Hypertension Medications

Hypertension (hypertension, hypertension) is a fairly common disease today that can lead to other serious health problems. In particular, the risk of stroke, myocardial infarction, progression of diabetes mellitus, etc. increases. In view of this, it is extremely important to be examined in a timely manner to determine the severity of the disease and to assign appropriate treatment.

Video: Hypertension - Overview (causes, pathophysiology, investigations, treatment)

Standard groups of drugs for hypertension

Hypertension is the most common modifiable risk factor for cardiovascular disease and death. It is well known that lowering blood pressure with antihypertensive drugs reduces the likelihood of damage to the target organ and prevents the consequences of cardiovascular diseases.

There are various classes of drugs that are prescribed for cardiovascular diseases. Most often they are used in combination therapy, which is adjusted if necessary.

For general information, brief characteristics of the main groups of antihypertensive drugs with examples of drugs in the form of a common name and brand are provided.

The main classes of drugs for high blood pressure:

• Diuretics
• Beta blockers
• ACE inhibitors
• Angiotensin II Receptor Blockers
• Calcium channel blockers
• Alpha blockers
• Alpha-2 receptor agonists
• Combined alpha and beta blockers
• Central agonists
• Peripheral adrenergic inhibitors
• Vasodilators

Diuretics

Diuretics help the body get rid of excess sodium (salt) and water, which allows better control of blood pressure.Preparations from this group are often used in combination with additional prescription drugs. The group of diuretics is further subdivided into thiazide, potassium-saving, loop and combined.

Common name	General trademarks
Thiazide diuretics
chlorthalidone	Hygroton
chlorothiazide	Diuril
hydrochlorothiazide	Esidrix, Gidrodiuril, Microzid
indapamide	Lozol
metolazone	Microx, Zaroxolin
Potassium-sparing diuretics
amiloride hydrochloride	Midamar
spironolactone	Aldactone
triamteren	Dyrenium
Loop diuretics
furosemide	Lasix
bumetanide	Bumex
Combined diuretics
amiloride hydrochloride + hydrochlorothiazide	Moduretic
spironolactone + hydrochlorothiazide	Aldactazide
triamterene + hydrochlorothiazide	Dyazid, Maxzid

Beta blockers

Beta-blockers reduce heart rate, stress on the heart, and cardiac output of blood. Similar effects of medication contribute to lowering blood pressure.

Common name	General trademarks
acebutolol	Sectral
atenolol	Tenormin
betaxolol	Kerlone
bisoprolol stearyl fumarate	Zebeta
carteolol hydrochloride	Cartrol
metoprolol tartrate	Lopressor
metoprolol succinate	Toprol-xl
nadolol	Corgard
penbutolol sulfate	Levatol
pindolol	Visken
propranolol hydrochloride	Inderal
solotol hydrochloride	Betapace
timolol maleate	Blocadren
Combined beta blocker / diure
hydrochlorothiazide and bisoprolol	Ziac

If a cardiologist prescribed beta-blockers, you need to consult with your doctor if you are planning a pregnancy or have already become pregnant. Pregnant women determine the safest drugs at this time, but this turns out to be a medical consultation.

ACE Inhibitors

Angiotensin is a chemical that causes narrowing of the arteries, especially in the kidneys, as well as throughout the body. APP stands for angiotensin-converting enzyme. ACE inhibitors help the body produce less angiotensin, which helps relax blood vessels and their expansion, which, in turn, reduces blood pressure.

Common name	General trademarks
benazepril hydrochloride	Lotensin
captopril	Capoten
enalapril maleate	Monopril
lisinopril	Prinivel, Zestril
moexipril	Univasc
perindopril	Aceon
hinapril hydrochloride	Accupril
ramipril	Altace
trandolapril	Mavik

Angiotensin Receptor Blockers

These drugs block the action of angiotensin, a chemical that causes narrowing of the arteries. Angiotensin needs a receptor-compatible chemical that it can bind with in order to constrict blood vessels. BAR, that is, angiotensin receptor blockers, block the nerve endings, so angiotensin cannot constrict blood vessels. This means that the blood flow is more free, while blood pressure decreases.

Common name	General trademarks
candesartan	Atacand
eprosartan mesylate	Teveten
irbesarten	Avapro
losartan potassium	Cozaar
telmisartan	Micardis
valsartan	Diovan

Calcium channel blockers

This group of drugs prevents the penetration of calcium into the smooth muscle cells of the heart and arteries. When calcium enters these cells, it causes a stronger contraction, therefore, reducing the concentration of calcium in the blood, the heart rate decreases, which means the blood pressure decreases. Calcium channel blockers relax and dilate constricted blood vessels, reduce heart rate and lower blood pressure.

Common name	General trademarks
amlodipine besylate	Norvask, Lotrel
bepridil	Vasocor
diltiazem hydrochloride	Cardizem CD, Cardizem SR, Dilacor XR, Tiazac
felodipine	Plandil
isradipine	DynaCirc, DynaCirc CR
nicardipine	Cardin sr
nifedipine	Adalat CC, Procardia XL
nisoldipine	Sular
verapamil hydrochloride	Kalan SR, Kovera XC, Izoptin CP, Verelan

Alpha blockers

These drugs reduce the resistance of arteries, relax the muscle tone of the vascular walls.

Common name	General trademarks
doxazosin mesilate	Cardura
prazosin hydrochloride	Minipress
terazosin hydrochloride	Hytrin

Alpha2-adrenoreceptor agonists

These drugs reduce blood pressure by reducing the activity of the sympathetic (adrenaline-producing) section of the nervous system. Methyldopa is considered a first-line antihypertensive agent during pregnancy, because side effects rarely occur in pregnant women, and the negative impact on the developing fetus is minimal.

Common name	General trademarks
methyldopa	Aldomet, Aldoril, Dopamet, Dopegyt

Combined alpha and beta blockers

Combined alpha and beta-blockers are most often used in the hospital, in particular, are prescribed to the patients in the form of an IV for relieving hypertensive crises. Also, drugs from this group can be prescribed for ambulatory treatment of high blood pressure, especially if the patient has a risk of heart failure.

Common name	General trademarks
carvedilol	Coreg
labetalol hydrochloride	Normodyne, trandat

Central agonists

Central agonists also help reduce the ability of blood vessels to tighten or shrink. Central agonists act on a different nerve path than alpha and beta adrenoblockers, but they achieve the same goal - they lower blood pressure.

Common name	General trademarks
alpha methyldopa	Aldomet
clonidine hydrochloride	Catapres
guanabenz acet	Wytensin
guanfacine hydrochloride	Tenex

Peripheral adrenergic inhibitors

These drugs lower blood pressure by blocking neurotransmitters in the brain. Preparations prevent the transmission of impulses to smooth muscles, as a result of which they do not contract. These medicines are rarely used, unless other means help.

Common name	General trademarks
guanadrel	Hylorel
guanethidine monosulfate	Ismelin
reserpine	Serpasil

Vasodilators

Blood vessel dilators, or vasodilators, can cause the muscle in the walls of blood vessels (most commonly arterioles) to relax, allowing the vessel to expand. As a result, the blood is able to flow better.

Common name	General trademarks
hydralazine hydrochloride	Apresoline
minoxidil	Loniten

It is important to know that Loniten is usually prescribed in severe cases or in the presence of renal failure.

Video: High Blood Pressure: What You Need to Know About Medications

New Medications for Hypertension

Despite the many options available for the treatment of hypertension, uncontrolled blood pressure is still a significant part of the population. In order to meet the need for managing blood pressure in this group of patients, new drugs and devices / procedures are being developed for the treatment of hypertension and its associated diseases. In particular, today there are new drugs and interventional treatments that are undergoing preclinical or clinical trials for the treatment of hypertension.

New classes of drugs for hypertension, which are in phase II / III of the test, are the following:

1. Vasopeptidase inhibitors.
2. Aldosterone synthase inhibitors.
3. Soluble epoxide hydrolase inhibitors.
4. Natriuretic peptide agonists A.
5. Agonists of the vasoactive intestinal peptide receptor 2.
6. A new mineralocorticoid receptor antagonist.

Medications for hypertension, which are in phase I or in preclinical testing:

• Aminopeptidase A inhibitors,
• dopamine β-hydroxylase.
• Intestinal Na (+) / H (+) exchanger.
• Angiotensin-converting enzyme agonists 2.
• Vaccines directed to angiotensin II and its type I receptor.

In some countries, in clinical practice, two main interventional approaches are used to treat severe, treatment-resistant hypertension:

1. Transcatheter renal denervation.
2. Activation of arterial baroreflex.

Renal denervation is also being evaluated for the treatment of various comorbidities, such as chronic heart failure, heart rhythm disturbances, and chronic renal failure. New interventional approaches in the early stages of development include the ablation of the carotid artery and the placement of arteriovenous fistulas . It is important to note that none of these new drugs or treatment devices can yet prevent the consequences of cardiovascular diseases or death in patients with hypertension.

Transcatheter renal denervation

The best cure for hypertension

Typical prescription hypertension drugs have unpleasant or even dangerous side effects that make health-conscious people avoid them in any way possible. There are exceptions, such as the anti- diabetic drug Metformin, which for most people provides far more benefits than risks.

The best-known positive effect of a group of antihypertensive drugs, known as angiotensin II receptor blockers, is that they increase insulin sensitivity, increase the activity of using fat for energy, and improve the functionality of mitochondria. Of all the drugs in this class, telmisartan stands out as an excellent means for potentially increasing life expectancy.

As a person ages, mitochondrial dysfunction becomes a fatal factor in the development of obesity, insulin resistance, endothelial destruction and type II diabetes. Telmisartan helps correct these mechanisms underlying aging and death.

Telmisartan activates a cellular energy regulator called PPAR-gamma coactivator 1 alpha (PGC-1a), which stimulates the burning of excess calories. This is often the deciding factor in weight management.

Studies show that telmisartan directly stimulates PPAR-gamma (a peroxisome-activated proliferator gamma-receptor gamma), a key inducer of beneficial metabolic effects. PPAR-gamma-activating properties are also characteristic of other angiotensin receptor blockers, but telmisartan is at least 10 times more potent.

Additionally, atherosclerosis remains the leading cause of death for many people in the whole world. Telmisartan has several mechanisms to protect against arterial occlusion, including an increase in nitric oxide, which is useful for the endothelium.

Finally, telmisartan appears to stimulate biochemical, biological and metabolic effects, which, according to some researchers, can enhance athletic performance.

Principles of telmisartan intake

With a slight increase in blood pressure, telmisartan can be given in a daily dose of 20 mg, 40 mg or 80 mg.

Also today it became known randomized study of the so-called “triple” pills, which includes the same telmisartan, as well as amlodipine and chlorthalidone.

The best medicine for hypertension today is based on a study of 700 people, an average of 56 years. All had high blood pressure.

Among those who took the so-called “triple pill” for six months, 70% achieved their blood pressure target, compared with 55% of those who received standard therapy. The usual treatment included taking two or three drugs for hypertension.

OTC Hypertension Medications for the Elderly

It is well known that older people are more sensitive to drugs than middle-aged people. They may need a lower dose, or some drugs are completely unacceptable. Nevertheless, in most cases, after prior consultation with a doctor, patients for middle and old hypertension can use such drugs for hypertension as CoQ10, garlic, magnesium, potassium, cod liver oil.

• CoQ10 . This substance is an antioxidant with vasodilating effect. Its level is usually reduced in patients with high blood pressure, cardiovascular diseases and type 2 diabetes. Newer drug formulas help improve the absorption of this fat-soluble supplement.
• Garlic to. Allicin, contained in garlic, is a vasodilator, so it can reduce blood pressure. Since heat treatment can reduce the content of allicin in dishes, it does not always enter the body in sufficient quantities. If possible, and looking at the state of health, you can use garlic, fresh or dried.
• Magnesium . Doses from 500 to 1000 milligrams per day can have a small but significant effect on lowering blood pressure. Chelated forms, such as magnesium glycinate, are best absorbed.
• Potassium . Adding from 1,000 to 2,000 milligrams of potassium per day can be effective, especially when potassium intake is insufficient, for example, when the patient is on a low carbohydrate diet and avoids starchy foods such as potatoes, sweet potatoes, bananas and flour products.
• Cod liver oil . If fatty fish of sea varieties is not consumed regularly and in sufficient quantities, at least several times a week, then it is advisable to consume at least one gram per day of cod liver oil.

Additionally, you should pay attention to the following options for lifestyle changes that are safe and quite effective.

• Weight loss More than a third of the US adult population is currently obese. It's no secret that weight gain increases blood pressure, and its decrease and maintaining a healthy lifestyle contribute to the overall strengthening of the body.
• Exercise. Many people believe that physical activity affects the state of the heart and blood pressure. It is worth knowing that all types of exercises - endurance, dynamic resistance, isometric gymnastics - can reduce blood pressure. Whatever exercise the patients do on a regular basis, this is the best way to reduce blood pressure. The only thing patients with extreme hypertension should be careful with those loads that can further increase blood pressure to an unsafe level.
• Rash . Short and poor-quality sleep is associated with high blood pressure. On the other hand, excessively long sleep can also be harmful. One study found an increase in blood pressure in those who slept less than five hours a day, and those who slept on average more than nine hours a day, compared with people who slept for about seven hours.There are suspicions that the problem is not the very length of sleep, but that one of the main conditions is an increase in the need for sleep and an increase in blood pressure.
• Stay in the sun . Exposure to sunlight increases the amount of nitrous oxide vasodilator, as a result, blood pressure may decrease. UV rays also help produce subcutaneous vitamin D3, which helps normalize blood pressure.
• Prayer / meditation . All kinds of prayers and meditations are associated with controlling blood pressure, increasing insulin resistance and reducing lipid peroxidation. The relaxing effect on the nervous system of this method is well manifested in both young and elderly people.
• Stress management . Today it is important for everyone to manage stress, since stress is the main factor in the development of hypertension and cardiovascular diseases. Self-care, good sleep and getting rid of the “fuss” are some of the strategies of stress management.

Some foods also help lower blood pressure: nuts, beet juice, blueberries, seaweed, chocolate, and hibiscus tea. They, to some extent, can be considered slow-acting, but safe and natural medicines for hypertension.

Side effects of drugs for hypertension

Treatment of high blood pressure is often associated with the occurrence of side effects that can significantly complicate the lives of patients. You should know what means which side effects can cause.

Possible side effects of diuretics:

1. Some of these drugs can reduce the amount of potassium in the body, which leads to symptoms such as weakness, leg cramps or fatigue. Eating foods containing potassium can help prevent significant loss of this trace element. Sometimes doctors recommend preventing potassium loss by taking fluids or potassium tablets along with a diuretic. Diuretics, such as amiloride (Midamar), spironolactone (Aldactone) or triamterene (Direnium), are called “potassium-sparing drugs. They do not force the body to lose potassium. They can be prescribed separately, but are usually used in combination with another diuretic. Some ready-to-use combinations are Aldactazide, Dyazide, Maxzide, or Moduretic.
2. Some patients begin to suffer from gout attacks after long-term diuretic treatment. This side effect is not common and can be eliminated through the use of another type of treatment.
3. In the presence of diabetes, diuretic drugs can increase blood glucose levels. Correction of medication taken, diet, use of insulin or oral antidiabetic dosage eliminate this side effect in most cases.

Additionally, against the background of diuretic intake in men increases the risk of impotence.

Possible side effects of beta blockers :

1. Insomnia
2. Cold hands and feet
3. Fatigue or depression
4. Slow heartbeat
5. Symptoms of bronchial asthma
6. Impotence

If the patient has diabetes and it is necessary to take insulin, it is important to closely monitor the response to therapy.

Possible side effects of ACE inhibitors:

1. Skin rash
2. Loss of taste
3. Chronic dry, hacking cough
4. In rare cases, kidney damage

Women who take ACE inhibitors or BAR with high blood pressure should not become pregnant. If you have to take an ACE inhibitor or BAR and there is a high probability that a pregnancy has occurred, you should immediately consult a doctor. Studies have shown that these drugs are dangerous for mother and child during pregnancy. They can cause a decrease in blood pressure, severe renal failure, an excess of potassium (hyperkalemia), and even death of the newborn.

Possible side effects of angiotensin receptor blockers :

1. May cause dizziness.
2. BAR should not be used during pregnancy. Medications that act directly on the renin-angiotensin system can cause injury or even death to the developing fetus. If pregnancy is detected on the background of taking a BAR, you need to consult a doctor as soon as possible.

Possible side effects of calcium channel blockers :

1. Heartbeat
2. Ankles swelling
3. Constipation
4. Headache
5. Dizziness

Possible side effects of alpha blockers :

1. Fast heart rate
2. Dizziness
3. Drop in blood pressure when a person gets up.

Possible side effects of alpha2-adrenergic receptors:

1. Drowsiness
2. Dizziness
3. Heart rate change
4. Orthostatic hypotension
5. Inflammation of the pancreas
6. Inflammation of the liver parenchyma
7. Sexual dysfunction.

Possible side effects of combined alpha and beta blockers:

1. May cause a drop in blood pressure when a person stands up (orthostatic hypotension).

Possible side effects of central agonists :

1. Alpha methyldopa (Aldomet) can cause a strong drop in blood pressure when a person is in an upright position (standing or moving). This can cause weakness or fatigue, especially if the pressure has been reduced too dramatically. This drug may also cause drowsiness or lethargy, dry mouth, fever, or anemia. In men, impotence may occur. If this side effect persists, the doctor may have to change the dosage of the drug or use another medicine.
2. Clonidine (Catapres), guanabenz (Wytensin) or guanfacine (Tenex) can cause severe dry mouth, constipation or drowsiness. If the patient is taking any of these medicines, do not stop taking them suddenly, because blood pressure can quickly rise to a dangerously high level.

Possible side effects of peripheral adrenergic inhibitors:

1. Reserpine may cause nasal congestion, diarrhea, or heartburn. These effects are not serious, and specific treatment is not carried out, unless the dosage can be changed. If nightmares, insomnia or depression occur, you should immediately inform your doctor.
2. Guanadrel (Hylorel) or guanethidine (Ismelin) can cause diarrhea, which often persists for some people. This side effect usually becomes less pronounced if treatment continues. These drugs reduce blood pressure most often in cases where a person is standing. Sometimes you may feel dizzy and weak when in the morning the patient gets out of bed or suddenly rises. If these reactions are noticed or they last more than a minute or two, you need to consult a doctor. If necessary, the dose of the drug will be reduced.
3. When taking guanethidine, you do not need to stand under the scorching sun or attend public events, as you may feel weak or tired. Also, active actions cause a decrease in blood pressure and fainting. In this case, men may experience impotence.

Possible side effects of vasodilators :

1. Hydralazine (Apresoline) can cause headaches, swelling around the eyes, heart palpitations, or joint pain. Usually, none of these symptoms are serious, and most of them will disappear after a few weeks of treatment. This drug is not usually used by itself, but in combination with other antihypertensive drugs.
2. Minoxidil (Loniten) is a potent drug that is usually used only in persistent cases of severe hypertension. May cause fluid retention (marked weight gain) or excessive hair growth.

Medications for hypertension: reviews

The presence of a large number of drugs on the market sometimes does not allow to determine correctly. Medical advice, as well as feedback from users who have tried this or that medication, will definitely help in making the decision.

Nadia

“Previously, quite often worried about high blood pressure, sometimes it went as far as not knowing what to do. But now I always have a bio tea in the first-aid kit, specially designed for people with problem vessels and heart. It suits me that it is natural and is offered at an affordable cost. And most importantly, signs of hypertension stopped bothering. ”

Valentine

“When a hypertensive crisis arose, it could not get back to normal. But the doctors prescribed the drug Edarbi, 80 mg each, and after a month the condition improved. Now I take 40 mg and that's enough !!! If dizziness is felt, then, on a medical recommendation, I accept Betaserc on the whole or in half. Carvedilol is also prescribed for the heart, and I also accept veroshpiron and cardiomagnyl. Now the pressure is 130/80. Thanks to the doctor !!! ”

Vera

“When my blood pressure rises, I take a calcium antagonist medication that is great for me. And virtually no side effects.For me, Lerkanidipine-SZ turned out to be the most effective and economical. ”

Arkady

“I was diagnosed with hypertension stage 2 and, in addition, there is overweight. When I do not take drugs, then the blood pressure rises to 170/100. For the last 5 months I have been taking Moxonidine-SZ, 0.2 g once a day. This medicine also helps to lose weight. Now I follow a diet, I lost weight, and by evening the pressure does not exceed 130 mm Hg. Art. ”

Dmitriy

“Blood pressure has long been raised. I tried various medications, but as a result, the fact that I quit smoking helped me to start eating, running and playing sports. I also accept a coronary of domestic production, which not only eliminates the symptoms, but treats the cause, namely, the vascular wall.

Conclusion

Medications for hypertension today are very different. Old, well-known drugs like losartan and captopril are very popular.There are also new groups of drugs, like vasopeptidase inhibitors. aldosterone synthase. soluble epoxy acid hydrolase, etc., which are still at the testing stage. Telmisartan also has good efficacy, which can, if necessary, be included in combination therapy. At the same time, it is important to adhere to the recommendations of taking medications that the attending physician gives.

Video: Antihypertensives: volume decreasing: ACE & Diuretics (VOLUME ONLY)