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Article update 01/30/2019

Arterial hypertension(AH) in the Russian Federation (RF) remains one of the most significant medical and social problems. This is due to the widespread prevalence of this disease (about 40% of the adult population of the Russian Federation has high blood pressure), as well as the fact that hypertension is the most important risk factor for major cardiovascular diseases - myocardial infarction and cerebral stroke.

Constant persistent increase in blood pressure (BP) up to 140/90 mm. rt. Art. and higher- a sign of arterial hypertension (hypertension).

Risk factors contributing to the manifestation of arterial hypertension include:

• Age (men over 55, women over 65)
• Smoking
• sedentary lifestyle,
• Obesity (waist circumference more than 94 cm for men and more than 80 cm for women)
• Familial history of early cardiovascular disease (men under 55 years of age, women under 65 years of age)
• The value of pulse blood pressure in the elderly (the difference between systolic (upper) and diastolic (lower) blood pressure). Normally it is 30-50 mmHg.
• Fasting plasma glucose 5.6-6.9 mmol/l
• Dyslipidemia: total cholesterol more than 5.0 mmol/l, low-density lipoprotein cholesterol 3.0 mmol/l or more, high-density lipoprotein cholesterol 1.0 mmol/l or less for men, and 1.2 mmol/l or less for women, triglycerides more than 1.7 mmol/l
• Stressful situations
• alcohol abuse,
• Excessive salt intake (more than 5 grams per day).

The development of hypertension is also promoted by diseases and conditions such as:

• Diabetes mellitus (fasting plasma glucose 7.0 mmol/l or more with repeated measurements, as well as postprandial plasma glucose 11.0 mmol/l or more)
• Other endocrinological diseases (pheochromocytoma, primary aldosteronism)
• Diseases of the kidneys and renal arteries
• Taking medications and substances (glucocorticosteroids, non-steroidal anti-inflammatory drugs, hormonal contraceptives, erythropoietin, cocaine, cyclosporine).

Knowing the causes of the disease, you can prevent the development of complications. Elderly people are at risk.

According to the modern classification adopted by the World Health Organization (WHO), hypertension is divided into:

• 1st degree: Increased blood pressure 140-159/90-99 mm Hg
• 2nd degree: Increased blood pressure 160-179/100-109 mm Hg
• 3rd degree: Increase in blood pressure to 180/110 mmHg and higher.

Blood pressure readings obtained at home can be a valuable addition to monitoring the effectiveness of treatment and are important in identifying hypertension. The patient’s task is to keep a diary of self-monitoring of blood pressure, where blood pressure and pulse values ​​are recorded when measured at least in the morning, at lunch, and in the evening. It is possible to make comments on lifestyle (getting up, eating, physical activity, stressful situations).

Blood pressure measurement technique:

• Quickly inflate the cuff to a pressure level 20 mmHg above systolic blood pressure (SBP) when the pulse disappears
• Blood pressure is measured with an accuracy of 2 mmHg
• Reduce cuff pressure at a rate of approximately 2 mmHg per second
• The pressure level at which the 1st sound appears corresponds to SBP
• The pressure level at which sounds disappear corresponds to diastolic blood pressure (DBP)
• If the tones are very weak, you should raise your hand and perform several squeezing movements with the hand, then repeat the measurement, but do not squeeze the artery too much with the membrane of the phonendoscope
• During the initial measurement, blood pressure is recorded in both arms. In the future, the measurement is carried out on the arm on which the blood pressure is higher
• In patients with diabetes mellitus and in those receiving antihypertensive drugs, blood pressure should also be measured after 2 minutes of standing.

Patients with hypertension experience pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, possible pain in the heart, and blurred vision.
The disease is complicated by hypertensive crises (when blood pressure rises sharply to high numbers, frequent urination, headache, dizziness, palpitations, and a feeling of heat occur); impaired renal function - nephrosclerosis; strokes, intracerebral hemorrhage; myocardial infarction.

To prevent complications, patients with hypertension need to constantly monitor their blood pressure and take special antihypertensive drugs.
If a person is bothered by the above complaints, as well as blood pressure 1-2 times a month, this is a reason to contact a therapist or cardiologist, who will prescribe the necessary examinations and subsequently determine further treatment tactics. Only after carrying out the necessary set of examinations can we talk about prescribing drug therapy.

Self-prescription of medications can lead to the development of unwanted side effects, complications and can be fatal! It is prohibited to independently use medicines on the principle of “helping friends” or resort to the recommendations of pharmacists in pharmacy chains!!! The use of antihypertensive drugs is possible only as prescribed by a doctor!

The main goal of treating patients with hypertension is to minimize the risk of developing cardiovascular complications and death from them!

1. Lifestyle change measures:

• To give up smoking
• Normalization of body weight
• Consumption of alcoholic beverages less than 30 g/day of alcohol for men and 20 g/day for women
• Increasing physical activity - regular aerobic (dynamic) exercise for 30-40 minutes at least 4 times a week
• Reducing table salt consumption to 3-5 g/day
• Changing your diet with an increase in the consumption of plant foods, an increase in the diet of potassium, calcium (found in vegetables, fruits, grains) and magnesium (found in dairy products), as well as a decrease in the consumption of animal fats.

These measures are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow you to: lower blood pressure, reduce the need for antihypertensive drugs, and have a beneficial effect on existing risk factors.

2. Drug therapy

Today we will talk about these drugs - modern drugs for the treatment of arterial hypertension.
Arterial hypertension is a chronic disease that requires not only constant monitoring of blood pressure, but also constant use of medications. There is no course of antihypertensive therapy; all drugs are taken indefinitely. If monotherapy is ineffective, drugs are selected from various groups, often combining several drugs.
As a rule, the desire of a patient with hypertension is to purchase the strongest, but not expensive, drug. However, it is necessary to understand that this does not exist.
What medications are offered for this purpose to patients suffering from high blood pressure?

Each antihypertensive drug has its own mechanism of action, i.e. influence one or another "mechanisms" of increased blood pressure :

a) Renin-angiotensin system— the kidneys produce the substance prorenin (with a decrease in pressure), which passes into renin in the blood. Renin (a proteolytic enzyme) interacts with the blood plasma protein angiotensinogen, resulting in the formation of the inactive substance angiotensin I. Angiotensin, when interacting with angiotensin-converting enzyme (ACE), is converted into the active substance angiotensin II. This substance increases blood pressure, constricts blood vessels, increases the frequency and strength of heart contractions, excites the sympathetic nervous system (which also leads to increased blood pressure), and increases the production of aldosterone. Aldosterone promotes sodium and water retention, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictor substances in the body.

b) Calcium channels of the cells of our body— calcium in the body is in a bound state. When calcium enters the cell through special channels, a contractile protein, actomyosin, is formed. Under its influence, the blood vessels narrow, the heart begins to contract more strongly, the pressure rises and the heart rate increases.

c) Adrenoreceptors— in our body, in some organs, there are receptors, the irritation of which affects blood pressure. These receptors include alpha-adrenergic receptors (α1 and α2) and beta-adrenergic receptors (β1 and β2). Stimulation of α1-adrenergic receptors leads to an increase in blood pressure, α2-adrenergic receptors - to a decrease in blood pressure. α-adrenergic receptors are located in arterioles. β1-adrenergic receptors are localized in the heart, in the kidneys, their stimulation leads to an increase in heart rate, an increase in myocardial oxygen demand and an increase in blood pressure. Stimulation of β2-adrenergic receptors located in the bronchioles causes dilation of the bronchioles and relief of bronchospasm.

d) Urinary system- as a result of excess water in the body, blood pressure increases.

e) Central nervous system- stimulation of the central nervous system increases blood pressure. The brain contains vasomotor centers that regulate blood pressure levels.

So, we have examined the main mechanisms of increasing blood pressure in the human body. It's time to move on to blood pressure lowering agents (antihypertensives), which affect these same mechanisms.

Classification of drugs for arterial hypertension

1. Diuretics (diuretics)
2. Calcium channel blockers
3. Beta blockers
4. Agents acting on the renin-angiotensin system
   1. Angiotensin receptor blockers (antagonists) (sartans)
5. Neurotropic agents of central action
6. Drugs acting on the central nervous system (CNS)
7. Alpha blockers

1. Diuretics (diuretics)

As a result of the removal of excess fluid from the body, blood pressure decreases. Diuretics prevent the reabsorption of sodium ions, which as a result are excreted and carry water with them. In addition to sodium ions, diuretics flush out potassium ions from the body, which are necessary for the functioning of the cardiovascular system. There are potassium-sparing diuretics.

Representatives:

• Hydrochlorothiazide (Hypothiazide) - 25 mg, 100 mg, included in combination preparations; Long-term use at a dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes!
• Indapamide (Arifonretard, Ravel SR, Indapamide MV, Indap, Ionic retard, Acripamidretard) - most often the dosage is 1.5 mg.
• Triampur (a combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide);
• Spironolactone (Veroshpiron, Aldactone). It has a significant side effect (in men it causes the development of gynecomastia and mastodynia).
• Eplerenone (Inspra) - often used in patients with chronic heart failure, does not cause the development of gynecomastia and mastodynia.
• Furosemide 20 mg, 40 mg. The drug is short but fast acting. Inhibits the reabsorption of sodium ions in the ascending limb of the loop of Henle, proximal and distal tubules. Increases the excretion of bicarbonates, phosphates, calcium, magnesium.
• Torsemide (Diuver) - 5 mg, 10 mg, is a loop diuretic. The main mechanism of action of the drug is due to the reversible binding of torasemide to the sodium/chlorine/potassium ion contransporter located in the apical membrane of the thick segment of the ascending limb of the loop of Henle, as a result of which the reabsorption of sodium ions is reduced or completely inhibited and the osmotic pressure of intracellular fluid and water reabsorption are reduced. Blocks myocardial aldosterone receptors, reduces fibrosis and improves myocardial diastolic function. Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its action is longer lasting.

Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used independently for hypertension.
Rapid-acting diuretics (furosemide) are not advisable to use systematically for hypertension; they are taken in emergency conditions.
When using diuretics, it is important to take potassium supplements in courses of up to 1 month.

2. Calcium channel blockers

Calcium channel blockers (calcium antagonists) are a heterogeneous group of drugs that have the same mechanism of action, but differ in a number of properties, including pharmacokinetics, tissue selectivity, and effect on heart rate.
Another name for this group is calcium ion antagonists.
There are three main subgroups of AKs: dihydropyridine (the main representative is nifedipine), phenylalkylamines (the main representative is verapamil) and benzothiazepines (the main representative is diltiazem).
Recently, they have been divided into two large groups depending on their effect on heart rate. Diltiazem and verapamil are classified as so-called “rhythm-slowing” calcium antagonists (non-dihydropyridine). The other group (dihydropyridine) includes amlodipine, nifedipine and all other dihydropyridine derivatives that increase or do not change the heart rate.
Calcium channel blockers are used for arterial hypertension, coronary heart disease (contraindicated in acute forms!) and arrhythmias. For arrhythmias, not all calcium channel blockers are used, but only pulse-lowering ones.

Representatives:

Pulse reducers (non-dihydropyridine):

• Verapamil 40 mg, 80 mg (extended: Isoptin SR, Verogalid EP) - dosage 240 mg;
• Diltiazem 90 mg (Altiazem RR) - dosage 180 mg;

The following representatives (dihydropyridine derivatives) are not used for arrhythmia: Contraindicated in acute myocardial infarction and unstable angina!!!

• Nifedipine (Adalat, Cordaflex, Cordafen, Cordipin, Corinfar, Nifecard, Phenigidine) - dosage 10 mg, 20 mg; NifecardXL 30mg, 60mg.
• Amlodipine (Norvasc, Normodipin, Tenox, Cordi Cor, Es Cordi Cor, Cardilopin, Kalchek,
• Amlotop, Omelarcardio, Amlovas) - dosage 5 mg, 10 mg;
• Felodipine (Plendil, Felodip) - 2.5 mg, 5 mg, 10 mg;
• Nimodipine (Nimotop) - 30 mg;
• Lacidipine (Latsipil, Sakur) - 2 mg, 4 mg;
• Lercanidipine (Lerkamen) - 20 mg.

Side effects of dihydropyridine derivatives include swelling, mainly lower extremities headache, redness of the face, increased heart rate, and increased urination. If swelling persists, it is necessary to replace the drug.
Lerkamen, which is a representative of the third generation of calcium antagonists, due to its higher selectivity to slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.

3. Beta blockers

There are drugs that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other drugs selectively block only the beta receptors of the heart - selective action. All beta blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels dilate, blood pressure decreases.

Representatives:

• Metoprolol (Betalok ZOK 25 mg, 50 mg, 100 mg, Egilok retard 25 mg, 50 mg, 100 mg, 200 mg, Egilok S, Vasocardin retard 200 mg, Metocard retard 100 mg);
• Bisoprolol (Concor, Coronal, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Aritel) - most often the dosage is 5 mg, 10 mg;
• Nebivolol (Nebilet, Binelol) - 5 mg, 10 mg;
• Betaxolol (Locren) - 20 mg;
• Carvedilol (Carvetrend, Coriol, Talliton, Dilatrend, Acridiol) - mainly dosage 6.25 mg, 12.5 mg, 25 mg.

Drugs in this group are used for hypertension combined with coronary heart disease and arrhythmias.
Short-acting drugs, the use of which is not rational for hypertension: anaprilin (obzidan), atenolol, propranolol.

Main contraindications to beta blockers:

• bronchial asthma;
• low pressure;
• sick sinus syndrome;
• pathology of peripheral arteries;
• bradycardia;
• cardiogenic shock;
• atrioventricular block of the second or third degree.

4. Drugs acting on the renin-angiotensin system

The drugs act on different stages of angiotensin II formation. Some inhibit (suppress) angiotensin-converting enzyme, others block the receptors on which angiotensin II acts. The third group inhibits renin and is represented by only one drug (aliskiren).

Angiotensin-converting enzyme (ACE) inhibitors

These drugs prevent the conversion of angiotensin I to active angiotensin II. As a result, the concentration of angiotensin II in the blood decreases, blood vessels dilate, and pressure decreases.
Representatives (synonyms are indicated in brackets - substances with the same chemical composition):

• Captopril (Capoten) - dosage 25 mg, 50 mg;
• Enalapril (Renitek, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam) - dosage is most often 5 mg, 10 mg, 20 mg;
• Lisinopril (Diroton, Dapril, Lysigamma, Lisinoton) - dosage is most often 5 mg, 10 mg, 20 mg;
• Perindopril (Prestarium A, Perineva) - Perindopril - dosage 2.5 mg, 5 mg, 10 mg. Perineva - dosage 4 mg, 8 mg;
• Ramipril (Tritace, Amprilan, Hartil, Pyramil) - dosage 2.5 mg, 5 mg, 10 mg;
• Quinapril (Accupro) - 5mg, 10mg, 20mg, 40mg;
• Fosinopril (Fosicard, Monopril) - in a dosage of 10 mg, 20 mg;
• Trandolapril (Hopten) - 2 mg;
• Zofenopril (Zocardis) - dosage 7.5 mg, 30 mg.

The drugs are available in different dosages for the treatment of varying degrees of increased blood pressure.

A feature of the drug Captopril (Capoten) is that, due to its short duration of action, it is rational only for hypertensive crises.

A prominent representative of the group, Enalapril and its synonyms are used very often. This drug does not have a long duration of action, so it is taken 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of drug use. In pharmacies you can find a variety of generics (analogues) of enalapril, i.e. Cheaper enalapril-containing drugs produced by small manufacturers. We discussed the quality of generics in another article, but here it is worth noting that generic enalapril is suitable for some, but does not work for others.

ACE inhibitors cause a side effect - dry cough. In cases of cough development, ACE inhibitors are replaced with drugs from another group.
This group of drugs is contraindicated during pregnancy and has a teratogenic effect in the fetus!

Angiotensin receptor blockers (antagonists) (sartans)

These drugs block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, and blood pressure decreases

Representatives:

• Losartan (Cozaar 50 mg, 100 mg; Lozap 12.5 mg, 50 mg, 100 mg; Lorista 12.5 mg, 25 mg, 50 mg, 100 mg; Vasotens 50 mg, 100 mg);
• Eprosartan (Teveten) - 400 mg, 600 mg;
• Valsartan (Diovan 40mg, 80mg, 160mg, 320mg; Valsacor 80mg, 160mg, 320mg, Valz 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; Valsafors 80mg, 160mg);
• Irbesartan (Aprovel) - 150 mg, 300 mg;
  Candesartan (Atacand) - 8 mg, 16 mg, 32 mg;
  Telmisartan (Micardis) - 40 mg, 80 mg;
  Olmesartan (Cardosal) - 10 mg, 20 mg, 40 mg.

Just like its predecessors, it allows you to evaluate the full effect 1-2 weeks after the start of administration. Does not cause dry cough. Should not be used during pregnancy! If pregnancy is detected during treatment, antihypertensive therapy with drugs of this group should be discontinued!

5. Centrally acting neurotropic agents

Centrally acting neurotropic drugs affect the vasomotor center in the brain, reducing its tone.

• Moxonidine (Physiotens, Moxonitex, Moxogamma) - 0.2 mg, 0.4 mg;
• Rilmenidine (Albarel (1 mg) - 1 mg;
• Methyldopa (Dopegit) - 250 mg.

The first representative of this group is clonidine, which was previously widely used for hypertension. This drug is now available strictly by prescription.
Currently, moxonidine is used both for emergency treatment of hypertensive crisis and for planned therapy. Dosage 0.2 mg, 0.4 mg. The maximum daily dosage is 0.6 mg/day.

6. Drugs acting on the central nervous system

If hypertension is caused by prolonged stress, then drugs that act on the central nervous system are used (sedatives (Novopassit, Persen, Valerian, Motherwort, tranquilizers, sleeping pills).

7. Alpha blockers

These agents attach to alpha adrenergic receptors and block them from the irritating effects of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin (Cardura, Tonocardin) - is often available in dosages of 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many alpha blocker drugs have been discontinued.

Why do you take several medications at once for arterial hypertension?

In the initial stage of the disease, the doctor prescribes one drug, based on some research and taking into account the patient’s existing diseases. If one drug is ineffective, other drugs are often added, creating a combination of blood pressure-lowering drugs that target different mechanisms of blood pressure lowering. Combination therapy for refractory (stable) arterial hypertension can combine up to 5-6 drugs!

Drugs are selected from different groups. For example:

• ACE inhibitor/diuretic;
• angiotensin receptor blocker/diuretic;
• ACE inhibitor/calcium channel blocker;
• ACE inhibitor/calcium channel blocker/beta blocker;
• angiotensin receptor blocker/calcium channel blocker/beta blocker;
• ACE inhibitor/calcium channel blocker/diuretic and other combinations.

There are combinations of drugs that are irrational, for example: beta blockers/calcium channel blockers, pulse-lowering drugs, beta blockers/central acting drugs and other combinations. It is dangerous to self-medicate!!!

There are combination drugs that combine in 1 tablet components of substances from different groups of antihypertensive drugs.

For example:

• ACE inhibitor/diuretic
  • Enalapril/Hydrochlorothiazide (Co-Renitec, Enap NL, Enap N,
  • Enap NL 20, Renipril GT)
  • Enalapril/Indapamide (Enzix duo, Enzix duo forte)
  • Lisinopril/Hydrochlorothiazide (Iruzid, Lisinoton, Liten N)
  • Perindopril/Indapamide (NoliprelA and NoliprelAforte)
  • Quinapril/Hydrochlorothiazide (Accusid)
  • Fosinopril/Hydrochlorothiazide (Fosicard N)
• angiotensin receptor blocker/diuretic
  • Losartan/Hydrochlorothiazide (Gizaar, Lozap plus, Lorista N,
  • Lorista ND)
  • Eprosartan/Hydrochlorothiazide (Teveten plus)
  • Valsartan/Hydrochlorothiazide (Co-diovan)
  • Irbesartan/Hydrochlorothiazide (Co-aprovel)
  • Candesartan/Hydrochlorothiazide (Atacand Plus)
  • Telmisartan / HCTZ (Micardis Plus)
• ACE inhibitor/calcium channel blocker
  • Trandolapril/Verapamil (Tarka)
  • Lisinopril/Amlodipine (Equator)
• angiotensin receptor blocker/calcium channel blocker
  • Valsartan/Amlodipine (Exforge)
• calcium channel blocker dihydropyridine/beta blocker
  • Felodipine/metoprolol (Logimax)
• beta blocker/diuretic (not recommended for diabetes and obesity)
  • Bisoprolol/Hydrochlorothiazide (Lodoz, Aritel plus)

All drugs are available in different dosages of one and another component; the dose must be selected for the patient by the doctor.

Achieving and maintaining target blood pressure levels requires long-term medical supervision with regular monitoring of the patient’s compliance with recommendations for lifestyle changes and compliance with prescribed antihypertensive drugs, as well as adjustment of therapy depending on the effectiveness, safety and tolerability of treatment. During dynamic monitoring, the establishment of personal contact between the doctor and the patient and patient education in schools for patients with hypertension, which increases the patient’s adherence to treatment, are crucial.

Hypertension is one of the most common problems among the elderly population. High blood pressure is a disorder of the cardiovascular system that can lead to serious complications and cause premature death.. Against the background of hypertension, heart failure, stroke, heart attack and other pathological serious conditions can develop. Pressure in blood vessels often provokes the formation of aneurysms and other abnormal phenomena that pose a threat not only to people’s health, but also to their lives. Frequent attacks of hypertension force patients to systematically take hypertensive drugs in order to maintain their performance and their condition normal.

In the treatment of pathology, various drugs are used, differing in their action, composition and basic properties. Diuretics occupy an important place in the complex treatment of high blood pressure.. Let's try to figure out what these pharmacological agents are and what their role is in the treatment of hypertension.

Diuretics for hypertension

Drugs in this group are diuretics and are widely used for diseases of the heart and blood vessels, which are accompanied by increased blood pressure. These medicines are one of the main treatments for the disease. Diuretics for hypertension help cleanse the body of excess salt and water, which are excreted from the body along with urine.

After a certain time after starting to take the drugs, the body becomes accustomed to it, and the process of removing excess fluid occurs naturally. The effect of reducing blood pressure also persists, which is subsequently normalized not under the influence of diuretics, but against the background of weakening resistance to blood flow.

There are different types of diuretics and each of them affects the body differently and causes certain side effects. However, their inclusion in therapy is more appropriate than treatment with modern drugs that lower blood pressure, such as ACE inhibitors and calcium antagonists. The use of the latter is accompanied by numerous side effects.

The great advantage of diuretics is their relatively low cost combined with high efficiency.

Diuretics significantly reduce the risk of complications that often occur with hypertension. The risk of myocardial infarction is reduced by 15%, and stroke by 40%.

Types of diuretics

1. Thiazide - weakly remove salt and fluid from the body, but are highly effective in lowering blood pressure. This type includes: Hydrochlorothiazide, Chlorthiazide, Benzthiazide.
2. Thiazide-like - are analogues of the previous type. Trade names of drugs: Indapamide, Chlorthalidone, Clopamide.
3. Loop - influence the filtration functions of the kidneys. They successfully cope with the task of activating the processes of removing moisture and salt, but at the same time they cause numerous adverse reactions from the body systems. Loop diuretics are represented by the following drugs: Torasemide, Furasemide, Ethacrynic acid.
4. Potassium-sparing - act on the renal nephrons, promoting the release of sodium and chloride substances from the body. Moreover, such drugs prevent the active excretion of potassium, which is how the drugs got their name. This type of diuretics includes: Triamterene, Amiloride, Spironolactone.
5. Aldosterone antagonists are drugs for hypertension that differ in their action from the others, since the decrease in pressure does not occur by removing fluid, but by blocking the release of aldosterone, a hormone that helps retain moisture and salt in the body.

Mainly used in the treatment of hypertension thiazide And thiazide-like types of diuretics that are combined with taking other medications for high blood pressure. In cases where therapy is ineffective and a hypertensive crisis develops with all the ensuing complications, patients are prescribed loop diuretics.

Features of treatment

Diuretics for hypertension are used in small doses, but over long courses. If patients do not experience improvement and blood pressure surges continue as before, then therapy is adjusted. It is not recommended to increase the daily intake of diuretics, since such a measure will not help cope with hypertension, but can lead to serious consequences.

Taking diuretics in high doses leads to the development of diabetes mellitus, as well as an increase in blood cholesterol levels. Therefore, it is advisable not to increase the dosage of drugs, but to replace them with more powerful diuretics, and supplement them with other drugs for the treatment of hypertension.

Diuretics are generally not prescribed to young people who have high blood pressure. Also, medications in this group are contraindicated for hypertensive patients with diabetes and obesity. At the discretion of the doctor, patients may be prescribed the diuretics Indapamide and Torsemide. These two types of drugs have a minimum of contraindications and side effects, and therefore do not cause undesirable metabolic phenomena in the body.

What medications are used for hypertension?

Pharmacology to protect health

The development of drugs for hypertension has been going on for decades. But even today, medicine and pharmacology are still faced with the acute problem of developing new, more effective and safe means of reducing and controlling blood pressure.

Today there is a wide range of such drugs, but they all differ in the type of effect, effectiveness, indications and contraindications. Their cost also plays an important role.

Therefore, for each patient, the doctor selects an individual drug treatment regimen for hypertension, based primarily on the reasons that caused it.

People have been struggling with high blood pressure for many years.

Main groups of drugs for hypertension

Hypertension is an extremely complex and multifaceted disease, the cause of which can be a variety of factors. Therefore, in each individual case, the doctor selects drugs from the appropriate group. The most frequently used categories are:

Diuretics

An extensive group of diuretic drugs that allow you to remove excess fluid from the body, reducing the load on the heart and blood vessels. But they can only be used if there are no kidney diseases, diabetes, or obesity. They are often prescribed to older people suffering from hypertension. This group includes Arifon, Triamtaren, Indap, Indapamide.

Calcium antagonists

These drugs partially block calcium channels, producing a vasodilator effect. They are recommended if there are vascular diseases along with hypertension, but are contraindicated for people who have had a myocardial infarction. They are quite safe and can be used during pregnancy and lactation. This group is extremely extensive, primarily including Kalchek, Blockaltsin, Cordipin, Cordaflex, Lomir, Lacipin, Felodip and so on.

ACE inhibitors

These drugs reduce the production of angiotensin-converting enzyme, which stimulates vasoconstriction. They are very effective, well tolerated by patients with hypertension, and have a beneficial effect on the cardiovascular system. They are often recommended after a myocardial infarction, as well as for high blood pressure due to diabetes mellitus. The most popular drugs of the group: Aceten, Capoten, Monopril, Enap, Ednit, Dapril, Accupro, Hopten.

Medicines that lower blood pressure should be prescribed by a doctor.

Beta-blockers

They lower the heart rate and reduce its force. They have a wide range of applications and can be recommended for angina pectoris, tachycardia, after a heart attack, and against the background of heart failure. However, they should not be prescribed to patients with diseases of the respiratory system and blood vessels. The most common representatives of the group: Metacard, Nebilet, Atenolol, Betak, Serdol, Metokard, Egilok.

Selective imidazoline receptor agonists

This group of drugs not only reduces blood pressure, but also reduces appetite, which makes them especially effective in the treatment of hypertension in the setting of obesity. The group includes Tsint, Albarel, Physiotens.

Angiotensin II receptor antagonists

In their action they are similar to ACE inhibitors and can replace it in case of intolerance or in case of other contraindications. But they are used infrequently due to their high cost. Representatives of this group: Diovan, Kozaar, Atakand, Teveten, Aprovel.

These are not all groups of drugs used to treat hypertension, but they are the ones recommended most often. Of course, they are presented for informational purposes only. Buying and starting to take something on your own is strictly prohibited, since only a doctor and only after consultation and examination can select the most effective and safe remedy and draw up a regimen for its administration.

It is necessary to understand that most drugs have an effect only during use, without affecting the causes of hypertension. Therefore, it is necessary to treat this disease comprehensively, using both medicinal and non-medicinal means.

Medicines for emergency blood pressure reduction

All of the medications listed above are taken in long courses as part of the complex treatment of hypertension. At the same time, sometimes a situation arises when the pressure needs to be reduced urgently. Most often this occurs during a hypertensive crisis, when blood pressure within a short period of time becomes significantly higher than the working zone. In such cases, the following tactics are recommended:

1. Drink a sedative: extract of motherwort, valerian, peony root.

2. Place 1-2 nitroglycerin tablets under the tongue.

3. Take a tablet of medication for emergency blood pressure reduction: Captopril, Nifedepine, Clonidine.

In people prone to high blood pressure, these drugs should always be on hand in case of a hypertensive crisis. But after the first emergency actions, it is necessary to call an ambulance and continue treatment under the supervision of a doctor.

Use of the drug Valsacor for arterial hypertension: results of a Slovenian multicenter study

Ostroumova O.D. Guseva T.F. Shorikova E.G.

Currently for treatment arterial hypertension(HTN) five main classes of antihypertensive drugs are recommended drugs. angiotensin converting enzyme inhibitors, angiotensin 1 receptor blockers (ARBs), calcium antagonists, b-blockers, diuretics.

To choose from drug are influenced by many factors, the most important of which are: the presence of risk factors in the patient, target organ damage, associated diseases, kidney damage, diabetes mellitus, metabolic syndrome, concomitant diseases for which prescription or restriction is necessary applications antihypertensive drugs different classes, the patient's previous individual reactions to drugs different classes (pharmacological history), the likelihood of interaction with medications that the patient is prescribed for other reasons, as well as socio-economic factors, including the cost of treatment.

When choosing an antihypertensive drug it is necessary first of all to evaluate its effectiveness, the likelihood of side effects and the benefits of the drug in a certain clinical situation. Russian recommendations for the diagnosis and treatment of hypertension specifically emphasize that the cost of the drug should not be the main deciding factor.

Based on results multicenter randomized research. it can be assumed that none of the main classes of antihypertensive drugs has a significant advantage in reducing arterial pressure (BP). At the same time, in each specific clinical situation it is necessary to take into account the peculiarities of the action of various antihypertensive drugs discovered during randomized trials. research .

ARBs have proven themselves to slow down the rate of progression of target organ damage and the possibility of regression of their pathological changes. They have proven effective in reducing the severity of left ventricular myocardial hypertrophy, including its fibrotic component, as well as significantly reducing the severity of microalbuminuria, proteinuria and preventing a decrease in renal function.

In recent years, indications for application BRAs have expanded significantly. To the previously existing ones (nephropathy in type 2 diabetes mellitus, diabetic microalbuminuria, proteinuria, left ventricular myocardial hypertrophy, cough when taking ACE inhibitors), such items as chronic heart failure, previous myocardial infarction, atrial fibrillation, metabolic syndrome and diabetes mellitus were added.

Currently, several ARBs are used or are undergoing clinical trials in global medical practice: valsartan, irbesartan, candesartan, losartan, telmisartan, eprosartan, zolarsartan, tazosartan, olmesartan (olmesartan, zolarsartan and tazosartan are not yet registered in Russia). Different sartans differ in the set of indications for their application(Fig. 1), which is due to the degree of study of the clinical effectiveness of drugs in the relevant large research.

Valsartan is one of the most studied ARBs. Conducted more than 150 clinical research with the study of more than 45 performance assessment points. Total number of patients included in clinical trials research. reaches 100 thousand, of which more than 40 thousand are included in studies studying morbidity and mortality. The effect of valsartan on patient survival and survival without cardiovascular complications was studied in a number of large randomized trials. multicenter research: VALUE, Val-HeFT, VALIANT, JIKEI Heart.

The antihypertensive effect of valsartan and other angiotensin II antagonists is due to a decrease in total peripheral vascular resistance due to the elimination of the pressor (vasoconstrictor) effect of angiotensin II, a decrease in sodium reabsorption in the renal tubules, a decrease in the activity of the renin-angiotensin-aldosterone system and mediator processes in the sympathetic nervous system. Antihypertensive effect with long-term application is stable, since it is also caused by regression of pathological remodeling of the vascular wall. The effectiveness of the original valsartan in hypertension, its good tolerability and safety during long-term application fully confirmed in a large number of clinical studies.

All of the above effects of angiotensin II are in one way or another involved in the regulation of blood pressure under normal conditions, as well as in maintaining it at a pathologically high level in hypertension. Selective blockade of AT1 receptors makes it possible to reduce the pathologically increased tone of the vascular wall, promotes regression of myocardial hypertrophy and improves diastolic function of the heart, reducing the rigidity of the myocardial wall in patients with hypertension.

There is a strong relationship between blood pressure levels and the likelihood of stroke or coronary events. Although the activity of the RAAS can be more or less successfully controlled using ACE inhibitors, blockade of the action of angiotensin II at the receptor level is believed to have a number of advantages compared to ACE inhibitors - it blocks the effect of angiotensin II regardless of its origin, the absence of "escape effect" , as well as no effect on the degradation of bradykinin and prostaglandins.

For hypertension, valsartan is prescribed once at a dose of 80-320 mg per day; the hypotensive effect is dose-dependent. The drug is rapidly absorbed from the gastrointestinal tract, peak plasma concentrations are reached approximately 2-4 hours after oral administration. The antihypertensive effect manifests itself within 2 hours in most patients after a single dose of the drug. The maximum decrease in blood pressure develops after 4-6 hours. After taking the drug, the duration of the hypotensive effect lasts more than 24 hours. With repeated use, the maximum reduction in blood pressure, regardless of the dose taken, is usually achieved within 2-4 weeks and is maintained at the achieved level during long-term therapy. The stability of the effect is due to the strength of the connection of valsartan with AT1 receptors, as well as the long half-life (about 9 hours). At the same time, the normal daily rhythm of blood pressure is maintained. Randomized studies have shown that the hypotensive effect of valsartan persists with long-term use - for 1 year, 2 years or more.

In 2008, one of the first generic drugs of valsartan was registered in Russia - Valsacor produced by KRKA (Slovenia). First of all, it was proven that Valsacor bioequivalent to the original valsartan (Fig. 2).

However, any generic drug must have studies that examined the clinical effects of this particular drug, and not just blood concentrations in healthy volunteers. For antihypertensive drugs, this is, at a minimum, an effect on blood pressure levels. Unfortunately, only a few generic medicines can boast of this.

Therefore, they deserve special attention results recently ended multicenter research conducted by our Slovenian colleagues. The purpose of this study was to evaluate the effectiveness and safety of valsartan (Valsacor) in patients with mild to moderate hypertension. The total number of patients was 1119 people (53% men, 44% women, mean age 63.5±11.7 years). Of these, 174 patients (15.5%) had not previously received antihypertensive therapy, and 944 patients (84.4%) had already received antihypertensive medications. Patients receiving therapy before enrollment most often received enalapril (20.4%), ramipril (13.5%), valsartan (11.3%), indapamide (7.9%) and perindopril (7.5%). %). Since the 24-hour effect of valsartan was proven, patients received 40, 80, 160 or 320 mg of valsartan (Valsakor®, KRKA) once daily and were examined 3 times over 3 months. At the first visit and two visits over time, blood pressure was measured, information on tolerability was collected, and at the end of the observation period the effectiveness of therapy was assessed.

Initially, before appointment Valsacora. Blood pressure averaged 155.4 mm Hg. for systolic blood pressure (SBP) and 90.9 mm Hg. for diastolic blood pressure (DBP) (Fig. 3). Within a month, the SBP reached 142.6 mm Hg. and DBP also decreased to 84.9 mmHg. At the third visit, a further decrease in blood pressure was noted, and the average SBP was 136.4 mmHg. Art. and DBP 81.6 mm Hg. Overall, the average reduction in SBP was 19 mmHg. Art. (12.2%), DBP - 9.3 mm Hg. (-10.2%). All of these changes were statistically significant.

During the entire observation period, 52 adverse reactions were observed in 42 patients (3.8%) out of a total of 1119 patients. The most frequently observed side effects were headache (15 patients, 1.3%), dizziness (8 patients, 0.7%) and fatigue (4 patients, 0.4%). Cough was reported in 3 patients (0.3%). 13 patients (1.2%) discontinued therapy due to adverse reactions.

By the end of the study, 64% of patients achieved blood pressure less than 140/90 mmHg. and had no adverse reactions (clinical assessment of treatment “excellent”) (Fig. 4); 20% of patients achieved a blood pressure level of less than 140/90 mm Hg. and had mild adverse reactions (clinical assessment of treatment “very good”); In 8% of patients, SBP decreased by at least 10 mmHg. and DBP by at least 5 mmHg. Art. without the manifestation of unwanted side reactions (clinical assessment of treatment “good”) (Fig. 4). The remaining patients achieved target blood pressure levels and had moderate or severe adverse reactions (rated as “satisfactory” or “unsatisfactory”).

Received in result The data from this study allowed the authors to conclude that Valsacor®; is an effective and safe antihypertensive drug for the treatment of patients with mild and moderate hypertension.

Appearance Valsacora in Russia will make ARB treatment more accessible to a wide range of patients, which will help improve the effectiveness of hypertension treatment and reduce cardiovascular and cerebrovascular morbidity and mortality.

Literature

1. Diagnosis and treatment arterial hypertension. Russian recommendations (third revision). Cardiovascular therapy and prevention - 2008 - No. 6 (Appendix 2) - Page. 3-32.

2. Study of the effectiveness and safety of valsartan (Valsacor) in the treatment of patients with mild and moderate hypertension. Krka's own data, New Place, 2009.

Hypertension is one of those chronic conditions that you have to fight with throughout your life. Therefore, drugs for hypertension are constantly being improved, new drugs are emerging that are more effective and have less pronounced side effects. It should be noted that to achieve maximum effect, such drugs are always included in complex treatment for high blood pressure.

Hypertension medications - indications for use

The goal of prescribing all antihypertensive drugs is to reduce and stabilize blood pressure. The mechanism of action may be different, but it always has the effect of dilating peripheral blood vessels. It is due to this that the redistribution of blood occurs - more goes into small vessels, accordingly, tissues receive more nutrition, the load on the heart is reduced and blood pressure decreases.

Depending on the mechanism of action, this effect can be achieved quickly as a result of the use of ACE inhibitors (Captopril, Capoten), or develop gradually when prescribing beta-blockers (Concor, Coronal). Medicines, the effect of which is achieved within half an hour, are used to treat hypertensive crisis, myocardial infarction, and cerebrovascular accidents. Medications that act gradually are prescribed for daily use.

The large number of antihypertensive drugs is due to various mechanisms of the onset of the disease, as well as the fact that the selection of drugs for the treatment of hypertension is always carried out individually, based on the characteristics of the course of the disease and concomitant diseases in the patient. The main indications for antihypertensive therapy are:

• Essential arterial hypertension;
• Heart diseases - heart failure, arrhythmia, post-infarction condition;
• Kidney diseases accompanied by increased blood pressure;
• Diseases of the nervous system that cause increased blood pressure.

For endocrine diseases, a symptom of which may be arterial hypertension, blood pressure lowering drugs are prescribed only after consultation with an endocrinologist, since without hormonal therapy their effectiveness is extremely low.

Diseases such as stenosis of the aorta or renal arteries are also most often contraindications for the prescription of antihypertensive drugs, since their effectiveness in this case is low, and the likelihood of side effects is much higher. Blood pressure lowering drugs are almost never prescribed to pregnant women, nursing mothers, children and adolescents. The use of antihypertensive drugs from different groups has its own characteristics, indications and contraindications. Therefore, only specialists can prescribe them, taking into account the individual characteristics of the patient.

Main groups of drugs for hypertension

Adrenergic blocking drugs for hypertension

Adrenergic blockers are one of the most commonly used groups of drugs for hypertension, arrhythmias and heart failure. The action of medications is aimed at preventing the synthesis of excitatory neurotransmitters (adrenaline and norepinephrine). These substances cause vasoconstriction, increased blood pressure, increased heart rate and increased force of heart contractions. Adrenergic blockers “turn off” some of the receptors for adrenaline, which is why its effect on the cardiovascular system is reduced.

According to the level of impact, drugs of this pharmacological group are divided into selective and non-selective. Non-selective (Propranolol, Anaprilin) ​​affect all types of adrenergic receptors, causing a strong hypertensive effect and many adverse reactions in the form of bronchospasm, circulatory disorders in the lower extremities, and impotence.

Selective adrenergic blockers act only on a certain type of receptor. Most often, β-adrenergic blockers (BABs) are used for heart disease associated with hypertension. They block receptors located in peripheral vessels, which are responsible for their narrowing. Due to this, a hypotensive effect is achieved. These include drugs for hypertension such as Carvedilol, Bisoprolol, Metoprolol and others. Indications for prescribing beta blockers:

• hypertonic disease;
• heart failure;
• post-infarction state;
• arrhythmias with a tendency to tachycardia.

These drugs can be used in patients with diabetes mellitus after consultation with an endocrinologist. New generation drugs for hypertension in this group, such as Bisoprolol, can be prescribed to patients with bronchial asthma and COPD with virtually no risk due to their high selectivity. For kidney diseases, hyperaldosteronism and other diseases not directly related to the heart and blood vessels, they are used as an additional preventive agent.

Alpha blockers are used much less frequently. They have a strong antihypertensive effect, improve the metabolism of glucose and fat, and reduce the severity of symptoms of prostate adenoma. They are used as a means to control blood pressure in patients with type 2 diabetes mellitus, especially in elderly men, in the absence of contraindications.

Agents affecting the RAAS

The renin-angiotensin-aldosterone system is the second system in the body responsible for maintaining renal blood flow and increasing blood pressure. This is a complex chain of sequentially released biologically active substances. By interrupting this chain, you can weaken its effect on blood pressure. Among the drugs that affect the RAAS, two classes of drugs are used - ACE inhibitors and angiotensin-II receptor blockers.

ACE inhibitors come in fast and slow acting forms. Rapid-acting antihypertensive drugs, such as Captopril, are necessary to help with a hypertensive crisis or myocardial infarction, as well as for the rehabilitation of patients after a heart attack. If necessary, they can be prescribed as a daily medication to control blood pressure.

Enalapril, Lisinopril and other daily medications for hypertension act rather slowly, gradually normalizing blood pressure. Their dosage is selected individually, based on the patient’s well-being and the effectiveness of the drug.

Indications for the use of ACE inhibitors are the following conditions:

• essential arterial hypertension;
• heart failure;
• rehabilitation after myocardial infarction;
• kidney diseases, including diabetic nephropathies.

Unlike beta blockers, ACE inhibitors can be prescribed for kidney disease, in which case they do not lose their effectiveness. Contraindications for their use are stenosis of the aorta or renal arteries, endocrine diseases. For heart defects they are prescribed with caution.

Angiotensin receptor blockers are classified as vasodilators for hypertension. They also affect the RAAS, but at a different stage. Their use allows for long-term effects and, as a result, more stable pressure control.

These include drugs such as Losartan, Valsartan and others. They have a wider range of applications in kidney diseases and endocrine pathologies. Due to their high specificity, they have few side effects. Drugs of both groups are ineffective for arrhythmias and diseases of the nervous system that cause increased blood pressure.

Calcium channel blockers

These hypertension drugs, also called calcium antagonists, block the flow of calcium into muscle tissue. First of all, they affect the tissue of the vascular wall, reducing its ability to contract. Thus, an antihypertensive effect is achieved.

Side effects include muscle weakness, decreased mental performance, changes in urine laboratory parameters and heart rhythm disturbances. In this group, new generation drugs for hypertension, such as Amlodipine, have clear indications for use. They should be used under the supervision of a doctor, as there is a possibility of developing dangerous complications. Calcium channel blockers are used for the following pathologies:

• coronary heart disease;
• myocardial infarction and post-infarction state;
• hypertensive crisis;
• some heart rhythm disturbances.

Most drugs in this group are intended for use in emergency situations. For constant daily use, other medications are used that are milder and have fewer side effects.

Diuretics

Diuretics are also included in the list of medications for hypertension. They stimulate the secretion of urine, due to which the volume of circulating blood decreases, and as a result, blood pressure decreases. The mechanism of action of different groups of diuretics has its own characteristics, as a result of which their side effects also differ.

Most adverse reactions are associated with loss of electrolytes and dehydration of the body, since it is the concentration of sodium in the urine that regulates its amount. You can combat these side effects by taking medications that maintain the level of electrolytes in the blood. For hypertension, thiazide diuretics and sulfonamides (Hypothiazide, Indapamide, Cyclomethiazide) are used. Indications for the use of diuretics for high blood pressure are as follows:

1. essential hypertension;
2. heart failure;
3. kidney diseases, including diabetic nephropathy;

Diuretics should be prescribed with caution for cardiac arrhythmias. Side effects - thirst, muscle weakness, pain, cramps, headaches, heart rhythm disturbances. In severe cases, fainting is possible. Contraindications for use are arrhythmias, endocrine diseases, pregnancy and breastfeeding.

Centrally acting drugs for hypertension

For arterial hypertension caused by disturbances in the regulation of blood pressure by the centers of the brain, centrally acting antihypertensive drugs are used. These are the most radical means for lowering blood pressure, which are used strictly according to indications.

The most modern drug today is, which is prescribed for diseases of the central nervous system, with a combination of arterial hypertension and diabetes. The advantage of this drug is that it does not affect insulin receptors.

Central antihypertensive drugs may be used in combination with other drugs to lower blood pressure. They have pronounced adverse reactions - orthostatic hypotension, emotional disturbances, headaches. Contraindicated for mental illness, as well as for pregnant and lactating women, as they can cause serious disturbances in the regulation of blood pressure in the baby.

Review of the best blood pressure medications - list

Captopril (analogues of Capoten, Alkadil)

A drug from the group of ACE inhibitors, blocks the production of the enzyme responsible for vasoconstriction, prevents hypertrophy and thickening of the heart muscle, reduces blood flow to the heart and helps relieve stress. Captopril tablets are intended for the relief of acute conditions (hypertensive crises).

They are not suitable for long-term use (especially in elderly people with atherosclerosis). During course treatment, take 1 tablet twice a day, 1 hour before meals, starting with minimal doses. The drug has quite a lot of contraindications (history of angioedema, pregnancy, lactation, kidney pathologies, coronary artery disease, autoimmune diseases) and side effects, so the medicine should be taken strictly according to indications. The average cost of the drug is 20-40 rubles.

Enalapril (analogues of Enap, Enam, Renipril)

An ACE inhibitor of the carboxyl group, it acts more gently than Captopril and its analogues. Prescribed for daily use to control blood pressure. When used correctly, Enalapril significantly increases the life expectancy of patients with hypertension, but can cause such an unpleasant side effect as a dry cough.

The drug is usually prescribed in a minimum dose (5 mg), taken once (in the morning), and then the dose is gradually increased every 2 weeks. Like most medications in this group, Enalapril has many contraindications; the drug is prescribed with extreme caution for renal and liver failure, diabetes mellitus, and in old age. If side effects occur, reduce the dose or discontinue the drug. The price of Enalapril in pharmacies is from 40 to 80 rubles.

Bisoprolol

A drug from the group of selective beta blockers that effectively reduces the risk of cardiovascular complications in high blood pressure. Suitable for the treatment of resistant forms of hypertension, it is prescribed for angina pectoris, chronic heart failure, and patients who have had a heart attack.

The principle of action of the drug is based on preventing the production of hormones (renin and angiotensin 2) that affect vasoconstriction, as well as blockade of vascular beta receptors. can be used for long-term treatment, it is prescribed once, in a dose of 5-10 mg, taken in the morning. The medication should be discontinued gradually, otherwise a sharp rise in pressure is possible. The price of the medicine varies from 50 to 200 rubles.

Popular sartan (angiotensin receptor blocker). This is a relatively new drug, with fewer side effects and a milder and longer-lasting effect. Effectively reduces blood pressure; the tablet should be taken once (in the morning or before bed).

Treatment begins with a therapeutic dose of 50 mg, a persistent hypotensive effect develops on average after a month of regular medication use. Losaratan has few contraindications (pregnancy, lactation, hyperkalemia), but it can cause a number of unwanted side effects. Therefore, you should strictly follow medical recommendations and not exceed the indicated dosages. The price of the drug is 300-500 rubles.

Representative of the group of calcium channel blockers. The use of the drug improves exercise tolerance, which is especially important when treating elderly patients with cardiac arrhythmias, angina pectoris or atherosclerosis. When combining the drug with ACE inhibitors, you can refuse to prescribe diuretics.

The drug is taken once in a dose of 5 mg, then, taking into account tolerability, the dosage is increased to 10 mg per day. Side effects when taken are rare; contraindications for use are hypersensitivity, liver failure, pregnancy, lactation. The price of the medicine is 80-160 rubles.

Indapamide

A diuretic from the sulfonamide group, prescribed for severe forms of arterial hypertension, as part of complex therapy. Indapamide can be used for concomitant diabetes mellitus, as it does not affect blood sugar levels. The diuretic reduces the risk of complications on the heart and blood vessels; it is taken daily at a dose of 2.5 mg, regardless of meals.

After a single dose, the therapeutic effect lasts throughout the day. Indopamine should not be prescribed for severe renal or liver failure, during pregnancy and breastfeeding. The drug can cause allergic reactions and side effects from various body systems (nervous, digestive). The cost of a diuretic is from 120 rubles.

General principles of treatment

The modern pharmaceutical industry has not been able to invent drugs for hypertension without side effects, so it is necessary to take into account possible adverse reactions when taking blood pressure medications. Each patient’s reaction to a particular drug is individual, so it is necessary not only to select the drug itself, but also to accurately calculate the dose.

Treatment with antihypertensive drugs always starts with a minimum dose, then increases it if necessary. If an undesirable reaction occurs even at the minimum dose, the drug is discontinued and replaced with another.

In the treatment of arterial hypertension, the financial factor also plays an important role - the cost of these drugs varies, and they have to be taken for life. That is why, when asking what medications to take for hypertension, the doctor is forced to focus more on the cost of the medication and the financial capabilities of the patient.

Hypertension (HTN) is an increase in blood pressure (BP) above 140/80 miHg.

There are essential and symptomatic hypertension. Essential hypertension, often called essential hypertension (HTN), accounts for about 90% of all cases of arterial hypertension. With essential hypertension, the specific cause of the increase in blood pressure, as a rule, cannot be identified. In the development of this form of the disease, a major role belongs to the activation of the sympatho-adrenal, renin-angiotensin, and kalekriein-kinin systems. The reasons for such activation may be hereditary predisposition, psycho-emotional stress, excess body weight, physical inactivity, etc. Hypertension is called symptomatic or secondary if the cause of increased pressure is disease or damage to organs (kidneys, endocrine disorders, congenital and acquired heart and vascular defects). Treatment of this form of hypertension begins with eliminating the cause that caused the increase in blood pressure. Hypertension is not dangerous in itself - the threat is posed by complications of hypertension - hemorrhagic stroke, heart failure, nephrosclerosis, coronary heart disease.

Therapy of patients with hypertension has two tasks:

1. reduce blood pressure below 140/90 mm Hg. Art.

2. prevent or slow down the development of complications;

Currently, a large number of groups of drugs are used to treat hypertension:

1. β-blockers;

2. ACE inhibitors;

5. diuretics,

4. blockers of slow calcium channels;

5. α-blockers;

6. AT1-anigiotensin receptor blockers;

7. agonists of I 1 -imidazodine receptors;

8. agonists of central α 2 -adrenergic receptors

9. vasodilators

10. other groups of drugs that lower blood pressure.

However, despite the many pharmacological groups, the first four play the main role in the treatment of hypertension.

β-ADRENOBLOCKERS.

(for a detailed description of the group, see the lecture β-blockers)

β-blockers belong to the first-line drugs of antihypertensive drugs, their use is especially important in patients with increased activity of the sympathoadrenal system; β-blockers have several mechanisms leading to a persistent decrease in blood pressure:

A decrease in cardiac output by 15-20% due to a weakening of myocardial contractility and a decrease in heart rate,

Decreased activity of the vasomotor center,

Decreased renin secretion

Decrease in total peripheral vascular resistance (this effect is expressed in drugs with vasodilating activity)

In the treatment of hypertension, preference should be given to β-blockers with vasodilating properties (carvedilol and nebivolol) and cardioselective drugs (atenolol, betaxolop, bisoprolol). The former are recommended to be used due to increased peripheral vascular resistance in most patients. The latter, to a lesser extent than non-selective drugs, negatively affect vascular tone. In addition, cardioselective blockers are safer when prescribed to patients with bronchial asthma. For hypertension, it is advisable to use long-acting drugs (betaxolol, talinolol retard, nadolol, atenolol). Firstly, it is more convenient for patients to take medications once a day. Secondly, the use of short-acting drugs has disadvantages: fluctuations in the activity of the sympathoadrenal system in accordance with changes in the concentration of the drug in the body during the day, and if the drug is suddenly discontinued, the “recoil” syndrome may develop - a sharp increase in blood pressure. A stable hypotensive effect of β-blockers develops 3-4 weeks after starting the drug. It is stable and does not depend on the physical activity and psycho-emotional state of the patient. β-blockers reduce left ventricular hypertrophy and improve myocardial contractility.

The hypotensive effect of β-blockers is enhanced when combined with diuretics, calcium antagonists, α-blockers, and ACE inhibitors.

α - ADRENO BLOCKERS.

The classification of α-adrenergic receptor blockers is based on their selectivity in relation to various α-adrenergic receptors:

1. Non-selective α-adrenergic blotting agents: dihydrogenated ergot alkaloids, tropafen, phentolamine;

2. Selective α-blockers: prozosin, doxazosin, terazosin.

Currently, selective α-blockers are used for hypertension. Drugs blocking α-adrenergic receptors reduce systemic vascular resistance, cause reverse development of left ventricular hypertrophy, and improve the lipid composition of the blood. The presence of a large number of α-adrenergic receptors in the smooth muscles of the prostate gland and the bladder neck allows the use of drugs in patients with prostate adenoma to improve urination.

Prazosin is a selective short-acting α 1-blocker. When taken orally, it is quickly absorbed from the gastrointestinal tract. Bioavailability of prazosin is 60%. More than 90% of prazosin is bound to plasma proteins. The maximum concentration in the blood is determined after 2-3 hours. The half-life of prazosin is 3-4 hours. The latent period of the drug is 30-60 minutes, the duration of action is 4-6 hours. It is metabolized in the liver. 90% of prazosin and its metabolites are excreted through the intestines, the rest through the kidneys. The drug is taken 2-3 times a day, the daily dose is 3-20 mg. Prazosin is characterized by a “first dose” effect - a sharp decrease in blood pressure after taking the first dose of the drug, so treatment begins with small doses of the drug (0.5-1 mg). The drug causes postural hypotension, weakness, drowsiness, dizziness, and headache.

Doxazosin is a long-acting α-blocker. The drug has a beneficial effect on the blood lipid profile and does not cause the “first dose” effect. Doxazosin is almost completely absorbed from the gastrointestinal tract. Food slows down the absorption of the drug by about 1 hour. Bioavailability of doxazosium is 65-70%. The maximum concentration in the blood is determined 2-3.5 hours after taking the drug. Half-life 16-22 hours. Duration of action - 18-36 hours. Doxazosin is prescribed once a day.

Phentolamine is a non-selective α-blocker. It is mainly used in the treatment of hypertensive crises associated with hypercatecholemia, for example, in patients with pheochromocytoma. In addition, phentolamine is used for diagnostic purposes when pheochromocytoma is suspected.

BLOCKERSα- and β-ADRENORESCEPTORS.

Labetalol (trandate) is a β-adrenergic blocker, which simultaneously has an α 1 -adrenergic blocking effect. Labetalol as an α-adrenergic blocker is 2-7 times less active than phentolamine, and as a β-adrenergic blocker it is 5-18 times less active than anaprilin. the drug has a hypotensive effect, mainly due to a decrease in peripheral vascular resistance. Labetalol has little effect on cardiac output and heart rate. The main indication for the use of the drug is hypertensive crisis.

DIURETICS

Diuretics have been used for hypertension for a long time, but in the beginning they were used as auxiliaries. Now many drugs can be used for long-term monotherapy of hypertension.

Considering the negative significance of increasing the concentration of sodium ions in the plasma and vascular wall in the pathogenesis of hypertension, the main role in treatment belongs to saluretic drugs - drugs whose mechanism is associated with the inhibition of sodium and chlorine reabsorption. These include benzothiadiazine derivatives and heterocyclic compounds. The latter are often called thiazide-like diuretics.

In emergency situations, for example during a hypertensive crisis, stronger drugs are used - “loop” diuretics: furosemide and ethacrynic acid. Potassium-sparing diuretics play a supporting role and are usually prescribed with thiazide and loop diuretics to reduce potassium loss.

The initial decrease in blood pressure with the use of saluretic diuretics is associated with an increase in sodium excretion, a decrease in plasma volume, and a decrease in cardiac output. After two months, the diuretic effect decreases and cardiac output normalizes. This is due to a compensatory increase in the concentration of renin and aldosterone, which prevent fluid loss. The hypotensive effect of diuretics at this stage is explained by a decrease in peripheral vascular resistance, most likely due to a decrease in the concentration of sodium ions in vascular smooth muscle cells. Diuretics reduce both systolic and diastolic pressure and have a slight effect on cardiac output.

Hydrochlorothiazide (hypothiazide, esidrex)- a diuretic of medium strength and duration, a typical representative of thiazide diuretics. The drug primarily increases the excretion of sodium, chlorine and secondarily water, mainly in the initial part of the distal tubules of the nephron. Hydrochlorothiazide is well absorbed from the gastrointestinal tract. The latent period of the drug is 1-2 hours, the maximum effect develops after 4 hours, the duration of action is 6-12 hours. 95% of hydrochlorothiazide is excreted unchanged in the urine.

The drug is prescribed during or after meals, 25-100 mg/day in 1-2 doses in the first half of the day. With long-term use of the drug, the development of hypokalemia, hyponatremia, hypomagnesemia, hypochloremic alkalosis, and hyperuricemia is possible. Hydrochlorothiazide may cause weakness, leukocytopenia and skin rash.

Indapamide (arifon) It has not only a diuretic effect, but also a direct vasodilator effect on the systemic and renal arteries. The decrease in blood pressure when using the drug is explained not only by a decrease in sodium concentration, but also by a decrease in total peripheral resistance due to a decrease in the sensitivity of the vascular wall to norepinephrine and angiotensin II, an increase in the synthesis of prostaglandins (E 2), and a weak anti-calcium effect of the drug. With long-term use in patients with moderate hypertension and impaired renal function, indapamide increases the glomerular filtration rate. The drug is well absorbed from the gastrointestinal tract, the maximum concentration in the blood is determined after 2 hours. In the blood, the drug is 75% protein bound and can reversibly bind to red blood cells. The half-life of indapamide is approximately 14 hours. 70% of it is excreted through the kidneys, the rest through the intestines. Indapamide at a dose of 2.5 mg 1 time per day has a prolonged hypotensive effect. Side effects when using indapamide are observed in 5-10% of patients. Nausea, diarrhea, skin rash, and weakness may occur.

Furosemide (Lasix)- a strong, short-acting diuretic. Furosemide interferes with the reabsorption of sodium and chloride ions in the ascending limb of the loop of Henle. The latent period of furosemide when administered enterally is 30 minutes, when administered intravenously - 5 minutes. The effect of the drug when taken orally lasts 4 hours, when administered intravenously - 1-2 hours. Intravenous administration of the drug at a dose of up to 240 mg/day is used to relieve a hypertensive crisis. Side effects: hypokalemia, hyponatremia, hypochloremic alkalosis, dizziness, muscle weakness, convulsions.

Ethacrynic acid is similar in pharmacodynamic and pharmacokinetic parameters to furosemide.

Spironolactone is a potassium-sparing diuretic with a steroid structure. The drug is an aldosterone antagonist and acts at the level of the distal convoluted tubules and collecting ducts. It has a weak and inconsistent hypotensive effect, which manifests itself 2-3 weeks after the drug is prescribed. The indication for use of the drug is hypertension with adrenal aldosterome. Side effects: nausea, vomiting, dizziness, gynecomastia, in women - menstrual irregularities.

ANGIOTENSIN CONVERTING FACTOR INHIBITORS (ACEI).

The renin-angiotensin system is of particular importance in the development and progression of arterial hypertension and heart failure. The function of the renin-angiotensin-aldosterone system (RAAS) is to regulate fluid and electrolyte balance, blood pressure and blood volume. The main components of the RAAS are angiotensinogen, angiotensin I, angiotensin II. Renin, angiotensin-converting enzyme, as well as angiotensinase, an enzyme that destroys angiotensin II, take part in the activation and inactivation of these components.

In the secretion of renin, the main role is played by the cells of the juxtaglomerular (JG) apparatus in the wall of the afferent arterioles of the glomeruli of the kidneys. Renin secretion occurs in response to a drop in blood pressure in the renal vessels below 85 mm or to an increase in β 1 -sympathetic activity. Renin secretion is inhibited by angiotensin II and vasopressin. Renin converts α-globulin - angiotensinogen (synthesized in the liver) into angiotensin I. Another enzyme, angiotensin-converting enzyme (ACE), transforms angiotensin I into angiotensin II. The effects of angiotensin II on target cells are carried out through angiotheisin receptors (AT). Information is transmitted intracellularly by regulatory G proteins. They inhibit adenylate cyclase or activate phospholipase C or open calcium channels in the cell membrane. These processes cause various cellular effects of target organs. First of all, this concerns changes in the tone of smooth muscle cells of the vascular walls. Activation of the RAAS leads to vasoconstriction as a result of the direct effect of AP on vascular smooth muscle cells and secondarily as a result of aldosterone-dependent sodium retention. The resulting increase in blood volume increases preload and cardiac output.

The study of the RAAS has led to the creation of ACE inhibitors, which have a therapeutic effect in various pathologies, primarily hypertension and heart failure.

The mechanism of the hypotensive effect of ACE inhibitors:

1. The drugs, by inhibiting ACE activity, reduce the formation or release of vasoconstrictor substances that affect sodium retention such as angiotensin II, aldosterone, norepinephrine, and vasopressin.

2. The drugs increase the content in tissues and blood of such vasorelaxants as bradykinin, prostaglandins E 2 and I 1, endothelial relaxation factor, atrial natriuretic hormone.

3. Reduced sodium retention as a result of decreased aldosterone secretion and increased renal blood flow.

ACE inhibitors relatively rarely cause side effects. In addition to allergic reactions, the most well-known is the appearance of a dry cough. There is an assumption that the reason for this may be excessive release of bradykinin in the bronchial mucosa. Cough is noted in 8% of patients taking ACE inhibitors for a long time.

From the group of angiotensin-converting enzyme inhibitors, captopril, enalapril maleate, lisinopril, which is a metabolite of enaprilin, and ramipril are used in clinical practice.

There are short-acting drugs (captopril) and long-acting (more than 24 hours) drugs (enalapril, lnzinopril, ramipril).

Captopril (Capoten) reduces blood pressure at any initial renin level, but to a greater extent at elevated levels. Captopril helps increase serum potassium levels. Captopril is rapidly absorbed from the gastrointestinal tract. Eating reduces its bioavailability by 35-40%. Only 25-30% of the drug binds to plasma proteins. Its maximum concentration in the blood is achieved within 1 hour. The half-life of free captopril is 1 hour, and in combination with the metabolite it is 4 hours. The drug is prescribed orally, starting with a dose of 25 mg 2-3 times a day. The most common side effects are cough, skin rash and loss of taste. After stopping treatment, these symptoms disappear.

Enaladril maleate (Renitec) when taken orally is hydrolyzed and converted into the active form - enalaprilat. Its bioavailability is about 40%. After oral administration in healthy people and patients with arterial hypertension, the drug is detected in the blood after 1 hour and its concentration reaches a maximum after 6 hours. Half-life is 4 hours. In the blood, enalapril maleate is 50% protein bound and excreted in the urine. The drug is prescribed for arterial hypertension and heart failure at a dose of 5-10 mg 2 times a day. Side effects occur very rarely.

1-ANGIOTENSIN RECEPTOR BLOCKERS (AT1)

Angiotensin 1 receptor blockers (AT1) are used to treat hypertension. The main cardiovascular and neuroendocrine effects of AT1 receptor blockers:

Systemic arterial vasodilation (decrease in blood pressure, decrease in total peripheral vascular resistance and afterload on the left ventricle);

Coronary vasodilation (increased coronary blood flow), improvement of regional blood circulation in the kidneys, brain, skeletal muscles and other organs;

Reversal of left ventricular hypertrophy (cardioprotection);

Increased natriuresis and diuresis, potassium retention in the body (potassium-sparing effect);

Decreased aldosterone secretion,

Decreased functional activity of the symlatico-adrenal system.

According to the mechanism of action, AT1 receptor blockers are in many ways similar to ACE inhibitors. Therefore, the pharmacological effects of AT1 blockers and ACE inhibitors are generally similar, but the former, being more selective RAAS inhibitors, are less likely to produce side effects.

Losartan is the first non-peptide AT1 receptor blocker. After oral administration, losartan is absorbed from the gastrointestinal tract, the concentration of the drug in the blood plasma reaches a maximum within 30-60 minutes. The antihypertensive effect of the drug persists for 24 hours, which is explained by the presence of an active metabolite, which blocks AT1 receptors 10-40 times more powerfully than losartan. In addition, the metabolite has a longer half-life in blood plasma - from 4 to 9 hours. The recommended dose of losartan for the treatment of arterial hypertension is 50-100 mg / day in one dose. Contraindications to the prescription of AT1 receptor blockers are: individual intolerance to the drug, pregnancy, breastfeeding.

Slow calcium channel blockers

The hypotensive effect of calcium antagonists is associated with a decrease in the content of free calcium in the cytoplasm of cells due to disruption of the entry of calcium into the cell through voltage-dependent slow calcium channels. This leads to relaxation of vascular smooth muscle cells (reduction of total peripheral resistance) and a decrease in the contractile activity of cardiomyocytes. In the treatment of hypertension, long-acting drugs are used, because they do not cause reflex stimulation of the sympathetic nervous system. Such drugs include amlodipine, mibefradil and retard forms of verapamil, diltiazem, nifedipine.

Calcium channel blockers are relatively well tolerated by patients. Amlodipine, diltiazem and mibefradil have minimal side effects. The side effects of drugs are determined by the chemical structure. Thus, when using verapamil, constipation is often observed, and severe bradycardia, conduction disorders, and heart failure may develop. Taking dihydropyridines is often accompanied by redness of the skin, a feeling of heat, and swelling, usually localized on the feet and legs.

Medicines with a central mechanism of action.

Centrally acting drugs reduce the activity of the vasomotor center of the medulla oblongata.

Clonidine, an imidazoline derivative, is a central mimetic of α 2 -adreno- and I 1 -imidazoline receptors. The drug stimulates the receptors of the nuclei of the solitary tract of the medulla oblongata, which leads to inhibition of neurons of the vasomotor center and a decrease in sympathetic innervation. The hypotensive effect of the drug is a consequence of a decrease in cardiac activity and general peripheral vascular resistance. Clonidine is well absorbed from the gastrointestinal tract. When taken orally, the latent period of the drug is 30-60 minutes, when administered intravenously - 3-6 minutes. The duration of action varies from 2 to 24 hours. Clonidine is excreted from the body by the kidneys mainly in the form of metabolites. When the drug is suddenly discontinued, a “recoil” syndrome occurs - a sharp increase in blood pressure. Clonidine has a sedative and hypnogenic effect, potentiates the central effects of alcohol, sedatives, and depressants. Clofeliv reduces appetite, secretion of the salivary glands, and retains sodium and water.

Moxonidine (cinth)- selective agonist of I 1 -imidazoline receptors. Activation of imidazoline receptors in the central nervous system leads to a decrease in the activity of the vasomotor center and a decrease in peripheral vascular resistance. In addition, the drug inhibits the renin-angiotensin-aldosterone system. The drug is well absorbed from the gastrointestinal tract and has high bioavailability (88%). The maximum concentration in the blood is recorded after 0.5 -3 hours. 90% of the drug is excreted by the kidneys, mainly (70%) unchanged. Despite its short half-life (about 3 hours), moxodonine controls blood pressure throughout the day. The drug is prescribed 0.2-0.4 mg once a day in the morning. Moxonidine may cause fatigue, headaches, dizziness, and sleep disturbances.

Vasodilators.

Vasodilators for the treatment of arterial hypertension are represented by drugs of two groups; arteriolar (hydrolazine, disacoid and minocoid) and mixed (sodium nitroprusside and isosorbide dinitrate). Arteriolar vasodilators dilate resistance vessels (arterioles into small arteries) and reduce total peripheral resistance. In this case, there is a reflex increase in cardiac activity and an increase in cardiac output. The activity of the sympathoadrenal system increases, followed by the secretion of renin. The drugs cause sodium and water retention. Mixed-action drugs also cause dilation of capacitance vessels (venules, small veins) with a decrease in venous return of blood to the heart.

Hydralazine (apressin)- due to the large number of side effects (tachycardia, pain in the heart, facial flushing, headache, lupus erythematosus syndrome), it is rarely used and only in the form of ready-made combinations (adelfan). Hydralazine is contraindicated for stomach ulcers and autoimmune processes.

Diazoxide (hyperstat)- arteriolar vasodilator - activator of potassium channels. The effect on potassium channels leads to hyperpolarization of the muscle cell membrane, which reduces the entry of calcium ions into the cells necessary to maintain vascular tone. The drug is used intravenously for hypertensive crisis. Duration of action is about 3 hours.

Minoxidil is an arteriolar vasodilator - an activator of potassium channels. The drug is well absorbed from the gastrointestinal tract. Half-life is 4 hours. Mnnoxidil is used orally 2 times a day.

Sodium nitroprusside (niprid)- mixed vasodilator. The hypotensive effect of the drug is associated with the release of nitric oxide from the drug molecule, which acts similarly to the endogenous endothelial-relaxing factor. Thus, its mechanism of action is similar to nitroglycerin. Sodium nitroprusside is prescribed intravenously for hypertensive crises and acute left ventricular failure. Side effects: headache, anxiety, tachycardia.

Sympatholytics

(see lecture "Adrenolytics") Sympatholytics include reserpine and octadine.

Reserpine is a rauwolfia alkaloid. The drug disrupts the deposition of norepinephrine in vesicles, which leads to its destruction by cytoplasmic monoamine oxidase and a decrease in its concentration in varicose thickenings. Reserpine reduces the content of norepinephrine in the heart, blood vessels, central nervous system and other organs. The hypotensive effect of reserpine when administered orally develops gradually over several days, after intravenous administration of the drug - within 2-4 hours. Side effects of reserpine: drowsiness, depression, stomach pain, diarrhea, bradycardia, bronchosiasm. The drug causes sodium and water retention in the body.

Ectadin disrupts the release of norepinephrine and prevents the reuptake of the neurotransmitter by sympathetic endings. The decrease in blood pressure is caused by a decrease in cardiac output and a decrease in total peripheral vascular resistance. Bioavailability of the drug is 50%. Half-life is about 5 days. The drug causes postural hypotension, sodium and water retention in the body, dizziness, weakness, swelling of the nasal mucosa, and diarrhea. Rarely used.

1. Pharmacodynamic characteristics
2. Release form and composition
3. Instructions for Moxonidine
4. How the drug works
5. How does Moxonidine interact with other medications?
6. Common adverse reactions to Moxonidine
7. Main contraindications to taking Moxonidine
8. Moxonidine and its foreign analogues
9. Moxonidine and alcohol
10. Features of treatment for pregnant women
11. Impact on ability to drive
12. Efficacy of the drug
13. Help with overdose
14. For whom is Physiotens indicated and contraindicated?
15. Reviews about Mosconidine

Moxonidine is a medicine used by cardiologists and neurologists to treat patients with high blood pressure. The main substance of the same name, which is part of the drug, acts on imidazoline receptors of the nervous system, which are located in the ventrolateral part of the medulla oblongata.

The substance lowers blood pressure, fighting arterial hypertension. When taken over a long period of time, the medicine relieves left ventricular myocardial hypertrophy and tissue fibrosis that develops against the background of the underlying disease.

The price of Moxonidine is affordable; it is available for sale in all pharmacies. You do not need a doctor's prescription to purchase it. the drug belongs to the category of relatively new ones; it has recently been used in medical practice, but has already gained the trust of patients and doctors.

Stress, trauma, bad habits, high cholesterol, infections, age-related changes in blood vessels and poor heredity increase the number of hypertensive patients. Today, at least 40% of Russians are familiar with high blood pressure. In addition to revising your lifestyle, adequate drug therapy is also important.

One of the modern drugs effectively used in the treatment of hypertension is Moxonidine Canon. This is a trade version of the name, the international format is Moxonidine canon. There are also synonyms - Physiotens, Tenzotran, etc. Pharmacotherapeutic group - centrally acting antihypertensive drug ATC.

Pharmacodynamic characteristics

Moxonidine is a medication with antihypertensive properties. The mechanism of influence is based on the effect of the active component on the central links that regulate blood pressure. The medication belongs to the group of selective antagonists of imidazoline receptors that control the sympathetic nervous system. By stimulating these receptors, the drug, through interneuron blockers, inhibits the activity of descending sympathetic influences on the heart and blood vessels. This allows you to gradually reduce the upper and lower limits of blood pressure both with one-time use and with regular use. Even with prolonged use, heart rate and cardiac output are maintained.

With long-term treatment, Physiotens reduces myocardial hypertrophy of the left ventricle, reduces the symptoms of microarteriopathy, myocardial fibrosis, and restores myocardial capillary blood flow. Against the background of such therapy, norepinephrine, epinephrine, angiotensin II, and renin are not active.

Moxonidine differs from its analogues in its weak similarity to α2-adrenergic receptors, which provides it with a low likelihood of sedative effects and symptoms of dry mouth. In overweight hypertensive patients with high insulin resistance, the drug increases cell sensitivity to insulin by 21% (when comparing the effect with placebo). The drug does not affect lipid metabolism.

Pharmacokinetic effects

When used internally, Moxonidine, as stated in the instructions for use, is quickly and completely processed in the gastrointestinal tract with a bioavailability of up to 88%. The greatest therapeutic effect of the drug is achieved within an hour. The maximum concentration (Cmax) in the blood is observed after 30-180 minutes with internal use and reaches 1-3 ng/ml. Volume of distribution - 1.4-3 l/kg.

The pharmacokinetics of the drug does not depend on the time of food intake. Moxonidine binds to blood protein by 7.2%. The main metabolites of the drug are guanidine derivatives and dehydrogenated moxonidine. The latter of them has a pharmacodynamic activity of up to 10% (when compared with the original).

The half-life of Moxonidine is two and a half hours, for the metabolite it is about five hours. During the day, 90% of the drug is excreted by the kidneys, the intestines account for no more than 1%.

Pharmacokinetics in hypertension and renal failure

In case of hypertension, no changes in the pharmacokinetics of the drug were recorded. Minor changes in these parameters are observed in adulthood. This is due to a reduction in metabolic activity and slightly increased bioavailability.

In renal pathologies, the pharmacokinetics of Physiotens is predominantly correlated with creatinine clearance (creatinine clearance). If the symptoms of renal pathology are moderate (with CC 30-60 ml/min), the blood level and the final T/2 period are 2 and 1.5 times higher than in hypertensive patients with normal kidneys (with CC more than 90 ml/min).

In case of serious kidney pathologies (CK - up to 30 ml/min.), the concentration in the blood and the final T/2 period are three times greater when compared with a normally functioning organ. In patients diagnosed with end-stage renal failure (creatinine clearance less than 10 ml/min), the same indicators are 6 and 4 times higher. For all of these categories of patients, the dose is determined differentially.

About the benefits of the medicine, watch the video “Doctor, prescribe Physiotens!”

Release form and composition

The active ingredient is moxonidine. Fillers include Tween, magnesium stearate, cellulose, Aerosil, castor oil.

The pharmacy chain receives the medicine in paper packaging. One box contains 10-98 round, convex white tablets on both sides with a pink film coating. The surface of the pills may be matte. The tablets are packaged in blisters, 14 pieces each. One box can contain from 1 to 7 blisters.

Tablets of different dosages have different markings: “0.2”, “0.3”, “0.4”. When prescribing different doses, such labeling is very convenient. Moxonidine is well tolerated by obese hypertensive patients and diabetics (type 2). With regular use of the drug, slight weight loss is even observed (1-2 kg in six months).

Instructions for Moxonidine

Detailed instructions for using Moxonidine are contained in each pack of this medicine. Its common form is tablets. One blister contains 14 or 20 tablets, each containing 200 mg of active ingredient, which is a standard single dose.

The daily dosage in severe cases can be increased to 600 mg, that is, three tablets. It is advisable to divide them into several steps. This method of use is appropriate for symptomatic treatment of high blood pressure; a single dose should not exceed two tablets.

The effect of the drug is observed quickly. To determine its effectiveness, it is necessary to measure blood pressure every 10-15 minutes during a hypertensive crisis. Many patients suffering from these conditions do not experience any associated symptoms when their blood pressure is very high.

This is a serious problem because they may miss the moment when they need to see a doctor immediately. The consequences of this state of affairs are sad.

As a consequence of hypertension, cerebral hemorrhages, myocardial infarctions, and other serious problems of the cardiovascular and nervous system occur. Sometimes it is no longer possible to help such patients.

To prevent such consequences, it is necessary to constantly monitor blood pressure, respond promptly to even the slightest increase, follow the doctor’s recommendations for treatment, and not use Moxonidine only symptomatically.

The medication is intended for internal use. Drink a tablet with water at the same time of day (preferably in the morning), usually at one time, regardless of meals. At the first stage of treatment, the dosage does not exceed 200 mcg. Take it once a day. If the body responds normally to the medicine, you can gradually adjust the dose within 600 mcg, distributing this amount over two times. The maximum dosage is rarely used.

For renal pathology of moderate severity and higher, as well as for hemodialysis, the initial dosage of the drug Moxonidine Canon according to the instructions does not exceed 200 mcg/day. If the body reacts normally, the dose can be adjusted to a maximum of 400 mg/day.

For mature patients in the absence of kidney problems, dosage advice is general. In case of a sharp increase in pressure (for example, in the heat, when stopping a hypertensive crisis), the emergency doctor recommends only Physiotens among all antihypertensive drugs: one tablet orally and one tablet sublingually.

Blood pressure is guaranteed to stabilize and headaches go away. The advantage of Moxonidine is that it will not reduce blood pressure below normal, which means that the patient is not at risk of cerebrovascular accident (mini-stroke). In the future, the doctor may prescribe another drug or leave Physiotens, but in terms of first aid it is indispensable and there are no side effects from one dose.

The drug is used mainly in complex treatment. Monotherapy guarantees the desired result only for half of hypertensive patients. There is evidence of insufficient effect of treatment with Moxonidine in women during menopause.

How the drug works

Moxonidine is an agonist of imidazoline receptors; it does not block them, but increases the response, thereby relieving vasospasm and reducing blood pressure. The effect of taking it is noticeable after 20-30 minutes and lasts up to 12 hours.

With constant use of the drug, not only blood pressure decreases, but also pulmonary vascular resistance. If a patient experiences difficulty breathing during a crisis and cannot breathe deeply, the drug quickly combats this problem, returning the patient to normal, removing the patient from a state of shock.

The advantage of Moxonidine is that it acts in combination on different systems and internal organs of a person, without negatively affecting their functions. It is advisable to take it in courses according to the scheme prescribed by the attending physician.

How does Moxonidine interact with other medications?

Moxonidine can be taken together with diuretics, which are often prescribed to combat high blood pressure. This drug is used in combination with calcium antagonists. The effectiveness of drugs with such a complex use does not decrease.

It is allowed to take Moxonidine with other antihypertensive drugs, the overall effect is enhanced, so the calculation of single and daily doses must be carried out with special care. Simultaneous use with tranquilizers and antidepressants, beta-blockers is undesirable. Using the drug together with sedatives enhances the sedative effect of taking the latter.

Knowing about such features of the drug, the doctor and the patient are able to jointly develop an optimal treatment regimen in order to achieve the maximum therapeutic effect.

Parallel use of Physiotens and other drugs that lower blood pressure provides an additive effect. Tricyclic antidepressants can reduce the potential of antihypertensive medications, so they are not taken with Moxonidine. The medicine accelerates the effects of tranquilizers and antidepressants. In individuals taking Lorazepam, the medication slightly improves weakened cognitive functions.

Physiotens is a catalyst for the sedative properties of benzodiazepine derivatives, if patients receive them in parallel. The drug is released by tubular secretion; other drugs with the same properties come into contact with it.

Common adverse reactions to Moxonidine

Adverse reactions to Moxonidine occur in various organs and systems:

Most side effects are rare, but if they occur and you are sure that the cause is taking Moxonidine, you should completely stop taking the drug and see your doctor. He will try to determine why the reaction occurred, eliminate it and prescribe adequate therapy so that the unpleasant situation does not recur.

The likelihood of adverse symptoms occurring is assessed according to the WHO classification: very often (over 10%), often (up to 10%), infrequently (>0.1% and<1%), редко (>0.01% and<0,1%), очень редко (<0.01%).

Main contraindications to taking Moxonidine

Some patients have strict or relative contraindications to the continuous and intermittent use of Moxonidine. This list includes the following conditions and diseases:

The final decision to refuse to take Moxonidine is made by the attending physician. If you have high blood pressure, you should not self-medicate. You should definitely contact a medical institution, where they will provide emergency care and prescribe further treatment to stabilize the condition.

During pregnancy, the use of Moxonidine is strictly contraindicated. During this period, increased blood pressure often occurs in women, due to physiological changes in the body, but the use of imidazoline receptor agonists during this period is contraindicated.

Moxonidine and its foreign analogues

On the shelves of pharmacies, in addition to domestic Moxonidine, you can find foreign analogues of this drug. The most popular of them is Physiotens. This German drug contains the same active ingredient, but its price is significantly more expensive. When wondering which is better, Physiotens or Moxonidine, you must understand that these medications do not have any significant differences. Mosconidine preparations are also commercially available under trade names such as Moxonidine-SZ, Moxonidine CANON, and Tenzotran. You can safely use analogues if the usual medicine is not on sale. The dosage of the active substance is the same in all drugs.

You can buy Moxonidine, a popular drug for quickly normalizing blood pressure, without a prescription and at an affordable price. For example, a blister with 14 tablets sells for an average of 120 rubles. If Moxonidine is not available in pharmacies or the medicine is not suitable, the doctor replaces it with analogues:

Physiotens is an original remedy, the others have a similar effect. The composition of alternative drugs has some differences, but they have a common active base component. The decision about the possibility of replacing Moxonidine should be made by a doctor. It would also be a good idea to read the instructions in detail.

Moxonidine and alcohol

Taking Moxonidine and alcohol together is strictly contraindicated. Sometimes blood pressure rises significantly under the influence of alcohol-containing drinks. In a state of alcoholic intoxication, the patient's blood vessels dilate, which leads to negative consequences. If you have already had attacks of hypertension, it is advisable to completely stop drinking intoxicating drinks, even in small doses.

If a hypertensive crisis occurs against the background of a hangover, it is first necessary to detoxify the body. It is advisable to carry out such activities in a hospital or outpatient setting, or under the supervision of a physician. The pressure level should be monitored at regular intervals.

Features of treatment for pregnant women

The effect of the drug on pregnant women has not been sufficiently studied. And although there are no clinical data, the toxic effect of the drug on animal embryos has been proven, which means that it is better for pregnant women to refrain from taking the drug. It is prescribed only when the expected effect of therapy for the mother significantly outweighs the danger of consequences for the child.

Physiotens gets into mother's milk, so when prescribing it, nursing mothers need to decide on stopping lactation.

Impact on ability to drive

While taking the drug, you must be careful while driving, on the assembly line and during other potentially dangerous activities, as concentration and psychomotor reactions may be reduced.

Efficacy of the drug

Cardiologists and patients leave positive reviews about Moxonidine. It is highly efficient. The likelihood that blood pressure will not decrease after taking it is extremely low.

Some patients have an individual reaction to the components of the drug. If you have never taken it before, the first single dose should be halved in order to assess the body’s reaction to it and take timely measures to eliminate negative consequences. If there are no side effects, it is allowed to continue treatment with full doses.

Help with overdose

An overdose of the drug can be determined by:

Symptoms of a sharp increase in blood pressure, hyperglycemia, and increased heart rate are also allowed.

A specific antidote for reversing an overdose has not been developed. Immediately after poisoning, it is advisable for the victim to rinse the stomach, take activated charcoal and a laxative; otherwise, treatment is in accordance with the symptoms.

If blood pressure drops significantly, blood circulation must be restored by taking additional fluids and Dopamine injections. Bradyardia is eliminated with Atropine.

α-adrenergic receptor antagonists will also help relieve the symptoms of transient hypertension. You can take Physiotens with thiazide diuretics and calcium channel blockers.

For whom is Physiotens indicated and contraindicated?

Moxonidine is prescribed only to hypertensive patients. Not recommended for:

Use the medicine with caution for Parkinson's disease, glaucoma, epileptic seizures, depression, and Raynaud's disease.

When treating hypertensive patients with AV block of the first degree, threatening cardiac arrhythmia, pathology of the coronary vessels, after myocardial infarction, with ischemic disease, unstable angina (not enough experience has been accumulated), it is also necessary to constantly monitor the readings of the tonometer, ECG, and CC.

There are no statistics stating that stopping the medication increases blood pressure, but it is better to stop treatment gradually, reducing the dose over 2 weeks.

Reviews about Mosconidine

Reviews about Moxonidine Canon are mostly positive. Hypertensive patients note its good compatibility with other tablets, effective work during the day after taking one tablet, improvement of metabolic processes in case of excess weight, independence of taking the medicine from lunches or breakfasts.

Inna Kovalskaya, 40 years old: For the last 5 years I have been suffering from severe hypertension, I am actively fighting the problem, because my heart is already beating. I found a good cardiologist, he recommended Moxonidine. I am very pleased with this drug. The main thing is to take it in a timely manner. The pressure decreases gradually, there is no headache or nausea. I always have a blister of these tablets in my medicine cabinet at home.

Ivan Kropkin, 64 years old: After suffering a stroke, I am very afraid of high blood pressure, but attacks of hypertension sometimes occur. The doctor recommended Moxonidine. At first I took the German equivalent for a long time, everything suited me, but one day it wasn’t in the pharmacy, so I bought a domestic drug. It turned out that there is not much difference, but the price is significantly different. Now I'm treating sparingly.

Inna: Moxonidine helps me. It’s convenient to take: drink it in the morning and you feel in shape all day. I don't see any side effects. I saw similar tablets in pharmacies - Moxonidine Sandoz. Maybe it's worth a try?

Kirill: If the doctor selected the pills for you so successfully, why change them? Moreover, the composition of the analogues is approximately the same. According to the cardiologist's prescription, I take Physiotens 0.2 mg. It’s good that taking the medicine does not depend on food, since I take it at night. The pressure doesn't bother me.

Svetlana: I’ve been controlling my blood pressure with Noliprel A for 15 years now. I don’t know if I’m used to it or if the tablets are now not as high quality, but recently my blood pressure has started to jump again. The doctor prescribed me additional Moxonidine. The price is affordable for pensioners - 200 rubles, I feel much more confident. Sometimes I feel chilly (I take aspirin) or feel stuffy (validol helps), but this is normal for my health.

Hypertension drugs

Hypertension is characterized by increased blood pressure. Many people over 45 years of age suffer from it. The problem especially often concerns patients who do not follow a healthy lifestyle and have pathologies of the cardiovascular system. It is impossible to completely recover from the disease; it only progresses over time. Drug therapy is used to alleviate the condition. It includes various tablets for hypertension based on natural and artificially synthesized components. They can be used only after the approval of the attending physician in order to avoid adverse reactions.

Features of therapy

Arterial hypertension is recorded when indicators exceeding 140/90 mm Hg are detected. Art. If blood pressure is persistently elevated, then the doctor, after a series of measurements at different times, will diagnose “hypertension.” According to the international classification, there are 2 types:

• Essential (primary) form of hypertension occurs in almost 90% of patients.
• A symptomatic (secondary) type of pathology, which is detected in approximately 10% of cases.

The development of hypertension is influenced by many external (constant stress and overload) and internal factors (diseases, hormonal imbalances, pregnancy, medications). Its form is revealed through a comprehensive examination. Based on generally accepted standards, the specialist will draw up a treatment regimen. Its effectiveness depends on the correct choice of drugs and the patient’s compliance with all doctor’s recommendations. Treatment will be carried out at home. There are people in hospital in serious condition who require constant monitoring by medical personnel.

The essence of tablets with an antihypertensive effect is to lower blood pressure by providing a vasodilator effect. If hypertension suffers from tachycardia, bradycardia, atrial fibrillation and other types of heart failure, then medications from the antiarrhythmic group are used. Most of them can be taken for arterial hypertension or combined with the main course of therapy.

It is recommended to entrust the determination of the required dose of the drug to a doctor. His job includes assessing all possible risks and choosing the most effective drugs. In the presence of other diseases that cause pressure surges and disruptions in hemodynamics (atherosclerosis, myocardial hypertrophy, ischemia), other drugs will be included in the treatment regimen.

The effectiveness of monotherapy (that is, treatment with 1 drug) is quite high only in the early stages of hypertension. Gradually, other medications are introduced into the treatment regimen, or the current ones are replaced with new ones, with a combined effect. It is equally important to periodically replace medications with similar analogues. This is due to the body’s gradual adaptation to the drugs, which causes their therapeutic effect to be lost.

Groups of medications with antihypertensive properties

Finding good drugs with a prolonged (extended) effect is not difficult, given their number on the pharmacological market. The most important thing is to study the mechanism of how the medicine works, and then, focusing on the cause of the problem, make the right choice. According to this criterion, antihypertensive drugs are divided into the following groups:

• adrenergic blockers;
• drugs that affect the RAAS;
• calcium antagonists;
• diuretics;
• centrally acting drugs.

The above list is considered the most relevant when drawing up a drug treatment regimen for arterial hypertension. Additionally, doctors can prescribe vitamin complexes, homeopathic remedies, sedative tablets and medications based on natural ingredients.

Adrenaline blockers

Treatment of hypertension with drugs from the group of adrenergic blockers involves reducing the effect of adrenaline and norepinephrine on the heart muscle. These excitatory neurotransmitters have a hypertensive effect, as they contribute to vasoconstriction and increased contractions. If you start blocking the receptors that perceive them in a timely manner, you will be able to avoid heart failure, hypertensive encephalopathy, left ventricular hypertrophy and other complications.

Medicines from this group according to their mechanism of action are divided into 2 types:

• Non-selective blockers affect all adrenaline receptors in the body. Because of them, there is a pronounced decrease in the upper and lower pressure limits.
• Selective (cardioselective) drugs act on receptors localized in the heart. Their course intake allows you to fix the pressure within the permissible limit, without provoking the development of serious complications, unlike drugs from the previous group.

Alpha and beta adrenergic receptors are located in the walls of blood vessels. For the treatment of hypertension, drugs belonging to the group of beta-blockers are predominantly used. Their purpose is relevant for an adult suffering from the following diseases:

• hypertension;
• chronic heart failure;
• increased heart rate;
• condition after the acute phase of a heart attack;
• obstructive pulmonary diseases;
• asthma;
• high intracranial pressure;
• kidney pathologies.

It is recommended to take alpha-blockers in the following cases:

• diabetes;
• hypertension;
• BPH;
• pulmonary hypertension.

• hypertrophic cardiomyopathy;
• vegetative-vascular dystonia;
• headaches caused by migraines;
• withdrawal syndrome.

Drugs that affect the RAAS

RAAS stands for renin-angiotensin-aldosterone system. With its help, the required concentration of water and salts remains in the body. Balance is maintained by regulating vascular tone and kidney function. A small malfunction in the RAAS is enough to cause problems with blood pressure. They can be prevented by using tablets that affect this system. They are divided into 2 types:

• ACE inhibitors slow down the synthesis of angiotensin II, which causes vasoconstriction and increases blood pressure. They are used to achieve a fast or slow but prolonged effect. In the first case, the tablet should be taken sublingually (under the tongue), and in the second, after waking up, 1 time per day. A quick result is especially important during the development of a crisis and heart attack. Extended action is convenient for chronic disease for a long course of use.
• Angiotensin receptor antagonists (sartans) prevent the substance from exerting its effects, thereby reducing blood pressure. Unlike the first group of drugs, these medications actually do not cause side effects even with a long course of treatment.

Dosages of drugs for hypertension that affect the RAAS are selected individually based on the examination results. This group of tablets is especially in demand in the following cases:

• primary hypertension;
• heart failure;
• recovery period after a heart attack;
• kidney pathologies.

ACE inhibitors and angiotensin receptor antagonists allow you to quickly and without developing dangerous consequences to reduce blood pressure, but they are virtually useless for arrhythmias and pathologies of the nervous system. To relieve such causes, other groups of medications are most often used.

Calcium antagonists

Calcium blockers prevent the element from fully affecting the heart muscle. It stops participating in vasoconstriction, due to which arrhythmia is stopped and pressure drops. If you use medications for hypertension from this group for other purposes or if you choose the wrong dosage, there is a possibility of side effects. It is especially common for a person taking calcium antagonists to experience general weakness, decreased cognitive abilities, and arrhythmia. To avoid consequences, they should be used only in certain cases. Their list is given below:

Many drugs used for hypertension from the group of calcium blockers are necessary only in severe cases. For long-term use, doctors will recommend tablets with fewer side effects and a milder effect on the heart muscle.

Diuretics

For hypertension, the treatment regimen often includes medications from the group of diuretics. Thanks to their influence, excess moisture is removed from the body. The volume of circulating blood rapidly decreases and the severity of the disease decreases.

Side effects are mostly caused by potassium depletion and dehydration. To avoid complications, doctors advise taking potassium-sparing diuretics or drugs based on this element. Diuretics are used in the following cases:

• primary form of hypertension;
• heart failure;
• kidney dysfunction.

Centrally acting medications

If hypertension is caused by disorders of the nervous system, then central-spectrum medications are used. They directly affect the parts of the brain that regulate blood pressure, thereby stabilizing the patient’s condition. Such drugs belong to radical measures of therapy, and therefore are prescribed strictly by the attending physician.

Centrally acting medications are well compatible with other drugs with hypotensive and antiarrhythmic effects. When combining them, special attention is paid to the dosage, since various adverse reactions can be provoked (hypotension, psycho-emotional disturbances, migraines).

Table of the best drugs for hypertension

The form (tablets, capsules, solution or powder for injections) and the mechanism of action are selected individually. The specialist will assess the patient’s condition, learn about possible concomitant pathologies and recommend effective medications. The patient will only have to follow his advice and take it strictly according to the instructions.

Many experts believe that the best drugs to use in the treatment of hypertension are from the table below:

Name

Peculiarities

"Andipal"	Bendazole, papaverine, phenobarbital, matmizole sodium.	A combined remedy that relieves spasms, dilates blood vessels and reduces pain.
"Valocordin", "Corvalol"	Ethyl bromizovalerianate, phenobarbital, mint and hop oil	Medicines consist of several main ingredients, thanks to which they have a sedative and antispasmodic effect. Often these drugs are prescribed for insomnia due to their hypnotic effect. “Corvalol” differs from “Valocardin” in the absence of hop cone oil and lower cost.
"Hypertostop" (gipertostop, hooperstop)	Extract from deer antlers and white willow, St. John's wort, bee venom, ginkgo biloba, chestnut extract	The product is intended to strengthen blood vessels, normalize sugar and cholesterol levels, restore the usual rhythm of sleep and relieve nervous excitability. It is often used to improve hemodynamics and the functioning of the heart muscle, thereby reducing the severity of hypertension and slowing down its development.
"Diroton"	Lisinopril	The drug represents a group of angotensin-converting enzyme inhibitors. I use it as a means to improve hemodynamics and heart function. After a heart attack, Diroton is prescribed to avoid complications.
"Captopril"	Captopril	Due to its active substance, this ACE inhibitor prevents the development of heart failure, increases exercise tolerance and reduces the degree of myocardial proliferation.
"Cardimap"	Sarpagandha, jatamansi, shankhapushpi, brahmi, pippali	Cardimap is a cardiotonic drug based on medicinal herbs. Prescribing the drug is advisable to calm the nervous system, relieve spasms, normalize metabolic processes and improve the functioning of the heart and digestive system.
"Lerkamen"	Lercanidipine	The medicine blocks the flow of calcium, resulting in a hypotensive effect. The patient's peripheral vascular tone decreases, heart rhythm normalizes and blood pressure drops.
"Lozap", "Lorista" "Lozap PLUS"	Losartan, hydrochlorothiazide	The drugs prevent the formation of angiotensin II, which causes blood pressure to drop and the condition of hypertensive patients to stabilize. They are often used to improve blood supply to the heart and kidneys and increase tolerance to stress (psycho-emotional and physical). “Lozap PLUS” differs from “Lozap” and “Lorista” in the presence of a diuretic in the composition (hydrochlorothiazide), which enhances the hypotensive effect.
"Corvitol", "Metoprolol"	Metoprolol	Medicines are effective in the treatment of hypertension, ischemia, and heart failure. They are no less in demand as a means of preventing myocardial infarction. The result is achieved through selective blocking of beta-adrenergic receptors.
"Normalife" (normallife)	Deer antler extract, bee venom, larch and pine needle concentrate, white willow extract.	The remedy is homeopathic. It is prepared from natural ingredients, which prevent the formation of blood clots, strengthen the heart muscle, improve metabolic processes, reduce nervous excitability and reduce cholesterol levels in the body.
"Papazol"	Bedazole, papaverine	The medicine has a combined effect. With its help, you can relieve spasms and nervous tension, dilate blood vessels and normalize blood pressure levels.
"Tenor"	Atenolol, chlorthalidone	The combination of a cardioselective beta-blocker and a diuretic enhances the hypotensive effect of the drug. Its regular use allows you to reduce the heart rate, dilate blood vessels and remove excess moisture from the body, thereby reducing the load on the heart.
	Moxonidine	The drug has a central spectrum of action. Thanks to the effect on the vasomotor center, the release of adrenaline is reduced, the functioning of the cardiovascular system is stabilized and the predominance of the sympathetic nervous system and insulin resistance are reduced.
"Enalapril"	Enalapril	Due to the inhibition of angiotensin II production in patients taking Enalapril, blood vessels dilate, which leads to stabilization of blood pressure and heart rate. With long-term use, it is possible to reduce the severity and rate of development of heart failure and left ventricular hypertrophy.
"Anaprilin"	Propranolol	A decrease in blood pressure after taking this beta-blocker occurs after the first dose. Closer to 3-4 weeks, the effect becomes more lasting. In the presence of coronary heart disease, patients experience angina attacks much less frequently.
"Belisa"	Linden, passionflower, oregano, sage, lemon balm	An effective combination of medicinal plants in the composition of the drug allows you to calm the nervous system, relieve spasms and inflammation, remove excess moisture and improve metabolism.
"Dimecolin"	Captopril, hydrochlorothiazide	The medication blocks the parasympathetic and sympathetic nodes, causing blood pressure to quickly drop. It is used only for hypertensive crises in the form of intravenous and intramuscular injections.
"Normopres"	Captopril, hydrochlorothiazide	The drug has the effect of an ACE inhibitor and diuretic, thereby reducing the preload on the myocardium, the concentration of sodium and moisture in the body, and the resistance in peripheral vessels.
"Recardio" (recardio)	Ginkgo biloba, bee venom, pyridoxine, extracts of St. John's wort, rhodiola and kaupan, biflavonoids extracted from larch, rose hips, hawthorn, lysine, extracts from white willow and deer antlers.	The drug is based on useful substances. With long-term use, it is possible to stabilize blood pressure, improve well-being, reduce the likelihood of complications, stop migraine attacks and dizziness, strengthen blood vessels and normalize metabolic processes.
"Sedistress"	Passionflower, alpha-bromoisovaleric acid ethyl ester	The drug "Sendistress" is used as an addition to the treatment regimen for arterial hypertension. It reduces the activity of the vasomotor center in the brain, reduces nervous tension and has a mild hypnotic and antispasmodic effect.
"Triplixam"	Indapamide, perindopril, amlodipine	A combination of a calcium antagonist, an ACE inhibitor and a diuretic is required only in severe cases. The tablets have a triple effect, due to which the patient’s blood pressure is significantly reduced and heart function is stabilized. It is prescribed strictly by the attending physician so as not to cause an attack of hypotension and other complications.
"Golubitox"	Blueberry extract, pterostilbene, vitamin C, propolis tincture	The medicine helps reduce spasms, relieve headaches, normalize blood pressure, increase tolerance to physical and mental stress and improve metabolic processes in the body.
"Panangin"	Magnesium, potassium	The drug is used as a means of prevention and as a supplement to the treatment regimen for various types of arrhythmias. It is also prescribed to improve the tolerability of cardiac glycosides and replenish nutrients lost due to diuretics.

You can purchase the mentioned medications at virtually any major pharmacy. If you do not have the necessary medication, you can ask the pharmacist how to treat hypertension and buy a drug that is similar in its mechanism of action.

Contraindications

Any medicine has certain contraindications. If they are not taken into account, side effects will appear. In most cases, it ends in an allergic reaction, but there are complications that can be fatal. Before purchasing medications, it is recommended that you familiarize yourself with the contraindications for the most common groups of medications for hypertension:

Name

List of contraindications

Diuretics	Chronic liver disease, hypokalemia (low potassium levels)
Adrenergic blockers	Severe bradycardia, impaired cerebral (cerebral) circulation, cardiac shock, kidney dysfunction caused by various pathologies, COPD (chronic obstructive pulmonary disease), atrioventricular block.
Calcium blockers	Severe forms of arrhythmia, acute myocardial infarction, arterial hypotension, heart failure, angina pectoris (chaotic), parkinsonism.
Medicines affecting the RAAS	Renal failure, severe diuresis, low potassium levels, mitral valve narrowing, biliary obstruction.
Centrally acting medications	Liver failure, impaired conduction or integrity of cerebral vessels, severe bradycardia, recent heart attack.

It is necessary to take medications with caution in the following cases:

• pregnancy;
• children under 18 years of age;
• lactation period (breastfeeding);
• patients over 65-70 years old;
• the presence of chronic pathologies in the body.

Despite the high level of modern medicine, there are no pills that do not have any side effects. Experts recommend finding out all the necessary information from your doctor and additionally reading the instructions for use.

It is advisable to start using medications for hypertension in a minimum dosage and gradually increase it. When the desired result is achieved, the medications continue to be taken for preventive purposes. Only the attending physician has the right to change the treatment regimen and discontinue medications. If adverse reactions occur, you should contact him to replace the medication or adjust its dosage.

Medicines prescribed for hypertension help slow down the development of the pathological process, prevent complications and improve the patient’s well-being. To prescribe them, you will need to undergo a comprehensive examination. Based on the results obtained, the cardiologist will draw up a treatment regimen and give useful recommendations for lifestyle correction.