Author Ольга Кияница
High blood pressure, also known as hypertension (the old name is hypertension), is determined by almost a third of the adult population of the planet. With this disease, the blood in the arteries circulates under too much pressure. This not only leads to damage to the vessels themselves, but also to the disruption of the work of other organs that are forced to endure stress.
In adults, blood pressure is considered normal if the upper number (systolic pressure) is between 90 and 120, and the lower number (diastolic) is between 60 and 80.
Blood pressure (BP) is estimated using two parameters - systolic and diastolic pressure. They show, respectively, the maximum pressure created in the arteries during compression of the heart, and the minimum pressure generated in these vessels between the heartbeats.
Video: High Pressure Tablets
Description of drug pressure classes
There are several classes of drugs used to treat blood pressure. Each class lowers blood pressure according to its mechanism of action.
Diuretics increase urination, which reduces sodium and body fluids. This can help normalize blood pressure, as the blood volume in the vessels decreases. Mild hypertension can sometimes be treated using diuretics alone, although they are more often used in combination with other drugs for high blood pressure. Examples of diuretics are as follows:
|Hydrochlorothiazide||Esidrix, Hydrodiuril, Microzide|
A key side effect of diuretics is the loss of potassium, which is excreted in the urine along with sodium. Potassium is necessary for proper muscle contraction, so a deficiency of this mineral leads to fatigue, weakness, leg cramps and even heart problems. Patients taking diuretics, it is recommended to take special medications containing potassium, and use foods rich in potassium (orange juice, bananas, raisins).
It should be noted that combined diuretics have been developed to solve the problem of potassium loss. These blood pressure lowering medicines are known as “potassium-sparing” diuretics. The group includes amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide) and triamterene (Dyrenium, Dyazide, Maxzide).
These drugs reduce blood pressure by acting directly on the receptors in the heart. With the help of these drugs for high blood pressure, the heart rate is reduced. Also, the discharge function of the heart is normalized. The blood volume in the bloodstream is also reduced. This group includes:
|Carvedilol||Coreg - combined alpha / beta blocker|
|Labetalol||Trandate, Normodyne - combo alpha / beta blocker|
|Metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol-XL)||Lopressor and Toprol-XL respectively|
|Hydrochlorothiazide + bisoprolol||Ziac - a diuretic. + Beta-blocker|
Angiotensin is a hormonal substance that causes blood vessels to constrict. Angiotensin-converting enzyme inhibitors (ACE inhibitors) reduce the synthesis of angiotensin and, in turn, help normalize blood pressure. Examples of ACE inhibitors are as follows:
Angiotensin Receptor Blockers
The hormone angiotensin constricts blood vessels, but in order to fulfill its task it is necessary for it to join the angiotensin receptors. This is where the area of impact of angiotensin receptor blockers. They prevent the binding of angiotensin with nerve endings located in the vascular wall, which helps to normalize blood pressure. To the present group of drugs include:
Calcium channel blockers
Calcium potentiates the contractile capabilities of the heart, which causes constriction of the blood vessels. When blocking the receipt of this trace element in smooth-muscle tissue, this effect is reduced. Under the influence of calcium channel blockers, the blood vessels relax, resulting in a decrease in heart rate, and with it - blood pressure. Examples from this group of drugs:
|Amlodipine besylate||Norvasc, Lotrel|
|Diltiazem hydrochloride||Cardizem CD, Cardizem SR, Dilacor XR, Tiazac|
|Cardarm||Dilacor XR, Tiazac|
|Isradipine||DynaCirc, DynaCirc CR|
|Nifedipine||Adalat CC, Procardia XL|
|Verapamilu hydrochloride||Calan SR, Isoptin SR, Verelan, Covera HS|
Means contribute to the expansion of blood vessels, thereby causing a decrease in blood pressure. Preparations from the present group are also used to treat an enlarged prostate in men. Alpha blockers include:
Alpha-2 receptor agonists
A prominent representative is methyldopa, previously known under the trademark Aldomet. It is one of the oldest drugs used to treat hypertension. It was first introduced more than 50 years ago. Today the drug continues to be used.Methyldopa has an impact on the central nervous system, which allows to lower blood pressure. In general, the distribution of the drug has decreased in recent years, but at the same time, methyldopa is considered to be the first-line treatment for high blood pressure, which is determined in pregnant women.
Some drugs for hypertension have a therapeutic effect through the central nervous system, and not through a direct effect on the heart and blood vessels. Against this background, central agonists can cause drowsiness, a decrease in attention. Drugs in this class include:
Peripheral adrenergic inhibitors
At one time, there was very little medicine for high blood pressure. In the 1950s, reserpine was one of the few drugs on the pharmacological market used to treat hypertension. He was rarely prescribed due to numerous side effects and adverse interactions with other drugs.
Peripheral adrenergic inhibitors work in the brain by blocking the signals that flow to the blood vessels to narrow them.They are mainly used when other high blood pressure medications cannot solve the problem. This class of antihypertensive drugs include:
Funds from this class relax the muscles in the artery walls, and this leads to a decrease in blood pressure. Vasodilators are usually not used separately, therefore they are often prescribed only for severe hypertension in combination with minoxidil (Loniten). The main representatives of this class are:
The most common pressure pills
Recent statistical studies conducted in the United States have made it possible to determine the most popular pressure drugs. The angiotensin receptor blocker valsartan (Diovan) was determined to be the first among the best-selling drugs for high blood pressure. Beta-blocker metoprolol, a combination of valsartan and hydrochlorothiazide (GHTZ), olmesartan (Benicar) and a combination of olmesartan and hydrochlorothiazide (Benicar HCT) turned out to be less popular in sales.
Among prescription drugs, ACE inhibitor lisinopril (Prinivil, Zestril), followed by amlodipine besyat (Norvasc), a blocker of slow calcium channels, and hydrochlorothiazide, are most common in the American market.
The best medicine for high blood pressure
The choice of the “best” drug for hypertension depends on several factors, including the patient’s general health, age, ethnicity, and whether the patient has any concomitant diseases or bad habits.
For example, patients with hypertension and asthma may not be advisable to use beta-blockers, since these drugs can aggravate the course of respiratory disease. Similarly, patients who are prone to constipation (for example, in the elderly) should better avoid using certain calcium channel blockers, as well as diuretics, because agents from both classes can inhibit (suppress) intestinal motility.
For the treatment of certain groups of patients requires the use of drugs from certain classes of antihypertensive drugs.In particular, pregnant women, the elderly, representatives of African culture require special attention.
- Pregnant women
The drug of choice for treating hypertension in pregnant women is the oldest remedy for high blood pressure - methyldopa (Dopegit). This medicine helps to reduce blood pressure through the central nervous system, and therefore has the lowest risk of harming the mother and fetus.
Other possible safe options include:
- Beta blockers (labetalol)
Two classes of drugs that should never be used during pregnancy are ACE inhibitors and angiotensin receptor blockers, since they will contribute to a number of complications.
- Elderly patients
With age, there is an increased risk of systolic hypertension, which can be exacerbated by severe atherosclerosis and other pathological conditions.
According to one study, the diuretic chlorthalidone (Hygroton) had a significant positive effect on elderly patients who had systolic hypertension. Along with the diuretic, calcium channel blockers, ACE inhibitors and angiotensin II receptor blockers are also quite effective.
It is worth noting that beta-blockers may not be as effective in the treatment of hypertension in persons older than 60 years. Nevertheless, these drugs are a good option if the patient has concomitant heart disease. It is also preferable that older patients receive drugs from blood pressure in a slightly lower dose compared with standard regimens.
Hypertension in African culture tends to develop earlier and progress more seriously. In addition, some drugs that effectively lower blood pressure in other ethnic groups may have a limited effect on Africans.
Thiazide diuretics (such as HCTZ) or calcium channel blockers are recommended as essential drugs along with the possible addition of a second drug from the class of ACE inhibitors or angiotensin receptor blockers.
Video: Which pressure pills are the best?
Common side effects of pressure pills
Different classes of drugs for the treatment of high blood pressure have different side effects.
Diuretics can lead to an increase in potassium loss, known as hypokalemia. This pathology in turn can affect the function of muscle fibers, including the heart muscle (myocardium).
There is an increased risk of gout when taking diuretics, as well as the likelihood of weakness, thirst, dehydration and increased urination. Changes in blood sugar levels are also possible.
The appearance of skin reactions, sometimes quite serious, is possible with treatment with thiazide diuretics (such as hydrochlorothiazide).
Potassium-sparing diuretics, such as spironolactone (Aldactone), can cause breast enlargement in men.
- Beta blockers
Beta blockers slow the heart rate, so some of their side effects stem from this mechanism of action. In particular, dizziness, weakness, fatigue, depression, and fainting are possible. Cold hands and feet are sometimes noted.
Beta-blockers also affect the respiratory system, so other side effects include shortness of breath, difficulty breathing and chest pain.
Reception of drugs from this class should not suddenly stop, as this can lead to a heart attack or sudden death.
- ACE Inhibitors
The most common side effect of ACE inhibitors is an unusually severely annoying dry cough. As a rule, it disappears with continued use of the drug, but it may take weeks for such an adaptation.
ACE inhibitors reduce blood pressure too much, which can lead to hypotension, which, in turn, can cause headache, dizziness, fainting and reduced kidney function.
- Angiotensin II Receptor Blockers
The most common side effect of angiotensin receptor blockers is an increased level of potassium in the blood, known as hyperkalemia. Dizziness is also common, along with fatigue. It has also been reported about upper respiratory tract infections - along with gastrointestinal disorders such as dyspepsia and diarrhea.
- Calcium channel blockers
One-third of patients have side effects such as swelling of the ankles and other parts of the body, redness of the skin and dizziness.
Other common side effects include feeling of heartburn and nausea.
- Alpha blockers
A temporary but rather alarming side effect of alpha blockers is postural hypotension. This condition is characterized by a sudden drop in blood pressure during the lifting of the patient from a lying or sitting position. The resulting violation can lead to quite serious consequences like dizziness or even fainting. In addition, alpha blockers may contribute to an increase in heart rate, headaches, nausea and weakness.
This drug is generally well tolerated, but some patients may experience dizziness, drowsiness, weakness, headache, and dry mouth.
- Central agonists
Up to 40% of patients taking clonidine (Catapres) experience dry mouth, and about a third complain of drowsiness, headache and fatigue. Other common side effects include constipation, dizziness, and local skin reactions, especially when using the drug Catapres-TTS.
The use of reserpine is associated with various side effects, including nightmares, nasal congestion, depression, and the inability to fall asleep normally. Diarrhea and heartburn are also possible.
Guanadrel and guanethidine can cause diarrhea and other gastrointestinal problems, as well as dizziness and drowsiness.
Taking minoxidil can lead to excessive body hair growth, as well as weight gain and dizziness.
Hydralazine is often associated with headaches, palpitations, swelling around the eyes and pain in the joints.
Pills for pressure and pregnancy
Some high blood pressure drugs should NOT be used during pregnancy, as they may harm the mother and the development of the fetus. These drugs include ACE inhibitors and angiotensin II receptor blockers.
Reserpine (a central agonist) can also be harmful during pregnancy and should be used only when there are no other alternatives.
Safe medicines for use include methyldopa, certain diuretics, and beta-blockers, including labetalol.
Alcohol while taking pills for pressure
Some drugs for high blood pressure initially cause drowsiness, dizziness and weakness. Some even faint at the first dose. The body usually adapts to the action of these drugs, and the side effects disappear.
Consuming alcohol during the early phase of antihypertensive therapy can be risky, because alcohol can also cause dizziness, drowsiness, and general weakness.
In addition, alcohol consumption causes a short-term increase in blood pressure, which can persist if the drink exceeds the “moderation” level.
Pills for pressure and weight gain
Some drugs for high blood pressure can actually lead to weight gain. This usually occurs when treating older beta blockers such as propranolol (Inderal) and atenolol (Tenormin) . This happens for several reasons - including the fact that drugs can make patients feel tired, which makes them less physically active.
Minoksidil tablets (Loniten) is used only when other antihypertensive drugs have been ineffective, because it can also lead to weight gain.
Weight changes in the direction of increase is also a common side effect of doxazosin (Cardura). Diuretics often cause weight loss.
Video: Are there pills for hypertension without side effects?
Combined treatment is a combination of one main drug and another supplement taken from different classes of antihypertensive drugs to increase the effectiveness of antihypertensive therapy.
Many patients with low blood pressure respond positively to one medicine. In some cases, it may take several pill changes on the pressure before you can find the most effective combination of drugs.
Severe or progressive hypertension may not be controlled with a single drug for high blood pressure. In such cases, the doctor increases the dose of the drug or changes it to another. If after that the arterial pressure still remains high, then, as a rule, the second agent is added.
The combined treatment of hypertension is very individualized. With proper selection of drugs can achieve the best control of blood pressure with the least side effects.
In addition, the combined treatment may require less financial investment. Sometimes you need to visit your doctor less often to control your blood pressure, as the combination of pills relieves hypertension effectively from pressure.
Common combinations of drugs used to treat high blood pressure
Different combinations of drugs in different doses are used to treat hypertension. Sometimes using lower doses of one or more drugs in combination can minimize side effects without reducing the overall effectiveness of antihypertensive therapy.
- Thiazide diuretics are often used separately in the treatment of hypertension. However, diuretics in low doses can also be combined with other drugs, such as beta-blockers, if necessary.
- ACE inhibitors and calcium channel blockers are often more effective if they are combined in the treatment of hypertension.
- Calcium channel blockers can also be used in combination with thiazide diuretics, beta-blockers and angiotensin receptor blockers.
- Sometimes a beta blocker is combined with an alpha blocker. This can be useful for treating men with hypertension and an enlarged prostate. The alpha blocker in such cases helps to solve both problems simultaneously.
The best combinations are inhibitors of the renin-angiotensin system and calcium channel blockers or inhibitors of the renin-angiotensin system and diuretics. [1 - Sever PS, Messerli FH (October 2011). Hypertension management 2011: optimal combination therapy. Eur. Heart J. 32 (20): 2499-506.]
Invalid combination of drugs for pressure:
- Beta-blockers with blockers of the renin-angiotensin system.
- Beta-blockers with other adrenergic drugs.
- ACE inhibitors and angiotensin 2 receptor blockers due to the double blocking effect on the renin-angiotensin system.
- Calcium channel blockers of non-dihydropyridine origin and beta-blockers.
Doctors usually prescribe a combination antihypertensive medication. For example, if both drugs reduce the heart rate, the doctor will closely monitor the patient's condition. As a result, you can avoid a slow heartbeat (the so-called bradycardia).
In some cases, the combined use of diuretics and nonsteroidal anti-inflammatory drugs can cause acute renal failure. A similar complication can occur with a combination of an ACE inhibitor and an arr.
If the patient has asthma, doctors try to avoid taking pressure pills, which can cause symptoms associated with respiratory illness. Thus, you need to trust your doctor, who will try to prescribe the most effective treatment, taking into account the individual characteristics of a particular patient.
Video: Combined Hypertension Medication