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Hypotensive action is a decrease in blood pressure under the influence of a certain drug.

Experienced professional therapists of the highest category of the therapy clinic of the Yusupov Hospital, who own advanced methods of treatment and diagnostics, will provide qualified assistance to patients with arterial hypertension, select an effective treatment regimen that excludes the development of negative consequences.

Antihypertensive therapy: general rules

Both symptomatic hypertension and hypertension require correction with antihypertensive drugs. Antihypertensive therapy can be carried out with drugs that differ in the mechanism of action: antiadrenergics, vasodilators, calcium antagonists, angiotensin antagonists, and diuretics.

You can get information about what the hypotensive effect of the drug is, what medications to take with high blood pressure not only from your doctor, but also from a pharmacist.

Arterial hypertension is a chronic disease that requires constant drug support, daily monitoring and regular intake of prescribed medications. Not only the state of health, but also the life of a person depends on compliance with these rules.

Despite the general availability of the rules of therapy for reducing pressure, many patients have to be reminded of how the treatment regimen for hypertension should look like:

• taking antihypertensive drugs should be regular, regardless of the patient's well-being and the level of blood pressure. This allows you to increase the effectiveness of blood pressure control, as well as prevent cardiovascular complications and damage to target organs;
• it is necessary to strictly observe the dosage and apply the form of release of the drug, which was prescribed by the attending physician. Self-change of the recommended dose or replacement of the drug may distort the hypotensive effect;
• even under the condition of constant intake of antihypertensive drugs, it is necessary to systematically measure blood pressure, which will allow to evaluate the effectiveness of therapy, timely identify certain changes and adjust treatment;
• in the case of an increase in blood pressure against the background of constant antihypertensive treatment - the development of an uncomplicated hypertensive crisis, an additional dose of the previously taken long-acting drug is not recommended. It is possible to quickly lower blood pressure with the help of short-acting antihypertensive drugs.

Antihypertensive therapy: drugs to reduce pressure

In the course of antihypertensive therapy, several main groups of drugs that help lower blood pressure are currently used:

• beta-blockers;
• ACE inhibitors;
• calcium antagonists;
• diuretics;
• angiotensin II receptor blockers.

All of the above groups have comparable effectiveness and their own characteristics that determine their use in a given situation.

Beta blockers

The drugs of this group reduce the likelihood of developing coronary complications in patients suffering from angina pectoris, prevent cardiovascular accidents in patients with myocardial infarction, tachyarrhythmia, and are used in patients with chronic heart failure. Beta-blockers are not recommended for patients with diabetes mellitus, lipid metabolism disorders and metabolic syndrome.

ACE inhibitors

Angiotensin-converting enzyme inhibitors have pronounced hypotensive properties, they have organoprotective effects: their use reduces the risk of complications of atherosclerosis, reduces left ventricular hypertrophy, and slows down the decline in kidney function. ACE inhibitors are well tolerated, with no negative effects on lipid metabolism and glucose levels.

calcium antagonists

In addition to antihypertensive properties, drugs in this group have antianginal and organ-protective effects, help reduce the risk of stroke, atherosclerotic lesions of the carotid arteries and left ventricular hypertrophy. Calcium antagonists may be used alone or in combination with other antihypertensive drugs.

Diuretics

Diuretic drugs are usually used while taking other antihypertensive drugs in order to enhance the therapeutic effect.

Diuretics are also prescribed for people suffering from pathologies such as refractory hypertension and chronic heart failure. In order to avoid the development of side effects, with the constant intake of these drugs, minimal dosages are prescribed.

Angiotensin II receptor blockers

Drugs in this group, which have a neuro- and cardioprotective effect, are used to improve the control of blood glucose. They allow to increase the life expectancy of patients suffering from chronic heart failure. Antihypertensive therapy using angiotensin II receptor blockers can be prescribed to patients who have had a myocardial infarction, suffering from renal failure, gout, metabolic syndrome and diabetes mellitus.

Antihypertensive therapy in hypertensive crisis

Even despite constant antihypertensive therapy, a sudden increase in blood pressure to sufficiently high levels may periodically occur (there are no signs of target organ damage). The development of an uncomplicated hypertensive crisis may be due to unusual physical activity, emotional stress, drinking alcohol or salty, fatty foods. Such a condition is not life-threatening, but it threatens the development of negative consequences, therefore, it requires timely treatment.

Too rapid a decrease in blood pressure is undesirable. Optimally, if in the first two hours after taking the drug, the pressure drops by no more than 25% of the initial values. Normal blood pressure values ​​are usually restored within a day.

Quick-acting drugs help to restore blood pressure control, due to which an almost instantaneous hypotensive effect is provided. Each of the drugs for quickly lowering blood pressure has its own contraindications, so a doctor should select them.

30 minutes after taking an antihypertensive drug, it is necessary to measure the level of blood pressure to assess the effectiveness of therapy. If necessary, in order to restore the normal level of blood pressure, after half an hour or an hour, you can take an additional tablet (orally or sublingually). If there is no improvement (less than a 25% decrease in pressure or its previous excessively high rates), you should immediately seek the help of a doctor.

In order for arterial hypertension not to turn into a chronic form, accompanied by quite serious complications, it is necessary to pay attention to the first signs of arterial hypertension in time. Do not self-medicate and randomly select drugs that reduce pressure. Despite their hypotensive effect, they can have a lot of contraindications and be accompanied by side effects that aggravate the patient's condition. The selection of drugs for antihypertensive therapy should be carried out by a qualified specialist familiar with the characteristics of the patient's body, his anamnesis.

The Therapy Clinic of the Yusupov Hospital offers a comprehensive approach to addressing problems associated with high blood pressure.

The clinic has the latest modern diagnostic and treatment equipment from the world's leading manufacturers of medical equipment, which makes it possible to identify the first manifestations of hypertension at the earliest diagnostic level and select the most effective methods of treating the disease. When drawing up a treatment regimen, the age, condition of the patient and other individual factors are taken into account.

Conservative therapy in the Yusupov hospital involves the use of the latest generation of drugs with a minimum number of side effects. Consultations are carried out by highly qualified general practitioners with extensive experience in the treatment of hypertension and its consequences, including stroke.

You can sign up for a consultation with the leading specialists of the clinic by phone or on the website of the Yusupov hospital through the feedback form.

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Antihypertensive drugs: principles of therapy, groups, list of representatives

Antihypertensive drugs (antihypertensives) include a wide range of medicines designed to lower blood pressure. Since about the middle of the last century, they began to be produced in large volumes and massively used in patients with hypertension. Until that time, doctors had only recommended diet, lifestyle changes, and sedatives.

Arterial hypertension (AH) is the most frequently diagnosed disease of the cardiovascular system. According to statistics, approximately every second inhabitant of the planet of advanced age has signs of high blood pressure, which requires its timely and correct correction.

To prescribe drugs that reduce blood pressure (BP), it is necessary to establish the very fact of the presence of hypertension, assess the possible risks for the patient, contraindications to specific drugs and the feasibility of treatment in principle. The priority of antihypertensive therapy is to effectively reduce pressure and prevent possible complications of a dangerous disease, such as stroke, myocardial infarction, and renal failure.

The use of antihypertensive drugs has reduced mortality from severe forms of hypertension over the past 20 years by almost half. The optimal level of pressure to be achieved with the help of treatment is considered to be a figure not exceeding 140/90 mm Hg. Art. Of course, in each case, the question of the need for therapy is decided individually, but with prolonged high blood pressure, the presence of damage to the heart, kidneys, retina, it should be started immediately.

According to the recommendation of the World Health Organization, an absolute indication for antihypertensive therapy is a diastolic pressure of 90 mm Hg or more. Art., especially if such a figure holds for several months or six months. Usually, drugs are prescribed for an indefinite period, for most patients - for life. This is due to the fact that when therapy is discontinued, three-quarters of patients again experience manifestations of hypertension.

Many patients are afraid of long-term or even lifelong medication, and often the latter are prescribed in combinations that include several items. Of course, the fears are understandable, because any medicine has side effects. Numerous studies have shown that there is no health risk with long-term use of antihypertensive drugs, side effects are minimal if the dose and regimen are correctly selected. In each case, the doctor individually determines the features of treatment, taking into account the form and course of hypertension, contraindications, comorbidities in the patient, but it is still necessary to warn about possible consequences.

Principles of prescribing antihypertensive therapy

Thanks to many years of clinical studies involving thousands of patients, the main principles of drug treatment of arterial hypertension were formulated:

• Treatment begins with the smallest doses of the drug, using a drug with a minimum of side effects, that is, choosing the safest remedy.
• If the minimum dose is well tolerated, but the pressure level is still high, then the amount of the drug is gradually increased to the amount necessary to maintain normal blood pressure.
• To achieve the best effect, it is recommended to use combinations of drugs, prescribing each of them in the lowest possible dosages. Currently, standard regimens for the combined treatment of hypertension have been developed.
• If the second prescribed drug does not give the desired result, or its administration is accompanied by side effects, then it is worth trying a remedy from another group without changing the dosage and regimen of the first drug.
• Preferably drugs with long-acting, allowing you to maintain normal blood pressure throughout the day, without allowing fluctuations in which the risk of complications increases.

Antihypertensive drugs: groups, properties, features

Many drugs have antihypertensive properties, but not all of them can be used to treat patients with hypertension due to the need for long-term use and the possibility of side effects. Today, five main groups of antihypertensive drugs are used:

1. Angiotensin-converting enzyme inhibitors (ACE inhibitors).
2. Angiotensin II receptor blockers.
3. Diuretics.
4. calcium antagonists.
5. Beta blockers.

Medicines from these groups are effective in arterial hypertension, can be prescribed as initial treatment or maintenance therapy, alone or in various combinations. Choosing specific antihypertensive drugs, the specialist is based on the patient's pressure indicators, the characteristics of the course of the disease, the presence of lesions of target organs, comorbidities, especially those of the cardiovascular system. The overall likely side effect, the possibility of combining drugs from different groups, as well as the existing experience in the treatment of hypertension in a particular patient, is always evaluated.

Unfortunately, many effective drugs are not cheap, which makes them inaccessible to the general population. The cost of the drug may become one of the conditions under which the patient will be forced to abandon it in favor of another, cheaper analogue.

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

ACE inhibitors are quite popular and are widely prescribed for a wide variety of patients with high blood pressure. The list of ACE inhibitors includes such drugs as: captopril, enalapril, lisinopril, prestarium, etc.

As you know, the level of blood pressure is regulated by the kidneys, in particular, by the renin-angiotensin-aldosterone system, the correct operation of which determines the tone of the vascular walls and the final level of pressure. With an excess of angiotensin II, a spasm of the vessels of the arterial type of the systemic circulation occurs, which leads to an increase in the total peripheral vascular resistance. To ensure adequate blood flow in the internal organs, the heart begins to work with an excessive load, forcing blood into the vessels under high pressure.

In order to slow down the formation of angiotensin II from the precursor (angiotensin I), it was proposed to use drugs that block the enzyme involved in this stage of biochemical transformations. In addition, ACE inhibitors reduce the release of calcium, which is involved in the contraction of the vascular walls, thereby reducing their spasm.

mechanism of action of ACE inhibitors in CHF

The appointment of ACE inhibitors reduces the likelihood of cardiovascular complications (stroke, myocardial infarction, severe heart failure, etc.), the degree of damage to target organs, especially the heart and kidneys. If the patient already suffers from chronic heart failure, then the prognosis of the disease when taking funds from the ACE inhibitor group improves.

Based on the characteristics of the action, it is most rational to prescribe ACE inhibitors to patients with kidney pathology and chronic heart failure, with arrhythmias, after a heart attack, they are safe for use by the elderly and diabetes mellitus, and in some cases can be used even by pregnant women.

The disadvantage of ACE inhibitors is considered the most frequent adverse reactions in the form of dry cough associated with a change in the metabolism of bradykinin. In addition, in some cases, the formation of angiotensin II occurs without a special enzyme, outside the kidneys, so the effectiveness of ACE inhibitors is sharply reduced, and treatment involves choosing another drug.

Absolute contraindications to the appointment of ACE inhibitors are:

• Pregnancy;
• A significant increase in the level of potassium in the blood;
• Sharp stenosis of both renal arteries;
• Quincke's edema with the use of ACE inhibitors in the past.

Angiotensin II receptor blockers (ARBs)

The drugs from the ARB group are the most modern and effective. Like ACE inhibitors, they reduce the action of angiotensin II, but, unlike the latter, their point of application is not limited to a single enzyme. ARBs act more widely, providing a powerful antihypertensive effect by disrupting the binding of angiotensin to receptors on cells of various organs. Thanks to this targeted action, relaxation of the vascular walls is achieved, and the excretion of excess fluid and salt by the kidneys is also enhanced.

The most popular ARBs are losartan, valsartan, irbesartan, and others.

Like ACE inhibitors, agents from the group of angiotensin II receptor antagonists show high efficacy in the pathology of the kidneys and heart. In addition, they are practically devoid of adverse reactions and are well tolerated in long-term administration, which allows them to be widely used. Contraindications to ARBs are similar to those for ACE inhibitors - pregnancy, hyperkalemia, renal artery stenosis, allergic reactions.

Diuretics

Diuretics are not only the most extensive, but also the most long-used group of drugs. They help to remove excess fluid and salt from the body, thereby reducing the volume of circulating blood, the load on the heart and blood vessels, which eventually relax. The classification implies the allocation of groups of potassium-sparing, thiazide and loop diuretics.

Thiazide diuretics, among which are hypothiazide, indapamide, chlorthalidone, are not inferior in effectiveness to ACE inhibitors, beta-blockers and other groups of antihypertensive drugs. High concentrations of them can lead to changes in electrolyte metabolism, lipid and carbohydrate metabolism, but low dosages of these drugs are considered safe even with long-term use.

Thiazide diuretics are used in combination therapy along with ACE inhibitors and angiotensin II receptor antagonists. It is possible to prescribe them to elderly patients, people suffering from diabetes, various metabolic disorders. Gout is considered an absolute contraindication to taking these drugs.

Potassium-sparing diuretics are milder than other diuretics. The mechanism of action is based on blocking the effects of aldosterone (an antidiuretic hormone that retains fluid). Pressure reduction is achieved by removing liquid and salt, but potassium, magnesium, calcium ions are not lost.

Potassium-sparing diuretics include spironolactone, amiloride, eplerenone, etc. They can be prescribed to patients with chronic heart failure, severe edema of cardiac origin. These drugs are effective in refractory hypertension, which is difficult to treat with other groups of drugs.

Due to their action on renal aldosterone receptors and the risk of hyperkalemia, these substances are contraindicated in acute and chronic renal failure.

Loop diuretics (lasix, edecrin) are the most aggressive, but at the same time, they can reduce blood pressure faster than others. For long-term use, they are not recommended, since there is a high risk of metabolic disorders due to the excretion of electrolytes along with the liquid, but these drugs are successfully used for the treatment of hypertensive crises.

calcium antagonists

The contraction of muscle fibers occurs with the participation of calcium. Vascular walls are no exception. Preparations of the group of calcium antagonists carry out their action by reducing the penetration of calcium ions into the smooth muscle cells of blood vessels. The sensitivity of vessels to vasopressor substances that cause vascular spasm (adrenaline, for example) also decreases.

The list of calcium antagonists includes drugs of three main groups:

1. Dihydropyridines (amlodipine, felodipine).
2. Benzothiazepine calcium antagonists (diltiazem).
3. Phenylalkylamines (verapamil).

The drugs of these groups differ in the nature of the effect on the walls of blood vessels, the myocardium, the conduction system of the heart. So, amlodipine, felodipine act mainly on the vessels, reducing their tone, while the work of the heart does not change. Verapamil, diltiazem, in addition to the hypotensive effect, affect the work of the heart, causing a decrease in heart rate and its normalization, therefore, they are successfully used for arrhythmias. By reducing the need of the heart muscle for oxygen, verapamil reduces pain in angina pectoris.

In the case of the appointment of non-dihydropyridine diuretics, it is necessary to take into account the possible bradycardia and other types of bradyarrhythmias. These drugs are contraindicated in severe heart failure, atrioventricular blockade, and simultaneously with intravenous administration of beta-blockers.

Calcium antagonists do not affect metabolic processes, reduce the degree of left ventricular hypertrophy in hypertension, and reduce the likelihood of stroke.

Beta blockers

Beta-blockers (atenolol, bisoprolol, nebivolol) have a hypotensive effect by reducing cardiac output and the formation of renin in the kidneys, causing vascular spasm. Due to their ability to regulate the heart rate and have an antianginal effect, beta-blockers are preferred for lowering blood pressure in patients suffering from coronary heart disease (angina pectoris, cardiosclerosis), as well as in chronic heart failure.

Beta-blockers change carbohydrate, fat metabolism, can provoke weight gain, so they are not recommended for diabetes and other metabolic disorders.

Substances with adrenoblocking properties cause bronchospasm and slow heart rate, and therefore they are contraindicated in asthmatics, with severe arrhythmias, in particular, atrioventricular block II-III degree.

Other antihypertensive drugs

In addition to the described groups of pharmacological agents for the treatment of arterial hypertension, additional drugs are also successfully used - imidazoline receptor agonists (moxonidine), direct renin inhibitors (aliskiren), alpha-blockers (prazosin, cardura).

Imidazoline receptor agonists act on nerve centers in the medulla oblongata, reducing the activity of sympathetic vascular stimulation. Unlike drugs from other groups, which at best do not affect carbohydrate and fat metabolism, moxonidine is able to improve metabolic processes, increase tissue sensitivity to insulin, and reduce triglycerides and fatty acids in the blood. Taking moxonidine in overweight patients promotes weight loss.

Direct renin inhibitors are represented by the drug aliskiren. Aliskiren helps to reduce the concentration of renin, angiotensin, angiotensin-converting enzyme in the blood serum, providing hypotensive, as well as cardioprotective and nephroprotective effects. Aliskiren can be combined with calcium antagonists, diuretics, beta-blockers, but the simultaneous use with ACE inhibitors and angiotensin receptor antagonists is fraught with impaired renal function due to the similarity of the pharmacological action.

Alpha-blockers are not considered drugs of choice, they are prescribed as part of combined treatment as a third or fourth additional antihypertensive agent. Medicines of this group improve fat and carbohydrate metabolism, increase blood flow in the kidneys, but are contraindicated in diabetic neuropathy.

The pharmaceutical industry does not stand still, scientists are constantly developing new and safe drugs to reduce pressure. Aliskiren (rasilez), olmesartan from the group of angiotensin II receptor antagonists can be considered drugs of the latest generation. Among diuretics, torasemide has proven itself well, which is suitable for long-term use, safe for elderly patients and patients with diabetes mellitus.

Combined preparations are also widely used, including representatives of different groups “in one tablet”, for example, the equator, combining amlodipine and lisinopril.

Folk antihypertensives?

The described drugs have a persistent hypotensive effect, but require long-term use and constant monitoring of the pressure level. Fearing side effects, many hypertensive patients, especially elderly people suffering from other diseases, prefer herbal remedies and traditional medicine to taking pills.

Hypotensive herbs have a right to exist, many really have a good effect, and their action is mostly associated with sedative and vasodilating properties. So, the most popular are hawthorn, motherwort, peppermint, valerian and others.

There are ready-made fees that can be bought in the form of tea bags at a pharmacy. Evalar Bio tea containing lemon balm, mint, hawthorn and other herbal ingredients, Traviata is the most famous representatives of herbal antihypertensive drugs. Hypotensive monastic tea has also proven itself well. At the initial stage of the disease, it has a general strengthening and calming effect on patients.

Of course, herbal preparations can be effective, especially in emotionally labile subjects, but it should be emphasized that self-treatment of hypertension is unacceptable. If the patient is elderly, suffers from heart disease, diabetes, atherosclerosis, then the effectiveness of traditional medicine alone is doubtful. In such cases, drug therapy is required.

In order for the drug treatment to be more effective, and the dosages of drugs to be minimal, the doctor will advise patients with arterial hypertension to first change their lifestyle. Recommendations include smoking cessation, weight control, and a diet that restricts salt, fluids, and alcohol. Adequate physical activity and the fight against physical inactivity are important. Non-pharmacological measures to reduce pressure can reduce the need for drugs and increase their effectiveness.

Antihypertensive therapy

What drugs should be prescribed in the selection of antihypertensive therapy in the first place? Science is still developing different methods and approaches, new groups of drugs are being tested. Different doctors may have their own treatment regimen. However, there are general concepts based on statistics and research.

At the initial stage

In uncomplicated cases, drug antihypertensive therapy is often started with the use of proven "conventional" drugs: beta-blockers and diuretics. In large-scale studies involving patients, it has been shown that the use of diuretics, beta-blockers reduces the risk of cerebrovascular accident, sudden death, and myocardial infarction.

An alternative option is the use of captopril. According to new data, the incidence of heart attacks, strokes, deaths with conventional treatment or with captopril is almost the same. Moreover, in a special group of patients who have not previously been treated with antihypertensive drugs, captopril shows a clear advantage over conventional therapy, significantly reducing the relative risk of cardiovascular events by 46%.

Long-term use of fosinopril in patients with diabetes, as well as arterial hypertension, is also associated with a significant reduction in the risk of death, myocardial infarction, stroke, exacerbation of angina pectoris.

Therapy for left ventricular hypertrophy

As an antihypertensive therapy, many doctors practice the use of angiotensin-converting enzyme (ACE) inhibitors. These drugs have cardioprotective properties and lead to a decrease in the mass of the LV myocardium (left ventricle). When studying the degree of influence of various drugs on the LV myocardium, it was revealed that the reverse degree of development of its hypertrophy is most pronounced in ACE inhibitors, since antiotensin-2 controls the growth, hypertrophy of cardiomyocytes and their division. In addition to cardioprotective effects, ACE inhibitors have a nephroprotective effect. This is important, because despite all the successes of antihypertensive therapy, the number of patients who develop terminal renal failure is growing (4 times compared to the "eighties").

Therapy with calcium antagonists

Increasingly, calcium antagonists are being used as first-line drugs. For example, long-acting dihydropyridine calcium channel blockers are effective in isolated systemic arterial hypertension (AH). A four-year study of 5000 patients showed a significant effect of nitrendipine on the incidence of cerebral stroke. In another study, the base drug was a long-acting calcium antagonist, felodipine. Patients were followed up for four years. As blood pressure (blood pressure) decreased, beneficial effects increased, there was a significant decrease in the risk of developing cardiovascular complications, and the frequency of sudden death did not increase. The SystEur study, which included 10 Russian centers, also showed a 42% reduction in the incidence of stroke with nisoldipine.

Calcium antagonists are also effective in pulmonary arterial hypertension (this is systemic hypertension that occurs in patients with obstructive pulmonary disease). Pulmonogenic hypertension develops several years after the onset of a pulmonary disease, and there is a clear connection between the exacerbation of the pulmonary process and pressure rises. An advantage of calcium antagonists in pulmonary hypertension is that they reduce calcium-mediated hypoxic vasoconstriction. The delivery of oxygen to tissues increases, hypoxia of the kidneys and vasomotor center decreases, blood pressure decreases, as well as afterload and myocardial oxygen demand. In addition, calcium antagonists reduce the synthesis of histamine, kinin, serotonin in tissues, swelling of the bronchial mucosa and bronchial obstruction. An additional advantage of calcium antagonists (in particular, isradipine) is their ability to change metabolic processes in hypertensive patients. By normalizing or lowering blood pressure, these drugs can prevent the development of dyslipidemia, glucose and insulin tolerance.

Calcium antagonists showed a clear relationship between dose, plasma concentration and pharmacological hypotensive effect. By increasing the dose of the drug, it is possible, as it were, to control the hypotensive effect, increasing or decreasing it. For long-term treatment of hypertension, long-acting drugs with a low absorption rate (amlodipine, a long-acting gastrointestinal form of nifedipine, or osmoadolat, a long-acting form of felodipine) are preferred. When using these drugs, smooth vasodilation occurs without reflex activation of the sympathetic-adrenal system, release of catecholamines, reflex tachycardia and increased myocardial oxygen demand.

Myotropic vasodilators, central alpha-2-adrenergic agonists, and peripheral adrenergic agonists are not recommended as first-choice drugs, taking into account tolerability.

Antihypertensive therapy: what you need to know?

Arterial hypertension is one of those chronic diseases that require constant drug support, daily monitoring and regular intake of prescribed drugs. Not only well-being, but also the life of a sick person directly depends on how carefully the rules of antihypertensive therapy are observed.

Not only the attending physician, but the pharmacist who advises the visitor who has applied to the pharmacy can tell about how to properly treat arterial hypertension, what drugs are used and in what cases.

General rules of therapy

The rules of antihypertensive therapy are simple and well known, but many patients often neglect them, and therefore it will not be out of place to remind you once again what the treatment of hypertension should be.

1. Antihypertensive drugs are taken constantly. Regardless of whether the person feels bad or well, the level of blood pressure (BP) is elevated or remains normal, drug therapy should be constant. Only with daily intake of antihypertensive drugs can effectively control the level of blood pressure, avoid damage to target organs and cardiovascular complications.
2. Antihypertensive drugs are taken in the dosage and form of release in which they are prescribed by the doctor. You should not independently change the recommended dose or try to replace one drug with another, because. this may adversely affect the hypotensive effect.
3. Even with constant intake of antihypertensive drugs, blood pressure should be measured regularly, at least 2 times a week. This is necessary to control the effectiveness of therapy, allows you to notice the changes taking place in the body in time and adjust the treatment.
4. If, against the background of constant antihypertensive therapy, blood pressure suddenly rises, i.e. an uncomplicated hypertensive crisis develops, it is not recommended to take an additional dose of the drug familiar to the patient. For continuous use, long-acting drugs are prescribed, the effect of which develops gradually. To quickly reduce blood pressure, a hypertensive home medicine cabinet must have short-acting antihypertensive drugs.

Features of different groups of drugs

For the treatment of arterial hypertension, 5 main groups of antihypertensive drugs are currently used: ACE inhibitors, beta-blockers, diuretics, calcium antagonists and angiotensin II receptor blockers. All of them have comparable effectiveness, but each of the groups has its own characteristics that determine the use of these drugs in different situations.

ACE inhibitors (enalapril, lisinopril, perindopril, captopril, etc.), in addition to a pronounced hypotensive effect, have organoprotective properties - they reduce the risk of atherosclerosis complications, reduce left ventricular hypertrophy, and slow down the decline in kidney function. The drugs of this group are well tolerated, do not have a negative effect on lipid metabolism and blood glucose levels, which allows them to be used in cases where arterial hypertension is combined with metabolic syndrome or diabetes mellitus, as well as in patients who have had myocardial infarction, in the case of chronic heart failure. insufficiency, arrhythmia, atherosclerosis and impaired renal function.

Beta-blockers (atenolol, bisoprolol, metoprolol, carvedilol, nebivolol) reduce the risk of coronary complications in patients with angina pectoris and cardiovascular accidents in patients who have had myocardial infarction, as well as patients with chronic heart failure, can be used for tachyarrhythmia. The use of beta-blockers is undesirable in patients with metabolic syndrome, lipid metabolism disorders and diabetes mellitus.

Diuretics (hydrochlorothiazide, chlorthalidone, indapamide, spironolactone) are most often used in combination with other antihypertensive drugs, such as ACE inhibitors, to more effectively control blood pressure. The drugs of this group have proven themselves in refractory hypertension and chronic heart failure. For continuous use, diuretics are prescribed in minimal doses - to reduce the risk of side effects.

Calcium antagonists (nifedipine, amlodipine, verapamil, diltiazem), in addition to hypotensive, have antianginal and organ-protective effects, reduce the risk of stroke, prevent platelet aggregation, slow down atherosclerotic lesions of the carotid arteries and left ventricular hypertrophy. Calcium antagonists are used both separately and in combination with other antihypertensive drugs (most often ACE inhibitors).

Angiotensin II receptor blockers

Angiotensin receptor blockers (losartan, candesartan, telmisartan, valsartan) have a cardio- and neuroprotective effect, improve blood glucose control, and have a positive effect on the life expectancy of patients with chronic heart failure. All drugs in this group can be used in the treatment of hypertension in patients with impaired renal function, myocardial infarction, metabolic syndrome, gout, diabetes mellitus.

Hypertensive crisis - what to do?

Even against the background of constant antihypertensive therapy, blood pressure can periodically rise suddenly to individually high numbers (without signs of target organ damage). This condition is called uncomplicated hypertensive crisis, most often it occurs after unusual physical activity, emotional stress, drinking alcoholic beverages or fatty salty foods.

And although an uncomplicated form of a hypertensive crisis is not considered a life-threatening condition, it is impossible to leave it without treatment, because. even a small increase in blood pressure (by 10 mmHg) increases the risk of cardiovascular complications by 30%.2 And the sooner treatment is started, the less the chance of undesirable consequences.

Antihypertensive drugs for uncomplicated hypertensive crisis are often recommended to be taken sublingually, because. this method is convenient for the patient and at the same time provides a rapid development of the therapeutic effect. It is undesirable to reduce blood pressure too quickly - in the first 2 hours by no more than 25% of the baseline and to a normal level within 24 hours. To restore blood pressure control, short-acting drugs that provide a rapid hypotensive effect should be used: nifedipine, captopril, moxonidine, clonidine, propranolol. It is better if a doctor chooses a drug to quickly reduce pressure, since each of them has contraindications.

Half an hour after taking 1 tablet of an antihypertensive drug, you should measure the level of blood pressure and evaluate the effectiveness of treatment. If necessary, to restore the normal level of blood pressure, after 30-60 minutes, you can additionally take 1 more tablet sublingually or orally. If after that the pressure has decreased by less than 25%, it is urgent to call a doctor.

Therapy of comorbid conditions

Arterial hypertension rarely develops as a separate disease, in most cases it is accompanied by underlying disorders that exacerbate target organ damage and increase the risk of cardiovascular complications. Therefore, in addition to antihypertensive drugs, patients with hypertension are often prescribed lipid-lowering therapy, agents for preventing thrombosis and correcting blood glucose levels in patients with metabolic syndrome and diabetes mellitus.

A particularly important role in arterial hypertension is played by the use of statins (simvastatin, atorvastatin, rosuvastatin) - drugs that reduce the level of total cholesterol, low-density lipoproteins and triglycerides. Long-term use of statins can stop atherosclerotic vascular damage, suppress the inflammatory process in the plaque, improve endothelial function and thereby significantly reduce the risk of cardiovascular accidents (myocardial infarction and stroke). First of all, statins are prescribed to patients with coronary artery disease, as well as after myocardial infarction.

Prophylactic antiplatelet therapy is also prescribed for patients at high cardiovascular risk, people with impaired renal function, as well as all those who have undergone vascular surgery (bypass surgery, stenting). Drugs in this group prevent the formation of blood clots and reduce the risk of arterial thrombosis. The most widely used today are acetylsalicylic acid, clopidogrel and dipyridamole, which are prescribed for long courses in minimal therapeutic doses.

And, of course, all these drugs, as well as antihypertensive drugs, are prescribed only by the attending physician, because. any self-treatment for hypertension can be dangerous, which must be reminded to a pharmacy visitor.

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Drug antihypertensive therapy

Angiotensin II receptor antagonists.

α2-Agonists of central action.

Potassium channel activators.

Vasoactive prostaglandins and prostacyclin synthesis stimulators.

The main groups of antihypertensive drugs are currently considered the first 4 groups: beta-blockers, diuretics, calcium antagonists, ACE inhibitors. When choosing antihypertensive drugs, the ability of drugs to influence left ventricular hypertrophy, quality of life, and the ability of drugs to affect the level of atherogenic lipoproteins in the blood are taken into account. The age of patients, the severity of concomitant coronary artery disease should also be taken into account.

propranolol (anaprilin, inderal, obzidan) - non-cardioselective beta-blocker without internal sympathomimetic activity. It is prescribed to patients with arterial hypertension at the beginning of 40 mg 2 times a day, a decrease in blood pressure is possible on the 5th-7th day of treatment. In the absence of an antihypertensive effect, every 5 days you can increase the daily dose by 20 mg and bring it to an individual effective dose. It can range from 80 to 320 mg (i.e. 80 mg 4 times a day). After achieving the effect, the dose is gradually reduced and switched to a maintenance dose, which is usually 120 mg per day (in 2 divided doses). Long-acting propranolol capsules are prescribed once a day.

Nadolol (corguard) - non-cardioselective long-acting beta-blocker without internal sympathomimetic activity and membrane stabilizing effect. The duration of the drug is about 1 hour, so it can be taken once a day. Treatment begins with taking 40 mg of the drug 1 time per day, then you can increase the daily dose by 40 mg every week and bring it up to 240 mg (less often - 320 mg).

Trazikor (oxprenolol) - a non-cardioselective beta-blocker with internal sympathomimetic activity, is prescribed 2 times a day. Available in tablets of the usual duration of action of 20 mg and prolonged action of 80 mg. Treatment begins with a daily dose of mg (in 2 divided doses) followed by an increase in dosage.

Cardioselective beta-blockers

Cardioselective p-blockers selectively block myocardial beta1-adrenergic receptors and have almost no effect on bronchial beta2-adrenergic receptors, do not cause skeletal muscle vasoconstriction, do not impair blood flow in the extremities, slightly affect carbohydrate metabolism and have a less pronounced negative effect on lipid metabolism.

Atenolol - a cardioselective beta-blocker without internal sympathomimetic activity, devoid of a membrane-stabilizing effect. At the beginning of treatment, it is prescribed in a daily dose of 50 mg (in 1 or 2 doses). In the absence of a hypotensive effect, the daily dose may be increased after 2 weeks to 200 mg. The drug has a prolonged action and can be taken 1-2 times a day.

Tenoric - a combined preparation containing 0.1 g of atenolol and 0.025 g of the diuretic chlorthalidone. Tenorik is prescribed 1-2 tablets 1-2 times a day.

metoprolol (specicor, betaxolol) is a cardioselective beta-blocker without intrinsic sympathomimetic activity. The drug acts for about 12 hours, is prescribed 100 mg 1 time per day or 50 mg 2 times a day. After 1 week, the dose can be increased to 100 mg 2 times a day. The maximum daily dose with a gradual increase is 450 mg.

betaloc durules - long-acting metoprolol. Available in tablets of 0.2 g. Treatment begins with a dose of 50 mg 1 time per day and gradually increase the dose to 100 mg. In the absence of a hypotensive effect, the daily dose is increased to 200 mg.

Kordanum (talinolol) - cardioselective beta-blocker with internal sympathomimetic activity. Treatment begins with taking 50 mg of the drug 3 times a day, then, if necessary, the daily dose is increased by domg (in 3 divided doses).

Betaxolol (lokren) - long-acting beta-blocker with high cardioselectivity. The hypotensive effect of the drug persists for 24 hours, so it can be administered once a day. The effect of betaxolol begins to appear after 2 weeks, and after 4 weeks reaches a maximum. Begin treatment with a dose of 10 mg per day. With insufficient hypotensive effect after 2 weeks from the start of treatment, the dose is increased to 20 mg per day (average therapeutic dose), and if necessary, gradually up to 30 or even 40 mg per day.

bisoprolol - long-acting cardioselective beta-blocker. The drug is prescribed 1 tablet 1 time per day, in the morning.

For the treatment of patients with arterial hypertension, it is advisable to use beta-blockers with vasodilating properties.

Beta-blockers with vasodilatory properties include:

non-cardioselective (pindolol, dilevalol, labetolol, niprandilol, proxodolol, carteolol);

cardioselective (carvedilol, prizidilol, celiprolol, bevantolol).

Carvedilol (dilatrend) - a vasodilating cardioselective beta-blocker, is prescribed in a daily dose (in 1-2 doses).

Labetolol (trandat, albetol, normodin) - non-cardioselective vasodilating beta-blocker, used in daily doses (2-4 doses). It has internal sympathomimetic activity and has almost no effect on lipid levels.

Bevantolol - a long-acting cardioselective vasodilating beta-blocker without internal sympathomimetic activity. It is prescribed 100 mg 1 time per day. With insufficient hypotensive effect, you can increase the daily dose to 600 mg (in 1-2 doses).

Side effects of beta-blockers

negative inotropic effect, which may contribute to the development of heart failure or aggravate it;

negative chronotropic effect (development of bradycardia);

slowing atrioventricular conduction;

suppression of mechanisms that counteract the development of hypoglycemia in diabetes mellitus;

the ability to provoke the development of Raynaud's syndrome, intermittent claudication and gangrene;

increased angina with a sudden cessation of beta-blockers in patients suffering from coronary artery disease;

an increase in triglycerides and a decrease in high-density lipoprotein cholesterol; this negative effect is much less pronounced in beta-blockers with internal sympathomimetic activity and vasodilatory properties;

withdrawal syndrome with the rapid discontinuation of beta-blockers, which is manifested by tachycardia, trembling, sweating, increased blood pressure.

Indications for long-term monotherapy of hypertension with beta-blockers and factors influencing the choice of drug

Arterial hypertension with the presence of left ventricular myocardial hypertrophy; beta-blockers cause the reverse development of left ventricular hypertrophy and thereby reduce the risk of sudden death.

Arterial hypertension in young patients, leading, as a rule, an active lifestyle. In such patients, an increase in the tone of the sympathetic nervous system and plasma renin activity are usually detected. The volume of circulating blood is not changed or even reduced. Beta-blockers reduce sympathetic activity, tachycardia, and normalize blood pressure. However, it should be borne in mind that β-blockers adversely affect high-density lipoproteins, can cause sexual dysfunction and interfere with sports, as they reduce cardiac output.

The combination of arterial hypertension with angina pectoris. Beta-blockers have an antianginal effect. At the same time, it is preferable to prescribe non-selective blockers to non-smoking patients with arterial hypertension, while in smokers, apparently, preference should be given to selective blockers (metoprolol or atenolol).

Long-term treatment of patients with arterial hypertension who suffered transmural myocardial infarction. According to the results of controlled studies, in this situation, blockers without internal sympathomimetic activity (propranolol, nadolol, sotalol, timolol, atenolol) should be used for at least 1-3 years, regardless of the presence or absence of angina pectoris.

Arterial hypertension in combination with cardiac arrhythmias, primarily supraventricular ones, as well as with sinus tachycardia.

In patients with arterial hypertension in combination with dyslipidemia, especially in young people, preference should be given to cardioselective blockers, as well as drugs with internal sympathomimetic activity or vasodilating action.

When arterial hypertension is combined with diabetes mellitus, non-cardioselective adrenergic blockers, which can disrupt carbohydrate metabolism, should not be prescribed. Selective blockers (atenolol, acebutalol, metoprolol, talindol) or blockers with pronounced internal sympathomimetic activity (pindolol) have the least effect on carbohydrate metabolism and insulin secretion.

In patients with arterial hypertension and liver dysfunction, doses of lipophilic blockers (propranolol, metoprolol) should be used less than under normal conditions or hydrophilic drugs (nadolol, atenolol, etc.) that are not metabolized in the liver should be prescribed.

When arterial hypertension is combined with impaired renal function, the most suitable drug is the non-cardioselective blocker nadolol, which does not change renal blood flow and glomerular filtration rate or even increases them, despite a decrease in cardiac output and mean blood pressure. The remaining non-cardioselective blockers reduce renal blood flow due to the fact that they reduce cardiac output. Cardioselective blockers, drugs with internal sympathomimetic activity worsen kidney function.

Diuretics have been used for many years not only as diuretics, but also to lower blood pressure.

For the treatment of arterial hypertension, the following groups of diuretic drugs are used:

thiazide and thiazide-like;

with vasodilatory properties.

Thiazide and thiazide-like diuretics

Most often, thiazide diuretics are used in patients with mild to moderate arterial hypertension. When treated with these drugs, a large natriuresis develops in the first 2-3 days, which contributes to the removal of a large amount of water from the body, which leads to a decrease in BCC, a decrease in blood flow to the heart and, consequently, cardiac output. Thiazide diuretics are ineffective if the glomerular filtration rate is less than 25 ml / min. In these cases, stronger loop diuretics should be used.

Hydrochlorothiazide (hypothiazide, dihydrochlorothiazide, ezidrex) - with high arterial hypertension, treatment with hydrochlorothiazide begins with a dose of 1 mg once a day in the morning or 50 mg in 2 divided doses in the first half of the day, with mild and moderate hypertension - with a dose of 25 mg 1 time in the morning. The maintenance dose for long-term use is mg in 1 dose (sometimes the daily dose is 50 mg in 2 doses).

Against the background of taking hypothiazide and other thiazide diuretics, it is necessary to adhere to a hyponatric and potassium-enriched diet. If such a diet is observed, the use of smaller doses of drugs is required, therefore, the likelihood of side effects and their severity are reduced.

Corzid - a combined preparation containing in 1 tablet 5 mg of bendroflumetazide and 40 or 80 mg of the non-selective adrenoblocker nadolol.

Chlorthiazide (diuril) - the hypotensive effect develops a few days after administration, the diuretic effect develops after 2 hours. 2 receptions.

When treated with thiazide diuretics, the following may develop: side effects:

hypokalemia (manifested by muscle weakness, paresthesia, sometimes muscle cramps, nausea, vomiting, extrasystole, a decrease in the level of potassium in the blood;

hyponatremia and hypochloremia (main manifestations: nausea, vomiting, severe weakness, decreased levels of sodium and chlorides in the blood);

hypomagnesemia (the main clinical signs are muscle weakness, sometimes muscle twitches, vomiting);

hypercalcemia (rarely develops);

hyperglycemia (its development is directly dependent on the dose of hypothiazide and the duration of its administration; discontinuation of hypothiazide treatment can restore glucose tolerance, but in some patients not completely; the addition of potassium salts to hypothiazide treatment can reduce the severity of hyperglycemia or even eliminate it. It has been established that the combination of hypothiazide with ACE inhibitors has a beneficial effect, preventing a decrease in carbohydrate tolerance);

increased levels of cholesterol and beta-lipoproteins in the blood. In recent years, it has been established that hydrochlorothiazide breaks carbohydrate tolerance and increases blood cholesterol and triglycerides only during the first two months of regular use of these drugs. In the future, with continued treatment, normalization of these indicators is possible;

Due to the relatively high frequency of side effects, many experts believe that monotherapy with hypothiazide and other thiazide compounds is not always appropriate.

From thiazide-like diuretics The most commonly used drugs are:

Chlortalidone (hygroton, oxodoline) - after oral administration, the diuretic effect begins after 3 hours and lasts up to 2-3 days. Unlike hypothiazide, hypokalemia is less common with chlorthalidone. The drug is used in the daily dose.

Clopamid (brinaldix) - in the daily dozemg helps to reduce systolic blood pressure by 30 mm Hg. Art., diastolic blood pressure - 10 mm Hg. Art., the most pronounced hypotensive effect occurs after 1 month.

Loop diuretics act primarily at the level of the ascending loop of Henle. By inhibiting sodium reabsorption, they cause the strongest dose-dependent diuretic effect. At the same time, the reabsorption of potassium, calcium and magnesium is inhibited.

The following loop diuretics are known: furosemide (lasix), ethacrynic acid (edecrin, uregit), bumetanide (bumex).

Usually, loop diuretics are used in patients with arterial hypertension with resistance to thiazide diuretics, for the relief of hypertensive crises, and in severe renal failure.

The most commonly used loop diuretics are furosemide and ethacrynic acid.

When taken orally, the initial dose of furosemide is 40 mg 2 times a day, but in many patients the initial dose may be 20 mg. If necessary, the daily dose is gradually increased, but the maximum daily dose should not exceed 360 mg (in 2 divided doses). In hypertensive crises accompanied by pulmonary edema, as well as in acute renal failure, the initial dose is mg intravenously. With a stable course of hypertension, dozumg is used for intravenous administration.

Furosemide is the drug of choice in the treatment of patients with impaired renal function (glomerular filtration rate less than 25 ml/min).

Ethacrynic acid (uregit) - Currently, ethacrynic acid for the treatment of arterial hypertension is rarely used.

The most common side effects of loop diuretics are: hypovolemia, hypokalemia, hyperuricemia; high doses may be ototoxic, especially in patients with renal insufficiency. Loop diuretics may also adversely affect carbohydrate and lipid metabolism.

Potassium-sparing diuretics have a weak diuretic effect, but they reduce the excretion of potassium in the urine due to a decrease in its secretion into the lumen of the tubules. These drugs also have a hypotensive effect. The most commonly used potassium-sparing agents are:

spironolactone (veroshpiron, aldactone);

Spironolactone (veroshpiron, aldactone) - Available in tablets of 25, 50 and 100 mg.

The use of spironolactone in hypertension is justified by the fact that it has a hypotensive effect, reduces the effects of fibrosis in the myocardium and retains potassium in the body, preventing hypokalemia in the treatment of diuretics.

When using spironolactone, it is recommended to start treatment with a daily dose of mg (in 1 or 2 doses) for at least 2 weeks, then at intervals of 2 weeks the daily dose is gradually increased to 200 mg. The maximum daily dose is 400 mg.

Spironolactone does not cause hyperglycemia, hyperuricemia and does not adversely affect lipid metabolism (does not increase blood levels of cholesterol and triglycerides), therefore it can be prescribed to those patients in whom thiazide diuretics cause these side effects.

To side effects spironolactone include:

Contraindications for the appointment of spironolactone:

increased levels of creatinine or urea nitrogen in the blood;

taking potassium supplements or potassium-sparing drugs;

Triamterene - is available in capsules of 50 and 100 mg, as well as in the form of fixed combination drugs of the following composition:

tablets triampur compositum(25 mg triamterene and 12.5 mg hydrochlorothiazide);

capsules diazide(50 mg triamterene and 25 mg hydrochlorothiazide);

tablets m axzid(75 mg triamterene and 50 mg hydrochlorothiazide).

The hypotensive effect of triamterene is weak, but its potassium-retaining effect is significant. As a rule, the drug is prescribed in combination with hydrochlorothiazide or furosemide. With a hypotensive purpose, triampur compositum is most often used, 1-2 tablets per dose 1-2 times a day.

Contraindications to the appointment of triamterene :

severe liver failure;

concomitant use of potassium supplements or potassium-sparing agents.

Diuretics with vasodilatory properties

Indapamide hemihydrate (arifon) - available in tablets of 1.25 and 2.5 mg, is a sulfanilamide diuretic, specially designed for the treatment of arterial hypertension.

Indapamide has no negative effect on lipid and carbohydrate metabolism, can cause the development of hypokalemia and slightly increase the content of uric acid in the blood.

It is recommended to use the drug at a dose of 2.5 mg 1 time per day for any severity of hypertension, after 1-2 months you can increase the dose to 5 mg per day. Contraindicated in hepatic and renal insufficiency.

The hypotensive effect of indapamide is enhanced when combined with beta-blockers, ACE inhibitors, methyldopa.

Indications for the predominant use of diuretics in as antihypertensive drugs

As mentioned above, diuretics do not reduce the severity of myocardial hypertrophy, do not significantly improve the quality of life, and adversely affect lipid and carbohydrate metabolism. In this regard, diuretics are most often used as a second drug in combination with other antihypertensive drugs.

The main indications for the appointment of diuretics in arterial hypertension are:

volume-dependent hyporenin variant of hypertension, which is often found in women in pre- and menopausal periods. It is characterized by clinical symptoms of fluid retention (tendency to edema, increased blood pressure following the intake of excess water and salt, periodic oliguria, headaches in the occipital region), low levels of renin in the blood;

high stable arterial hypertension, since it causes sodium and water retention, not due to cardiac insufficiency; long-term use of diuretics leads to a vasodilating effect;

a combination of arterial hypertension with congestive heart failure, obstructive bronchial diseases (beta-blockers are contraindicated in this situation), peripheral arterial diseases;

a combination of arterial hypertension with renal failure (except for potassium-sparing diuretics).

Treatment with calcium antagonists

Calcium antagonists have the following mechanisms of action:

block slow calcium channels and calcium entry into smooth muscle cells, due to which the arteries, arterioles relax, the total peripheral resistance decreases and a hypotensive effect is manifested;

increase renal blood flow without changing or increasing glomerular filtration;

reduce sodium reabsorption in the renal tubules, which leads to an increase in sodium excretion (natriuretic effect) without significant loss of potassium and hypokalemia;

reduce platelet aggregation due to a decrease in the production of thromboxane and an increase in the production of prostacyclin, which reduces platelet aggregation and dilates blood vessels;

reduce the degree of hypertrophy of the left ventricular myocardium, which reduces the risk of developing fatal arrhythmias of the heart;

verapamil and diltiazem have an antiarrhythmic effect and are the drugs of choice for the relief of paroxysmal supraventricular tachycardia, as well as for the treatment of supraventricular extrasystoles that occur in patients with arterial hypertension;

have an angioprotective, anti-atherogenic effect, prevent the deposition of cholesterol and calcium in the vessel wall.

Calcium antagonists do not change the plasma lipid profile, carbohydrate tolerance, do not increase uric acid in the blood, do not impair sexual function in men, do not worsen bronchial conduction, do not reduce physical performance, as they do not aggravate muscle weakness.

First generation calcium antagonists

The main first generation calcium antagonists are:

dihydropyridine derivative nifedipine;

phenylalkylamine derivative verapamil;

benzothiazepine derivative diltiazem.

Nifedipine is available in the following dosage forms:

conventional dosage forms: adalat, corinfar, cordafen, procardia, nifedipine in tablets of 10 mg; the duration of these forms is 4-7 hours;

prolonged dosage forms - adalat retard, nifedipine SS in tablets and capsules of 20, 30, 60 and 90 mg. The duration of the hypotensive action of these forms is 24 hours.

Nifedipine is the most powerful short-acting calcium antagonist, has a pronounced antianginal and hypotensive effect.

To stop a hypertensive crisis, capsules or short-acting tablets, previously chewed, are taken under the tongue. The hypotensive effect occurs in 1-5 minutes.

For the regular treatment of arterial hypertension, prolonged-release nifedipine is used - slow-release tablets and capsules and very prolonged-release tablets, they are prescribed pomg 1 time per day; with an interval of 7-14 days, the dose can be gradually increased by domg 1 time per day; extended-release dosage forms must be swallowed whole, without chewing; The maximum allowable daily dose is 120 mg.

The most significant side effects nifedipine are:

pastosity on ankles and shins;

increased frequency of angina attacks or painless myocardial ischemia (“steal syndrome”);

decrease in myocardial contractility.

Main contraindications to treatment with nifedipine: aortic stenosis, hypertrophic cardiomyopathy, decreased myocardial contractility, unstable angina and myocardial infarction.

Verapamil is available in the following dosage forms:

conventional dosage forms: verapamil, isoptin, finoptin in tablets, dragees and capsules of 40 and 80 mg;

extended forms: tablets of 120 and 240 mg, capsules of 180 mg;

ampoules of 2 ml of a 0.25% solution (5 mg of the substance in the ampoule).

For the treatment of arterial hypertension, the drug is used as follows:

a) in conventional dosage forms - the initial dose is 80 mg 3 times a day; in elderly patients, as well as in people with low body weight, with bradycardia - 40 mg 3 times a day. During the first 3 months, the effect of verapamil may increase. The maximum daily dose for arterial hypertension is mg;

b) prolonged forms of verapamil - the initial dose is mg 1 time per day, then after a week you can increase the dose to 240 mg 1 time per day; then, if necessary, you can increase the dose to 180 mg 2 times a day (morning and evening) or 240 mg in the morning and 120 mg in the evening every 12 hours.

Main side effects verapamil are:

development of bradycardia and slowing of atrioventricular conduction;

decrease in myocardial contractility;

Verapamil contributes to the development of glycoside intoxication, as it reduces the clearance of cardiac glycosides. Therefore, in the treatment of verapamil, the doses of cardiac glycosides are reduced by.

Main contraindications to treatment with verapamil:

sick sinus syndrome;

Atrial fibrillation in patients with additional pathways;

Diltiazem is available in the following dosage forms:

conventional dosage forms: diltiazem, dilzem, cardizem, cardil in tablets of 30, 60, 90 and 120 mg;

prolonged dosage forms in capsules of 60, 90 and 120 mg with a slow release of the drug;

ampoules for intravenous administration.

For the treatment of arterial hypertension, diltiazem is used as follows:

a) conventional dosage forms (capsule tablets) - start with a dose of 30 mg 3 times a day, then gradually increase the daily dose to 360 mg (in 3 divided doses);

b) long-acting (sustained release) dosage forms - start with a daily dose of 120 mg (in 2 divided doses), then the daily dose can be increased to 360 mg (in 2 divided doses);

c) very prolonged forms - start with a dose of 180 mg 1 time per day, then the daily dose can be gradually increased to 360 mg (with a single dose).

Diltiazem has the same side effects as verapamil, but its negative chrono- and inotropic effects are less pronounced.

Second generation calcium antagonists

Nicardipine (cardin) - compared with nifedipine, it has a more selective effect on the coronary and peripheral arteries.

The drug has a very weak negative inotropic and chronotropic effect and slightly slows down intraventricular conduction. The hypotensive effect of nicardipine is similar to that of other calcium antagonists.

Nicardipine is available in extended-release capsules and is prescribed initially at 30 mg 2 times a day, then the dose is gradually increased to 60 mg 2 times a day.

Darodipine - prescribed 50 mg 2 times a day, steadily reduces systolic and diastolic blood pressure without increasing heart rate.

Amlodipine (norvask) - Available in tablets of 2.5, 5 and 10 mg. The drug has a long-term hypotensive and antianginal effect, it is prescribed once a day, initially at a dose of 5 mg, if necessary, after 7-14 days, the dose can be increased to 10 mg.

Logimax - a combination drug consisting of the long-acting dihydropyridine drug felodipine and the beta-blocker metoprolol. The drug is used 1 time per day.

Thus, calcium antagonists are effective antihypertensive and antianginal drugs that lead to the regression of left ventricular hypertrophy, improve the quality of life, have a nephroprotective effect, do not cause significant metabolic disorders and sexual dysfunctions.

Indications for the preferential appointment of calcium antagonists in arterial hypertension

combination of hypertension with exertional angina and vasospastic angina;

a combination of hypertension and cerebrovascular disease;

combination of arterial hypertension with severe dyslipidemia;

Arterial hypertension in patients with diabetic nephropathy;

The presence of chronic renal failure in patients with arterial hypertension;

The combination of arterial hypertension with cardiac arrhythmias.

Treatment with ACE inhibitors

In addition to the hypotensive effect, ACE inhibitors also have the following positive effects:

reduce left ventricular myocardial hypertrophy;

significantly improve the quality of life;

have a cardioprotective effect (reduce the likelihood of re-infarction and the risk of sudden death, increase coronary blood flow, eliminate the imbalance between myocardial oxygen demand and its delivery);

Reduce the excitability of the myocardium, tachycardia and the frequency of extrasystoles, which is due to an increase in the content of potassium and magnesium in the blood, a decrease in myocardial hypertrophy and hypoxia;

favorably affect carbohydrate metabolism, increase the uptake of glucose by cells due to the fact that an increase in the content of bradykinin under the influence of ACE inhibitors increases the permeability of cell membranes for glucose;

show a potassium-sparing effect;

The following ACE inhibitors are most commonly used to treat hypertension.

Captopril (capoten, tensomin) - available in tablets of 12.5, 25, 50 and 100 mg, as well as in the form of fixed complex preparations caposide-25(captopril and hydrochlorothiazide 25 mg each) and caposide-50(captopril and hydrochlorothiazide 50 mg each).

Treatment of arterial hypertension with capoten begins with a dose of 12.5-25 mg 2-3 times a day, subsequently, in the absence of a hypotensive effect, the dose is gradually increased to 50 mg 2-3 times a day. If necessary, the daily dose of captopril can be increased.

Enalapril (Enap, Renitek, Vasotek, Xanef) - available in tablets of 2.5, 5, 10 and 20 mg and ampoules for intravenous administration (1.25 mg per 1 ml). The initial dose is 5 mg orally once a day. If necessary, you can gradually increase the dose of domg / day in 1-2 doses. The maintenance dose is 10 mg per day. The drug has a renoprotective effect even with significant renal failure.

Cilazapril (inhibase) - prolonged ACE inhibitor. In terms of strength and duration of action, it surpasses captopril and enalapril. Usually the drug is prescribed in a dose of 2.5-5 mg 1 time per day, and in the first 2 days, 2.5 mg. Further, the dose is selected individually depending on the change in blood pressure.

Ramipril (tritace) - is a long-acting drug. Treatment begins with taking 2.5 mg of ramipril 1 time per day. With insufficient hypotensive effect, the daily dose of the drug can be increased to 20 mg.

Perindopril (prestarium, coversil) - long-acting ACE inhibitor. Perindopril is produced in tablets of 2 and 4 mg, is prescribed 2-4 mg 1 time per day, in the absence of a hypotensive effect - 8 mg per day.

Quinapril (akkupril, akkupro) - duration of action - h. For patients with mild to moderate hypertension, the drug is prescribed initially at 10 mg 1 time per day, then the daily dose can be increased every 2 weeks to 80 mg (in 2 divided doses).

ACE inhibitors have the following side effects :

with prolonged treatment, oppression of hematopoiesis is possible (leukopenia, anemia, thrombocytopenia);

cause allergic reactions - itching, redness of the skin, urticaria, photosensitivity;

on the part of the digestive organs, taste perversion, nausea, vomiting, discomfort in the epigastric region, diarrhea or constipation are sometimes observed;

Some patients may develop severe hoarse breathing, dysphonia, dry cough;

Contraindications to treatment with ACE inhibitors :

Individual hypersensitivity, including with a history of indications of angioedema;

severe aortic stenosis (danger of reducing the perfusion of the coronary arteries with the development of myocardial ischemia);

pregnancy (toxicity, development of hypotension in the fetus), lactation (drugs pass into breast milk and cause arterial hypotension in newborns);

stenosis of the renal artery.

Indications for prescribing inhibitors ACE in hypertension

ACE inhibitors can be used at any stage of arterial hypertension, both as monotherapy and in combination with calcium antagonists or diuretics (if monotherapy is ineffective), as they significantly improve the quality of life, reduce left ventricular myocardial hypertrophy, improve life prognosis, and have a cardioprotective effect. .

Indications for the preferential prescription of ACE inhibitors with arterial hypertension:

combination of arterial hypertension with congestive circulatory failure;

combination of arterial hypertension with coronary artery disease, including after myocardial infarction (cardioprotective effect);

arterial hypertension in diabetic nephropathy (nephroprotective effect);

combination of arterial hypertension with chronic obstructive bronchial diseases;

a combination of arterial hypertension with impaired glucose tolerance or diabetes mellitus (ACE inhibitors improve carbohydrate metabolism);

the development of adverse changes in lipid metabolism and an increase in the level of uric acid in the blood during the treatment of arterial hypertension with diuretics and beta-blockers;

severe hyperlipidemia in patients with arterial hypertension;

combination of arterial hypertension with obliterating diseases of peripheral arteries.

Angiotensin receptor antagonists II

A drug losartan (cozaar) is a non-peptide AT II receptor antagonist and blocks the following effects of AT II related to the pathogenesis of arterial hypertension:

renin release (negative feedback);

development of left ventricular myocardial hypertrophy.

The advantages of losartan are its good tolerability, the absence of side effects characteristic of ACE inhibitors. Indications for the use of the drug are the same as for ACE inhibitors. It is produced in capsules of 50 and 100 mg, it is used in doses 1 time per day.

Direct vasodilators cause direct relaxation of blood vessels, primarily arterial ones.

Hydralazine (apressin) - available in tablets of 10, 25, 50 and 100 mg, as well as in ampoules of 20 mg / ml for intravenous and intramuscular administration. The drug is a peripheral vasodilator, reduces the resistance of arterioles, causes a decrease in blood pressure, load on the myocardium, increases cardiac output.

The drug is not able to cause regression of left ventricular myocardial hypertrophy; with prolonged use, tolerance to its hypotensive effect develops.

Hydralazine is prescribed initially at 10 mg 2-4 times a day, in the future, with insufficient hypotensive effect, the daily dose is gradually increased to 300 mg in 3-4 doses.

Treatment with hydralazine may include: side effects effects:

Headache; nausea;

tachycardia (due to activation of the sympathetic nervous system); when combined with beta-blockers, tachycardia is less pronounced;

sodium and water retention;

Adelfan-ezidreks - a combined preparation consisting of adelfan 10 mg hydrochlorothiazide is prescribed 1-4 tablets per day.

Adrenoblockers block adrenoreceptors at the level of peripheral arterioles, which reduces peripheral resistance and causes a hypotensive effect.

For the treatment of arterial hypertension, highly selective postsynaptic adrenergic blockers are used - prazosin and second-generation drugs - doxazosin, terazosin, ebrantil (urapidil).

Postsynaptic adrenergic blockers do not cause regression of left ventricular myocardial hypertrophy, have an anti-atherogenic effect (reduce blood levels of cholesterol, triglycerides, atherogenic lipoproteins and increase the level of high-density lipoproteins). They do not cause reflex tachycardia. These drugs almost do not retain sodium and water in the body, do not increase the content of uric acid in the blood, and do not adversely affect carbohydrate metabolism.

Prazosin . Treatment with prazosin begins with a dose of 0.5-1 mg at bedtime, after a few days before canceling diuretics. After the first dose of the drug, the patient must necessarily be in a horizontal position due to the risk of developing orthostatic hypotension (“the effect of the first dose”). In the future, prazosin is prescribed 1 mg 2-3 times a day. The maximum daily dose of the drug is 20 mg.

Prazosin can cause the following side effects :

sodium and water retention during long-term treatment;

orthostatic hypotension up to fainting when taking the first dose;

Postsynaptic blockers of the second generation have a prolonged action, are better tolerated, the phenomenon of the first dose (orthostatic syncope) is less typical for them, they have more pronounced positive properties such as anti-atherogenic effect, improved glucose metabolism.

Terazosin (sly)- The initial dose is 1 mg per day. Subsequently, in the absence of effect, you can increase the dose to 5-20 mg 1 time per day.

Doxazosin (kardura) - used in a daily dose of 1 to 16 mg (in 1 dose).

Ebranil(urapidil) - Treatment begins with a dose of 30 mg 2 times a day. In the future, you can gradually increase the daily dose to 180 mg in 2 divided doses.

α2-Centrally acting agonists

a2-Agonists of central action stimulate adrenoreceptors in the vasomotor center of the medulla oblongata, which leads to inhibition of sympathetic impulses from the brain and a decrease in blood pressure. Centrally acting adrenergic stimulants cause regression of left ventricular hypertrophy.

Clonidine (clofelin) - in case of oral treatment of arterial hypertension with clonidine, the initial dose is 0.075-0.1 mg 2 times a day, then every 2-4 days the daily dose is increased by 0.075-1 mg and adjusted to 0.3-0.45 mg (in 2-3 doses). After achieving a hypotensive effect, the dose can be gradually reduced to maintenance, which is usually 0.15-0.2 mg per day.

When using clonidine, it is possible side effects :

severe dry mouth due to inhibition of the secretion of the salivary glands;

drowsiness, lethargy, sometimes depression;

retention of sodium and water due to an increase in their reabsorption in the kidneys;

constipation with prolonged use;

impaired carbohydrate tolerance, development of morning hyperglycemia during long-term treatment with clonidine;

a significant increase in blood pressure (up to a hypertensive crisis) with a sharp abolition of clonidine;

inhibition of secretion of gastric juice;

a sharp drop in blood pressure, loss of consciousness and subsequent amnesia;

possible decrease in glomerular filtration.

Contraindications to treatment with clonidine:

treatment with antidepressants (antagonistic relationships are possible, which prevents the hypotensive effect of clonidine);

professions that require a quick physical and mental reaction;

stunted state of patients.

Methyldopa (dopegit, aldomet) -At the beginning of treatment, the dose is 0.25 g 2-3 times a day. Subsequently, the daily dose can be increased to 1 g (in 2-3 doses), the maximum daily dose is 2 g. Methyldopa does not impair renal blood flow, does not reduce the glomerular filtration rate.

Retention of sodium and water with prolonged use of the drug, an increase in the volume of circulating blood, a decrease in the hypotensive effect; given this, it is advisable to combine methyldopa with saluretics;

Lethargy, drowsiness, but to a lesser extent than with clonidine treatment;

Significant doses of metiddopa can cause depression, night terrors, nightmares;

development of parkinsonism is possible;

violation of the menstrual cycle;

increased secretion of prolactin, the appearance of galactorrhea;

with a sharp cessation of treatment with methyldopa, a withdrawal syndrome with a sharp increase in blood pressure may develop.

Contraindications to treatment with metiddopa:

hepatitis and cirrhosis of the liver;

tendency to depression;

suspected pheochromocytoma;

significant circulatory disorders;

Reserpine - has a direct blocking effect on the sympathetic nervous system, reducing the content of norepinephrine in the central nervous system and peripheral nerve endings.

Reserpine is available in tablets of 0.1 and 0.25 mg, as well as in the form of 0.1% and 0.25% solutions for parenteral administration in 1 ml ampoules (1 and 2.5 mg, respectively).

The drug is administered orally, starting with a daily dose of 0.1-0.25 mg, after meals, then, after 5-7 days, the daily dose is gradually increased to 0.3-0.5 mg.

Side effects reserpine:

nasal congestion and difficulty in nasal breathing due to swelling of the mucous membrane;

development of parkinsonism with prolonged use;

frequent, loose stools;

weakening of sexual desire in men;

increased production of prolactin by the adenohypophysis, persistent galactorrhea;

sodium and water retention;

increased gastric secretion, development of a hyperacid state (heartburn, abdominal pain, exacerbation of peptic ulcer of the stomach and duodenum).

Contraindications to treatment with reserpine:

bronchial asthma, obstructive bronchitis;

peptic ulcer of the stomach and duodenum;

severe sinus bradycardia;

disorders of atriovectricular conduction;

Currently, sympatholytics are not considered as first-line drugs in the treatment of arterial hypertension and are used as more accessible (cheap) means and, moreover, in the absence of the effect of other drugs, and also due to tradition.

The effect of antihypertensive drugs on myocardial hypertrophyleft ventricle

Left ventricular myocardial hypertrophy in hypertension is a risk factor for fatal cardiac arrhythmias, heart failure, and sudden death. In this regard, the influence of some antihypertensive drugs on the regression of myocardial hypertrophy is extremely important.

The following antihypertensive drugs are capable of causing regression of myocardial hypertrophy:

beta-blockers: propranolol, acebutalol, nadolol, targets-prolol, delivalol, betaxolol, bisoprolol and possibly some others (there are conflicting data regarding atenolol and metoprolol);

calcium antagonists: nifedipine, verapamil, nitrendipine, amlodipine, isradipine; nisoldipine not only does not affect hypertrophy, but can also cause a deterioration in the functional ability of the heart with a sudden increase in blood pressure;

centrally acting antiadrenergic drugs moxonidine and methyldopa;

The main new provisions of the drug strategy treatment of arterial hypertension

individualized, differentiated therapy of patients, taking into account the clinical and pathogenetic features of arterial hypertension;

rejection of rigid treatment regimens, including mandatory stepwise therapy; the possibility of monotherapy not only in patients with "light", mild forms of arterial hypertension, but also in patients requiring more intensive treatment;

Increasing the role of ACE inhibitors and calcium antagonists in the treatment of arterial hypertension and changing the "hierarchy" of antihypertensive drugs: if earlier treatment was started with a diuretic or beta-blocker and only in the late stages of hypertension resorted to a1-blockers, calcium antagonists, ACE inhibitors, then in at present, these drugs can be "starter", i.e. treatment can begin with them;

displacement from the number of widely used drugs clonidine, reserpine, ismelin (isobarine);

the use of diuretics only in a potassium-sparing regimen and in the second (auxiliary) row in most patients;

clarification of indications for the use of beta-blockers and an increase in the role of selective beta-blockers in antihypertensive therapy, as well as beta-blockers with vasodilating properties;

mandatory assessment of the possible negative effects of antihypertensive drugs on the risk factors for coronary artery disease (atherogenic dyslipoproteinemia), glucose tolerance, blood uric acid levels;

mandatory assessment of the effect of an antihypertensive drug on the regression of left ventricular myocardial hypertrophy, quality of life;

development and testing of new promising antihypertensive drugs, in particular true angiotensin II receptor blockers (losartan);

transition with maintenance, indefinitely long-term therapy to drugs of prolonged action (the principle of "one day - one tablet";

Improved cerebral blood flow (treatment with cerebroangiocorrectors)

Cerebral hemodynamics in hypertension is violated ambiguously. To identify these disorders, rheoencephalography can be used.

With a "spastic" type of cerebral hemodynamic disturbance it is advisable to connect antispasmodics to antihypertensive therapy: papaverine, no-shpy. Calcium antagonists can be recommended as antihypertensive agents.

In violation of the venous outflow from the brain, drugs that increase the tone of cerebral veins are recommended: small doses of caffeine (0.02-0.03 g per 1 dose for intense headaches), magnesium sulfate, diuretics, beta-blockers.

With a mixed type of cerebral hemodynamic disorders cavinton, cinnarizine are shown, and from antihypertensive drugs - clonidine (hemiton, clonidine), rauwolfia preparations.

Treatment of a hypertensive crisis

Hypertensive crisis is a clinical syndrome characterized by a sudden and violent exacerbation of hypertension or symptomatic arterial hypertension, a sharp increase in blood pressure to individually high magnitude, subjective and objective manifestations of cerebral, cardiovascular and general vegetative disorders.

Non-emergency (within a few hours) relief of hypertensive crisis

Non-emergency relief of a hypertensive crisis (during hours) is performed with an uncomplicated and non-threatening course. To stop such variants of a hypertensive crisis, antihypertensive drugs are used in forms for oral administration.

In addition to the drugs described below, for non-emergency relief of a hypertensive crisis, you can use dibazole in the form of intramuscular injections (1-2 ml of 1% solution) 3-4 times a day. It is also advisable to include tranquilizers in the complex therapy. (seduxena etc.), sedatives (valerian, motherwort and etc.).

Antihypertensive drugs are medications that are aimed at having a hypotensive effect, that is, lowering blood pressure.

Their identical name is antihypertensive (Ukr.

The drugs are produced in large quantities, since the problem of high blood pressure is quite common.

According to statistics, antihypertensive therapy has helped to reduce mortality in extreme forms of hypertension, over the past twenty years, by almost fifty percent.

The opposite action (increasing pressure) are hypertensive drugs, also referred to as antihypotensive, or having a hypertensive effect.

Hypotensive effect, what is it?

The most common diagnosed pathology of the heart and blood vessels is arterial hypertension.

According to statistics, the diagnosis of signs of this pathological condition occurs in about fifty percent of the elderly, requiring timely intervention and effective therapy to prevent burdens.

In order to prescribe treatment with drugs that have an antihypertensive effect, it is necessary to accurately diagnose the presence of arterial hypertension in a patient, determine all risk factors for the progression of complications, and contraindications to individual antihypertensive drugs.

Antihypertensive therapy is aimed at reducing pressure, preventing all kinds of complications against the background of kidney failure, stroke, or the death of heart muscle tissue.

In a person with an elevated level of pressure, when treated with antihypertensive drugs, the pressure is normal, not exceeding one hundred and forty ninety.

It is important to understand that normal blood pressure and the need for antihypertensive therapy are determined for each individual.

However, with the progression of complications in the heart, retina, kidneys, or other vital organs, treatment should begin without delay.

The presence of a prolonged increase in diastolic pressure (from 90 mm Hg) requires the use of therapy with antihypertensive drugs, such indications are prescribed in the recommendations of the World Health Organization.

In most cases, antihypertensive drugs are prescribed for life use, but in some cases they can be prescribed courses for an indefinite period.

The latter is due to the fact that when the course of therapy is stopped, three-quarters of patients experience a return of signs of hypertension.

For a lifelong course of treatment, antihypertensive treatment is selected with the least side effects and complete tolerability of all components by the patient.

Antihypertensive therapy, with prolonged use, is as safe as possible, and side effects are due to incorrect dosage, or course of treatment.

For each individual case, the doctor determines his course of treatment, depending on the form and severity of hypertension, contraindications and concomitant diseases.

When prescribing antihypertensive drugs, the doctor should inform the patient about the possible side effects of antihypertensive drugs.

What are the main principles of therapy?

Since drugs with antihypertensive action have been prescribed for a long time, a large number of patients have tested them.

Physicians have formed the basic principles for countering high blood pressure, which are given below:

• It is preferable to use drugs with a long-term effect, and helps to maintain blood pressure at a normal level throughout the day and prevents the deviation of indicators, which can lead to burdens;
• A drug that has an antihypertensive effect should be prescribed exclusively by the attending physician. The appointment of certain antihypertensive drugs should occur exclusively by the attending physician, based on the studies and features of the course of the disease, already affected organs, as well as the individual tolerance of each of the components of the drug by the patient;
• When, with the use of a small dose of antihypertensive drugs, the effectiveness is fixed, but the indicators are still high, then the dosage is gradually increased, under the supervision of the attending physician, until the pressure returns to normal;
• With combined treatment if the second medication does not have the desired effect, or provokes side effects, then it is necessary to try to use another antihypertensive drug, but do not change the dosage and course of treatment with the first remedy;
• Rapid fall in blood pressure is not allowed, as this can lead to ischemic attacks on vital organs. It is of particular importance to observe this in elderly patients;
• Therapy begins with small doses of antihypertensive drugs.. At this stage, the most suitable remedy with the least number of side effects is selected;
• To achieve the best antihypertensive effect, the principles of combined use of antihypertensive drugs are taken into account. Therapy begins with the selection of funds in minimal doses, with their gradual increase in order to achieve the desired result. At the moment, in medicine, there are schemes for the combined treatment of arterial hypertension;
• In modern pharmaceuticals, there are drugs in which there are several active ingredients at once.. This is much more convenient, since the patient needs to take only one drug, and two or three different tablets;
• If there is no effectiveness from the use of antihypertensive drugs, or the patient does not tolerate the drug well, then its dosage cannot be increased, or combined with other drugs. In this case, it is required to completely eliminate the drug, and try to use another one. The range of antihypertensive drugs is very large, so that the selection of effective therapy occurs gradually for each patient.

Classification of antihypertensive drugs

The main antihypertensive drugs are divided into two more groups. The table below shows the classification in the table by group.

Modern drugs are effectively used in arterial hypertension, and can be used as initial treatment or maintenance therapy, either alone or in combination with other drugs.

The choice of one or another drug is carried out by the attending physician based on the degree of increase in blood pressure, the characteristics of the disease and other individual indicators.

What is special about ACE inhibitors?

ACE inhibitors are the best and most effective antihypertensive drugs. The decrease in blood pressure, when using these antihypertensive drugs, occurs under the influence of the expansion of the lumen of the vessel.

With an increase in the lumen of the vessel, a decrease in the total resistance of the walls of the vessels occurs, which leads to a decrease in blood pressure.

ACE inhibitors have practically no effect on the amount of blood ejected by the heart and the number of contractions of the heart muscle, which allows them to be used with concomitant pathology - heart failure.

Efficiency is felt already after taking the first dose of an antihypertensive drug - a decrease in blood pressure is noted. If you use ACE inhibitors for several weeks, then the effect of antihypertensive therapy is enhanced and reaches maximum levels, completely normalizing blood pressure.

The main disadvantage of these antihypertensive drugs are frequent side effects compared to other groups of drugs. They are characterized by: a strong dry cough, failure of taste buds and characteristic signs of increased potassium in the blood.

In very rare cases, hypersensitivity reactions are recorded, manifested as angioedema.

Reducing the dosage of ACE inhibitors is done with kidney failure.

Unconditional contraindications to the use of these antihypertensive drugs are:

• The period of bearing a child;
• High levels of potassium in the blood;
• A sharp narrowing of both arteries of the kidneys;
• Quincke's edema.

The list of the most common antihypertensive drugs from the group of ACE inhibitors is given below:

• Gopten- use one to four milligrams, once a day;
• Vitopril, Lopril, Diroton- it is recommended to use ten to forty milligrams up to two times a day;
• Renitek, Enap, Berlipril- consume from five to forty milligrams, up to two times a day;
• Moex- consume from eight to thirty milligrams, up to two times a day. Recommended for people suffering from kidney failure;
• Quadropril- consume six milligrams, once a day;
• Phosicardium- use ten to twenty milligrams, up to two times a day;
• Accupro- take from ten to eighty milligrams, up to two times a day.

What is special about angiotensin II receptor inhibitors?

This group of antihypertensive drugs is the most modern and effective. IRA drugs lower blood pressure by dilating blood vessels, similar to ACE inhibitors.

However, RA inhibitors act more widely, having the strongest effect on lowering pressure, by disrupting the binding of angiotensin to receptors in cells of various organs.

It is thanks to this action that they achieve relaxation of the walls of blood vessels, and increase the excretion of excess amounts of fluid and salts.

Medications in this group cause effective monitoring of blood pressure for twenty-four hours if RA inhibitors are taken once a day.

In antihypertensive drugs of this subgroup, there is no side effect inherent in ACE inhibitors - a strong dry cough. That is why RA inhibitors effectively replace ACE inhibitors when they are intolerant.

The main contraindications are:

• The period of bearing a child;
• Excess potassium in the blood;
• Narrowing of both arteries of the kidneys;
• Allergic reactions.

The most common drugs of the latest generation

Scroll:

• Valsacor, Diovan, Vassar- take from eighty to three hundred and twenty milligrams per bitch in one go;
• Aprovel, Irbetan, Converium- it is recommended to use from one hundred and fifty to three hundred milligrams, once a day;
• Micardis, Prytor- it is recommended to use from twenty to eighty milligrams, once a day;
• Kasark, Kandesar- used in a dosage of eight to thirty-two grams, once a day.

What are the characteristics of diuretics?

This group of antihypertensive drugs is characterized as diuretics, and is the largest and longest used group of drugs.

Diuretics have the properties of removing excess fluid and salts from the body, reducing the volume of blood in the circulatory system, the load on the heart and vascular walls, which leads to their relaxation.

The modern group of diuretics is divided into the following types:

• Thiazide (Hypothiazide). This subgroup of diuretics is most often used to lower blood pressure. In most cases, doctors recommend small dosages. The drugs lose their effectiveness in severe kidney failure, which is a contraindication to their use.
  The most common of this group of diuretics is Hypothiazid. It is recommended to use in a dosage of thirteen to fifty milligrams, up to two times a day;
• Thiazide-like (Indap, Arifon and Ravel-SR). They use drugs, most often, from one and a half to five milligrams per day (once);
• Potassium-sparing (Spironolactone, Eplerenone, etc.). They have a milder effect compared to other types of diuretic drugs. Its action is to block the effects of aldosterone. They lower blood pressure when removing salts and fluids, but do not lose potassium, calcium and magnesium ions.
  Drugs can be prescribed to people with chronic heart failure and edema, provoked by a violation of the heart.
  Contraindication - kidney failure;
• Loop (Edecrin, Lasix). They are the most aggressive drugs, but they are fast-acting drugs. For prolonged use, they are not recommended, as the risk of metabolic disorders increases, because electrolytes are also removed with the liquid. These antihypertensive drugs are effectively used for the treatment of hypertensive crises.

What are the benefits of beta blockers?

Medicines of this group of antihypertensive drugs effectively lower blood pressure by blocking beta-adrenergic receptors. This leads to the fact that there is a decrease in the blood ejected by the heart, and the activity of renin in the blood plasma decreases.

Such antihypertensive drugs are prescribed for high blood pressure, which is accompanied by angina pectoris and certain types of violations of the rhythm of contractions.

Since beta-blockers have a hypotensive effect, achieved by reducing the number of contractions, bradycardia (slow heart rate) is a contraindication.

When using these antihypertensive drugs, the metabolic processes of fats and carbohydrates change, weight gain can be provoked. That is why beta-blockers are not recommended for patients with diabetes and other metabolic disorders.

These drugs can cause constriction of the bronchi and a decrease in the frequency of heart contractions, which makes them inaccessible to asthmatics and people with rhythm disturbances.

The most common drugs in this group are:

• Celiprol- use from two hundred to four hundred milligrams, once a day;
• Betacor, Lokren, Betak- are used in a dosage of five to forty milligrams, once a day;
• Biprol, Concor, Coronal- are used in a dosage of three to twenty milligrams per day, at a time;
• Egilok, Betalok, Corvitol- it is recommended to use from fifty to two hundred milligrams per day, you can break up the use of up to three doses per day;
• Tenobene, Tenolol, Atenol- It is recommended to use from twenty-five to one hundred milligrams, up to two times a day.

What is special about calcium antagonists?

With the help of calcium, muscle fibers contract, including the walls of blood vessels. The mechanism of action of these drugs is that they reduce the penetration of calcium ions into vascular smooth muscle cells.

There is a decrease in the sensitivity of blood vessels to vasopressor drugs that cause vasoconstriction.

In addition to the positive effects, calcium antagonists can provoke a number of serious side effects.

This group of antihypertensive drugs is divided into three subgroups:

• Dihydropyridines (Azomex, Zanidip, Felodip, Corinfar-retard, etc.). Helps effectively dilate blood vessels. They can provoke headaches, reddening of the skin in the facial area, accelerate the heart rate, swelling of the extremities;
• Benzothiazepines (Aldizem, Diacordin, etc.). It is used in a dosage of one hundred twenty to four hundred and eighty milligrams, up to two times a day. May provoke a severe low heart rate, or blockade of the atrioventricular pathway;
• Phenylalkylamines (Verapamil, Finoptin, Veratard)- it is recommended to use from one hundred twenty to four hundred and eighty milligrams per day. It can cause the same burdens as the previous subgroup.

How are hypertensive crises treated?

For the treatment of hypertension crises that occur without complications, it is recommended to lower the pressure not sharply, but gradually, over two days.

To achieve this effect, the following antihypertensive drugs are prescribed, in the form of tablets:

• Captopril- used in a dosage of six to fifty milligrams, for resorption under the tongue. The action begins after twenty to sixty minutes from the moment of use;
• Nifedipine- used orally, or for resorption under the tongue. When ingested, the effect occurs after twenty minutes, with resorption under the tongue - after five to ten minutes. It can provoke headaches, marked low blood pressure, accelerated heart rate, reddening of the skin in the facial area, as well as pain in the chest;
• - it is recommended to use in a dosage of 0.8 to 2.4 mg for resorption under the tongue. Efficiency manifests itself after five to ten minutes;
• Clonidine- is used orally in a dosage of 0.075 to 0.3 mg. The action comes after thirty to sixty minutes. May cause dry mouth and a state of calm and tranquility.

What are the traditional medicine with antihypertensive effect?

The above drugs have a persistent hypotensive effect, but require long-term use and constant monitoring of blood pressure.

Being wary of the progression of side effects, people, especially the elderly, tend to use traditional medicine.

Herbs that have a hypotensive effect can actually have a beneficial effect. Their effectiveness is aimed at vasodilation and sedative properties.

The most common traditional medicine are:

• Motherwort;
• Mint;
• Valerian;
• Hawthorn.

In the pharmacy, there are ready-made herbal preparations sold in the form of tea. Such teas contain a mix of various useful herbs, mixed in the required quantities, and have a favorable effective effect.

The most common herbal preparations are:

• Monastery tea;
• Traviata;
• Tea Evalar Bio.

When registering hypertension, high-quality effective drug therapy is necessary.

Prevention

In order for antihypertensive drugs to have the most effective effect, it is recommended to adhere to preventive measures, which are as follows:

• Proper nutrition. The diet should limit the intake of dietary salt, any liquids, fast food and other unfavorable foods. It is recommended to saturate the diet with foods that are rich in vitamins and nutrients;
• Get rid of bad habits. It is necessary to completely eradicate the use of alcoholic beverages and drugs;
• Follow the daily routine. It is required to plan the day so that there is a balance between work, healthy rest and good sleep;
• More active lifestyle. It is required to moderately actively move, allocate at least one hour a day for walking. It is recommended to engage in active sports (swimming, athletics, yoga, etc.);
• Check with your doctor regularly.

All of the above measures will help to effectively reduce the need for consumable antihypertensive drugs and increase their effectiveness.

Video: Antihypertensive drugs, elevated bilirubin.

Conclusion

The use of antihypertensive drugs is necessary to counter hypertension. The range of their choice is quite wide, so choosing the most effective drug for each patient, with the least number of side effects, is quite a feasible task.

The appointment of drugs is carried out by the attending physician, who helps to choose the course of treatment in each individual case. The course may consist of one or more drugs, and, in most cases, are prescribed for lifelong use.

The course of antihypertensive drugs can be supported by traditional medicine. It alone cannot be used as the main course of treatment.

Before using any medications, consult your doctor.

Do not self-medicate and be healthy!

HYPOTENSIVE THERAPY:

1. Antiadrenergics , predominantly central action:

DOPEGIT - synonyms: Aldomet, Alpha-methyldopa. Tablets 0.25 4 times / day. Increases the activity of alpha-adrenergic receptors in the brain stem and, as a result, reduces sympathetic activity in the periphery. It acts mainly on OPSS, to a lesser extent reduces cardiac output. methylated mediator (alpha-methylnorepinephrine). With prolonged use, side effects are possible: sodium and water retention in the body, an increase in BCC, volume overload of the heart, which can lead to or aggravate heart failure. Therefore, a combination with saluretics is necessary. The second complication is allergic reactions resembling systemic lupus erythematosus, dermatitis. It is advisable to start treatment with small doses: 3 tablets / day, gradually increasing the dose to 16 tablets / day. With long-term treatment, the Coombs reaction is performed every 6 months or the drug is replaced.

CLOFELIN - synonyms: Catapressan, Gemiton. Tablets according to O.OOOO75g

An imidazoline derivative. It acts on alpha-2-adrenergic receptors of the brain and has a inhibitory effect on the vasomotor center of the medulla oblongata. Has a sedative effect. Mainly reduces OPSS. Possible action on the spinal cord. There are almost no side effects, except for dry mouth, slowing down of motor reactions. The hypotensive effect is generally weak. Apply 1 table / 3 times a day.

2. Postganglionic blockers :(guanidine group)

OKTADIN - synonyms: Isobarin, Ofro, Inelin, Guanidine sulfate. Tablets according to O.O25.

The mechanism of action is based on the washing out of catecholamine nerve endings from the granules and enhancing their utilization. One of the most potent drugs. Unlike Reserpine, it does not penetrate the blood-brain barrier. It reduces the tone of arterioles. Reduces OPSS and diastolic pressure. Increases the amount of blood in the venous reservoir. Decreases venous return to the heart, thereby reducing cardiac output. The hypotensive effect of the drug is enhanced when moving to a vertical position. Thus, hypotension may occur in orthostasis and during exercise. Orthostatic collapse is very dangerous in atherosclerosis. In the first days of treatment, it is advisable to prescribe small doses: 25 mg / day. in order to avoid orthostatic complications. Then the dose is gradually increased. When monitoring treatment with Octadin, it is necessary to measure not only lying down, but also standing. Due to the significant number of complications, it is not the drug of choice for GB. contraindicated in pheochromocytoma.

3. Rauwolfia group (= antipsychotics of central action):

RESERPIN - synonyms: Rausedil. Ampoules of 1.0, 0.25 mg, Tablets of 0.1, 0.25 mg.

Penetrates through the blood-brain barrier and acts at the level of the brain stem and peripheral nerve endings. The hypotensive effect is average. The mechanism of action is based on the depletion of the catecholamine depot. Causes degranulation and release of catecholamines and then they (catecholamines) are destroyed in the axoplasm of neurons. As a result of inhibition of the sympathetic nervous system, the parasympathetic system begins to predominate, which is manifested by symptoms of vagotonia: bradycardia, increased acidity of gastric juice with an increase in gastric motility, which can contribute to the formation of a peptic ulcer. Reserpine can also provoke bronchial asthma, miosis, etc. Contraindications: peptic ulcer, bronchial asthma, pregnancy. Begin treatment with 0.1-0.25 mg / day. gradually bringing the dose to 0.3-0.5 mg / day. The decrease in blood pressure occurs gradually, over several weeks, but with parenteral or intravenous administration of Reserpine (usually during crises), the effect occurs very quickly.

RAUNATIN - synonym: Rauvazan. Tablets of 0.002.

The effect on the central nervous system is weaker than reserpine. It has an antiarrhythmic effect, because. contains amalin alkaloid.

4 . beta blockers - blockade of adrenergic receptors is accompanied by a decrease in heart rate, stroke volume and renin secretion. This eliminates the excessive influence of sympathetic nerves on these processes, which are regulated through beta-adrenergic systems. They are especially widely used in the initial stages of GB. A feature of this group of drugs is good tolerance and the absence of serious complications. Beta receptors in different tissues are specific, therefore, beta-1 and beta-2 receptors are isolated. to the expansion of the bronchi, relaxation of the ureters, smooth muscles of the vessels. The mechanism of action is based on the competitive blockade of receptors and the stabilization of membranes by the type of local anesthetics.

ANAPRILIN - synonyms: Propranolol, Inderal, Obzidan. Tablets of 0.01, 0.04, 0.1% - 5 ml it lacks sympathomimetic activity. It inhibits both beta-1 and beta-2 receptors. Causes: bradycardia, reduces cardiac output, blocks renin release, because. beta-2 receptors are laid in the juxtaglomerular apparatus. The initial dose is 60-80 mg / day, then increased to 200 mg / day. when the effect is achieved - a maintenance dose.

OXYPRENALOL - synonym: Trazikor. Tablets 0.02 each. It has a number of features: it has antiarrhythmic activity, it has a predominant effect on beta-2 receptors. However, the selectivity is incomplete. The hypotensive effect is less pronounced than that of Anaprilin.

These drugs are administered enterally, the effect is manifested after 30 minutes, reaching a maximum after 2-3 hours. The hypotensive effect develops slowly and depends on the stage of the disease. So, with labile hypertension, a decrease in blood pressure occurs already on days 1-3, normalization - on days 7-10. The most clear effect is observed in patients with initial tachycardia. In the hyperkinetic type, hemodynamic disturbances are observed. possible severe bradycardia with sinuricular block and other rhythm and conduction disturbances. Beta-blockers are contraindicated in bronchial asthma, bronchitis, concomitant heart failure, peptic ulcer and a number of chronic bowel diseases. The combination with saluretics and myotropic antispasmodics is optimal.

5. Diuretics The most common treatment for hypertension is the use of natriuretic drugs (saluretics).

HYPOTHIAZIDE -synonym: Dichlothiazide. Tablets 0.025, 0.1.

It has a significant hypotensive effect in hypertension. A decrease in blood pressure is associated with a diuretic effect, a decrease in BCC, as a result of which cardiac output decreases. Sometimes, when taking Hypothiazide, as a reflex reaction to a decrease in BCC, tachycardia occurs and OPSS increases. loss of potassium in the urine. The dose is selected individually.

FUROSEMIDE - synonym: Lasix. Tablets 0.04, 1% - 2 ml. A potent diuretic. After administration, the action begins after an average of 30 minutes. The drug acts especially quickly when administered intravenously - after 2-4 minutes. The mechanism of action is based on the inhibition of sodium and water reabsorption. Sodium begins to leave the vascular wall, because predominantly intracellular sodium is excreted. Potassium ions are always lost in the urine, so it is necessary to prescribe potassium preparations or combine them with potassium-sparing diuretics. Lasix causes a moderate and short-term hypotensive effect, so the drug is not suitable for long-term use. They are used more often during crises. With prolonged use, saluretics can provoke gout and turn latent hyperglycemia into overt, also increases blood clotting (there is a tendency to thrombosis).

Klopamid - synonyms: Brinaldix. Tablets 0.02.

The mechanism of action is the same, but unlike Furosemide, it has a longer action - about 20 hours.

TRIAMTEREN - synonym: Pterofen. Capsules for 0.05.

An active diuretic that causes active excretion of sodium without increasing the excretion of potassium, tk. inhibits the secretion of potassium in the distal tubules of the nephron. Combine with drugs that cause potassium loss.

SPIRONOLACTONE - synonyms: Veroshpiron, Aldactone. Tablets at 0.025.

Close in structure to aldosterone and blocks its action by competitive interaction. Weakens the effects of secondary hyperaldosteronism that develops in the late stages of GB and with symptomatic hypertension, as well as in the treatment of thiazides (hypothiazide). Used only in combination with saluretics at 75-100 mg / day. Courses for 4-6 weeks. Potentiates the action of sympatholytics. It is especially effective with increased secretion of aldosterone and low plasma renin activity.

6. Myotropic agents :

APRESSIN - synonym: Hydrolasin. Tablets 0.01, 0.025.

It has a direct effect on the smooth muscles of arterioles. Suppresses the activity of a number of enzymes in the vascular wall, which leads to a drop in its tone. Lowers predominantly diastolic pressure. Start with doses of 10-20 mg / 3 times a day. Further, a single dose is increased to 20-50 mg. Apply only in combination with other means. Especially indicated for bradycardia and low cardiac output (hypokinetic type of circulation). The combination of Apressin with Reserpine (Adelfan) + Hypothiazid is rational. It combines well with beta-blockers - this is one of the best combinations for patients with persistent hypertension. Side effects: tachycardia, increased angina pectoris, throbbing headaches, redness of the face.

DIBAZOL - Tablets of 0.04 and 0.02, ampoules 1% 1ml. Similar in action to papaverine. Reduces peripheral vascular resistance, improves renal blood flow, no side effects.

PAPAVERIN - Tablets of 0.04 and 0.02, ampoules 2% 2ml. The effects are the same as those of Dibazol. Of the side effects are possible: ventricular extrasystole, atrioventricular block.

MINOXEDIL - synonym: Pratsezin 0.01.

DIAZOXIDE - synonym: Hyperstat 50 mg.

SODIUM NITROPRUSSIDE - 50 mg ampoules

DEPRESSIN: Hypothiazide 10 mg

Reserpine 0.1mg

Dibazol 0.02mg

Nembutal 0.05 mg

TREATMENT OF HYPERTENSION CRISES:

Hospitalization is required

Dibazol 1% to 10.0 ml IV

Rausedil 1 mg IV or IV in isotonic solution

Lasix 1% to 4.0 IV

Many patients are helped antipsychotics:

Aminazine 2.5%1.0 i/m

Droperidol 0.25 to 4.0 IM or slow IV.

If no effect is given ganglion blockers: (when using them, you should always have Mezaton on hand !!!)

Pentamine 5%1.0 i/m or i/v drip

Benzohexonium 2.5%1.0 w/m

It is necessary to ensure that the decrease in blood pressure is not very sharp, which can lead to coronary or cerebrovascular insufficiency.

Clonidine

Gemiton 0.01 - 1.0 i/m or slowly i/v per 20 ml isotonic solution

Dopegit inside up to 2.0 g / day. in protracted crises

Methyldopa

Tropafen 1% 1.0 per 20 ml isotonic solution IV slowly or IM for sympathoadrenal crises

Sodium nitroprusside 0.1 on glucose IV drip

With symptoms of encephalopathy associated with cerebral edema:

Magnesium sulfate 25% 10.0 w/m

Osmodiuretics: 20% Mannitol solution in isotonic solution

Calcium chloride 10% 5.0 IV in case of respiratory arrest from the introduction of Magnesia

With a heart shape:

Papaverine 2% 2.0

Beta blockers

Rausedil 0.25% 1.0

Ganglioblockers - in case of emergency

Arfonad - to create controlled hypotension, effect at the end of the needle, use only in a hospital

With pulmonary edema with apoplexy:

Bloodletting is the best method for 500 ml. Be sure to puncture the vein with a thick needle, because. at the same time, the coagulation ability of the blood is sharply increased.

What
drugs should be prescribed when selecting antihypertensive therapy in
first line? Science is still developing different methods and approaches,
new groups of drugs are being tested. Different doctors may have their own scheme
treatment. However, there are general concepts based on statistics and research.

At the initial stage

In uncomplicated cases, drug antihypertensive therapy
often start with the use of proven "conventional" drugs: beta-blockers and
diuretics. In large-scale studies involving 48,000 patients,
it has been shown that the use of diuretics, beta-blockers reduces the risk of
cerebral circulation, sudden death, myocardial infarction.

Alternative
option - the use of captopril. According to new data, the frequency of occurrence
heart attacks, strokes, deaths with conventional treatment or
when using captopril, almost the same. Moreover, for a special group
patients who have not previously been treated with antihypertensive drugs, captopril
shows a clear advantage over conventional therapy, significantly reducing the relative
risk of cardiovascular events by 46%.

Long-term use of fosinopril in patients with diabetes, as well as arterial
hypertension is also associated with a significant reduction in the risk of death, myocardial infarction, stroke,
exacerbation of angina pectoris.

Therapy for hypertrophy of the left
ventricle

AT
as antihypertensive therapy, many doctors practice the use of
angiotensin-converting enzyme (ACE) inhibitors. These drugs have
cardioprotective properties and lead to a decrease in the mass of the LV myocardium (left ventricle). At
study of the degree of impact of various drugs on the LV myocardium
it was found that the reverse degree of development of its hypertrophy is most pronounced
it is in ACE inhibitors, since antiotensin-2 controls growth, hypertrophy
cardiomyocytes and their division. In addition to their cardioprotective effects, ACE inhibitors
have a nephroprotective effect. This is important, because despite all the successes
antihypertensive therapy, the number of patients who develop terminal
kidney failure, increasing (compared to the "eighties" in
4 times).

Therapy with calcium antagonists

Increasingly used
as first-line calcium antagonists. For example, when
isolated systemic arterial hypertension (AH) effective dihydropyridine
long-term blockers
action of calcium channels. A four-year study of 5,000 patients showed a significant effect
nitrendipine on the incidence of cerebral stroke. In another study, basic
The drug was a long-acting calcium antagonist, felodipine. 19 000
patients were followed up for four years. As BP decreases
(blood pressure) beneficial effects increased, there was
significant reduction in the risk of cardiovascular events and
increased frequency of sudden death. "SystEur" study, in
which involved 10 Russian centers, also showed a 42% reduction in the incidence of strokes
when using nisoldipine.

Antagonists
calcium are also effective in pulmonary arterial hypertension (this is a systemic
hypertension in patients with obstructive pulmonary disease).
Pulmonogenic hypertension develops several years after the onset of pulmonary
diseases, and there is a clear connection between the exacerbation of the pulmonary process and
rises in pressure. Benefits of calcium antagonists in pulmonary hypertension
is that they reduce calcium-mediated hypoxic
vasoconstriction. Increases oxygen delivery to tissues, decreases
hypoxia of the kidneys, vasomotor center, decreased blood pressure, as well as
afterload and myocardial oxygen demand. In addition, the antagonists
calcium reduce the synthesis of histamine, kinin, serotonin in tissues, mucosal edema
bronchi and bronchial obstruction. An additional benefit of calcium antagonists (particularly
isradipine) - their ability to change metabolic processes in patients with hypertension.
By normalizing or lowering blood pressure, these drugs can prevent the development
dyslipidemia, glucose and insulin tolerance.

At
calcium antagonists revealed a clear relationship between dose, plasma concentration
blood and pharmacological hypotensive effect. By increasing the dose of the drug,
it is possible, as it were, to control the hypotensive effect, increasing or decreasing it. For
long-term treatment of hypertension, prolonged drugs with low
absorption rate (amlodipine, prolonged gastrointestinal form
nifedipine, or osmoadolat, a long-acting form of felodipine). At
the use of these funds occurs smooth vasodilation without reflex
activation of the sympathetic-adrenal system, the release of catecholamines, reflex tachycardia
and increased myocardial oxygen demand.

Not recommended as first choice drugs based on tolerability
vasodilators of myotropic type of action, central alpha-2-adrenergic
agonists, peripheral adrenergic agonists.

The concept of antihypertensive therapy includes a complex of pharmacological and non-pharmacological measures aimed at stabilizing blood pressure values ​​and preventing complications of hypertension. This is a combined regimen that includes medications and recommendations for the modification of risk factors, individually selected for the patient. Their implementation ensures the stabilization of pressure indicators, a decrease in the actual frequency of complications or their maximum delay, and an improvement in the patient's quality of life.

Introduction

Paradoxically! If everything is fine in words and printed materials of the press, then statistics reveal many problems. Among them are refusal to follow medical recommendations, lack of discipline in the patient, indulgence and inability to fully follow prescriptions. This is partly due to the unreasonably low level of trust in medical professionals, the abundance of media misinformation about cardiovascular diseases, medicine and beauty. This publication is intended to partially correct this situation, to reveal the concept of antihypertensive therapy for a patient, to characterize pharmacological treatment and approaches to its improvement in different categories of patients.

This voluminous material provides complete information on the treatment of hypertension with pharmacological and non-pharmacological means. Combination therapy with antihypertensive drugs is considered most fully in the context of the initially set goals of treatment. We advise you to carefully and thoughtfully study the article from beginning to end and use it as a material explaining the need for the treatment of hypertension and the methods of therapy.

Any of the information below is not new to the internist or cardiologist, but will be very helpful to the patient. It will be impossible to draw the right conclusions with a cursory review or a “vertical” reading of the material. Any theses of this publication should not be taken out of context and presented as advice to other patients.

The prescription of drugs or the selection of antihypertensive therapy is a difficult job, the success of which depends on a competent professional interpretation of risk factors. This is an individual work of a specialist with each patient, the result of which should be a treatment regimen that avoids high pressure values. It is important that there are no simple, understandable for each patient and universal recommendations for the selection of antihypertensive treatment.

Goals of antihypertensive therapy

One of the many mistakes patients make is the lack of a solid idea of ​​what antihypertensive therapy is being selected for. Patients refuse to think about why it is necessary to treat hypertension and stabilize blood pressure. And as a result, only a few adequately understand why all this is needed and what awaits them in case of refusal of therapy. So, the first goal, for the sake of which antihypertensive therapy is carried out, is to improve the quality of life. It is achieved through:

• reducing the number of episodes of malaise, headaches, dizziness;
• reducing the number of hypertensive crises with the need to provide emergency care with the involvement of medical workers;
• reduction of periods of temporary disability;
• increasing tolerance to physical activity;
• elimination of painful psychological sensation from the presence of symptoms of hypertension, increase in comfort through stabilization of the condition;
• elimination or maximum reduction of episodes of complicated crises of hypertension (nosebleeds, cerebral and myocardial infarction).

The second goal of drug antihypertensive therapy is to increase life expectancy. Although it should be more correctly formulated as the restoration of the former, which took place before the development of the disease, the potential for life expectancy due to:

• reducing the rate of hypertrophic and dilated transformation of the myocardium;
• reducing the likelihood and actual frequency of cases of developing atrial fibrillation;
• reduce the likelihood and frequency, reduce the severity or completely prevent the development of chronic kidney disease;
• prevention or delay of severe complications of hypertension (myocardial infarction, cerebral infarction, intracerebral hemorrhage);
• reduce the rate of development of congestive heart failure.

The third goal of treatment is pursued in pregnant women and is associated with a decrease in the total number of complications and abnormalities during gestation during childbirth or in the recovery period. High-quality and sufficient antihypertensive therapy in pregnancy in terms of average blood pressure is a vital necessity for the normal development of the fetus and its birth.

Approaches to therapy

Antihypertensive therapy should be carried out systematically and in a balanced way. This means that in the treatment it is necessary to adequately take into account the existing risk factors in a particular patient and the likelihood of developing associated complications. The ability to simultaneously influence the mechanism of the development of hypertension, prevent or reduce the frequency of possible complications, reduce the likelihood of aggravation of the course of hypertension, and improve the patient's health has formed the basis of modern therapeutic schemes. And in this context, we can consider such a thing as combined antihypertensive therapy. It includes both pharmacological and non-pharmacological directions.

Pharmacological treatment of hypertension is the use of drugs that affect specific biochemical and physical mechanisms of arterial pressure formation. Non-drug therapy is a set of organizational measures aimed at eliminating any factors (excess weight, smoking, insulin resistance, physical inactivity) that can cause hypertension, aggravate its course or accelerate the development of complications.

Treatment tactics

Depending on the initial pressure figures and the presence of risk factors, a specific treatment tactic is chosen on a stratification scale. It can only consist of non-pharmacological measures, if, on the basis of daily monitoring, hypertension of the 1st degree without risk factors is exposed. At this stage of the development of the disease, the main thing for the patient is the systematic control of blood pressure.

Unfortunately, in this publication, it is impossible to briefly, easily and clearly explain to each patient the principles of antihypertensive therapy based on arterial hypertension risk stratification scales. In addition, their evaluation is needed to determine the time of initiation of drug treatment. This is a task for a specially trained and trained employee, while the patient will only need to follow the doctor's recommendations in a disciplined manner.

Transition to medical treatment

In case of inadequate reduction in pressure figures as a result of weight loss, smoking cessation and modification of the diet, antihypertensive drugs are prescribed. Their list will be discussed below, but it should be understood that drug therapy will never be sufficient if the treatment regimen is not adequately followed and medications are skipped. Also, drug therapy is always prescribed along with non-drug methods of treatment.

It is noteworthy that antihypertensive therapy in elderly patients is always based on drugs. This is explained by the already existing risk factors for coronary heart disease with an inevitable outcome in heart failure. The drugs used for hypertension significantly slow down the rate of development of cardiac insufficiency, which justifies such an approach even from the moment of primary detection of hypertension in a patient older than 50 years.

Priorities in the management of hypertension

The effectiveness of non-pharmacological agents that prevent the development of complications and help control blood pressure in target numbers is very high. Their contribution to the reduction of the average pressure value with adequate disciplined implementation of the recommendations by the patient is 20-40%. However, with hypertension of the 2nd and 3rd degree, pharmacological treatment is more effective, as it allows you to reduce pressure figures, as they say, here and now.

For this reason, with hypertension of the 1st degree without complications, the patient can be treated without taking drugs. With the 2nd and 3rd degrees of hypertension, antihypertensive drugs used in therapy are simply necessary to maintain working capacity and comfortable life. In this case, priority is given to prescribing 2, 3 or more antihypertensive drugs from different pharmacological groups in low doses instead of using one type of drug in high doses. Several drugs used in the same treatment regimen affect the same or more mechanisms for increasing blood pressure. Because of this, drugs potentiate (mutually reinforce) each other's effect, which provides a stronger effect at low doses.

In the case of monotherapy, one drug, even at high doses, affects only one mechanism of blood pressure formation. Therefore, its effectiveness will always be lower, and the cost will be higher (drugs in medium and high doses always cost 50-80% more). In addition, due to the use of a single drug in high doses, the body quickly adapts to the xenobiotic and accelerates its administration.

With monotherapy, the rate of the so-called addiction of the body to the drug and the “escape” of the effect from therapy is always faster than in the case of prescribing different classes of drugs. Therefore, it often requires correction of antihypertensive therapy with a change in drugs. This creates the prerequisites for the fact that patients form a large list of drugs that, in the case of him, no longer “work”. While they are effective, they just need to be combined in the right way.

Hypertensive crisis

A hypertensive crisis is an episode of an increase in pressure to high numbers during treatment with the appearance of stereotypical symptoms. Among the symptoms, the most common is a pressing headache, discomfort in the parietal and occipital region, flies before the eyes, and sometimes dizziness. Less commonly, a hypertensive crisis develops with a complication and requires hospitalization.

It is important that even against the background of effective therapy, when the average blood pressure figures meet the standards, a crisis can (and periodically happens) occur. It appears in two versions: neurohumoral and water-salt. The first develops quickly, within 1-3 hours after stress or heavy exercise, and the second - gradually, over 1-3 days with excessive accumulation of fluid in the body.

The crisis is stopped by specific antihypertensive drugs. For example, with a neurohumoral variant of the crisis, it is reasonable to take the drug "Captopril" and "Propranolol" or seek medical help. With a water-salt crisis, the most appropriate would be to take loop diuretics (Furosemide or Torasemide) along with Captopril.

It is important that antihypertensive therapy in hypertensive crisis depends on the presence of complications. An uncomplicated variant is stopped independently according to the above scheme, and a complicated one requires an ambulance call or a visit to the emergency department of inpatient healthcare facilities. Crises more often than once a week indicate the failure of the current antihypertensive regimen, which requires correction after contacting a doctor.

Rare crises that occur with a frequency less than 1 time in 1-2 months do not require correction of the main treatment. Intervention in an effective combination antihypertensive therapy regimen in elderly patients is carried out as a last resort, only when evidence of an “escape” effect is obtained, with poor tolerance or an allergic reaction.

Groups of drugs for the treatment of hypertension

Among antihypertensive drugs, there are a huge number of trade names, which are neither necessary nor possible to list. In the context of this publication, it is appropriate to single out the main classes of drugs and briefly characterize them.

Group 1 - ACE inhibitors The ACE inhibitor group is represented by such drugs as Enalapril, Captopril, Lisinopril, Perindopril, Ramipril, Quinapril. These are the main drugs for the treatment of hypertension, which have the ability to slow down the development of myocardial fibrosis and delay the onset of heart failure, atrial fibrillation, and renal failure.

2nd group - angiotensin receptor blockers. The drugs of the group are similar in efficiency to ACE inhibitors, since they exploit the same angiotensinogen mechanism. However, ARBs are not enzyme blockers, but angiotensin receptor inactivators. In terms of efficiency, they are somewhat inferior to ACE inhibitors, but also slow down the development of CHF and CRF. This group includes the following drugs: Losartan, Valsartan, Candesartan, Telmisartan.

3rd group - diuretics (loop and thiazide). "Hypothiazid", "Indapofon" and "Chlortalidone" are relatively weak thiazide diuretics, convenient for continuous use. Loop diuretics "Furosemide" and "Torasemide" are well suited for stopping crises, although they can also be prescribed on an ongoing basis, especially with already developed congestive CHF. In diuretics, of particular value is their ability to increase the effectiveness of ARBs and ACE inhibitors. Antihypertensive therapy during pregnancy involves the use of diuretics as a last resort, with the ineffectiveness of other drugs, due to their ability to reduce placental blood flow, while in other patients it is the main (and almost always mandatory) drug for treating hypertension.

4th group - adrenoblockers: "Metoprolol", "Bisoprolol", "Carvedilol", "Propranolol". The latter drug is suitable for stopping crises because of the relatively fast action and effect on alpha receptors. The rest of the drugs on this list help control blood pressure, but are not the main ones in the antihypertensive regimen. Doctors appreciate their proven ability to increase the life expectancy of patients with heart failure when taken with ACE inhibitors and diuretics.

Group 5 - calcium channel blockers: Amlodipine, Lercanidipine, Nifedipine, Diltiazem. This group of drugs is widely used in the treatment of hypertension due to the possibility of taking it by pregnant patients. Amlodipine has a beneficial effect of nephroprotection, which, together with the use of ACE inhibitors (or ARBs) and diuretics, slows down the development of chronic renal failure in malignant hypertension in non-pregnant patients.

6th group - other medicines. Here it is necessary to indicate heterogeneous drugs that have found application as antihypertensive drugs and have heterogeneous mechanisms of action. These are Moxonidine, Clonidine, Urapidil, Methyldopa and others. A complete list of medicines is always present by the doctor and does not require memorization. It is much more profitable if each patient remembers well his antihypertensive regimen and those drugs that were successfully or unsuccessfully used earlier.

Antihypertensive therapy in pregnancy

During pregnancy, the most commonly prescribed drugs are Methyldopa (category B), Amlodipine (category C), Nifedipine (category C), Pindolol (category B), Diltiazem (category C). At the same time, an independent choice of drugs by a pregnant woman is unacceptable because of the need for primary diagnosis of increased blood pressure. Diagnosis is required to exclude preeclampsia and eclampsia - dangerous pathologies of pregnancy. The choice of treatment will be carried out by the attending physician, and any increase in blood pressure that was not previously observed (before pregnancy) in a pregnant woman should be carefully studied.

Antihypertensive therapy during lactation is subject to strict rules: in the first case, if the blood pressure is not higher than 150/95, breastfeeding can be continued without taking antihypertensive drugs. In the second case, with blood pressure in the range of 150/95-179/109, low-dose use of antihypertensive drugs is practiced (the dose is prescribed by a doctor and controlled under the supervision of medical staff) with continued breastfeeding.

The third type of antihypertensive therapy in pregnant and lactating women is the treatment of hypertension, including combined treatment, with the achievement of target blood pressure figures. This requires not breastfeeding and continued use of essential drugs: ACE inhibitors or ARBs with diuretics, calcium channel blockers, and beta-blockers, if these are required for successful treatment.

Antihypertensive therapy for chronic renal failure

Treatment of hypertension in chronic renal failure requires dispensary medical supervision and a careful attitude to doses. The priority drug groups are ARBs with loop diuretics, calcium channel blockers, and beta-blockers. Combination therapy of 4-6 drugs at high doses is often prescribed. Due to frequent crises in chronic renal failure, the patient may be prescribed "Clonidine" or "Moxonidine" for continuous use. It is recommended to stop hypertensive crises in patients with chronic renal failure with injectable "Clonidine" or "Urapidil" with a loop diuretic "Furosemide".

Arterial hypertension and glaucoma

Patients with diabetes mellitus and chronic renal failure often have damage to the organ of vision associated with both retinal microangiopathy and its hypertonic lesion. An increase in IOP to 28 with or without antihypertensive therapy indicates a tendency to develop glaucoma. This disease is not associated with arterial hypertension and damage to the retina, it is a lesion of the optic nerve as a result of an increase in intraocular pressure.

The value of 28 mmHg is considered borderline and characterizes only the tendency to develop glaucoma. Values ​​above 30-33 mmHg are a clear sign of glaucoma, which, together with diabetes, chronic renal failure and hypertension, can accelerate the loss of vision in a patient. It should be treated along with the main pathologies of the cardiovascular and urinary systems.