourself.

Unfortunately, all new drugs for hypertension (representatives of the ARB (ARB) and PIR classes) are not stronger than enalapril, invented more than 30 years ago; the evidence base (the number of studies on patients) for new drugs is smaller and the price is higher. Therefore, I cannot recommend “the newest drugs for hypertension” just because they are the newest.

Repeatedly, patients who wished to start treatment with “something new” had to be returned to older drugs due to the ineffectiveness of the new ones.

Where can I buy medicine for hypertension cheaply?

There is a simple answer to this question: look for a website - a pharmacy search engine in your city (region). To do this, type in Yandex or Google the phrase “pharmacy reference” and the name of your city.

There is a very good search engine for Moscow, aptekamos.ru.

Enter the name of the medicine into the search bar, select the dosage of the drug and your place of residence - and the site displays addresses, phone numbers, prices and the possibility of home delivery.

Is it possible to replace drug A with drug B? What can replace drug C?

These questions are very often asked to search engines, so I launched a special website analogs-medicines.rf, and started filling it out with cardiac drugs.

A brief reference page containing only the names of drugs and their classes is on this site. Come in!

If there is no exact replacement for the drug (or the drug has been discontinued), you can try one of its “classmates” UNDER THE CONTROL OF A DOCTOR. Read the section "Classes of drugs for hypertension."

What is the difference between drug A and drug B?

To answer this question, first go to the drug analogs page (here) and find out (or better yet, write down) which active ingredients from which classes both drugs contain. Often the answer lies on the surface (for example, a diuretic is simply added to one of the two).

If drugs belong to different classes, read the descriptions of these classes.

And in order to absolutely accurately and adequately understand the comparison of each pair of drugs, you still need to graduate from medical school.

Introduction

The writing of this article was dictated by two considerations.

The first is the prevalence of hypertension (the most common cardiac pathology - hence a lot of questions about treatment).

The second is the fact that instructions for medications are available on the Internet. Despite the huge number of warnings about the impossibility of self-prescribing drugs, the patient’s vigorous research thoughts force him to read information about the drugs and draw his own, not always correct, conclusions. It is impossible to stop this process, so I outlined my view on the issue.

THIS ARTICLE IS INTENDED EXCLUSIVELY FOR INFORMATION WITH THE CLASSES OF ANTIHYPERTENSIVE DRUGS AND CANNOT SERVE AS A GUIDE TO YOUR INDEPENDENT PRESCRIPTION OF TREATMENT!

PRESCRIPTION AND CORRECTION OF TREATMENT FOR HYPERTENSION SHOULD BE CARRIED OUT ONLY UNDER THE PERSONAL CONTROL OF A DOCTOR!!!

There are a lot of recommendations on the Internet for limiting the consumption of table salt (sodium chloride) for hypertension. Studies have shown that even a fairly strict restriction of table salt intake leads to a decrease in blood pressure numbers by no more than 4-6 units, so I personally am quite skeptical about such recommendations.

Yes, in the case of severe hypertension, all means are good; when hypertension is combined with heart failure, salt restriction is also absolutely necessary, but with low and non-severe hypertension, it can be a pity to look at patients who poison their lives by limiting salt intake.

I think that for patients with “average” hypertension, the recommendation “do not eat pickles (or analogues) in three-liter jars” will be sufficient.

If non-drug treatment is ineffective or insufficiently effective, pharmacological therapy is prescribed.

What is the strategy for selecting antihypertensive therapy?

When a patient with hypertension first consults a doctor, he undergoes a certain amount of research, depending on the equipment of the clinic and the financial capabilities of the patient.

A fairly complete examination includes:

• Laboratory methods:
  • General blood test.
  • A general urinalysis to rule out a renal origin of hypertension.
  • Blood glucose, glycosylated hemoglobin for screening diabetes mellitus.
  • Creatinine, blood urea to assess kidney function.
  • Total cholesterol, high and low density lipoprotein cholesterol, triglycerides to assess the degree of the atherosclerotic process.
  • AST, ALT to assess liver function if there is a possible need to prescribe cholesterol-lowering drugs (statins).
  • Free T3, free T4 and TSH to assess thyroid function.
  • It's a good idea to look at uric acid - gout and hypertension often go together.
• Hardware methods:
  • ABPM (24-hour blood pressure monitoring) to assess daily fluctuations.
  • Echocardiography (ultrasound of the heart) to assess the thickness of the left ventricular myocardium (whether there is hypertrophy or not).
  • Duplex scanning of neck vessels (commonly called MAG or BCA) to assess the presence and severity of atherosclerosis.
• Specialist consultations:
  • An ophthalmologist (to assess the condition of the fundus vessels, which are often affected by hypertension).
  • Endocrinologist-nutritionist (in case of increased weight of the patient and abnormalities in tests for thyroid hormones).
• Self-examination:
  • SCAD (Self-Control of Blood Pressure) - measurement and recording of blood pressure and pulse numbers on both hands (or on the one where the pressure is higher) in the morning and evening in a sitting position after 5 minutes of quiet sitting. The results of the SCAD recording are presented to the doctor after 1-2 weeks.

The results obtained during the examination may affect the doctor’s treatment tactics.

Now about the algorithm for selecting drug treatment (pharmacotherapy).

Adequate treatment should lead to a decrease in pressure to the so-called target values ​​(140/90 mmHg, for diabetes - 130/80). If the numbers are higher, the treatment is incorrect. THE PRESENCE OF HYPERTENSIVE CRISES IS ALSO EVIDENCE OF INADQUARE TREATMENT.

Drug treatment for hypertension MUST CONTINUE FOR LIFE, so the decision to start it must be strictly justified.

For low blood pressure numbers (150-160), a competent doctor usually first prescribes one drug in a small dose, the patient leaves for 1-2 weeks to record the SBP. If target levels are established during initial therapy, the patient continues to take treatment for a long time and the only reason for meeting with a doctor is an increase in blood pressure above the target, which requires adjustment of treatment.

ALL ALLEGATIONS ABOUT ADDITION TO DRUGS AND THE NECESSITY TO REPLACE THEM SIMPLY DUE TO THE LONG TIME OF TAKING ARE FICTIONAL. SUITABLE DRUGS HAVE BEEN TAKEN FOR YEARS, AND THE ONLY REASONS FOR CHANGING A DRUG ARE INTOLERANCE AND INEFFECTIVENESS.

If the patient’s blood pressure remains above the target level despite the prescribed therapy, the doctor may increase the dose or add a second and, in severe cases, a third and even a fourth drug.

Original drugs or generics (generics) - how to make a choice?

Before moving on to the story about the drugs, I will touch on a very important issue that significantly affects the wallet of every patient.

The creation of new drugs requires a lot of money - currently at least a BILLION dollars are spent on the development of one drug. In this regard, the development company, according to international law, has a so-called patent protection period (from 5 to 12 years), during which other manufacturers do not have the right to bring copies of the new drug to the market. During this period, the development company has a chance to return the money invested in development and get maximum profit.

If a new drug turns out to be effective and in demand, upon expiration of the patent protection period, other pharmaceutical companies acquire the full right to produce copies, so-called generics (or generics). And they actively use this right.

Accordingly, they do not copy drugs that cause little interest among patients. I prefer not to use "old" original drugs that have no copies. As Winnie the Pooh said, this is “lzhzh” for a reason.

Often, generic manufacturers offer a wider range of doses than manufacturers of the original drug (for example, Enap manufactured by KRKA). This additionally attracts potential consumers (few people enjoy the procedure of breaking tablets).

Generics are cheaper than original drugs, but since they are produced by companies with LESS financial resources, the production technologies of generic factories may well be less effective.

Nevertheless, generic drug manufacturing companies are doing quite well in the markets, and the poorer the country, the greater the percentage of generics in the total pharmaceutical market.

Statistics show that in Russia the share of generic drugs in the pharmaceutical market reaches up to 95%. This figure in other countries: Canada - more than 60%, Italy - 60%, England - more than 50%, France - about 50%, Germany and Japan - 30% each, USA - less than 15%.

Therefore, the patient faces two questions regarding generics:

• What to buy - original drug or generic?
• If a choice is made in favor of a generic, which manufacturer should you choose?

• If you have the financial opportunity to buy the original drug, it is better to buy the original.
• If you have a choice between several generics, it is better to buy a drug from a well-known, “old” and European manufacturer than from an unknown, new and Asian one.
• Drugs costing less than 50-100 rubles, as a rule, work extremely poorly.

And the last recommendation. When treating severe forms of hypertension, when 3-4 drugs are combined, taking cheap generics is generally impossible, since the doctor relies on the drug to work, which actually has no effect. The doctor can combine and increase doses without effect, and sometimes simply replacing a low-quality generic with a good drug eliminates all questions.

When talking about a drug, I will first indicate its international name, then the original brand name, then the names of trustworthy generics. The absence of a generic name in the list indicates my lack of experience with it or my reluctance to recommend it to the general public for one reason or another.

What classes of hypertension drugs are there?

There are 7 classes of drugs:

Angiotensin-converting enzyme inhibitors (ACEIs)

These are drugs that at one time revolutionized the treatment of hypertension.

In 1975, captopril (capoten) was synthesized, which is still used to relieve crises (its use in the permanent treatment of hypertension is undesirable due to the short period of action of the drug).

In 1980, Merck synthesized enalapril (Renitec), which remains one of the most prescribed drugs in the world, despite the intensive work of pharmaceutical companies to create new drugs. Currently, more than 30 factories produce analogues of enalapril, and this indicates its good qualities (bad drugs are not copied).

The rest of the drugs in the group do not differ significantly from each other, so I’ll tell you a little about enalapril and give the names of other representatives of the class.

Unfortunately, the reliable duration of enalapril is less than 24 hours, so it is better to take it 2 times a day - morning and evening.

The essence of the action of the first three groups of drugs - ACEI, ARA and PIR - is to block the production of one of the most powerful vasoconstrictor substances in the body - angiotensin 2. All drugs of these groups reduce systolic and diastolic pressure without affecting the pulse rate.

The most common side effect of ACE inhibitors is the appearance of a dry cough a month or more after starting treatment. If a cough appears, the drug must be replaced. Usually they change to representatives of the newer and more expensive ARA group (ARA).

The full effect of using ACE inhibitors is achieved by the end of the first - second week of use, so all earlier blood pressure numbers do not reflect the degree of effect of the drug.

All representatives of ACE inhibitors with prices and release forms.

Angiotensin receptor antagonists (blockers) (sartans or ARBs or ARBs)

This class of drugs was created for patients who had cough as a side effect of ACE inhibitors.

Currently, none of the companies that make ARBs claim that the effect of these drugs is greater than that of ACE inhibitors. This is confirmed by the results of large studies. Therefore, I personally regard the prescription of an ARB as the first drug, without attempts to prescribe an ACE inhibitor, as a sign of a positive assessment by the doctor of the thickness of the patient’s wallet. Prices for a month of use for none of the original sartans have yet fallen significantly below a thousand rubles.

ARBs reach their full effect by the end of the second to fourth week of use, so the effect of the drug can only be assessed after two or more weeks.

Class representatives:

• Losartan (Cozaar (50mg), Lozap (12.5mg, 50mg, 100mg), Lorista (12.5mg, 25mg, 50mg, 100mg), Vasotens (50mg, 100mg))
• Eprosartan (Teveten (600mg))
• Valsartan (Diovan (40mg, 80mg, 160mg), Valsacor, Valz (40mg, 80mg, 160mg), Nortivan (80mg), Valsafors (80mg, 160mg))
• Irbesartan (Aprovel (150mg, 300mg))
• Candesartan (Atacand (80mg, 160mg, 320mg))
• Telmisartan (Micardis (40 mg, 80 mg))
• Olmesartan (Cardosal (10mg, 20mg, 40mg))
• Azilsartan (Edarbi (40mg, 80mg))

Direct renin inhibitors (DRIs)

This class so far consists of only one representative, and even the manufacturer admits that it cannot be used as the only remedy for the treatment of hypertension, but only in combination with other drugs. Combined with the high price (at least one and a half thousand rubles for a month of use), I do not consider this drug very attractive for the patient.

• Aliskiren (Rasilez (150mg, 300mg))

For the development of this class of drugs, the creators received the Nobel Prize - a first for "industrial" scientists. The main effects of beta blockers are a decrease in heart rate and blood pressure. Therefore, they are used mainly in hypertensive patients with a rapid pulse and when hypertension is combined with angina pectoris. In addition, beta blockers have a good antiarrhythmic effect, so their use is justified in case of concomitant extrasystoles and tachyarrhythmias.

The use of beta blockers in young men is undesirable, since all representatives of this class negatively affect potency (fortunately, not in all patients).

In the annotations for all BBs, bronchial asthma and diabetes mellitus appear as contraindications, but experience shows that quite often patients with asthma and diabetes “get along well” with beta blockers.

Old representatives of the class (propranolol (obzidan, anaprilin), atenolol) are unsuitable for the treatment of hypertension due to their short duration of action.

I do not list short-acting forms of metoprolol here for the same reason.

Representatives of the beta blocker class:

• Metoprolol (Betaloc ZOK (25mg, 50mg, 100mg), Egilok retard (100mg, 200mg), Vasocardin retard (200mg), Metocard retard (200mg))
• Bisoprolol (Concor (2.5 mg, 5 mg, 10 mg), Coronal (5 mg, 10 mg), Biol (5 mg, 10 mg), Bisogamma (5 mg, 10 mg), Cordinorm (5 mg, 10 mg), Niperten (2.5 mg, 5 mg, 10 mg ), Biprol (5mg, 10mg), Bidop (5mg, 10mg), Aritel (5mg, 10mg))
• Nebivolol (Nebilet (5mg), Binelol (5mg))
• Betaxolol (Locren (20mg))
• Carvedilol (Carvetrend (6.25 mg, 12.5 mg, 25 mg), Coriol (6.25 mg, 12.5 mg, 25 mg), Talliton (6.25 mg, 12.5 mg, 25 mg), Dilatrend (6.25 mg, 12.5 mg , 25 mg), Acridiol (12.5 mg, 25 mg))

Pulse-suppressing calcium antagonists (PCA)

They are similar in action to beta blockers (reduce heart rate, lower blood pressure), only the mechanism is different. The use of this group for bronchial asthma is officially permitted.

I present only the “long-lasting” forms of the group’s representatives.

• Verapamil (Isoptin SR (240mg), Verogalid ER (240mg))
• Diltiazem (Altiazem RR (180 mg))

Calcium antagonists dihydropyridine (ACD)

The era of ACD began with a drug that is familiar to everyone, but modern recommendations do not recommend its use, to put it mildly, even during hypertensive crises.

You must firmly stop taking this drug: nifedipine (adalat, cordaflex, cordafen, cordipine, corinfar, nifecard, phenigidine).

More modern dihydropyridine calcium antagonists have firmly taken their place in the arsenal of antihypertensive drugs. They increase the pulse rate significantly less (unlike nifedipine), reduce blood pressure well, and are used once a day.

There is evidence that long-term use of drugs in this group has a preventive effect against Alzheimer's disease.

In terms of the number of factories producing it, amlodipine is comparable to the “king” of the ACE inhibitor enalapril. I repeat, bad drugs are not copied, only very cheap copies cannot be bought.

At the beginning of taking drugs in this group, swelling of the legs and hands may occur, but this usually goes away within a week. If it does not work, the drug is discontinued or replaced with the “tricky” form of Es Cordi Cor, which has almost no effect.

The fact is that “regular” amlodipine from most manufacturers contains a mixture of “right” and “left” molecules (they differ from each other, like the right and left hand - they consist of the same elements, but are organized differently). The “right” version of the molecule produces most of the side effects, while the “left” version provides the main therapeutic effect. The manufacturing company Es Cordi Core left only the beneficial “left” molecule in the medicine, so the dose of the drug in one tablet is halved, and there are fewer side effects.

Group representatives:

• Amlodipine (Norvasc (5mg, 10mg), Normodipine (5mg, 10mg), Tenox (5mg, 10mg), Cordi Cor (5mg, 10mg), Es Cordi Cor (2.5mg, 5mg), Cardilopin (5mg, 10mg), Kalchek (5mg, 10mg), Amlotop (5mg, 10mg), Omelar cardio (5mg, 10mg), Amlovas (5mg))
• Felodipine (Plendil (2.5mg, 5mg, 10mg), Felodip (2.5mg, 5mg, 10mg))
• Nimodipine (Nimotop (30mg))
• Lacidipine (Latsipil (2mg, 4mg), Sakur (2mg, 4mg))
• Lercanidipine (Lerkamen (20mg))

Centrally acting drugs (point of application - brain)

The history of this group began with clonidine, which “reigned” until the era of ACE inhibitors. Clonidine greatly reduced blood pressure (in case of overdose, to the point of coma), which was subsequently actively used by the criminal part of the country's population (clonidine thefts). Clonidine also caused terrible dry mouth, but this had to be tolerated since other drugs at that time were weaker. Fortunately, the glorious history of clonidine is ending, and it can only be purchased by prescription in a very small number of pharmacies.

Later drugs in this group are devoid of the side effects of clonidine, but their “power” is significantly lower.

They are usually used as part of complex therapy in easily excitable patients and in the evening for nocturnal crises.

Dopegit is also used to treat hypertension in pregnant women, since most classes of drugs (ACE inhibitors, sartans, beta blockers) have a negative effect on the fetus and cannot be used during pregnancy.

• Moxonidine (Physiotens (0.2 mg, 0.4 mg), Moxonitex (0.4 mg), Moxogamma (0.2 mg, 0.3 mg, 0.4 mg))
• Rilmenidine (Albarel (1 mg)
• Methyldopa (Dopegyt (250 mg)

Diuretics (diuretics)

In the mid-20th century, diuretics were widely used in the treatment of hypertension, but time has revealed their shortcomings (any diuretic “leashes” beneficial substances from the body over time and has been proven to cause new cases of diabetes, atherosclerosis, and gout).

Therefore, in modern literature there are only 2 indications for the use of diuretics:

• Treatment of hypertension in elderly patients (over 70 years of age).
• As a third or fourth drug when the effect of two or three already prescribed is insufficient.

When treating hypertension, only two drugs are usually used, most often as part of “factory” (fixed) combination tablets.

The prescription of fast-acting diuretics (furosemide, torasemide (Diuver)) is extremely undesirable. Veroshpiron is used to treat severe cases of hypertension and only under the strict supervision of a physician.

• Hydrochlorothiazide (Hypothiazide (25mg, 100mg)) - very widely used in combination drugs
• Indapamide (Potassium-sparing) - (Arifon retard (1.5 mg), Ravel SR (1.5 mg), Indapamide MV (1.5 mg), Indap (2.5 mg), Ionic retard (1.5 mg), Acripamide retard (1, 5mg))

Article publication date: 11/10/2016

Article updated date: 12/06/2018

Almost every person after 45–55 years old suffers from increased blood pressure (abbreviated A/D). Unfortunately, hypertension cannot be cured completely, so hypertensive patients have to constantly take blood pressure pills for the rest of their lives in order to prevent hypertensive crises (attacks of high blood pressure - or hypertension), which are fraught with a host of consequences: from severe headaches to heart attack or stroke.

Monotherapy (taking one drug) gives a positive result only at the initial stage of the disease. A greater effect is achieved with the combined use of two or three drugs from different pharmacological groups, which must be taken regularly. It is worth considering that the body gets used to any antihypertensive pills over time and their effect weakens. Therefore, for stable stabilization of normal A/D levels, periodic replacement is necessary, which is carried out only by a doctor.

Hypertensive patients should know that medications that lower blood pressure come in rapid and prolonged (long-term) action. Drugs from different pharmaceutical groups have different mechanisms of action, i.e. To achieve an antihypertensive effect, they affect various processes in the body. Therefore, the doctor may prescribe different drugs to different patients with arterial hypertension, for example, atenolol is better suited for one to normalize blood pressure, while for another it is undesirable to take it because, along with the hypotensive effect, it reduces the heart rate.

In addition to directly reducing pressure (symptomatic), it is important to influence the cause of its increase: for example, treat atherosclerosis (if such a disease exists), carry out the prevention of secondary diseases - heart attack, cerebrovascular accidents, etc.

The table provides a general list of drugs from different pharmaceutical groups prescribed for hypertension:

Drugs prescribed for hypertension

These medications are indicated for the treatment of arterial hypertension (persistent high blood pressure) of any degree. The stage of the disease, age, presence of concomitant diseases, individual characteristics of the body are taken into account when choosing a remedy, selecting a dosage, frequency of administration and combination of drugs.

Tablets from the sartan group are currently considered the most promising and effective in the treatment of hypertension. Their therapeutic effect is due to blocking receptors for angiotensin II, a powerful vasoconstrictor substance that causes a persistent and rapid increase in A/D in the body. Long-term use of the tablets provides a good therapeutic effect without the development of any undesirable consequences or withdrawal symptoms.

Important: only a cardiologist or local physician should prescribe medications for high blood pressure, as well as monitor the patient’s condition during therapy. An independently made decision to start taking some kind of hypertensive drug that helps a friend, neighbor or relative can lead to disastrous consequences.

Further in the article we will talk about which drugs are most often prescribed for high blood pressure, their effectiveness, possible side effects, as well as combination regimens. You will read a description of the most effective and popular drugs - Losartan, Lisinopril, Renipril GT, Captopril, Arifon-retard and Veroshpiron.

List of the most effective drugs for high blood pressure

Anti-hypertension pills with quick effect

List of rapid-acting antihypertensive drugs:

• Furosemide,
• Anaprilin,
• Captopril,
• Adelfan,
• Enalapril.

Fast-acting drugs for hypertension

For high blood pressure, it is enough to put half or a whole tablet of Captopril or Adelfan under the tongue and dissolve. The pressure will drop in 10–30 minutes. But you should know that the effect of taking such drugs is short-lived. For example, a patient is forced to take Captopril up to 3 times a day, which is not always convenient.

The action of Furosemide, a loop diuretic, is the rapid occurrence of strong diuresis. Within an hour of taking 20–40 mg of the drug and for the next 3–6 hours, you will begin to urinate frequently. Blood pressure will decrease due to the removal of excess fluid, relaxation of vascular smooth muscles and a decrease in the volume of circulating blood.

Extended-release tablets for hypertension

List of long-acting antihypertensive drugs:

• Metoprolol,
• Diroton,
• Losartan,
• Cordaflex,
• Prestarium,
• Bisoprolol,
• Propranolol.

Long-acting medications for hypertension

They have a prolonged therapeutic effect and are designed for ease of treatment. It is enough to take these medications only 1 or 2 times a day, which is very convenient, since maintenance therapy for hypertension is indicated continuously until the end of life.

These drugs are used for long-term combination therapy for grade 2–3 hypertension. Features of the reception include a long-term cumulative effect. To obtain lasting results, you need to take these drugs for 3 or more weeks, so you do not need to stop taking them if your blood pressure does not drop immediately.

Rating of tablets for high blood pressure with their descriptions

The list of antihypertensive drugs is compiled from the most effective with a minimum of unwanted effects to drugs with more frequent side effects. Although in this regard everything is individual, it is not in vain that antihypertensive therapy must be carefully selected and, if necessary, adjusted.

Losartan

A drug from the sartan group. The mechanism of action is to prevent the powerful vasoconstrictor effect of angiotensin II on the body. This highly active substance is obtained by transformation from renin produced by the kidneys. The medicine blocks receptors of the AT1 subtype, thereby preventing vasoconstriction.

Systolic and diastolic A/D decreases after the first oral administration of Losartan, at most after 6 hours. The effect lasts for a day, after which you need to take the next dose. Persistent stabilization of blood pressure should be expected after 3–6 weeks from the start of treatment. The drug is suitable for the treatment of hypertension in diabetics with diabetic nephropathy - damage to blood vessels, glomeruli, and kidney tubules due to metabolic disorders caused by diabetes.

What analogues does it have:

• Blocktran,
• Lozap,
• Presartan,
• Xartan,
• Losartan Richter,
• Cardomin-Sanovel,
• Vasotens,
• Lakea,
• Renicard.

Valsartan, Eprosartan, Telmisartan are drugs from the same group, but Losartan and its analogues are more productive. Clinical experience has shown its high effectiveness in eliminating elevated A/D even in patients with complicated arterial hypertension.

Lisinopril

Belongs to the group of ACE inhibitors. The antihypertensive effect is observed within 1 hour after taking the required dose, increases in the next 6 hours to a maximum and lasts for 24 hours. This is a drug with a long-term cumulative effect. Daily dosage – from 5 to 40 mg, taken 1 time per day in the morning. When treating hypertension, patients notice a decrease in blood pressure from the first days of taking it.

List of analogues:

• Diroton,
• Renipril,
• Lipryl,
• Lisinovel,
• Dapril,
• Lizacard,
• Lisinoton,
• Sinopril,
• Lysigamma.

Renipril GT

This is an effective combination drug consisting of enalapril maleate and hydrochlorothiazide. In combination, these components have a more pronounced hypotensive effect than each individually. The pressure decreases gently and without loss of potassium by the body.

What are the analogues of the product:

• Berlipril Plus,
• Enalapril N,
• Co-renitek,
• Enalapril-Acri,
• Enalapril NL,
• Enap-N,
• Enafarm-N.

Captopril

Perhaps the most common drug from the group of ACE inhibitors. Intended for emergency assistance in order to relieve a hypertensive crisis. It is undesirable for long-term treatment, especially in elderly people with atherosclerosis of cerebral vessels, since it can provoke a sharp decrease in pressure with loss of consciousness. Can be prescribed together with other hypertensive and nootropic drugs, but under strict A/D control.

List of analogues:

• Kopoten,
• Kaptopres,
• Alkadil,
• Katopil,
• Blockordil,
• Captopril AKOS,
• Angiopril,
• Reelcapton,
• Kapofarm.

Arifon-retard (indopamid)

Diuretic and antihypertensive drug from the group of sulfonamide derivatives. In complex therapy for the treatment of arterial hypertension, it is used in minimal doses that do not have a pronounced diuretic effect, but stabilize blood pressure throughout the day. Therefore, when taking it, you should not expect an increase in diuresis; it is prescribed to lower blood pressure.

Pros	Contraindications and special instructions
Ease of use (take 1 time per day in the morning before meals)	Prohibited for hypokalemia, severe renal failure or serious liver dysfunction, allergy to the active ingredient of the drug
One of the safest remedies for high blood pressure	Not recommended for people with lactose intolerance
Harmless for people with endocrine disorders (diabetes, obesity), because it does not affect the level of lipids and glucose in the blood
Has a minimum of side effects and is well tolerated by almost all patients
Reduces left ventricular hypertrophy
Affordable price

• Indopamide,
• Acripamide,
• Perinid,
• Indapamide-Verte,
• Indap,
• Acripamide retard.

Veroshpiron

Potassium-sparing diuretic. Take 1 to 4 times a day in courses. It has a pronounced diuretic effect, but does not remove potassium from the body, which is important for normal heart function. Used only in combination therapy for the treatment of arterial hypertension. If the dose prescribed by the doctor is followed, it does not cause side effects, with rare exceptions. Long-term treatment in large dosages (more than 100 mg/day) can lead to hormonal disorders in women and impotence in men.

Combination drugs for high blood pressure

To achieve maximum hypotensive effect and ease of administration, combination drugs have been developed, consisting of several optimally selected components. This:

• Noliprel (indopamid + perindopril arginine).
• Aritel plus (bisoprolol + hydrochlorothiazide).
• Exforge (valsartan + amlodipine).
• Renipril GT (enalapril maleate + hydrochlorothiazide).
• Lorista N or Lozap plus (losartan + hydrochlorothiazide).
• Tonorma (triamterene + hydrochlorothiazide).
• Enap-N (hydrochlorothiazide + enalapril) and others.

Combination use of several drugs for high blood pressure

Combination therapy is the most effective in the treatment of arterial hypertension. The simultaneous use of 2-3 drugs, always from different pharmacological groups, helps to achieve lasting positive results.

How to take high blood pressure pills in combination:

Resume

There are a large number of tablets for high blood pressure. With stage 2 and 3 hypertension, patients are forced to take medications constantly to keep their blood pressure normal. For this purpose, combination therapy is preferable, due to which a stable antihypertensive effect is achieved without hypertensive crises. Only a doctor should prescribe any blood pressure medication. Before making a choice, he will take into account all the features and nuances (age, presence of concomitant diseases, stage of hypertension, etc.) and only then select a combination of drugs.

An individual treatment regimen is drawn up for each patient, which he must adhere to and regularly monitor his A/D. If the prescribed treatment is insufficiently effective, you should contact your doctor again to adjust the dosage or replace the drug with another one. Self-administration of medications, relying on reviews from neighbors or acquaintances, most often not only does not help, but also leads to the progression of hypertension and the development of complications.