Buying good medicine for high blood pressure is not easy. A pharmacist at a pharmacy will rarely help; he will immediately send you to a doctor. Is it really so difficult to recommend a reliable drug at an affordable price? Let's try to understand the types of drugs and the principles of taking them.
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Hypertension
Few people in our time have not heard anything about hypertension, or high blood pressure. This is not surprising - after all, in the modern world, every third adult is faced with this problem and is forced to look for ways to solve it.
Blood pressure is considered elevated if its value is 140/90 mmHg. Art. or higher, regardless of the person's age. Most often, high blood pressure is an independent disease called hypertension. But sometimes hypertension is a symptom of some other disease (for example, kidney disease, thyroid disease, adrenal gland disease). In this case, in addition to reducing the numbers, the underlying disease must be treated.
Achieved effect
The medicine underwent clinical trials, during which its effectiveness was proven.
According to the instructions, Glycine helps:
- reduce psycho-emotional stress, conflict, aggressiveness, increase social adaptation;
- improve mood;
- make it easier to fall asleep;
- increase mental performance;
- reduce vegetative-vascular disorders;
- reduce the severity of brain disorders in traumatic brain injury and ischemic stroke;
- reduce the toxic effects of drugs and alcohol.
Symptoms
Symptoms that may indicate increased blood pressure include:
- headache;
- dizziness;
- “flies” before the eyes;
- discomfort in the heart area.
If any of them appear, you should measure your blood pressure. If it is higher than normal, you need to take care of reducing it.
Does it happen that nothing bothers a person, but his blood pressure is elevated? Unfortunately, such cases are not uncommon. This is why it is so important to control your blood pressure even when you feel normal. Many people mistakenly think that if there are no symptoms, then there is no need to reduce blood pressure. Indeed, why take pills if you feel good? Alas, the frequency of complications of hypertension does not depend on whether you feel it or not.
Hypertension can cause serious complications.
Dangerous complications:
- myocardial infarction;
- stroke;
- renal failure.
The higher the pressure, the greater the risk of their development.
It is known that the level of blood pressure in the morning upon awakening, according to 24-hour monitoring, is a more significant risk factor for serious cardiovascular complications than the level of blood pressure at any other time of the day or the average blood pressure values per day. However, there have never been any well-designed studies that directly compared the effect of antihypertensive therapy depending on the timing of its administration.
In addition, the prescription of antihypertensive drugs before bedtime has a certain pathophysiological justification: for example, it is known that the activity of the RAAS is maximum at night.
The European Heart Journal published the results of an open-label, prospective study of Hygia Chronotherapy conducted in primary care clinics in Spain.
The study included 19,084 patients with arterial hypertension, the course of which allowed a single dose of antihypertensive drugs (both monotherapy and combinations). Patients were divided into 2 groups: taking standard medications in the morning or taking the same medications before bed. It was allowed to take small doses of diuretics (hypothiazide no more than 25 mg). It was assumed that such a dose of diuretics would not disturb the patients' sleep at night. At each visit (at least once a year), two-day blood pressure monitoring was carried out, and adverse events were recorded. The average follow-up duration was 6 years.
It turned out that in the group taking antihypertensive drugs before bedtime, daytime blood pressure was slightly lower, and patients were less likely to be classified as non-dippers. In addition, it turned out that such a regimen of taking antihypertensive drugs was associated with a decrease in the incidence of the combined endpoint of cardiovascular death/MI/coronary revascularization/CHF/stroke. After adjustment for major risk factors, the OR was 0.55 (95% CI 0.50–0.61), P < 0.001. -=»» 0=»» 44=»» 34=»» 56=»» p=»»>Such impressive results are difficult to explain solely by a decrease in blood pressure, since the differences in the degree of blood pressure reduction with the standard therapy group were quite modest. Perhaps there were some pleiotropic effects that normalized circadian rhythms in the functioning of the cardiovascular system.
Of course, randomized placebo-controlled studies are required to confirm the results obtained.
Based on materials:
Ramon C Hermida, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial, European Heart Journal, ehz754, https://doi.org/
Text: Ph.D. Shakhmatova O.O.
Treatment
Almost all patients with hypertension need blood pressure lowering medications. At the initial stage of the disease, with a slight increase in blood pressure, it is sometimes possible to bring the indicators back to normal by changing lifestyle (diet, weight loss, stress management, physical activity). But most patients still require constant medication. If treatment is stopped, high blood pressure, and along with it unpleasant symptoms, and the risk of complications return. During treatment, it is very important to monitor the level of pressure and keep a diary by the patient in which his indicators are recorded. This allows you to select the optimal treatment and accurately assess its effect.
Nowadays, a large number of drugs have been created that reduce blood pressure. Let's look at the main groups of these drugs.
ACE inhibitors
- Enap;
- Diroton;
- Prestarium A;
- Hartil.
They suppress (inhibit) one of the enzymes involved in raising blood pressure and are often used as the first choice drugs when starting treatment for hypertension.
Advantages of this group:
- do not affect the pulse rate (can be prescribed for any pulse rate);
- do not cause an increase in cholesterol and blood sugar levels;
- for diabetes mellitus and chronic kidney disease, they not only reduce blood pressure, but also prevent the development of renal failure;
- these medications are also effective for chronic heart failure.
But this group is not suitable for pregnant (or planning pregnancy) women - it can have a negative effect on the fetus. Also, sometimes, while taking these medications, a dry cough appears. If it greatly bothers the patient, it is necessary to replace it with a drug from another group.
ACE inhibitors are not suitable for pregnant women, because negatively affect the fetus.
Angiotensin receptor blockers (ARBs).
- Lozap;
- Valsacor;
- Aprovel;
- Edarby.
Their mechanism of action is close to the drugs of the previous group, but blocks the process at a different level. In general, they have the same properties as ACE inhibitors. They are often prescribed if a dry cough develops while taking ACE inhibitors, since this group does not have such a side effect.
Beta blockers
- Concor;
- Betalok;
- Nebilet.
They reduce blood pressure by acting on beta-adrenergic receptors of the heart and blood vessels. In addition to lowering blood pressure, these medications slow down the heart rate. They are preferable if you are prone to rapid heartbeats, but if your heart rate is initially low, they are not recommended. When selecting a dose and treatment, pulse control is required (it should be at least 50 beats per minute).
They are also recommended for use when hypertension is combined with coronary heart disease or chronic heart failure. And when combined with bronchial asthma or chronic obstructive pulmonary disease (COPD), they should be used with caution - bronchospasm may increase.
Calcium antagonists
They reduce blood pressure by affecting the calcium channels of cells. They can be used when hypertension is combined with bronchial asthma, COPD, diabetes mellitus, and kidney disease.
Diltiazem, Verapamil, Isoptin (extended form) - also reduce heart rate and can be used as an alternative to beta blockers.
Cordaflex, Normodipin, Lerkamen - without reducing the pulse, they have a vasodilating effect. They are especially effective in increasing diastolic (“bottom”) pressure.
Diuretics
- Hypothiazide;
- Indapamide;
- Arifon-retard;
- Indapamide retard.
Remove excess water and sodium from the body. Especially relevant for people with edema or signs of heart failure. Long-acting indapamide has the least pronounced diuretic effect and minimal side effects, but at the same time it stabilizes blood pressure well.
Diuretics are suitable for people with signs of heart failure.
This group should be used with caution if blood sugar and uric acid levels are elevated.
Centrally acting drugs
- Physiotens;
- Albarel.
They reduce blood pressure by acting on receptors in the brain. As a rule, they are added to combinations of other drugs if the desired effect cannot be achieved.
Combined products
When treating hypertension, combinations of several active ingredients are often used. According to research, the use of combinations is more effective than simply increasing the dose of the drug and causes fewer side effects. Many medications, when used together, complement and enhance each other's effect. That is why many combination drugs have been created, when one tablet contains 2, and sometimes three drugs at once. Their use is both effective and very convenient.
Combinations of 2 drugs:
- ACE inhibitor + diuretic: Enap N, co-diroton, noliprel;
- ACE inhibitor + calcium antagonist: tarka, dalneva, equator;
- angiotensin receptor blocker + diuretic: lozap plus, valsacor N, edarbi clo;
- angiotensin receptor blocker + calcium antagonist: lortenza, vamloset, aprovasc;
- beta blocker + calcium antagonist: Concor AM, Logimax.
Combinations of 3 drugs:
- ACE inhibitor + diuretic + calcium antagonist: co-dalneva, triplixam;
- angiotensin receptor blocker + diuretic + calcium antagonist: co-vamloset, Co-Exforge.
When selecting treatment for hypertension, they usually start with small doses and, if necessary, gradually increase them. You cannot sharply reduce blood pressure to normal if it is initially very high. It is better to first stabilize it at a lower level (for example, if the initial blood pressure is more than 180/100, reach values not exceeding 150-160/90 mm Hg), and after some time try to intensify therapy, taking into account its tolerability.
Finding the optimal treatment is not easy. Even doctors need time for this. The patient's active participation in keeping a diary and taking medications regularly is mandatory. Changing the treatment regimen on your own or stopping it can lead to unpleasant consequences, including complications of hypertension (heart attacks, strokes). If for some reason you change your medication intake, do not hide it from your doctor. Only together can we achieve sustainable results in treatment.
Kapoten
When used simultaneously with immunosuppressants and cytostatics, the risk of developing leukopenia increases.
When used simultaneously with potassium-sparing diuretics (including spironolactone, triamterene, amiloride), potassium preparations, salt substitutes and dietary supplements containing potassium, hyperkalemia may develop (especially in patients with impaired renal function), because ACE inhibitors reduce the content of aldosterone, which leads to potassium retention in the body while limiting the excretion of potassium or its additional intake into the body.
With the simultaneous use of ACE inhibitors and NSAIDs, the risk of developing renal dysfunction increases; hyperkalemia is rarely observed.
When used simultaneously with loop diuretics or thiazide diuretics, severe arterial hypotension is possible, especially after taking the first dose of the diuretic, apparently due to hypovolemia, which leads to a transient increase in the antihypertensive effect of captopril. There is a risk of developing hypokalemia. Increased risk of developing renal dysfunction.
When used simultaneously with anesthetics, severe arterial hypotension is possible.
When used simultaneously with azathioprine, anemia may develop, which is due to inhibition of erythropoietin activity under the influence of ACE inhibitors and azathioprine. Cases of the development of leukopenia have been described, which may be associated with additive suppression of bone marrow function.
When used simultaneously with allopurinol, the risk of developing hematological disorders increases; Cases of severe hypersensitivity reactions, including Stevens-Johnson syndrome, have been described.
With the simultaneous use of aluminum hydroxide, magnesium hydroxide, magnesium carbonate, the bioavailability of captopril decreases.
Acetylsalicylic acid in high doses may reduce the antihypertensive effect of captopril. It has not been conclusively established whether acetylsalicylic acid reduces the therapeutic effectiveness of ACE inhibitors in patients with coronary artery disease and heart failure. The nature of this interaction depends on the course of the disease. Acetylsalicylic acid, by inhibiting COX and prostaglandin synthesis, can cause vasoconstriction, which leads to a decrease in cardiac output and worsening of the condition of patients with heart failure receiving ACE inhibitors.
There are reports of increased plasma concentrations of digoxin when captopril is administered concomitantly with digoxin. The risk of drug interactions is increased in patients with impaired renal function.
When used simultaneously with indomethacin and ibuprofen, the antihypertensive effect of captopril decreases, apparently due to inhibition of prostaglandin synthesis under the influence of NSAIDs (which are believed to play a role in the development of the hypotensive effect of ACE inhibitors).
When used simultaneously with insulins, hypoglycemic agents and sulfonylurea derivatives, hypoglycemia may develop due to increased glucose tolerance.
With simultaneous use of ACE inhibitors and interleukin-3, there is a risk of developing arterial hypotension.
When used simultaneously with interferon alpha-2a or interferon beta, cases of severe granulocytopenia have been described.
When switching from clonidine to captopril, the antihypertensive effect of the latter develops gradually. If clonidine is suddenly discontinued in patients receiving captopril, a sharp increase in blood pressure may occur.
With simultaneous use of lithium carbonate, the concentration of lithium in the blood serum increases, accompanied by symptoms of intoxication.
When used simultaneously with minoxidil and sodium nitroprusside, the antihypertensive effect is enhanced.
When used simultaneously with orlistat, the effectiveness of captopril may decrease, which can lead to increased blood pressure, hypertensive crisis, and a case of cerebral hemorrhage has been described.
With simultaneous use of ACE inhibitors with pergolide, the antihypertensive effect may be enhanced.
When used simultaneously with probenecid, the renal clearance of captopril is reduced.
When used simultaneously with procainamide, the risk of developing leukopenia may increase.
When used simultaneously with trimethoprim, there is a risk of developing hyperkalemia, especially in patients with impaired renal function.
When used simultaneously with chlorpromazine, there is a risk of developing orthostatic hypotension.
When used simultaneously with cyclosporine, there are reports of the development of acute renal failure and oliguria.
It is believed that the effectiveness of antihypertensive drugs may be reduced when used simultaneously with erythropoietins.
