Constantly elevated blood pressure level( BP) to 140-150 / 90 mm.gt;Art.and above - a reliable sign of hypertensive disease. And, hypertension, as we know, is a widespread and "youthful" disease. It appears not only among middle-aged citizens, but also among those who have just been "overtaken" by the third ten.
CONTENTS
Why does blood pressure increase? The causes of hypertension lie:
- in prolonged stress( psychological and emotional overload),
- in endocrine system diseases,
- in sedentary lifestyle,
- in excess of adipose tissue, including visceral fat in the absence of external signs of obesity,
- in alcohol abuse,
- in tobacco smoking,
- in a passion for highly salty foods( excessive intake of table salt).Knowing the causes of the disease, we can prevent the disease. At risk are the elderly. Having asked grandfathers acquaintances about whether their blood pressure rises, we will find that 50-60% of them have hypertension of one or another stage.
Stages of arterial hypertension
- Mild is the 1 st stage of hypertension when the pressure rises to 150-160 / 90 mm.gt;Art. The pressure "jumps" and normalizes during the day. The electrocardiogram( ECG) shows the norm.
- Secondary in severity is the 2nd stage of the disease. AD up to 180/100 mm.gt;has a stable character. On the ECG - left ventricular hypertrophy. When examining the fundus, the change in the vessels of the retina is evident. Typical for this stage are hypertensive crises.
- Stage 3 is severe. Blood pressure above 200/115 mm.gt;Art. The organs are affected: deep lesions of the eye vessels, impaired renal function, thrombosis of the brain vessels, encephalopathy.
If a person rises pressure 1-2 times a month - this is the reason to consult a therapist who will prescribe the necessary examinations.
It is necessary to determine whether the "jump" of pressure is associated with stress or with other diseases, only after that you can talk about the need for taking medications.
Perhaps starting non-drug therapy( salt-free diet, emotional rest, optimal exercise for the patient's age), the pressure will cease to increase.
It happens that increased pressure is associated with diseases of the endocrine, urinary system. In any case, a survey is necessary.
Patients with hypertensive illness experience pain in the head( often in the occipital region), dizziness, fatigue and sleep badly, many suffer from heart pain, vision impairment.
Complications of hypertension
Complications of the disease with hypertensive crises( when blood pressure rises sharply to high figures), kidney failure - nephrosclerosis;stroke, intracerebral hemorrhage. To prevent complications of patients with hypertension, you need to constantly monitor your blood pressure and take special antihypertensive drugs, that is - reducing and normalizing blood pressure.
Today we will talk specifically about these drugs - modern drugs for the treatment of hypertension.
Pharmacists pharmacies, often visited by grandmothers, not only to buy the necessary medicine, but also just talk, you hear about these words:
"Daughter, well, tell me, did you study, which drug will help best with pressure? I've been prescribed a heap by the doctor, can not I just replace one? "
As a rule, the patient's desire for hypertension is to purchase a drug that would be" the strongest "and inexpensive. And it is also desirable that after drinking the course of these pills "pressure" never again suffer.
However, the hypertensive patient should understand that his illness is chronic, and if there is no miracle, the blood pressure level will have to be adjusted for the rest of his life. What are the drugs for this offer people suffering from high blood pressure?
Each antihypertensive drug has its own mechanism of action. For simplicity of understanding, we can say that he presses certain "buttons" in the body, after which the pressure decreases.
What is the mechanism of action of antihypertensive agents?
Renin-angiotensive system - the kidney produces a substance prorenin( with a decrease in pressure), which passes into the blood in the renin.
Renin interacts with a blood plasma protein called angiotensinogen, resulting in the formation of an inactive substance called angiotensin I. Angiotensin converts into the active substance angiotensin II when it interacts with an angiotesin converting enzyme( ACE).This substance helps increase blood pressure, narrow the blood vessels, increase the frequency and strength of the heart, stimulate the sympathetic nervous system( which also leads to an increase in blood pressure), increase the production of aldosterone. Aldosterone promotes the retention of sodium and water, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictors in the body.
Calcium channels of body cells - calcium in the body is in a bound state. When calcium enters through special channels into the cell, the contractile protein, actomyosin, forms. Under its action, the vessels narrow, the heart begins to contract more strongly, the pressure increases and the heart rate increases.
Adrenoceptors - in our body in some organs there are receptors, the irritation of which increases the pressure. These receptors include alpha and beta-adrenergic receptors. The increase in blood pressure is affected by the excitation of alpha receptors in arterioles and beta receptors located in the heart and kidneys.
The urinary system - as a result of excess water in the body, blood pressure rises.
Central nervous system - excitation of the central nervous system increases blood pressure. In the brain there are vasomotor centers, which regulate the level of arterial pressure.
Hypertension: classification of drugs from increased pressure
We examined the main mechanisms of increasing blood pressure in our body. We turn to the means for reducing pressure( antihypertensive), which affect the above mechanisms.
Remedies for the renin-angiotensin system
The drugs act on different stages of the formation of angiotensin II.Some inhibit angiotensin-converting enzyme, others block receptors on which angiotensin II acts. The third group inhibits renin, it is represented only by one drug( aliskiren), which is expensive and is used only in complex therapy of hypertension.
Angiotensin-converting enzyme( ACE) inhibitors
These drugs prevent the transfer of angiotensin I into active angiotensin II.As a result, the blood levels of angiotensin II decrease, the vessels dilate, and the pressure decreases.
Representatives( in parentheses there are synonyms - substances with the same chemical composition):
- Captopril ( Kapoten ) - dosage of 25 mg, 50 mg;
- Enalapril ( Renitec, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam ) - dosage is most often 5 mg, 10 mg, 20 mg;
- Lysinopril ( Diroton, Dapril, Lysigamma, Lysinate ) - dosage is most often 5 mg, 10 mg, 20 mg;
- Perindopril ( Prestarium A, Perineva ) - available in 2 dosages;
- Ramipril( Tritace, Amprilan, Hartil, Piramil ) is basically a dosage of 2.5 mg, 5 mg, 10 mg;
- Hinapril ( Accupro ) - 10 mg;
- Fosinopril ( Fosicard, Monopril ) - most often in a dosage of 10 mg, 20 mg;
- Trandolapril ( Hopten ) - 2 mg;
- Zofenopril ( Zokardis ) is a dosage of 7.5 mg, 30 mg.
Drugs are available in different dosages for the treatment of hypertension in various stages.
The peculiarity of the drug Captopril( Kapoten) is that, due to its short duration of action, it is rational only for hypertensive crises.
A bright representative of the Enalapril group and its synonyms are used very often. This drug does not differ in the duration of action, so take 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of administration. In pharmacies, you can find a variety of generics enalaprila - cheaper, containing enalapril drugs that produce small manufacturers. On the quality of generics, we reasoned in another article, here it is worth noting that someone else's enalapril generics are suitable, someone does not work.
The rest of the drugs are fewer than they differ from each other. ACE inhibitors cause a bright side effect - a dry cough. This side effect develops in every third patient taking ACE inhibitors, about one month after the start of the admission. In cases of cough development, ACE inhibitors are replaced with drugs of the following group.
Angiotensin receptor antagonists( sartans)
These agents block the angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, the blood pressure drops.
Representatives:
- Losartan ( Cosaar, Lozap, Lorista, Vasotens ) - dosages are different;
- Eprosartan ( Teveten ) - 600 mg;
- Valsartan ( Diovan, Valsakor, WALZ, Nortivan, Valsafors ) - various dosages;
- Irbesartan ( Aprovel ) -150 mg, 300 mg;
- Candesartan ( Atacand ) 80 mg, 160 mg, 320 mg;
- Telmisartan ( Mikardis ) 40 mg, 80 mg;
- Olmesartan ( Cardosal ) 10 mg, 20 mg, 40 mg.
As well as its predecessors, you can evaluate the full effect in 1-2 weeks after the start of the admission. Do not cause a dry cough. Costs more than ACE inhibitors, but are not more effective.
Calcium channel blockers
Another name for this group is calcium ion antagonists. The drugs are attached to the cell membrane and block the channels through which calcium enters the cell. The contractile protein actomyosin is not formed, the vessels dilate, the blood pressure drops, the pulse is attenuated( antiarrhythmic action).Expansion of the vessels reduces the resistance of the arteries to the blood flow, therefore, the load on the heart decreases.
Therefore, calcium channel blockers are used in hypertension, angina and arrhythmias, or when all these ailments are combined, which is also not uncommon. In arrhythmias, not all calcium channel blockers are used, but only pulsatile.
Representatives:
Pulsedreasive :
- Verapamil ( Isoptin SR, VEGOHALID EP ) - dosage of 240 mg;
- Diltiazem ( Altiazem PP ) - dosage of 180 mg;
The following representatives( dihydropyridine derivatives) are not used for arrhythmia :
- Nifedipine ( Adalat, Cordaflex, Cordafen, Cordipine, Corinfar, Nifecard, Phenigidin ) - dosage is generally 10 mg, 20 mg;
- Amlodipine ( Norvasc, Normodipine, Tenox, Cordy Cor, Es Cordy Cor, Cardilopin, Calchek, Amlotop, Omelar cardio, Amlovas ) - dosage is generally 5 mg, 10 mg;
- Felodipine ( Plendil, Felodip ) 2.5 mg, 5 mg, 10 mg;
- Nimodipine ( Nimotop ) - 30 mg;
- Latsidipin ( Latsipil, Sakur ) - 2 mg, 4 mg;
- Lercanidipine ( Lercamen ) - 20 mg.
The first of the representatives of dihydropyridine derivatives nifedipine, some modern cardiologists are not advised to use even with hypertensive crisis. This is due to a very short action and many emerging side effects( for example, increased heart rate).
Other dihydropyridine calcium antagonists have good efficacy and duration of action. Of side effects, you can indicate puffiness of the limbs at the beginning of the reception, which usually takes place within 7 days. If the hands and shins continue to swell, you need to replace the drug.
Alpha-adrenoblockers
These agents attach to alpha-adrenergic receptors and block them for the irritating effect of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin( Cardura, Tonokardin) - is more often available in dosages of 1 mg, 2 mg. It is used for relief of attacks and prolonged therapy. Many preparations of alpha-blockers have been discontinued.
Beta-blockers
Beta-adrenergic receptors are found in the heart and bronchi. There are means blocking all these receptors - indiscriminate action, contraindicated in bronchial asthma. Other drugs block only the beta-receptors of the heart - selective action. All beta-blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. From this, the vessels expand, the blood pressure decreases.
Representatives :
- Metoprolol ( Betaloc ZOK, Egilok retard, Vasocardin retard, Metocard retard ) - in various dosages;
- Bisoprolol ( Concor, Coronale, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Arilil ) - most often a dosage of 5 mg, 10 mg;
- Nebivolol ( Non-Ticket, Binelol ) - 5 mg;
- Betaxolol ( Lokren ) - 20 mg;
- Carvedilol ( Carvetrend, Coriol, Talliton, Dilatrend, Acridiol ) is basically a dosage of 6.25 mg, 12.5 mg, 25 mg.
Drugs of this group are used in hypertension, combined with angina and arrhythmias.
We do not list here those drugs, the use of which is not rational in hypertensive disease. This anaprilin ( is observed ), atenolol , propranolol .
Beta-blockers are contraindicated in diabetes mellitus, bronchial asthma.
Diuretics( diuretics)
As a result of excretion of water from the body, blood pressure is lowered. Diuretics prevent reverse absorption of sodium ions, which as a result are discharged outside and entrain water. In addition to sodium ions, diuretics wash out the body of potassium ions, which are necessary for the operation of the cardiovascular system. There are diuretics that conserve potassium.
Representatives of :
- Hydrochlorothiazide ( Hypothiazide ) - 25 mg, 100 mg, is a part of the combined preparations;
- Indapamide ( Arifon retard, Ravel SR, Indapamide MV, Indap, Ionik retard, Acripamid retard ) - more often a dosage of 1.5 mg.
- Triampur ( combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide );
- Spironolactone ( Veroshpiron, Aldactone ).
Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used in GB alone. Diuretic fast action( such as furosemide) is undesirable to use in hypertensive disease, they are taken in emergency, extreme cases. When using diuretics, it is important to take potassium preparations.
Neurotrophic central-acting drugs and CNS-specific drugs
If hypertension is caused by prolonged stress, then drugs acting on the CNS( soothing, tranquilizers, hypnotics) are used.
Neurotropic drugs of central action affect the vasomotor center in the brain, reducing its tone.
- Moxonidine ( Physiotens, Moxonitex, Moxogamma ) 0.2 mg, 0.4 mg;
- Rilmenidine ( Albarel ( 1 mg) - 1 mg
- Methyldopa ( Dopegit ) 250 mg
The first representative of this group is clonidine, which was widely used earlier in hypertension, and it lowered the pressure so that a person could fallin whom, when the dose is exceeded, now this drug is dispensed strictly according to the prescription.
Why are several drugs taken at the same time with hypertension?
In the initial stage of the disease, the doctor prescribes one drug depending on the origin of the disease, on the basesome studies and taking into account the existing diseases in the patient
If one drug is ineffective, which often happens, add other drugs, creating a complex to reduce the pressure, acting on various mechanisms of reducing blood pressure. These complexes can consist of 2-3 drugs
Preparations are selectedfrom different groups, for example:
- ACE inhibitor / diuretic;
- angiotensin receptor blocker / diuretic;
- ACE inhibitor / calcium channel blocker;
- ACE inhibitor / calcium channel blocker / beta-blocker;
- angiotensin receptor blocker / calcium channel blocker / beta-blocker;
- ACE inhibitor / calcium channel blocker / diuretic and other combinations.
Drugs for hypertension and their complexes are prescribed only by a doctor! In no case can not select funds for hypertension alone or on the advice( neighbors, for example).
One patient can be helped by one combination, another by another. One has diabetes mellitus, in which some combinations and drugs are prohibited, another does not have this ailment.
There are combinations of drugs that are non-rational, for example: beta-blockers / calcium channel blockers pulsaturizing, beta-blockers / drugs of central action and other combinations. To understand this, you need to be a cardiologist. It is dangerous to joke with your cardiovascular system, doing self-medication with such a serious illness.
Hypertension often asks if it is not possible to replace several drugs with one. There are combined drugs that combine components of substances from different groups of antihypertensive drugs.
For example:
ACE inhibitor / diuretic:
- Enalapril / hydrochlorothiazide( Corenitec, Enap NL, Enap H, ENAP NL 20, Renipril GT).
- Enalapril / Indapamide( Enzyme duo, Enzyme duo forte).
- Lysinopril / Hydrochlorothiazide( Isuzid, Lysinoton, Liten N).
- Perindopril / Indapamide( Noliprel and Noliprel forte).
- Hinapril / Hydrochlorothiazide( AQUIDIDE).
- Fosinopril / Hydrochlorothiazide( Fosicard H).
Angiotensin Receptor Blocker / Diuretic:
- Losartan / Hydrochlorothiazide( Gisaar, Lozap plus, Lorista N, Lorista ND).
- Eprosartan / Hydrochlorothiazide( Teveten Plus).
- Valsartan / Hydrochlorothiazide( Co-Diovan).
- Irbesartan / Hydrochlorothiazide( Co-Sprove).
- Candesartan / Hydrochlorothiazide( Atacand Plus).
- Telmisartan / HCT( Mykardis Plus).
ACE inhibitor / calcium channel blocker:
- Trandolapril / Verapamil( Tarka).
- Lysinopril / Amlodipine( Equator).
Angiotensin receptor blocker / calcium channel blocker:
- Valsartan / Amlodipine( Exforge)
Calcium channel blocker dihydropyridine / beta blocker:
- Felodipine / metoprolol( Logimax)
Beta-blocker / diuretic( not with diabetes and obesity):
- Bisoprolol/ Hydrochlorothiazide( Lodose, Aritel plus)
All drugs are available in different dosages of one and the other component, the doctor should select the dose for the patient.
Reviews and comments
Consider comments and feedback from readers - "colleagues in misfortune".
Olga : "Thank you. Just awesome! Only to me 64 years and I till now do not know than to be treated. I have hypertension. Systolic pressure is often 150 and 160. Doctors do not know either. "
Elena : "I take in the morning ravel , in the evening lisinopril , holds perfectly."
Svetlana : "Pressure jumps are very bad. It is necessary to find a good cardiologist. Mom also suffered for several years, the pressure did not hold, the tablets could not pick up until she got to the hospital in the pre-infarction state. There, the doctor prescribed Vamloset 10/160 and Veroshpiron in the morning on an empty stomach + Betalok ZOK 50 mg for pulse control( after breakfast).The second week already - the flight is normal. While slightly lowered, let's see how further, it is possible to reduce the dose( write that we should start with 5/80).But this is our story. In any case, you should take the medicine for the intended purpose and under the supervision of a doctor. "
Love : "Good afternoon! The doctor prescribed to drink pills at 2 st hypertension concord and zokardis 30 before taking one zokaridis. To me of 46 years and recently there was a hypertensive crisis, pressure has jumped up to 200/130 analyzes, all in norm now jumps up to 160 \ 110.Still on an electrocardiogram at me a hypertrophy of a left ventricle, but the therapist has told or said nothing, all in norm or rate. I have a question that it is better to drink zokaridis + concor or go to concor + indapamide, because when I was brought to the ambulance to the hospital, the doctor said that I might have to switch to concor + indapamide, and the district therapist did not respond very distinctly to me which is better".
Olga : "Good afternoon. I am 52 years old. I accept three years soon prestarium .A dose of 10 mg. I suffer from hypertension for more than 10 years. First, Enap-om was treated. I'm worried that there is an addiction to the medicine, since it became frequent( 2-3 times a month) to increase the pressure( 160 \ 110AD)( especially when changing the climate, which happens often to me).The lower pressure is often elevated( the norm for me is 130/90).Arrhythmia happens. There is no extra weight. To the doctor to descend or go there is no time. Tell me, is it worth changing the drug and on what? "
Irina :" My name is Irina, I'm 44 years old, from the pressure I drink lisinopril 5 ml in the morning and 5 in the evening, and bisoprolol 2.5.A month of pressure was not, but yesterday sat down at the festive table a little ate, and the pressure rose 180 to 120, a heartbeat of 126 beats per minute. The question is, if you start taking WALZ, can the situation change? "
Natalia :" Try a week before eating for 15 minutes.take 15 caps. valerian and motherwort ".
Irina : "Is there a course drug from increased pressure at the initial stage?"
Alexandra Viktorovna ( doctor ) in response to the author - Irina: "There is no course treatment for arterial hypertension. If increased pressure has appeared, it will remain forever. To treat hypertension by the principle "I drink medicines only when high blood pressure" is even worse than not taking any medications at all, since in this case sharp pressure changes can trigger strokes and heart attacks.
At the initial stage of arterial hypertension, the drug is selected( the dosage and the frequency of reception is determined by the doctor after the examination of the patient), which should be drunk regularly .It is a mistake to believe that the drug can "drop" normal pressure. If the medicine is selected correctly, it will not drop anything - it will keep the pressure at a stable level. "
Sofia : "Thank you very much to the author. An unusually accessible and understandable article for us-people far from medicine, but in our lives needing to understand themselves what doctors prescribe to us. Good specialists are fired, and those that remain themselves are stupefied by the huge flow of patients and appoint everything and not the news at any price, just to get rid of them. At least we have therapists in Kaluga in the 4th and 5th polyclinics like that. All doctors were crammed, and the remaining two were hanged. Withstood only old-age pensioners and what's the cure? "
If you have any questions, I highly recommend that you contact your local doctor-therapist at your place of residence.
Source of publication: https: //azbyka.ru/zdorovie/ sovremennye-sredstva-dlya-snizheniya-arterialnogo-davleniya
Stages of arterial hypertension
- Mild is the 1 st stage of hypertension when the pressure rises to 150-160 / 90 mm.gt;Art. The pressure "jumps" and normalizes during the day. The electrocardiogram( ECG) shows the norm.
- Secondary in severity is the 2nd stage of the disease. AD up to 180/100 mm.gt;has a stable character. On the ECG - left ventricular hypertrophy. When examining the fundus, the change in the vessels of the retina is evident. Typical for this stage are hypertensive crises.
- Stage 3 is severe. Blood pressure above 200/115 mm.gt;Art. The organs are affected: deep lesions of the eye vessels, impaired renal function, thrombosis of the brain vessels, encephalopathy.
If a person rises pressure 1-2 times a month - this is the reason to consult a therapist who will prescribe the necessary examinations.
It is necessary to determine whether the "jump" of pressure is associated with stress or with other diseases, only after that you can talk about the need for taking medications.
Perhaps starting non-drug therapy( salt-free diet, emotional rest, optimal exercise for the patient's age), the pressure will cease to increase.
It happens that increased pressure is associated with diseases of the endocrine, urinary system. In any case, a survey is necessary.
Patients with hypertensive illness experience pain in the head( often in the occipital region), dizziness, fatigue and sleep badly, many suffer from heart pain, vision impairment.
Complications of hypertension
Complications of the disease with hypertensive crises( when blood pressure rises sharply to high figures), kidney failure - nephrosclerosis;stroke, intracerebral hemorrhage. To prevent complications of patients with hypertension, you need to constantly monitor your blood pressure and take special antihypertensive drugs, that is - reducing and normalizing blood pressure.
Today we will talk specifically about these drugs - modern drugs for the treatment of hypertension.
Pharmacists pharmacies, often visited by grandmothers, not only to buy the necessary medicine, but also just talk, you hear about these words:
"Daughter, well, tell me, did you study, which drug will help best with pressure? I've been prescribed a heap by the doctor, can not I just replace one? "
As a rule, the patient's desire for hypertension is to purchase a drug that would be" the strongest "and inexpensive. And it is also desirable that after drinking the course of these pills "pressure" never again suffer.
However, the hypertensive patient should understand that his illness is chronic, and if there is no miracle, the blood pressure level will have to be adjusted for the rest of his life. What are the drugs for this offer people suffering from high blood pressure?
Each antihypertensive drug has its own mechanism of action. For simplicity of understanding, we can say that he presses certain "buttons" in the body, after which the pressure decreases.
What is the mechanism of action of antihypertensive agents?
Renin-angiotensive system - the kidney produces a substance prorenin( with a decrease in pressure), which passes into the blood in the renin.
Renin interacts with a blood plasma protein called angiotensinogen, resulting in the formation of an inactive substance called angiotensin I. Angiotensin converts into the active substance angiotensin II when it interacts with an angiotesin converting enzyme( ACE).This substance helps increase blood pressure, narrow the blood vessels, increase the frequency and strength of the heart, stimulate the sympathetic nervous system( which also leads to an increase in blood pressure), increase the production of aldosterone. Aldosterone promotes the retention of sodium and water, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictors in the body.
Calcium channels of body cells - calcium in the body is in a bound state. When calcium enters through special channels into the cell, the contractile protein, actomyosin, forms. Under its action, the vessels narrow, the heart begins to contract more strongly, the pressure increases and the heart rate increases.
Adrenoceptors - in our body in some organs there are receptors, the irritation of which increases the pressure. These receptors include alpha and beta-adrenergic receptors. The increase in blood pressure is affected by the excitation of alpha receptors in arterioles and beta receptors located in the heart and kidneys.
The urinary system - as a result of excess water in the body, blood pressure rises.
Central nervous system - excitation of the central nervous system increases blood pressure. In the brain there are vasomotor centers, which regulate the level of arterial pressure.
Hypertension: classification of drugs from increased pressure
We examined the main mechanisms of increasing blood pressure in our body. We turn to the means for reducing pressure( antihypertensive), which affect the above mechanisms.
Remedies for the renin-angiotensin system
The drugs act on different stages of the formation of angiotensin II.Some inhibit angiotensin-converting enzyme, others block receptors on which angiotensin II acts. The third group inhibits renin, it is represented only by one drug( aliskiren), which is expensive and is used only in complex therapy of hypertension.
Angiotensin-converting enzyme( ACE) inhibitors
These drugs prevent the transfer of angiotensin I into active angiotensin II.As a result, the blood levels of angiotensin II decrease, the vessels dilate, and the pressure decreases.
Representatives( in parentheses there are synonyms - substances with the same chemical composition):
- Captopril ( Kapoten ) - dosage of 25 mg, 50 mg;
- Enalapril ( Renitec, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam ) - dosage is most often 5 mg, 10 mg, 20 mg;
- Lysinopril ( Diroton, Dapril, Lysigamma, Lysinate ) - dosage is most often 5 mg, 10 mg, 20 mg;
- Perindopril ( Prestarium A, Perineva ) - available in 2 dosages;
- Ramipril( Tritace, Amprilan, Hartil, Piramil ) is basically a dosage of 2.5 mg, 5 mg, 10 mg;
- Hinapril ( Accupro ) - 10 mg;
- Fosinopril ( Fosicard, Monopril ) - most often in a dosage of 10 mg, 20 mg;
- Trandolapril ( Hopten ) - 2 mg;
- Zofenopril ( Zokardis ) is a dosage of 7.5 mg, 30 mg.
Drugs are available in different dosages for the treatment of hypertension in various stages.
The peculiarity of the drug Captopril( Kapoten) is that, due to its short duration of action, it is rational only for hypertensive crises.
A bright representative of the Enalapril group and its synonyms are used very often. This drug does not differ in the duration of action, so take 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of administration. In pharmacies, you can find a variety of generics enalaprila - cheaper, containing enalapril drugs that produce small manufacturers. On the quality of generics, we reasoned in another article, here it is worth noting that someone else's enalapril generics are suitable, someone does not work.
The rest of the drugs are fewer than they differ from each other. ACE inhibitors cause a bright side effect - a dry cough. This side effect develops in every third patient taking ACE inhibitors, about one month after the start of the admission. In cases of cough development, ACE inhibitors are replaced with drugs of the following group.
Angiotensin receptor antagonists( sartans)
These agents block the angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, the blood pressure drops.
Representatives:
- Losartan ( Cosaar, Lozap, Lorista, Vasotens ) - dosages are different;
- Eprosartan ( Teveten ) - 600 mg;
- Valsartan ( Diovan, Valsakor, WALZ, Nortivan, Valsafors ) - various dosages;
- Irbesartan ( Aprovel ) -150 mg, 300 mg;
- Candesartan ( Atacand ) 80 mg, 160 mg, 320 mg;
- Telmisartan ( Mikardis ) 40 mg, 80 mg;
- Olmesartan ( Cardosal ) 10 mg, 20 mg, 40 mg.
As well as its predecessors, you can evaluate the full effect in 1-2 weeks after the start of the admission. Do not cause a dry cough. Costs more than ACE inhibitors, but are not more effective.
Calcium channel blockers
Another name for this group is calcium ion antagonists. The drugs are attached to the cell membrane and block the channels through which calcium enters the cell. The contractile protein actomyosin is not formed, the vessels dilate, the blood pressure drops, the pulse is attenuated( antiarrhythmic action).Expansion of the vessels reduces the resistance of the arteries to the blood flow, therefore, the load on the heart decreases.
Therefore, calcium channel blockers are used in hypertension, angina and arrhythmias, or when all these ailments are combined, which is also not uncommon. In arrhythmias, not all calcium channel blockers are used, but only pulsatile.
Representatives:
Pulsedreasive :
- Verapamil ( Isoptin SR, VEGOHALID EP ) - dosage of 240 mg;
- Diltiazem ( Altiazem PP ) - dosage of 180 mg;
The following representatives( dihydropyridine derivatives) are not used for arrhythmia :
- Nifedipine ( Adalat, Cordaflex, Cordafen, Cordipine, Corinfar, Nifecard, Phenigidin ) - dosage is generally 10 mg, 20 mg;
- Amlodipine ( Norvasc, Normodipine, Tenox, Cordy Cor, Es Cordy Cor, Cardilopin, Calchek, Amlotop, Omelar cardio, Amlovas ) - dosage is generally 5 mg, 10 mg;
- Felodipine ( Plendil, Felodip ) 2.5 mg, 5 mg, 10 mg;
- Nimodipine ( Nimotop ) - 30 mg;
- Latsidipin ( Latsipil, Sakur ) - 2 mg, 4 mg;
- Lercanidipine ( Lercamen ) - 20 mg.
The first of the representatives of dihydropyridine derivatives nifedipine, some modern cardiologists are not advised to use even with hypertensive crisis. This is due to a very short action and many emerging side effects( for example, increased heart rate).
Other dihydropyridine calcium antagonists have good efficacy and duration of action. Of side effects, you can indicate puffiness of the limbs at the beginning of the reception, which usually takes place within 7 days. If the hands and shins continue to swell, you need to replace the drug.
Alpha-adrenoblockers
These agents attach to alpha-adrenergic receptors and block them for the irritating effect of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin( Cardura, Tonokardin) - is more often available in dosages of 1 mg, 2 mg. It is used for relief of attacks and prolonged therapy. Many preparations of alpha-blockers have been discontinued.
Beta-blockers
Beta-adrenergic receptors are found in the heart and bronchi. There are means blocking all these receptors - indiscriminate action, contraindicated in bronchial asthma. Other drugs block only the beta-receptors of the heart - selective action. All beta-blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. From this, the vessels expand, the blood pressure decreases.
Representatives :
- Metoprolol ( Betaloc ZOK, Egilok retard, Vasocardin retard, Metocard retard ) - in various dosages;
- Bisoprolol ( Concor, Coronale, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Arilil ) - most often a dosage of 5 mg, 10 mg;
- Nebivolol ( Non-Ticket, Binelol ) - 5 mg;
- Betaxolol ( Lokren ) - 20 mg;
- Carvedilol ( Carvetrend, Coriol, Talliton, Dilatrend, Acridiol ) is basically a dosage of 6.25 mg, 12.5 mg, 25 mg.
Drugs of this group are used in hypertension, combined with angina and arrhythmias.
We do not list here those drugs, the use of which is not rational in hypertensive disease. This anaprilin ( is observed ), atenolol , propranolol .
Beta-blockers are contraindicated in diabetes mellitus, bronchial asthma.
Diuretics( diuretics)
As a result of excretion of water from the body, blood pressure is lowered. Diuretics prevent reverse absorption of sodium ions, which as a result are discharged outside and entrain water. In addition to sodium ions, diuretics wash out the body of potassium ions, which are necessary for the operation of the cardiovascular system. There are diuretics that conserve potassium.
Representatives of :
- Hydrochlorothiazide ( Hypothiazide ) - 25 mg, 100 mg, is a part of the combined preparations;
- Indapamide ( Arifon retard, Ravel SR, Indapamide MV, Indap, Ionik retard, Acripamid retard ) - more often a dosage of 1.5 mg.
- Triampur ( combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide );
- Spironolactone ( Veroshpiron, Aldactone ).
Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used in GB alone. Diuretic fast action( such as furosemide) is undesirable to use in hypertensive disease, they are taken in emergency, extreme cases. When using diuretics, it is important to take potassium preparations.
Neurotrophic central-acting drugs and CNS-specific drugs
If hypertension is caused by prolonged stress, then drugs acting on the CNS( soothing, tranquilizers, hypnotics) are used.
Neurotropic drugs of central action affect the vasomotor center in the brain, reducing its tone.
- Moxonidine ( Physiotens, Moxonitex, Moxogamma ) 0.2 mg, 0.4 mg;
- Rilmenidine ( Albarel ( 1 mg) - 1 mg
- Methyldopa ( Dopegit ) 250 mg
The first representative of this group is clonidine, which was widely used earlier in hypertension, and it lowered the pressure so that a person could fallin whom, when the dose is exceeded, now this drug is dispensed strictly according to the prescription.
Why are several drugs taken at the same time with hypertension?
In the initial stage of the disease, the doctor prescribes one drug depending on the origin of the disease, on the basesome studies and taking into account the existing diseases in the patient
If one drug is ineffective, which often happens, add other drugs, creating a complex to reduce the pressure, acting on various mechanisms of reducing blood pressure. These complexes can consist of 2-3 drugs
Preparations are selectedfrom different groups, for example:
- ACE inhibitor / diuretic;
- angiotensin receptor blocker / diuretic;
- ACE inhibitor / calcium channel blocker;
- ACE inhibitor / calcium channel blocker / beta-blocker;
- angiotensin receptor blocker / calcium channel blocker / beta-blocker;
- ACE inhibitor / calcium channel blocker / diuretic and other combinations.
Drugs for hypertension and their complexes are prescribed only by a doctor! In no case can not select funds for hypertension alone or on the advice( neighbors, for example).
One patient can be helped by one combination, another by another. One has diabetes mellitus, in which some combinations and drugs are prohibited, another does not have this ailment.
There are combinations of drugs that are non-rational, for example: beta-blockers / calcium channel blockers pulsaturizing, beta-blockers / drugs of central action and other combinations. To understand this, you need to be a cardiologist. It is dangerous to joke with your cardiovascular system, doing self-medication with such a serious illness.
Hypertension often asks if it is not possible to replace several drugs with one. There are combined drugs that combine components of substances from different groups of antihypertensive drugs.
For example:
ACE inhibitor / diuretic:
- Enalapril / hydrochlorothiazide( Corenitec, Enap NL, Enap H, ENAP NL 20, Renipril GT).
- Enalapril / Indapamide( Enzyme duo, Enzyme duo forte).
- Lysinopril / Hydrochlorothiazide( Isuzid, Lysinoton, Liten N).
- Perindopril / Indapamide( Noliprel and Noliprel forte).
- Hinapril / Hydrochlorothiazide( AQUIDIDE).
- Fosinopril / Hydrochlorothiazide( Fosicard H).
Angiotensin Receptor Blocker / Diuretic:
- Losartan / Hydrochlorothiazide( Gisaar, Lozap plus, Lorista N, Lorista ND).
- Eprosartan / Hydrochlorothiazide( Teveten Plus).
- Valsartan / Hydrochlorothiazide( Co-Diovan).
- Irbesartan / Hydrochlorothiazide( Co-Sprove).
- Candesartan / Hydrochlorothiazide( Atacand Plus).
- Telmisartan / HCT( Mykardis Plus).
ACE inhibitor / calcium channel blocker:
- Trandolapril / Verapamil( Tarka).
- Lysinopril / Amlodipine( Equator).
Angiotensin receptor blocker / calcium channel blocker:
- Valsartan / Amlodipine( Exforge)
Calcium channel blocker dihydropyridine / beta blocker:
- Felodipine / metoprolol( Logimax)
Beta-blocker / diuretic( not with diabetes and obesity):
- Bisoprolol/ Hydrochlorothiazide( Lodose, Aritel plus)
All drugs are available in different dosages of one and the other component, the doctor should select the dose for the patient.
Reviews and comments
Consider comments and feedback from readers - "colleagues in misfortune".
Olga : "Thank you. Just awesome! Only to me 64 years and I till now do not know than to be treated. I have hypertension. Systolic pressure is often 150 and 160. Doctors do not know either. "
Elena : "I take in the morning ravel , in the evening lisinopril , holds perfectly."
Svetlana : "Pressure jumps are very bad. It is necessary to find a good cardiologist. Mom also suffered for several years, the pressure did not hold, the tablets could not pick up until she got to the hospital in the pre-infarction state. There, the doctor prescribed Vamloset 10/160 and Veroshpiron in the morning on an empty stomach + Betalok ZOK 50 mg for pulse control( after breakfast).The second week already - the flight is normal. While slightly lowered, let's see how further, it is possible to reduce the dose( write that we should start with 5/80).But this is our story. In any case, you should take the medicine for the intended purpose and under the supervision of a doctor. "
Love : "Good afternoon! The doctor prescribed to drink pills at 2 st hypertension concord and zokardis 30 before taking one zokaridis. To me of 46 years and recently there was a hypertensive crisis, pressure has jumped up to 200/130 analyzes, all in norm now jumps up to 160 \ 110.Still on an electrocardiogram at me a hypertrophy of a left ventricle, but the therapist has told or said nothing, all in norm or rate. I have a question that it is better to drink zokaridis + concor or go to concor + indapamide, because when I was brought to the ambulance to the hospital, the doctor said that I might have to switch to concor + indapamide, and the district therapist did not respond very distinctly to me which is better".
Olga : "Good afternoon. I am 52 years old. I accept three years soon prestarium .A dose of 10 mg. I suffer from hypertension for more than 10 years. First, Enap-om was treated. I'm worried that there is an addiction to the medicine, since it became frequent( 2-3 times a month) to increase the pressure( 160 \ 110AD)( especially when changing the climate, which happens often to me).The lower pressure is often elevated( the norm for me is 130/90).Arrhythmia happens. There is no extra weight. To the doctor to descend or go there is no time. Tell me, is it worth changing the drug and on what? "
Irina :" My name is Irina, I'm 44 years old, from the pressure I drink lisinopril 5 ml in the morning and 5 in the evening, and bisoprolol 2.5.A month of pressure was not, but yesterday sat down at the festive table a little ate, and the pressure rose 180 to 120, a heartbeat of 126 beats per minute. The question is, if you start taking WALZ, can the situation change? "
Natalia :" Try a week before eating for 15 minutes.take 15 caps. valerian and motherwort ".
Irina : "Is there a course drug from increased pressure at the initial stage?"
Alexandra Viktorovna ( doctor ) in response to the author - Irina: "There is no course treatment for arterial hypertension. If increased pressure has appeared, it will remain forever. To treat hypertension by the principle "I drink medicines only when high blood pressure" is even worse than not taking any medications at all, since in this case sharp pressure changes can trigger strokes and heart attacks.
At the initial stage of arterial hypertension, the drug is selected( the dosage and the frequency of reception is determined by the doctor after the examination of the patient), which should be drunk regularly .It is a mistake to believe that the drug can "drop" normal pressure. If the medicine is selected correctly, it will not drop anything - it will keep the pressure at a stable level. "
Sofia : "Thank you very much to the author. An unusually accessible and understandable article for us-people far from medicine, but in our lives needing to understand themselves what doctors prescribe to us. Good specialists are fired, and those that remain themselves are stupefied by the huge flow of patients and appoint everything and not the news at any price, just to get rid of them. At least we have therapists in Kaluga in the 4th and 5th polyclinics like that. All doctors were crammed, and the remaining two were hanged. Withstood only old-age pensioners and what's the cure? "
If you have any questions, I highly recommend that you contact your local doctor-therapist at your place of residence.
Source of publication: https: //azbyka.ru/zdorovie/ sovremennye-sredstva-dlya-snizheniya-arterialnogo-davleniya
