- Categories of drugs for reducing blood pressure
- Central-acting drugs for high blood pressure
- Angiotensin Receptor Blockers
- Angiotensin-converting enzyme (ACE) inhibitors
- Renin Inhibitors
- Calcium channel blockers (calcium antagonists)
- What medicine to choose for high blood pressure?
In the past, high blood pressure was considered as a thing for elderly people or those with heart problems. However, the situation has changed – and not for the better. The initial forms of hypertension have become characteristic of many middle-aged people. And periodic pressure surges can be almost every person over 30 years.
There are many reasons for this phenomenon – a decrease in physical activity among the general population, an acceleration of the rhythm of life, an increase in the number of stresses, the prevalence of chronic diseases. In addition, the body of some people, especially the elderly, may respond to an increase in blood pressure to changes in weather conditions – cooling, changes in atmospheric pressure, etc.
Therefore, many people face the problem of choosing the appropriate drugs that reduce pressure (antihypertensive drugs). This process is not easy, since an increase in blood pressure has many causes. And a drug suitable for one category of patients will not work for another. In addition, the drug intended for the treatment of chronic hypertension, will be ineffective in acute hypertension (hypertensive crisis), and vice versa.
Categories of drugs for reducing blood pressure
Today in medical practice uses a huge number of different drugs from high pressure. The list of one pill has more than a dozen titles. They differ not only in price, but also in their mechanism of action, effectiveness, and the presence of side effects.
The main categories of drugs:
- Central-acting drugs
- Angiotensin receptor blockers
- ACE inhibitors
- Renin inhibitors
- Calcium channel blockers
Central-acting drugs for high blood pressure
This is one of the oldest and most used groups of drugs. Their principle of action is based on the influence on the centers of the brain that regulate blood pressure – primarily on the hypothalamus.
The most famous representative of this group is Clonidine, in the post-Soviet space better known under the name Clofelin. Clopheline is what our grandparents reduced pressure. The drug was distributed more than 50 years ago, but is still sometimes used to treat high blood pressure. It is especially effective in hypertensive crises.
The drug has many contraindications and side effects. Among them, it is worth noting the formation of drug dependence, depression of the central nervous system. Especially dangerous overdose clonidine, as well as its use in conjunction with alcohol, which can be fatal. Therefore, if possible, preference should be given to more modern and safer drugs, even if not with such a fast and strong effect.
Recently, several modern effective drugs of central action, such as Moxonidine, have appeared. These are effective, fast acting tablets that can be used with pressure surges. The effect of the drug begins to be felt after 20 minutes. The drug has fewer side effects than clonidine. The optimal dosage is 200 mcg (1 tablet). The maximum daily dose is 400 mcg.
Such a centrally acting drug as Methyldopa is also widespread. Its feature is that it is relatively safe and can be used during pregnancy.
Angiotensin Receptor Blockers
The most common type of drugs for the treatment of chronic hypertension. Usually drugs of this group are called sartans.
One of the mechanisms for increasing pressure is the effect of a particular enzyme, angiotensin, on receptors in the walls of blood vessels, which causes their narrowing. Sartans block a similar effect and thus provide a long-lasting hypotensive effect. Among all antihypertensive drugs, Sartans have the least side effects and contraindications. In this regard, they differ little from placebo. Drugs are easily tolerated by patients, suitable for long-term (for many years) reception.
However, it should be noted that the Sartans act relatively slowly and are not suitable for emergency pressure reduction.
Among the drugs in this group should be highlighted:
Losartan – the first drug from the group of Sartans, synthesized in the late 1980s. Light pills for increased pressure based on it can still be found on the market, despite the fact that it is somewhat inferior in efficiency to modern Sartans. This is largely due to the relatively low price.
Valsartan is a second-generation drug from the Sartans. It has the largest evidence base among other antihypertensive drugs. It was the most used antihypertensive drug in the world in the late 2000s. Currently also used, although somewhat inferior in efficiency to Telmisartan.
Telmisartan – the most modern sartan, having the greatest efficiency, duration and speed of action. The only downside is its relatively high price.
Telmisartan is also available under the brand name Mikardis and has a usual dosage of 80 mg. As a rule, for the treatment of hypertension should take one tablet per day. The effect of the drug does not depend on food intake.
Sartans not only reduce the pressure, but also have a protective effect on the heart and brain vessels, reduce the likelihood of heart attack and stroke. Often used in conjunction with diuretics.
Angiotensin-converting enzyme (ACE) inhibitors
A large and diverse group of drugs. The principle of action is based on blocking the formation of angiotensin – an enzyme that performs vasoconstriction.
Medications for hypertension from this group are divided into two main classes – agents with a sulfhydryl group and agents with a carboxyl group.
Sulfhydryl agents have a high speed and effectiveness of action. They are among the drugs of choice when arresting hypertensive crises. The most used drugs in this group are Capoten (Captopril), Benazepril and Zofenopril.
Captopril is considered by some experts to be the best fast-acting drug that is effective in hypertensive crises and is able to quickly reduce pressure (if you do not consider drugs of central action). He has a minimum of contraindications and, unlike most other drugs, begins to act within 10 minutes after administration. To accelerate the effect of the tablet must be absorbed under the tongue. Otherwise, the drug acts much slower. These high pressure pills can also be used as a long-lasting agent. The initial dose during therapy is 12.5 mg (half-pill), the maintenance dose for severe hypertension is 50 mg 2-3 times a day. The maximum daily dose is 600 mg.
The rate of action of carboxyl agents is lower than that of sulfhydryl ACE inhibitors. Therefore, they are more suitable for the treatment of chronic hypertension. A feature of the drugs is that they are recommended for patients with heart failure.
Carboxyl ACE inhibitors include such a popular and affordable drug as Renitec. This drug is recommended to be taken in a dosage of 10-20 mg once a day. You can also mention drugs such as Lisinopril and Perindopril. Preparations based on ACE inhibitors often contain diuretics as an auxiliary component.
Among the disadvantages of ACE inhibitors can be noted the frequent occurrence of the syndrome, which is expressed in a steady dry cough with prolonged use.
This is a new generation of drugs, only included in medical practice. Their action is similar to that of ATP inhibitors, however, renin inhibitors have fewer side effects. Currently, only one clinical trial is available – Aliskiren. It not only has a hypotensive effect, but also protects the heart and kidneys, and also prevents the occurrence of atherosclerotic vascular lesions.
The hypotensive effect of diuretics is based on the fact that they stimulate kidney activity, removing excess sodium from the body, which has a vasoconstrictive effect, as well as fluid that has accumulated in the tissues during edema, and thereby reduces the load on the cardiovascular system.
Diuretics are rarely prescribed as independent agents for the treatment of hypertension. Usually they are part of complex antihypertensive drugs, enhancing the effect of ACE inhibitors or sartans.
As a rule, two groups of diuretics are used – thiazides and loop diuretics. Thiazides have a milder effect and have few contraindications. The most common drug of the group is hypothiazide. In the treatment of hypertension, it can be used as an independent tool. The recommended dose is 25-50 mg per day.
Loop diuretics are used in the case of high-resistance hypertension. They have a fast and powerful effect, but at the same time they have a number of side effects – reducing the amount of sodium and magnesium ions, dehydration, increasing the concentration of uric acid in the blood. However, they have an important advantage over thiazides – they do not increase the level of cholesterol in the blood. The most famous representatives of the class are Furasemide, ethacrynic acid and Torasemide.
Sometimes potash-saving diuretics are used. They have a minimum of negative actions, but have a relatively low hypotensive effect. These drugs include Verohpiron and Amiloride.
Calcium channel blockers (calcium antagonists)
One of the most effective and safe groups of drugs. Regulate the concentration of calcium ions in the heart muscle, which causes the expansion of the coronary vessels. The effects are largely similar to beta blockers. However, they are well suited for the relief of hypertensive crises. The most popular drugs are Corinfar (Nifedipine), Verapamil, Diltiazem.
Nifedipine is a “fast” means, it helps well in emergency “knocking” the pressure. In terms of effectiveness in this regard, it is comparable with Captopril. If you do not know how to reduce the pressure of 160 to 90, then Nifedipine may be the best choice. To accelerate the action of the drug is recommended to dissolve under the tongue. It is a relatively safe drug, with the least side effects. It can be used during pregnancy (except for the first trimester), in childhood and adolescence (under the supervision of a physician). The usual dose of the drug is 10 mg 2 times a day, with a lack of effectiveness – up to 20 mg twice a day.
A popular group of drugs for pressure, with high reliability, versatility and efficiency. The disadvantage of drugs is a fairly large number of contraindications and side effects.
Hypertension is often caused by the effect of adrenaline on a special group of receptors – beta-adrenoreceptors located in the heart. Such an effect causes the heart to contract more rapidly and more intensively and increase blood pressure. Beta-blockers block this mechanism, than provide a stable hypertensive effect. Also, these drugs are used in the treatment of arrhythmias and tachycardias. In fact, the treatment of arrhythmias is their main purpose, and the hypotensive effect is simply one of the side effects of their action.
However, beta blockers are contraindicated in a number of syndromes, for example, in atrioventricular block and weakness of the sinus node, and have side effects – drowsiness and lethargy, bradycardia.
The most famous drugs of this group are Anaprilin, Concor and Atenolol (Tenoric). Atenolol is available in tablets of 50 and 100 mg. It should be taken before meals, preferably in the morning. The initial dose is 25-50 mg.
A group of drugs with high efficiency and speed of action. Alpha-adrenoreceptors are located directly in the vessels and react to the effects of adrenaline on them, causing vasoconstriction. Alpha receptor blockers inhibit this process, what causes a persistent vasodilator effect.
Pentolamine, Prazosin, Pyrroxan should be mentioned among the drugs of this group.
Alpha-blockers also have the ability to reduce the amount of “bad” cholesterol in the blood, improve glucose uptake of the body. They are often used to treat the effects of heart attacks and strokes.
However, alpha-blockers require careful selection of the dosage and, if used improperly, can cause a number of side effects, such as severe hypotension, collapse, heart failure. Therefore, cardiologists prescribe these drugs not as often as beta-blockers. Reception of alpha blockers should be carried out only under the supervision of a physician. There are also drugs that have both alpha and beta-blocking effects.
Most universal antispasmodics, such as Drotaverine, have a relatively weak hypotensive effect. However, these drugs have a minimum of side effects and contraindications compared with the “heavy” antihypertensives and therefore as an aid, their use is quite possible.
The action of drugs is based on the activation of the parasympathetic division of the autonomic nervous system, which in the case of the heart leads to a decrease in the intensity of heart contractions, and in the case of vessels, to their expansion.
The most famous drugs of the group are Raunatin and Reserpine. They contain vegetable alkaloids that have a sympatolytic effect. However, sympatholytics have a fairly large list of side effects and are only suitable for the treatment of mild to moderate hypertension.
It is no secret that an increase in blood pressure can often be caused not by some pathologies of the cardiovascular system, but by elementary stress or anxiety. Especially pressure jumps from nerves and stress are characteristic of people with a labile nervous system and suffering from vegetative-vascular dystonia.
In this case, sedative and mild vasodilators can help. As such remedies, one can recommend Corvalol drops or Validol tablets, preparations of valerian, mint and motherwort. Herbal preparations can also be used as a mild prophylactic agent in prehypertension. Of course, such funds are unlikely to help in the case of already formed hypertension.
It is also worth noting that in hypertensive crises many patients experience panic attacks, which aggravate their condition. In this case, no sedatives can also do. This can be not only Corvalol and Validol, but also quick-acting tranquilizers, such as Fenazepam and Diazepam.
What medicine to choose for high blood pressure?
It should be borne in mind that the treatment of hypertension – no matter whether it has a chronic form or is expressed in periodic acute manifestations (hypertensive crises) – a complex process. The patient cannot independently analyze all his symptoms and associated diseases and select the right medicine for hypertension without side effects. Yes, and there is at the moment such drugs. Even relatively safe drugs have a number of contraindications. But hypertension usually does not appear in completely healthy people, it is usually combined with a number of other adverse factors – arrhythmias, inflammatory processes, renal failure, diabetes, etc. Particularly difficult is the selection of the drug for the elderly, who, as a rule, have not only essential hypertension, but also chronic vascular, heart, kidney, etc. diseases.
Therefore, to choose drugs for hypertension, which would not harm, but only help, can only a qualified specialist cardiologist. After all, even drugs from the same drug group differ in the nuances of their action and contraindications. In addition, resistant (resistant) hypertension is usually not treated with a single drug, and requires an integrated approach. And consider all possible negative interactions between drugs can only be a doctor.
If you find yourself showing signs of hypertension, you should contact a specialist and undergo a thorough examination. You must take the medications recommended by him, following the prescribed regimen, and also have emergency medications on hand that could quickly knock off high blood pressure.