Modern antihypertensive drugs combined. Antihypertensive drugs of the latest generation

In the old days, our grandmothers used ordinary foxglove to reduce pressure. Therefore, hypertension and complications caused by this disease were the cause of high mortality. Thanks to the development of pharmacology, modern antihypertensive drugs of the latest generation have been developed to treat this disease, which have not only high efficiency, but also a minimum side effects.

Lack of treatment for hypertension or an incorrectly selected drug can threaten the development of serious conditions, including life-threatening ones such as heart attack, stroke. In this case, much more serious therapy may be needed, requiring hospitalization of the patient.

Treatment of complications hypertension held in one of best clinics Moscow - Yusupov hospital. The neurology clinic is equipped with the latest diagnostic and treatment equipment, which allows achieving high results in the treatment and rehabilitation of stroke patients.

Modern antihypertensive drugs: effects

The level of blood pressure directly depends on the vascular tone. Contraction of smooth muscle tissue spasmodic, leads to a narrowing of the lumen, resulting in the development of hypertension. Most often, these processes are associated with physical activity and nervous tension. Sometimes an increase in pressure can be due to kidney disease, of cardio-vascular system, hormonal imbalance. To normalize the level of blood pressure, an appointment is prescribed antihypertensive drugs.

Modern antihypertensive drugs of the latest generation, used in the Yusupov hospital, have following effects:

• normalize arterial pressure on long time;
• beneficial effect on the activity of target organs (heart, kidneys, eyes);
• minimum quantity or complete absence side effects.

Scientists do not stop there and continue to conduct various studies, develop new antihypertensive drugs that meet the above requirements, and also work on previously used drugs, improving them.

Antihypertensive drugs: list of main groups

Drugs that belong to different groups are used to lower blood pressure. medicines. Drugs have the greatest effect complex action. With their help, there is not only a decrease in pressure, vasodilation, but also the restoration of the work of the heart and kidneys, as well as the prevention of the development of serious complications.

The action of all antihypertensive drugs is aimed at eliminating the provoking factors for increasing pressure. Their classification depends on the way the normal regulation of pressure is changed: exactly how antihypertensive drugs work. The list consists of medicines of the following action:

• neurotropic;
• myotropic;
• diuretic;
• affecting the mechanism of humoral regulation.

Such a variety of drugs allows you to select drugs in each individual case. However, the choice must be entrusted to a qualified specialist, since certain antihypertensive drugs, due to their multifaceted action, may not be suitable for all patients.

Effective antihypertensive drugs with neurotropic action

Antihypertensive drugs of this group affect the central nervous system. They help to reduce the activity of the sympathetic nervous system, relieve tension in smooth muscle tissues, thereby reducing blood pressure. For this purpose, the following medications are prescribed:

• sedatives;
• ganglionic blocking agents;
• α-blockers;
• β-blockers;
• sympatholytics.

Neurotropic antihypertensive tablets, in case of abrupt discontinuation of their intake, can cause a rapid and persistent increase in blood pressure.

Antihypertensive drugs of a new generation of myotropic action

These antihypertensive drugs affect the regulation of ion exchange in smooth muscle tissues. Among them are:

• calcium channel blockers;
• calcium channel activators;
• phosphodiesterase inhibitors;
• stimulators of the formation of nitric oxide.

Antihypertensive drugs that affect humoral regulation

An increase in blood pressure in the human body is associated with the production of a hormone - angiotensin. Therefore, to reduce pressure, special antihypertensive drugs of a new generation have been developed that depress its products:

• ACE inhibitors;
• aldosterone receptor blockers;
• angiotensin receptor blockers.

Antihypertensive drugs that inhibit the angiotensin-converting enzyme have a beneficial effect on the heart, but may cause some side effects. Cough may occur when taking antihypertensive drugs - ACE inhibitors In addition, there may be development angioedema, tachycardia.

Diuretic antihypertensive drugs

New generation antihypertensive drugs with a diuretic effect improve water-salt exchange. The decrease in blood pressure is due to a decrease in the amount of sodium ions and fluid that enter the blood.

It must be remembered that while taking diuretics, there is an active excretion of potassium and magnesium, the presence of which in the body is necessary for normal functioning nervous and cardiovascular systems. Therefore, the intake of diuretics must be combined with the intake of asparkam or panangin.

Combined antihypertensive drugs of the latest generation

Correction of the resistant form of hypertension often requires the use of antihypertensive combined drugs, which contain two active substances to stabilize blood pressure. Treatment with these drugs is usually long-term or even lifelong.

Antihypertensive drugs of the central action of a new generation

Due to the presence of a large number of side effects, the use of centrally acting antihypertensive drugs is rarely prescribed these days. In addition, drugs in this category can be addictive.

Antihypertensive drugs of central action are most often used to stop a hypertensive crisis. The expediency of their use in this situation is explained by the rapid onset of action.

The intake of these vasodilators can be permanent, but in our time developed a large number of antihypertensive drugs of a new generation with higher efficacy, better tolerability and long-term therapeutic effect.

There are a number of contraindications to taking centrally acting antihypertensive drugs:

• pregnancy;
• cardiogenic shock;
• kidney failure;
• cerebral atherosclerosis.

Thanks to continuous development The pharmaceutical industry has developed modern antihypertensive drugs that are highly effective and the minimum amount contraindications and side effects. When choosing an antihypertensive drug that is most suitable in each case, the general practitioner or neurologist at the Yusupov Hospital takes into account a number of factors: individual tolerance of the active substance, the presence of concomitant diseases, and the patient's blood counts.

Our specialists will provide full support and assistance to patients at all stages of therapy. Patients are provided with the necessary consultations of narrow specialists. The Yusupov hospital has a round-the-clock hospital. The clinic has all the conditions for a comfortable stay and competent treatment of patients.

You can make an appointment with a specialist and clarify all the details of hospitalization by calling the clinic or on our website by contacting our coordinators.

Bibliography

• ICD-10 ( International classification diseases)
• Yusupov hospital
• Alpert, J. Treatment of myocardial infarction / J. Alpert. - Moscow: Mashinostroenie, 1994. - 255 p.
• Guide to outpatient cardiology. - M.: GEOTAR-Media, 2007. - 400 p.
• Topolyansky, A.V. Cardiology. Handbook of a practical doctor / A.V. Topolyansky. - M.: MEDpress-inform, 2009. - 379 p.

Prices for diagnostics with high blood pressure

*The information on the site is for informational purposes only. All materials and prices posted on the site are not public offer determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic. List of rendered paid services listed in the price list of the Yusupov hospital.

*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic.

Table of contents [Show]

Drug treatment of hypertension is indicated for all patients with blood pressure higher than 160/100 mm Hg. Art., and also when lifestyle modification measures have not led to the normalization of pressure indicators and it remains higher than 140/90 mm Hg. Art. There are many drugs that lower blood pressure. Depending on the composition and mechanism of action, they are divided into groups and even subgroups.

These drugs are called antihypertensive or antihypertensive drugs. We bring to your attention an overview of drugs for lowering blood pressure.

Before considering each of the groups of drugs separately, let's talk briefly about the basic principles drug treatment essential hypertension, or hypertension.

1. Blood pressure lowering drugs must be taken by the patient continuously throughout life.
2. An antihypertensive agent should be prescribed exclusively by a doctor. Its choice depends on the individual characteristics of the course of the disease of a particular patient, on the presence or absence of insufficiency of the coronary vessels of the heart or arrhythmia, the type of hemodynamics, damage to target organs, the presence or absence of risk factors for heart and vascular diseases, concomitant pathology and, finally, on the tolerability of this drug by patients.
3. Treatment begins with the lowest possible dose of the drug, thus assessing the reaction of the patient's body to it and reducing the severity of possible side effects. If the drug is well tolerated, but there is no decrease in pressure to the desired figures, then the dose of the drug is increased, but not immediately to the maximum possible, but gradually.
4. It is unacceptable to quickly reduce blood pressure: this can lead to ischemic damage to vital organs. This point is especially relevant for elderly and senile patients.
5. Long-acting drugs are taken once a day. It is these drugs that should be preferred, since when taking them, daily fluctuations in blood pressure are less pronounced, plus it is easier for the patient to take 1 tablet in the morning and forget about it until tomorrow than to take 3 times a day, periodically skipping doses due to their own inattention.
6. If, when taking the minimum or average therapeutic dose drug containing only one active remedy, the desired effect does not occur, the dose should not be increased to the maximum: it would be more correct (more effective) to add a small dose to the first drug antihypertensive drug another group (with a different mechanism of action). Thus, not only a faster hypotensive effect will be ensured, but the side reactions of both drugs will be minimized.
7. There are drugs containing several active antihypertensive drugs from different groups. It is much more convenient for the patient to take such a drug than 2 or 3 separate tablets.
8. If the effect of the treatment is absent at all or if it is poorly tolerated by the patient (side effects are pronounced and cause inconvenience to the patient), do not combine this drug with another or, moreover, increase its dose: it would be more correct to cancel this drug and switch to treatment with a drug of another group. Fortunately, the choice of antihypertensive drugs is quite large, and, by trial and error, each individual patient will still be able to choose an adequate, effective antihypertensive therapy.

Drugs used to lower blood pressure can be divided into 2 large groups:
I. First line drugs. They are the drugs of choice in the treatment of hypertension. The vast majority of hypertensive patients are recommended to prescribe them. This group includes 5 more groups of medicines:

• angiotensin-converting enzyme inhibitors (abbreviated as ACE inhibitors);
• diuretics, or diuretics;
• angiotensin II receptor inhibitors;
• β-blockers, or β-blockers;
• calcium antagonists.

II. Second line drugs. For long-term treatment essential hypertension are used only in certain classes of patients, such as pregnant women, or people with low incomes who, for financial reasons, cannot afford first-line drugs. These drugs include:

• α-blockers;
• rauwolfia alkaloids;
• α2-agonists of the central action;
• direct acting vasodilators.

Let's consider each of these groups separately.

Group of the most effective antihypertensive drugs. The decrease in blood pressure when taking these drugs occurs due to vasodilation: their total peripheral resistance decreases, and consequently, the pressure also decreases. ACE inhibitors practically do not affect the magnitude of cardiac output and heart rate, therefore they are widely used in concomitant chronic heart failure.

Already after taking the first dose of the drug in this group, the patient notes a decrease in blood pressure. When used for several weeks, the hypotensive effect is enhanced and, having reached a maximum, stabilizes.

Adverse reactions to ACE inhibitors are observed quite rarely and are manifested mainly by an obsessive dry cough, taste disturbance and signs of hyperkalemia (increased levels of potassium in the blood). Hypersensitivity reactions to ACE inhibitors in the form of angioedema are rarely noted.

Since ACE inhibitors are excreted mainly by the kidneys, in severe renal failure in a patient, the dose of these drugs should be reduced. Drugs of this group are contraindicated during pregnancy, in case of bilateral stenosis renal arteries as well as in hyperkalemia.

The main representatives of the class of ACE inhibitors are:

• enalapril (Enap, Berlipril, Renitek) - daily dose the drug ranges from 5-40 mg in 1-2 doses;
• captopril - taken at a dose of 25-100 mg per day for 2-3 doses;
• quinapril (Accupro) - the daily dose is 10-80 mg in 1-2 doses;
• lisinopril (Lopril, Diroton, Vitopril) - it is recommended to take 10-40 mg per day, the frequency of administration is 1-2 times;
• moexipril (Moex) - 7.5-30 mg daily dose, frequency of administration - 1-2 times; it is worth noting that this drug is one of the ACE inhibitors recommended for use by people with severe chronic renal failure;
• perindopril (Prenesa, Prestarium) - the daily dose is 5-10 mg in 1 dose;
• ramipril (Tritace, Ampril, Hartil) - a daily dose of 2.5-20 mg in 1-2 doses;
• spirapril (Quadropril) - taken at a dose of 6 mg 1 time per day;
• trandolapril (Gopten) - taken at a dose of 1-4 mg 1 time per day;
• Fosinopril (Fozicard) - take 10-20 mg 1-2 times a day.

Like ACE inhibitors, they are widely used in the treatment of hypertension. These drugs increase urine output, resulting in a decrease in circulating blood and extracellular fluid, a decrease in cardiac output, and vasodilation, all of which result in a decrease in blood pressure. It should be noted that against the background of taking diuretics, the development of sexual dysfunction is possible.

Diuretics are often used as part of combination therapy hypertension: they remove from the body excess water, which is delayed when taking many other antihypertensive drugs. They are contraindicated in gout.

Diuretics can also be divided into several groups.
1. Thiazide diuretics. Most often used with precisely hypotensive purpose. Generally, low dosages are recommended. They are ineffective in severe renal failure, which is also a contraindication to their use. The most commonly used thiazide diuretic is hydrochlorothiazide (Hypothiazide). The daily dose of this drug is 12.5-50 mg, the frequency of administration is 1-2 times a day.
2. Thiazide-like diuretics. The most prominent representative of this group of drugs is indapamide (Indap, Arifon, Ravel-SR). Take it, as a rule, 1.25-2.5-5 mg 1 time per day.
3. Loop diuretics. The drugs of this group do not play a significant role in the treatment of hypertension, however, in the case of concomitant cardiac or renal failure in hypertensive patients, they are the drugs of choice. Often used in acute conditions. The main loop diuretics are:

• furosemide (Lasix) - the daily dose of this drug is from 20 to 480 mg, depending on the severity of the disease, the frequency of administration is 4-6 times a day;
• torasemide (Trifas, Torsid) - taken at a dose of 5-20 mg twice a day;
• ethacrynic acid (Uregit) - the daily dose ranges from 25-100 mg in two divided doses.

4. Potassium-sparing diuretics. They have a weak hypotensive effect, and also excrete from the body a small amount of sodium while retaining potassium. Alone for the treatment of hypertension are rarely used, more often in combination with drugs from other groups. Do not apply in severe renal failure. The most prominent representatives of this class are the following potassium-sparing diuretics:

• spironolactone (Veroshpiron) - the daily dose of the drug is 25-100 mg, the frequency of administration is 3-4 times a day;
• triamterene - take 25-75 mg 2 times a day.

The second name of the drugs in this group is sartans. It's comparatively new class antihypertensive drugs that are highly effective. Provide effective 24-hour control of blood pressure when taking the drug 1 time per day. Sartans do not have the most common side effect of ACE inhibitors - dry, hacking cough, therefore, if ACE inhibitors are not tolerated, they are usually replaced with sartans. Preparations of this group are contraindicated during pregnancy, bilateral stenosis of the renal arteries, and also with hyperkalemia.

The main representatives of the sartans are:

• irbesartan (Irbetan, Converium, Aprovel) - it is recommended to take 150-300 mg 1 time per day;
• candesartan (Kandesar, Kasark) - taken at a dose of 8-32 g 1 time per day;
• losartan (Lozap, Lorista) - a daily dose of the drug 50-100 mg in 1 dose;
• telmisartan (Pritor, Micardis) - the recommended daily dose is 20-80 mg, in 1 dose;
• valsartan (Vazar, Diovan, Valsakor) - taken at a dose of 80-320 mg per day for 1 dose.

They reduce blood pressure due to the blocking effect on β-adrenergic receptors: cardiac output and renin activity in the blood plasma decrease. Especially shown in arterial hypertension associated with angina pectoris and some types of arrhythmias. Because one of the effects of β-blockers is to decrease heart rate, these drugs are contraindicated in bradycardia.
Drugs in this class are divided into cardioselective and non-cardioselective.

Cardioselective β-blockers act exclusively on the receptors of the heart and blood vessels, and do not affect other organs and systems.
The drugs in this class include:

• atenolol (Atenol, Tenolol, Tenobene) - the daily dose of this drug is 25-100 mg, the frequency of administration is twice a day;
• betaxolol (Betak, Betakor, Lokren) - taken at a dose of 5-40 mg once a day;
• bisoprolol (Concor, Coronal, Biprol, Bicard) - taken at a dose of 2.5-20 mg per day at a time;
• metoprolol (Betaloc, Corvitol, Egilok) - the recommended daily dose of the drug is 50-200 mg in 1-3 doses;
• nebivolol (Nebilet, Nebilong, Nebival) - take 5-10 mg once a day;
• celiprolol (Celiprol) - take 200-400 mg once a day.

Cardioselective β-blockers affect the receptors not only of the heart, but also of other internal organs, so they are contraindicated in a number of pathological conditions such as bronchial asthma, chronic obstructive pulmonary disease, diabetes mellitus, intermittent claudication.

The most commonly used representatives of this class of drugs are:

• propranolol (Anaprilin) ​​- taken at 40-240 mg per day in 1-3 doses;
• carvedilol (Coriol, Medocardil) - the daily dose of the drug is 12.5-50 mg, the frequency of administration is 1-2 times a day;
• labetalol (Abetol, Labetol) - it is recommended to take 200-1200 mg per day, dividing the dose into 2 doses.

They reduce blood pressure well, but due to the mechanisms of their action, they can have very serious side effects.

1. Phenylalkylamine derivatives. Verapamil (Finoptin, Isoptin, Veratard) - it is recommended to take at a dose of 120-480 mg per day in 1-2 doses; can cause bradycardia and atrioventricular block.
2. Benzothiazepine derivatives. Diltiazem (Aldizem, Diacordin) - its daily dose is equal to that of verapamil and is 120-480 mg in 1-2 doses; causes bradycardia and AV block.
3. Derivatives of dihydropyridine. They have a pronounced vasodilating effect. They can cause headache, reddening of the face, acceleration of the heart rate, swelling of the extremities. The main representatives of this class of calcium antagonists are as follows:

• amlodipine (Azomeks, Amlo, Agen, Norvask) - the daily dose of the drug is 2.5-10 mg in one dose;
• lacidipine (Lacipil) - take 2-4 mg per day at a time;
• lercanidipine (Zanidip, Lerkamen) - take 10-20 mg once a day;
• nifedipine (retard - long-acting - forms: Corinfar retard, Nifecard-XL, Nicardia) - take 20-120 mg per day at a time;
• felodipine (Felodipine) - the daily dose of the drug is 2.5-10 mg in one dose.

Often, first-line antihypertensive drugs are part of combined preparations. As a rule, it contains 2, less often - 3 active substances belonging to different classes, which means that they reduce blood pressure in different ways.

Here are some examples of such drugs:

• Triampur - hydrochlorothiazide + triamterene;
• Tonorma - atenolol + chlorthalidone + nifedipine;
• Captopress - captopril + hydrochlorothiazide;
• Enap-N - enalapril + hydrochlorothiazide;
• Liprazide - lisinopril + hydrochlorothiazide;
• Vazar-N - valsartan + hydrochlorothiazide;
• Ziak - bisoprolol + hydrochlorothiazide;
• Bi-Prestarium - amlodipine + perindopril.

Currently, they are used relatively rarely, as a rule, in combination with 1st line drugs. The main very serious drawback of drugs in this group is that their long-term use increases the risk of developing heart failure, acute disorders cerebral circulation(strokes) and sudden death. However, α-blockers also have positive property that distinguishes them from other drugs: they improve carbohydrate and lipid metabolism, which is why they are the drugs of choice for the treatment of hypertension in people with concomitant diabetes and dyslipidaemias.

The main representatives of this class of drugs are:

• prazosin - take it 1-20 mg 2-4 times a day; this drug is characterized by the effect of the 1st dose: a sharp decrease in blood pressure after the first dose;
• doxazosin (Kardura, Zoxon) - the recommended dose is 1-16 mg 1 time per day;
• terazosin (Kornam, Alfater) - 1-20 mg per day for 1 dose;
• phentolamine - 5-20 mg per day.

They have a good hypotensive effect (develops after about 1 week of regular use of the drug), but they have many side effects, such as drowsiness, depression, nightmares, insomnia, dry mouth, anxiety, bradycardia, bronchospasm, weakening of potency in men, nausea, vomiting, allergic reactions, parkinsonism. Of course, these drugs are cheap, so many elderly hypertensive patients continue to take them. However, among the first-line drugs, there are also financially affordable options for most patients: they should be taken if possible, and rauwolfia drugs should be gradually abandoned. These drugs are contraindicated in severe cerebral atherosclerosis, epilepsy, parkinsonism, gastric ulcer and duodenum, depression, bradycardia and severe heart failure.
Representatives of rauwolfia preparations are:

• reserpine - it is recommended to take 0.05-0.1-0.5 mg 2-3 times a day;
• raunatin - taken according to the scheme, starting with 1 tablet (2 mg) per day at night, increasing the dose by 1 tablet every day, bringing up to 4-6 tablets per day.

Combinations of these drugs are most often used:

• Adelfan (reserpine + hydralazine + hydrochlorothiazide);
• Sinepres (reserpine + hydralazine + hydrochlorothiazide + potassium chloride);
• Neokristepin (reserpine + dihydroergocristine + chlorthalidone).

Drugs in this group reduce blood pressure by acting on the central nervous system, reducing sympathetic hyperactivity. They can cause quite serious side effects, but in certain clinical situations they are indispensable, for example, methyldopa for hypertension in pregnant women. Side effects of central α2 receptor agonists are due to their effect on the central nervous system - this is drowsiness, decreased attention and reaction speed, lethargy, depression, weakness, fatigue, headache.
The main representatives of this group of drugs are:

• Clonidine (Clonidine) - used at 0.75-1.5 mg 2-4 times a day;
• Methyldopa (Dopegyt) - single dose is 250-3000 mg, the frequency of administration is 2-3 times a day; the drug of choice for the treatment of arterial hypertension in pregnant women.

Possess soft hypotensive action at the expense moderate expansion vessels. More effective in the form of injections than with oral intake. The main disadvantage of these drugs is that they cause the "steal" syndrome - roughly speaking, they disrupt the blood supply to the brain. This limits their intake in people suffering from atherosclerosis, and this is the bulk of patients with high blood pressure.
Representatives of this group of drugs are:

• bendazol (Dibazol) - inside is used at 0.02-0.05 g 2-3 times a day; often used intramuscularly and intravenously for rapid decline arterial pressure - 2-4 ml of 1% solution 2-4 times a day;
• hydralazine (Apressin) - the initial dose is 10-25 mg 2-4 times a day, the average therapeutic dose is 25-50 g per day in 4 divided doses.

In order to treat uncomplicated hypertensive crises, it is recommended to reduce the pressure not immediately, but gradually, over 1-2 days. Based on this, the drugs are prescribed in the form of tablets.

• Nifedipine - used orally or under the tongue (this method of administration is equated to intravenous efficiency) 5-20 mg; when taken orally, the effect occurs after 15-20 minutes, while sublingual - after 5-10 minutes; possible side effects such as headache, severe hypotension, tachycardia, redness of the skin of the face, symptoms of angina pectoris;
• Captopril - used at 6.25-50 mg under the tongue; begins to act in 20-60 minutes;
• Clonidine (Clonidine) - taken orally at 0.075-0.3 mg; the effect is observed after half an hour or an hour; side effects include the effect of sedation, dry mouth; care should be taken when using this drug in patients with arrhythmias;
• Nitroglycerin - the recommended dose is 0.8-2.4 mg sublingually (under the tongue); the hypotensive effect occurs quickly - after 5-10 minutes.

In the treatment of complicated hypertensive crises, the patient is prescribed intravenous infusions(infusion) of drugs. At the same time, they carry out constant control blood pressure. Most of the drugs used for this purpose begin to act within a few minutes after administration. As a rule, use the following drugs:

• Esmolol - injected intravenously; the onset of action is noted within 1-2 minutes after the start of the infusion, the duration of action is 10-20 minutes; is the drug of choice for dissecting aortic aneurysm;
• Sodium nitroprusside - used intravenously; the effect is noted immediately after the start of the infusion, lasts - 1-2 minutes; against the background of the administration of the drug, nausea, vomiting, as well as a sharp decrease in blood pressure may occur; caution should be exercised when using sodium nitroprusside in individuals with azotemia or high intracranial pressure;
• Enalaprilat - administered intravenously at 1.25-5 mg; the hypotensive effect begins 13-30 minutes after the injection and lasts for 6-12 hours; This drug is especially effective in acute insufficiency left ventricle;
• Nitroglycerin - administered intravenously; the effect develops 1-2 minutes after the infusion, the duration of action is 3-5 minutes; against the background of infusion often there is an intense headache, nausea; direct indications for the use of this drug are signs of ischemia of the heart muscle;
• Propranolol - administered intravenously by drip, the effect develops after 10-20 minutes and lasts for 2-4 hours; this drug is especially effective in acute coronary syndrome, as well as in the case of a dissecting aortic aneurysm;
• Labetalol - administered intravenously in a stream of 20-80 mg every 5-10 minutes or intravenously drip; a decrease in blood pressure is noted after 5-10 minutes, the duration of the effect is 3-6 hours; against the background of taking the drug, a sharp decrease in pressure, nausea, bronchospasm is possible; it is contraindicated in case of acute heart failure;
• Phentolamine - injected intravenously at 5-15 mg, the effect is noted after 1-2 minutes and lasts for 3-10 minutes; tachycardia, headache, and redness of the face may occur; this drug is especially indicated for a hypertensive crisis against the background of a tumor of the adrenal glands - pheochromocytoma;
• Clonidine - intravenously injected at 0.075-0.3 mg, the effect develops after 10 minutes; side effects include nausea and headache; possible development of tolerance (insensitivity) to the drug.

Since complicated hypertensive crises are often accompanied by fluid retention in the body, their treatment should begin with an intravenous jet injection of a diuretic - furosemide or torasemide at a dose of 20-120 mg. If the crisis is accompanied by increased urination or severe vomiting, diuretics are not indicated.
In Ukraine and Russia, with a hypertensive crisis, drugs such as magnesium sulfate (popularly Magnesia), papaverine, dibazol, aminofillin and the like are often administered. Most of them do not have the desired effect, lowering blood pressure to certain numbers, but, on the contrary, lead to rebound hypertension: an increase in pressure.

To prescribe antihypertensive therapy, you must consult a therapist. If the disease is discovered for the first time or it is difficult to treat, the therapist may refer the patient to a cardiologist. In addition, all patients with hypertension are examined by a neurologist and an ophthalmologist to exclude damage to these organs, and ultrasound of the kidneys is also performed to exclude renovascular or renal secondary hypertension.

List pharmaceuticals groups:

Specify

Adelfan-Ezidrex (reserpine + dihydralazine + hydrochlorothiazide): Combined antihypertensive. Pills.

Akkuzid (hinapril + hydrochlorothiazide): Antihypertensive combined. Pills.

Amprilan ND (ramipril + hydrochlorothiazide): Combined antihypertensive. Pills.

Amprilan NL (ramipril + hydrochlorothiazide): Antihypertensive combined. Pills.

Aprovasc: Combined antihypertensive agent.

Aritel Plus (bisoprolol + hydrochlorothiazide): Combined antihypertensive. Pills.

Combined antihypertensive agent (blocker of "slow" calcium channels + angiotensin II receptor antagonist). Film-coated tablets

Brinerdin (reserpine + dihydroergocristine + clopamid): Combined antihypertensive. Pills.

Vazotens N (losartan + hydrochlorothiazide): Combined antihypertensive. Pills.

Valz H (valsartan + hydrochlorothiazide): Combined antihypertensive. Pills.

Valsartan-Hydrochlorothiazide-Akrikhin: Combined antihypertensive agent.

Viskaldix (clopamid + pindolol): Antihypertensive combined. Pills.

Hypotensive combined remedy(angiotensin II receptor antagonist + diuretic). Pills.

Gizaar (losartan + hydrochlorothiazide): Antihypertensive combined. Pills.

Combined antihypertensive agent (diuretic + angiotensin-converting enzyme inhibitor (ACE inhibitor)). Capsules.

Combined antihypertensive agent (diuretic + ACE inhibitor). Capsules.

Valsartan + hydrochlorothiazide: antihypertensive combined agent (angiotensin II receptor antagonist + diuretic). film-coated tablets.

Iruzid (lisinopril + hydrochlorothiazide): Tablets.

Caposide (captopril + hydrochlorothiazide): Combined antihypertensive. Pills.

Co-Diovan (valsartan + hydrochlorothiazide): Combined antihypertensive. Pills.

Co-Diroton (lisinopril + hydrochlorothiazide): Antihypertensive combined. Pills.

Indapamide + perindopril: combined antihypertensive agent (angiotensin-converting enzyme (ACE) inhibitor + diuretic). Tablets

Co-Perineva (indapamide + perindopril): Combined antihypertensive. Pills.

Co-Renitec (enalapril + hydrochlorothiazide): Combined antihypertensive. Pills.

CoAprovel (irbesartan + hydrochlorothiazide): Angiotensin II receptor antagonist + thiazide diuretic. Pills.

Concor AM (bisoprolol + amlodipine): Combined antihypertensive. Pills.

Koripren (lercanidipine + enalapril): Antihypertensive combined. Pills.

Kristepin (reserpine + dihydroergocristine + clopamid): Antihypertensive combined. Dragee.

Lisinoton N (lisinopril + hydrochlorothiazide): Combined antihypertensive. Pills.

Lisoretic (lisinopril + hydrochlorothiazide): Antihypertensive combined. Pills.

Liten N (lisinopril + hydrochlorothiazide): Combined antihypertensive. Pills.

Logimaks (felodipine + metoprolol): Antihypertensive combined. Pills.

Lodoz (bisoprolol + hydrochlorothiazide): Combined antihypertensive. Pills.

Combined antihypertensive agent (blocker of "slow" calcium channels + angiotensin II receptor antagonist). Pills.

Lozap plus (losartan + hydrochlorothiazide): Angiotensin II receptor antagonist + thiazide diuretic. Pills.

Losarel Plus (losartan): Combined antihypertensive agent.

Losartan / Hydrochlorothiazide-Teva (losartan + hydrochlorothiazide): Combined antihypertensive. Pills.

Lorista N (losartan + hydrochlorothiazide): Antihypertensive combined. Pills.

Lorista ND (losartan + hydrochlorothiazide): Antihypertensive combined. Pills.

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Until the mid-twentieth century, strict diet food, reference healthy lifestyle life and reception sedatives. Hypertension in the second half of the last century has become global. This prompted medical scientists to develop special drugs for the treatment of this insidious disease. This is how centrally acting antihypertensive drugs appeared and did not causing cough, separated into a separate group.

Statistics of diseases of the cardiovascular system shows that almost every second inhabitant of the Earth is faced with age with symptoms of high blood pressure. These signs require the attention of doctors in order to reduce the risks to which the body of hypertensive patients is exposed.

When choosing a treatment regimen, the doctor sets accurate diagnosis, assesses risks, takes into account individual characteristics. The main thing in the treatment of hypertension is considered to be a gradual decrease in blood pressure and the prevention of concomitant diseases, such as heart attack, kidney and vascular diseases.

The action of an antihypertensive

Competent selection drug therapy reduces the percentage deaths from complex forms of the disease twice. At a pressure level of 140/90 mm Hg. and above, we can talk about the development of hypertension. Therapy in each case is selected individually. In the event of complications of other diseases, it is urgent to begin their treatment.

According to WHO, modern antihypertensive drugs for pressure should be started at a diastolic pressure level above 90 mm Hg. It is especially important to start using funds if these numbers have been stable for more than a few months. Drugs are prescribed to the patient for a long time, and for many for life, because often the abolition of treatment leads to a relapse of hypertension.

For most patients, lifelong use of drugs leads to stress. Such feelings can be understood, especially when prescribing a complex of medicines. Each drug has side effects that are minimized with well-designed therapy. Each patient is selected their own treatment regimen with antihypertensive drugs, taking into account the characteristics of the organism, the form of the disease. Even if all the conditions of treatment are met, the doctor is obliged to warn about possible side effects.

The appointment of antihypertensive drugs takes into account the basic principles of drug treatment of hypertension, which were formulated after a series of studies involving several thousand patients.

The main principles include:

• the appointment of minimal doses at the beginning of treatment, using the safest drug;
• while saving high pressure, the dose of the drug taken is increased to the one that maintains optimal performance;
• development of complex treatment;
• while maintaining the dose of the main drug, and if the second agent is ineffective, the selection is carried out from other groups, while maintaining the dose and regimen;
• preference is given to those drugs that support optimal level pressure during the day.

Not all blood pressure lowering drugs are used in the treatment of hypertension. This is due to the long period of taking these drugs and the list of side effects.

Currently, five main groups of antihypertensive drugs, pressure-lowering tablets are used:

• Angiotensin-converting enzyme inhibitor (ACE inhibitor).
• Angiotensin II receptor blockers (ARBs).
• Diuretics.
• Beta blockers.
• calcium antagonists.

All drugs of these groups are particularly effective in the treatment of arterial hypertension and can be taken both separately and in combination. When choosing a regimen for taking medications, the doctor is based on the patient's pressure readings, on the characteristics of the course of the disease, and on the parallel flow of vascular and heart disease.

The healthcare professional must take into account possible consequences combinations of drugs, previous experience in treating the patient.

Currently, not all medicines are offered at a price that anyone can afford. For the most part, drugs are expensive, and some patients are forced to refuse them, acquiring more affordable analogues.

Table of classifications of antihypertensive drugs

Of all the groups of drugs, ACE inhibitors (Angiotensin Converting Enzyme Inhibitors) are especially popular. Assign them to almost all categories of hypertensive patients.

IN this group drugs include:

• enalapril;
• lisinopril;
• captopril and others.

It is well known that blood pressure indicators depend on the full functioning of the kidneys, in which the renin-angiotensin-aldosterone system regulates the tone of the walls of blood vessels. Exceeding the level of angiotensin II provokes spasmodic phenomena in large vessels great circle circulation, thereby increasing blood flow resistance. In this situation, the heart works with increased load, and blood enters the vessels under increased pressure.

To slow down the process, drugs have been developed that lower the calcium content, with the help of which the vessels contract and the spasm is relieved.

When a doctor recommends taking an ACE inhibitor, the likelihood cardiovascular diseases decreases, the load is removed from the kidneys. In the presence of cardiac pathologies in a patient, the condition stabilizes when taking drugs of this group.

Peculiarities ACEI actions allow people with nephrotic diseases, cardiovascular diseases, as well as people prone to arrhythmias, diabetics, who have had a heart attack, to take it. In certain situations, these drugs can also be used by pregnant women.

One of the significant disadvantages of ACE inhibitors is dry cough, which occurs due to changes in the metabolism of bradykinin. In this case, it is better to cancel the drug and replace it with a more suitable one for the patient.

The group of ARBs (angiotensin receptor blockers) is a new generation of antihypertensive drugs. Unlike ACE inhibitors, they not only lower blood pressure, but also relax the walls of blood vessels, accelerate the excretion of fluid and salt by the kidneys. This effect is achieved due to the violation of the connection of angiotensin with the receptors of various organs.

The most famous drugs are angiotensin receptor blockers:

• Valsartan.
• Losartan and others.

Valsartan

Means of this group are highly effective in diseases of the kidneys and heart. Their advantage is that they have virtually no side effects. They are well tolerated by patients in a long-term regimen, which helps doctors to use them widely. Of the contraindications can be noted: pregnancy, individual intolerance, hyperkalemia.

Diuretics (diuretics) are the most commonly used group of drugs. With their help, excess fluid, salt is removed from the body. It is because of this that the volume of blood decreases, the load on the heart and blood vessels decreases, which relax, the patient's well-being improves. Diuretics are divided into potassium-sparing, thiazide and loop.

The names of antihypertensive drugs of the thiazide group are familiar to many hypertensive patients - indapamide, chlorthalidone, hypothiazide and others. In high doses, they can lead to a change in the electrolyte balance, the metabolism of fats and carbohydrates, but in the recommended minimum doses absolutely safe for long-term use. The only contraindication is called gout.

Potassium-sparing drugs act more gently. The mechanism of action of antihypertensive drugs in this group is based on blocking the effect of aldosterone - antidiuretic hormone that retains fluid. Hypotensive properties are achieved due to the excretion of fluid and salt, but K, Ca, Mg ions are preserved.

The drugs in this group include:

• Amiloride;
• eplerenone;
• Spironolactone and so on.

Contraindication is acute and chronic renal failure.

Reduce pressure faster loop diuretics who are very active. They are not advised to use for a long time, but during a hypertensive crisis they are very successfully used by doctors.

Types of diuretics

Any muscle contraction is provided by the presence of calcium. The contraction of blood vessels occurs with its own help. Medicines from the group of calcium antagonists carry out their action due to the entry of Ca into the smooth muscles of vascular cells.

The list of antihypertensive drugs in this group includes drugs that differ in the degree of influence on the walls of blood vessels, the myocardium. For example, felodipine has an effect on blood vessels, lowering their tone, and does not disturb cardiac activity. But verapamil, in addition to lowering pressure, affects the heart muscle, lowers the pulse and is used in violation of heart rate, puke syndrome in angina pectoris.

Calcium antagonists reduce the risk of stroke.

Preparations of the group of beta-blockers change fat and carbohydrate metabolism, lead to an increase in body weight, they are not recommended for diabetes mellitus.

In addition to the above groups of drugs for the treatment of hypertension, other drugs are also used.

For example, imidazoline receptor agonists affect nervous departments in the medulla oblongata, reducing the activity of the sympathetic innervation of the vessels. Moxodonin improves metabolic processes and promotes weight loss in obese patients.

Chemical production is actively developing, scientific groups are constantly working on the production of new more effective drugs to reduce pressure.

The list of antihypertensive drugs is headed by:

• Aliskiren;
• Olmesartan;
• Torasemide.

The last drug is advised to take diabetics. Perhaps even long-term use of this drug.

For more effective treatment medicines, doctors advise patients to correct their lifestyle. It is recommended to give up nicotine addiction, salty foods, alcohol. Active physical activity will help increase the hypotensive effect of taking drugs, strengthen vascular walls. Taken measures will allow minimizing the doses of drugs in the fight against high blood pressure.

Antihypertensive drugs are a pharmacological group medical devices that are taken to treat hypertension. The All-Russian Scientific Society of Cardiology classifies these funds into several groups (taking into account the mechanism of action).

1 Principles of classification

Before taking centrally acting antihypertensives, the classification table is studied. VNOK specialists divide antihypertensive drugs into the following classes:

1. 1. Diuretics.
2. 2. Beta-blockers.
3. 3. Calcium antagonists.
4. 4. ACE inhibitors.
5. 5. Angiotensin receptor blockers.

Treatment should be under the supervision of a physician. Sedatives reduce functional disorders CNS, which are observed in hypertension. Treatment of hypertension with tranquilizers and hypnotics at an early stage has a long-term hypotensive effect (lowering blood pressure). What is a hypotensive effect, every patient suffering from hypertension should know.

List of sedative drugs (some with a prescription):

• Bromide;
• Adalyn;
• Bromural.

You can replace the above medications with tranquilizers such as Meprotan, Trioxazin, Diazepam. The dosage is selected taking into account the sensitivity of the patient to such medicines. During the course of treatment, it is necessary to abandon work that requires a quick reaction from the motor apparatus.

Of the tranquilizers, Aminazine is more often taken. Indications for admission:

• arousal of an emotional nature;
• hypertensive crisis, which is accompanied by psychomotor agitation.

Aminazine has a central hypotensive effect, rapidly lowering blood pressure. But the hypotensive effect of this drug is expressed to varying degrees in all patients. What is the hypotensive effect, how it manifests itself, every patient should know. The hypotensive effect is understood as a decrease in the frequency and strength of heart contractions, which contributes to a decrease in minute and stroke output.

List and classification of antiarrhythmic drugs

2 The second group of medicines

If the doctor has diagnosed climacteric arterial hypertension, the patient is prescribed Frenolon. If necessary, combined therapy (tranquilizers and hormonal agents). To improve sleep, the use of sedatives is indicated. If sleep does not improve within 3 weeks, take tranquilizers with hypnotic effect(Noxiron, Seduxen). With prolonged sleep disturbance, it is recommended to drink antipsychotics (Levomepromazine).

Sympatholytic and antiadrenergic drugs include centrally acting drugs (Dimecarbine, Nepresol, Apressin). You can treat hypertension with drugs derived from the root or leaves of rauwolfia. They help to reduce the reserves of catecholamines and serotonin in the central nervous system, heart, pancreas.

This inhibits the activity of the motor and vascular centers, providing a sympatholytic effect. At the same time, the central nervous system calms down, sleep deepens, interoreceptive reflexes are inhibited. In the process of taking drugs of this group, a gradual but strong hypotensive effect is observed.

Parasympathetic effects include slow heart rate, increased peristalsis intestines. You will first need to consult your doctor. Rauwolfia medications correct the central adrenergic mechanisms, reducing the intracellular sodium concentration. At the initial stage of hypertension take Aymalin, Rescinamine. With the help of Reserpine, peripheral resistance can be reduced.

Symptoms and treatment of vascular dementia

3 Antiadrenergic agents

Sympatholytic and antiadrenergic substances include medicines such as Vixen, Anaprilin. They have a strong but short hypotensive effect. Therefore, Tropafen is prescribed for the relief of hypertensive crisis. At the same time, there is a threat of an excessive decrease in blood pressure.

With the help of ganglioblocking drugs, it is possible to prevent the transmission of impulses between various fibers of the parasympathetic and sympathetic departments. Medicines provoke autonomic denervation.

To have a hypotensive effect, to reduce the tone of arterioles, ganglionic blockers are taken.

At the same time, a decrease in venous pressure and a decrease in motor activity intestines.

The use of such drugs is subject to the following conditions:

• stationary reception;
• individual dosage setting;
• taking the drug / injections at the same time interval;
• after the administration of the drug, the patient should lie down (2 hours), raising his head;
• gradual increase in dose, while the doctor must monitor the body's response;
• long-term therapy;
• the drug is canceled by gradually reducing the dose.

Ganglioblockers are contraindicated:

• with hypertensive crisis;
• if the patient's age exceeds 60 years;
• with congenital cerebral atherosclerosis;
• with pheochromocytoma;
• during pregnancy.

But they are taken with the ineffectiveness of combination therapy, persistent hypertension with complications, hypertension, left ventricular failure, encephalitis. Also, the drugs of this pharmacological group prescribed in case of intolerance to modern antihypertensive drugs.

New generation drugs: a review of modern ACE inhibitors

4 Medicinal products of other groups

To increase diuresis in hypertension, the use of aldosterone inhibitors is indicated. This hormone is involved in the formation of severe and stable hypertension. The patient may also be prescribed other diuretic drugs with a saluretic effect (contribute to the removal of excess sodium). With increased blood pressure, they have a clear and constant hypotensive effect. Diuretics enhance the effect of other antihypertensive medications. Therefore, they are taken in combination. To thiazide diuretics, experts include Furosemide, Clopamid, Ethacrynic acid.

Other antihypertensive drugs of the current generation are presented in the form of Methyldopa and Clonidine. The list of antihypertensive drugs of the latest generation:

1. 1. Rasilez.
2. 2. Cardosal.
3. 3. Trifas.

Rasilez is a renin inhibitor that helps maintain normal blood pressure throughout the day. The drug is well tolerated by patients, without causing dry cough, characteristic of ACE inhibitors. Modern antagonists include Cardosal. It has the following benefits:

• systematic reception of the drug provides a stable decrease in blood pressure;
• no withdrawal syndrome;
• minor side effects.

Cardosal, unlike Rasilez, provides normal blood pressure for 8 weeks. Of the new generation diuretics, Trifas is isolated. It is prescribed to patients with diabetes. Trifas, unlike its classical counterparts, is taken daily.

In the treatment of hypertension, the use of blockers is indicated calcium channel. Amlodipine can be distinguished from the last generation. Such blockers are taken alone or in combination with other drugs. Any hypotensive medical preparations used after consultation with a doctor.

5 Valid treatment combinations

According to the recommendations of the All-Russian Scientific Society of Cardiology, the treatment of arterial hypertension begins with combination therapy. The patient is pre-treated with low dose medications. If the patient's blood pressure exceeds 160/100 mm Hg. and exists high risk cardiac and vascular complications, full-dose combination therapy is indicated.

Previously, the doctor evaluates the interaction of drugs from the standpoint of safety and efficacy. The antihypertensive drugs used must meet the following requirements:

• complementarity;
• achieving an improved result when taken together;
• the presence of pharmacokinetic and pharmacodynamic indicators.

According to the recommendations of the VNOK, it is allowed to take a low dose of a thiazide diuretic in combination with a highly selective or vasodilating beta-blocker. Men suffering from hypertension are prescribed the following scheme therapy: alpha and beta blockers.

Such a combination as a calcium antagonist and a diuretic causes great doubt. It can lead to myocardial infarction. VNOK experts recommend combining ACE inhibitors with calcium antagonists. With the help of these funds, you can quickly reduce blood pressure.

The amlodipine + lisinopril regimen allows to reduce diastolic and systolic blood pressure levels, while there is a minimal risk of manifestation adverse reactions. To ensure comfortable treatment, the doctor combines drugs. This treatment regimen for hypertension, in contrast to combination therapy, has the following advantages:

• ensuring social and psychological comfort;
• low price of drugs.

Features of taking combined antihypertensive drugs:

• shown to patients in need of combined treatment;
• typical course of hypertension;
• used as maintenance therapy;
• require lifelong admission.

Of the new combination drugs, experts distinguish Equator, presented as a combination of lisinopril and amlodipine. It controls blood pressure throughout the day. This reduces the risk of swelling of the legs, the development of tachycardia. If the first choice drug is ineffective, then:

• the doctor adds a drug of another class (taking into account the recommendations of the VNOK);
• replaces this remedy another drug in this class.

The interval between stages of therapy is more than 4 weeks, if there is no need for more fast normalization HELL.

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Antihypertensive drugs are used to treat hypertension. They are the only means that lower the pressure and prevent the consequences. The latest generation drugs have a minimal side effect and, with a properly selected dose, do not pose a risk to health during their long-term use.

Classification of antihypertensive drugs

• First line drugs:
  • ACE inhibitors;
  • diuretics;
  • angiotensin receptor blockers;
  • beta-blockers;
  • calcium antagonists.
• Second line drugs:
  • alpha-blockers;
  • rauwolfia alkaloids;
  • antagonists of the central action;
  • direct acting vasodilators.

Types of drugs

ACE inhibitors

The most effective antihypertensive drugs. The property of the group is the effect on the adrenal hormone, which retains fluid in the body, as a result of which pressure rises. They have vasodilating activity, while not affecting the heart rate and the amount of blood ejection by the heart. They are recommended for patients with chronic heart failure. With long-term use of new generation ACE inhibitors, blood pressure stabilization can be achieved. Contraindications for use are pregnancy, lactation, high level potassium in the blood.

ACE inhibitors with prolonged use cause a dry cough.

Diuretics

The hypotensive effect of this group of drugs is their diuretic effect. They are able to bring out excess liquid from the human body, as a result of which the load on the heart is reduced. People suffering from gout should not use. Very often, diuretics are prescribed in combination with other antihypertensive drugs. Classification of diuretic drugs:

• Thiazide. The combination of these diuretics with and angiotensin receptor antagonists is often used to treat high blood pressure in the elderly and diabetics. Contraindicated in renal failure.
• Potassium-sparing antihypertensive drugs. The hypotensive effect is achieved due to the withdrawal of sodium ions, while potassium is preserved. The list of these drugs (drugs) is recommended for people with chronic heart failure and heart edema. It is forbidden to take them with CRF (chronic renal failure).
• Loopback. The main difference from other diuretics is the ability of drugs to achieve a faster hypotensive effect. With the wrong dose of the drug, the pressure can drop sharply, then hypertensive drugs are used. They are considered optimal means for relieving a hypertensive crisis, but for long-term use they are not suitable, as they wash out electrolytes with the liquid. And this means that loop diuretic pills can break everything metabolic processes in organism. List of major loop diuretics:
  • "Torasemide";
  • "Ethacrynic acid".

Adrenoblockers-beta

Modern antihypertensive drugs. Reduce cardiac output and the production of renin in the kidneys, which causes vasospasm, resulting in lower blood pressure. Beta-blockers treat the combination of hypertension with angina pectoris, arrhythmia and chronic heart failure. Contraindicated in breastfeeding, pregnancy, diabetes, bronchial asthma. After discontinuation, a withdrawal syndrome may develop.

calcium antagonists

Drugs that have the ability to block the flow of calcium ions into smooth muscle cells blood vessels, due to which their spasm decreases and pressure decreases. Antihypertensive treatment This type of drug reduces the risk of heart attack and stroke. Not to be used on children with cardiovascular insufficiency, pregnant women and during lactation. Depending on the chemical structure Calcium antagonists are divided into the following types:

• dihydropyridines: "Felodipine", "Amlodipine";
• benzothiazepines: "Diltiazem";
• phenylalkylamines: "Verapamil".

Neurotropic

• Central action drugs:
  • Sedatives. The composition includes motherwort herb, valerian and magnesium sulfate.
  • Sleeping pills. With hypertension, the optimal drugs are Phenobarbital, Etaminal-sodium.
  • Antipsychotics. IN complex therapy use a list of funds: "Aminazin", "Reserpine", "Raunatin". Many antipsychotics are long-acting.
  • Tranquilizers. Apply at the initial degree of arterial hypertension: "Sibazon", "Chlozepin", "Oxylidine".
• Neurotropic agents of peripheral action:
  • Ganglioblockers: "Benzohexonium", "Pentamine". This type is rarely used due to big list side effects.
  • Alpha-blockers: "Fentolamine", "Tropafen", "Pyrroxan". Used in hypertensive crisis.
  • Beta-blockers: Anaprilin, Trazikor. They relieve vasospasm and have a sedative effect.
  • Sympatholytics: "Reserpine", "Guanetedine". Most often, combined preparations are used, which include sympatholytics.

Angiotensin receptor blockers

These are new generation drugs that are effective in the treatment of hypertension. They are recommended for long-term use, as they are well tolerated and do not have many side effects and contraindications. It can be prescribed to patients with pathologies of the heart and kidneys. Angiotensin receptor blockers should not be used during pregnancy, hyperkalemia and allergic reactions.

There are almost 1 billion people in the world who suffer from high blood pressure. It could be like independent disease(primary hypertension), and the manifestation of the pathology of any organ (secondary hypertension).

The following diseases can provoke high blood pressure:

• endocrine;
• renal;
• of cardio-vascular system;
• neurogenic (with damage to the central nervous system).

The causes for the occurrence of hypertension can be such factors:

• sedentary lifestyle;
• alcohol and smoking;
• increased salt intake;
• genetic predisposition.

As a rule, pressure over 140/70 mm Hg is considered elevated. To lower it, there are a number of antihypertensive drugs.

Classification of antihypertensive drugs

All antihypertensive drugs are divided into four categories.

Blockers

These are drugs that change the activity of the nervous system. These include drugs:

• Methyldopa;
• Clonidine;
• Reserpine;
• Oktadin.

In addition, this category includes ganglionic blockers, alpha-adrenergic blockers and beta-adrenergic blockers. The action of these drugs is aimed at reducing the activity of cardiac output and vascular tone, which helps to lower blood pressure. They are used for emergency reduction pressure in hypertensive crises and administered intravenously for 5-6 minutes.

Vasodilators

Means, predominantly peripheral action, aimed at vasodilatation. This:

• Apressin;
• sodium nitroprusside;
• Minoxidil;
• Diazoxide.

Such drugs are used for severe heart failure with high blood pressure.

Diuretics

These drugs are prescribed to cleanse the body of salts and water through the kidneys. With the decrease caused high blood pressure as a result of problems with cardiovascular system reduces the workload on the heart. They, in turn, are divided into three groups:

• thiazide (Oxodolin, Saluretin, Hygroton);
• potassium-sparing (Amiloride, Spironolator, Triamteren);
• loopback (Bumetonide, Furosemide, Piretanide, Torasemide, ethacrynic acid).

These drugs can be used in complex treatment aimed at lowering the pressure.

Combined antihypertensive drugs

Such drugs act on the renin - angiotensin system. These include:

• synthetic analogs and competitive antagonists of angiotensin II (Saralazin);
• angiotensin-converting enzyme inhibitors (captopril).

Antihypertensive drugs of a new generation - combined drugs of prolonged action. They combine medications from different groups in one tablet. These drugs are taken once a day and are much better tolerated than the short-term drugs that are indicated for emergency relief of high blood pressure. The list of new generation antihypertensive drugs has been replenished with Moxonidine (Physiotens). This medicine is not inferior in its characteristics to most of the time-tested predecessors, but it has fewer side effects and is fairly well tolerated by the body, without causing addiction.

Also going on now clinical trials another new generation drug - Aliskiren - an inhibitor of renin, a hormone that regulates the exchange of fluids and electrolytes in the body.

At proper treatment appointed by a specialist, it will not be superfluous to adhere to certain rules in everyday life:

All information on the site is provided for informational purposes only. Before using any recommendations, be sure to consult your doctor. Self-medication can be dangerous for your health.

Having identified arterial hypertension in a sick person, doctors often prescribe the latest generation of antihypertensive drugs, the list of which is not so long. Arterial hypertension is the most frequent pathology cardiovascular system, which affects millions of people. Most older generation drugs have many side effects. IN Lately they are used less and less.

Antihypertensive drugs are large group medicines used to lower blood pressure. The following groups of medicines are most commonly used:

• ACE inhibitors;
• diuretics;
• calcium channel blockers;
• blockers of beta-adrenergic receptors;
• angiotensin-2 antagonists.

Angiotensin-2 antagonists are very popular. They are most often used when ACE inhibitors are ineffective or intolerant. This group includes a medicine such as Losartan. The constriction of blood vessels is at the heart of the increase in blood pressure. Angiotensin-2 has a vasoconstrictive effect.

Losartan blocks angiotensin-2 receptors, thereby contributing to vasodilation and pressure drop. A distinctive feature of Losartan is that it does not interfere with the formation of angiotensin-converting enzyme. In this regard, this medicine does not cause side effects characteristic of ACE inhibitors.

Losartan is well tolerated by patients. Possible side effects include weakness, fast fatiguability, swelling in the extremities, tachycardia, palpitations, pain in the abdomen, stool disorders such as diarrhea, nausea, pain in the back, convulsions, headache, sleep disturbance. There may be a cough, inflammation of the sinuses or nasal mucosa. Significantly less often, there are disorders of the heart and blood vessels, anorexia, gastritis, hepatitis, stool disorders such as constipation, allergic reactions, changes in the blood.

Losartan reduces the risk of complications associated with hypertension. The drug is excellent for patients in whom arterial hypertension is combined with type 2 diabetes. Losartan should not be given to children, pregnant or lactating women. Contraindications to the appointment of Losartan include high content potassium in the blood, intolerance to the active substance, lactase deficiency, dehydration.

Centrally acting drugs are often used in arterial hypertension. In area medulla oblongata imidazoline receptors are located. Excitation of these neurons leads to a hypotensive effect. One such drug is Moxonidine. This tool has the following features:

• does not have a strong sedative effect;
• used when various forms arterial hypertension;
• acts for a long time;
• gradually reduces systolic and diastolic blood pressure;
• does not cause a withdrawal syndrome.

The indication for the appointment of this medication is arterial hypertension of central origin. This new generation antihypertensive drug is contraindicated in the presence of a person with heart block, bradycardia, heart and kidney failure, in violation of liver function and hypersensitivity to the active substance. Moxonidine is not suitable for children, pregnant or lactating women.

The drug must be taken orally. The dose is selected by the attending physician. When using Moxonidine, the following adverse reactions are possible:

• dizziness;
• headache;
• drowsiness;
• insomnia;
• backache;
• asthenia;
• dry mouth;
• diarrhea;
• vomit;
• nausea;
• rash.

Rarely, phenomena such as bradycardia, tinnitus, and edema are observed.

One of the most modern medicines against hypertension is Rasilez. It is a renin inhibitor. The latter refers to enzymes that regulate blood pressure. Renin takes part in the formation of angiotensin. In Russia, Rasilez was approved in 2008. It is produced in the form of tablets. chief active substance is aliskiren.

This medication has the following benefits:

• available to the public;
• has a rapid and pronounced hypotensive effect;
• well tolerated by patients;
• does not cause a withdrawal syndrome.

Stopping the use of this medicine does not lead to a sharp increase in pressure. Rasilez can be used together with other antihypertensive drugs. In this case, the hypotensive effect is enhanced. In persons suffering from diabetes, when using Rasilez, the pressure decreases safely. In this situation, it is recommended to combine Rasilez with Ramipril.

Rasilez should not be used in the following situations:

• with renal failure;
• with nephrotic syndrome;
• at ;
• at severe violations liver function;
• with individual intolerance to the drug.

Rasilez is not suitable for the treatment of children and persons requiring permanent hemodialysis. The most frequent side effect drug is diarrhea.

Cardosal belongs to the new generation drugs for the treatment of arterial hypertension.

The main component of the drug is olmesartan medoxomil. The drug reduces the pressure gradually. Maximum effect observed 2 weeks after the start of therapy. The drug is available in the form of tablets of 10, 20 and 40 mg. The degree of pressure reduction depends on the dose of the drug.

The drug does not cause withdrawal syndrome and tachycardia. A pronounced hypotensive effect is observed 14 days after the first dose. The drug can be taken before, during or after a meal. The drug is effective in primary arterial hypertension (hypertension). Contraindications to the use of Cardosal include biliary tract obstruction, pregnancy and breastfeeding, childhood, individual intolerance, galactosemia, lactase deficiency, kidney failure. Cardosal should be used with caution if the patient has stenosis of the heart valves, hypertrophic cardiomyopathy, aldosteronism, coronary disease hearts.

Principles of drug therapy

Treatment of arterial hypertension is carried out only after consultation with a general practitioner or cardiologist. Self-medication is unacceptable. When choosing a new generation antihypertensive agent, the following factors are taken into account:

• the presence of concomitant diseases;
• patient's age;
• form of arterial hypertension;
• the degree of pressure increase;
• drug tolerance.

Treatment of this pathology is long. It is often necessary to take medicines for life, as even the latest antihypertensive drugs are not able to completely cure the disease. To stabilize blood pressure and prevent possible complications you must adhere to the following guidelines.