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April 27, 2012

There are two approaches to the treatment of hypertension: drug therapy and the use of non-drug methods of reducing blood pressure.

Non-drug therapy for hypertension

If you carefully study the table “Risk stratification in patients with arterial hypertension”, you will notice that the risk of serious complications, such as heart attacks, strokes, is influenced not only by the degree of increase in blood pressure, but also by many other factors, for example, smoking, obesity, sedentary behavior life.

Therefore, it is very important for patients suffering from essential hypertension to change their lifestyle: quit smoking. start following a diet, and also select physical activities that are optimal for the patient.

It is necessary to understand that lifestyle changes improve the prognosis for arterial hypertension and other cardiovascular diseases no less than blood pressure that is ideally controlled with medications.

To give up smoking

Thus, the life expectancy of a smoker is on average 10-13 years less than that of non-smokers, and the main causes of death are cardiovascular diseases and oncology.

When you quit smoking, the risk of developing or worsening heart and vascular diseases decreases within two years to the level of non-smokers.

Diet

Following a low-calorie diet with large amounts of plant foods (vegetables, fruits, greens) will reduce the weight of patients. It is known that every 10 kilograms of excess weight increases blood pressure by 10 mmHg.

In addition, eliminating cholesterol-containing foods from food will reduce blood cholesterol levels, the high level of which, as can be seen from the table, is also one of the risk factors.

Limiting table salt to 4-5 grams per day has been proven to reduce blood pressure levels, since with a decrease in salt content, the amount of fluid in the vascular bed will also decrease.

In addition, losing weight (especially waist circumference) and limiting sweets will reduce the risk of developing diabetes, which significantly worsens the prognosis of patients with arterial hypertension. But even in patients with diabetes, weight loss can lead to normalization of blood glucose.

Physical exercise

Physical activity is also very important for patients with hypertension. During physical activity, the tone of the sympathetic nervous system decreases: the concentration of adrenaline and norepinephrine, which have a vasoconstrictive effect and increase heart contractions, decreases. And as is known, it is the imbalance in the regulation of cardiac output and vascular resistance to blood flow that causes an increase in blood pressure. In addition, with moderate exercise, performed 3-4 times a week, the cardiovascular and respiratory systems are trained: blood supply and oxygen delivery to the heart and target organs improves. In addition, physical activity coupled with diet leads to weight loss.

It is worth noting that in patients with low and moderate risk of cardiovascular complications, treatment of hypertension begins with the appointment of non-drug therapy for several weeks or even months (at low risk), the purpose of which is to reduce abdominal volume (in men less than 102, in women less 88 cm), as well as eliminating risk factors. If there is no dynamics during such treatment, tablet drugs are added.

In patients with high and very high risk according to the risk stratification table, drug therapy should be prescribed already at the moment when hypertension is first diagnosed.

Drug therapy for hypertension.

The scheme for selecting treatment for patients with hypertension can be formulated in several theses:

• For patients with low and average risk, therapy begins with the prescription of one drug that lowers blood pressure.
• For patients with a high and very high risk of cardiovascular complications, it is advisable to prescribe two drugs in a small dosage.
• If target blood pressure (at least below 140/90 mmHg, ideally 120/80 or below) is not achieved in patients at low and moderate risk, it is necessary to either increase the dosage of the drug they are receiving or start giving a drug from another drug. groups in a small dose. In case of repeated failure, it is advisable to treat with two drugs from different groups in small dosages.
• If target blood pressure values ​​are not achieved in patients at high and very high risk, you can either increase the dosage of the patient's medications or add a third drug from a different group to the treatment.
• If, when blood pressure decreases to 140/90 or lower, the patient’s well-being worsens, it is necessary to continue taking the drugs at this dosage until the body gets used to the new blood pressure numbers, and then continue to reduce blood pressure to the target values ​​​​of 110/70-120 /80 mmHg

Groups of drugs for the treatment of arterial hypertension:

The choice of drugs, their combinations and dosage should be made by a doctor, and it is necessary to take into account the presence of concomitant diseases and risk factors in the patient.

Listed below are the main six groups of drugs for the treatment of hypertension, as well as absolute contraindications for drugs in each group.

• Angiotensin-converting enzyme inhibitors - ACE inhibitors: enalapril (Enap, Enam, Renitek, Berlipril), lisinopril (Diroton), ramipril (Tritace®, Amprilan®), fosinopril (Fosicard, Monopril) and others. Drugs in this group are contraindicated in case of high blood potassium, pregnancy, bilateral stenosis (narrowing) of renal vessels, angioedema.
• Angiotensin-1 receptor blockers - ARBs: valsartan (Diovan, Valsacor®, Valz), losartan (Cozaar, Lozap, Lorista), irbesartan (Aprovel®), candesartan (Atacand, Candecor). The contraindications are the same as for ACE inhibitors.
• β-blockers – β-AB: nebivolol (Nebilet), bisoprolol (Concor), metoprolol (Egilok®, Betalok®) . Drugs of this group cannot be used in patients with 2nd and 3rd degree atrioventricular block, bronchial asthma.
• Calcium antagonists - AK. Dihydropyridine: nifedipine (Cordaflex®, Corinfar®, Cordipin®, Nifecard®), amlodipine (Norvasc®, Tenox®, Normodipin®, Amlotop). Non-dihydropyridine: Verapamil, Diltiazem.

ATTENTION! Non-hydropyridine calcium channel antagonists are contraindicated in chronic heart failure and 2-3 degree atrioventricular block.

• Diuretics (diuretics). Thiazide: hydrochlorothiazide (Hypothiazide), indapamide (Arifon, Indap). Loop: spironolactone (Veroshpiron).

ATTENTION! Diuretics from the group of aldosterone antagonists (Veroshpiron) are contraindicated in chronic renal failure and high blood potassium.

• Renin inhibitors. This is a new group of drugs that have performed well in clinical trials. The only renin inhibitor currently registered in Russia is Aliskiren (Rasilez).

Effective combinations of drugs that lower blood pressure

Since patients often have to be prescribed two or sometimes more drugs that have a hypotensive (pressure-lowering) effect, the most effective and safe group combinations are given below.

• ACE inhibitor + diuretic;
• ACEI+AA;
• ARB+diuretic;
• BRA+AK;
• AA + diuretic;
• AK dihydropyridine (nifedipine, amlodipine, etc.) + β-AB;
• β-AB + diuretic:;
• β-AB+α-AB: Carvedilol (Dilatrend®, Acridilol®)

Irrational combinations of antihypertensive drugs

The use of two drugs of the same group, as well as combinations of drugs listed below, is unacceptable, since drugs in such combinations increase side effects, but do not potentiate the positive effects of each other.

• ACE inhibitor + potassium-sparing diuretic (Veroshpiron);
• β-AB + non-dihydropyridine AK (Verapamil, Diltiazem);
• β-AB+ is a centrally acting drug.

Combinations of drugs that are not found in any of the lists belong to the intermediate group: their use is possible, but it must be remembered that there are more effective combinations of antihypertensive drugs.

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No. 7. Centrally acting drugs for the treatment of arterial hypertension

You are reading a series of articles about antihypertensive (antihypertensive) drugs. If you want to get a more holistic view of the topic, please start at the beginning: an overview of antihypertensive drugs that act on the nervous system.

In the medulla oblongata (this is the lowest part of the brain) there is vasomotor (vasomotor) center. It has two departments - pressor And depressor. which increase and decrease blood pressure, respectively, acting through the nerve centers of the sympathetic nervous system in the spinal cord. The physiology of the vasomotor center and the regulation of vascular tone is described in more detail here: http://www.bibliotekar.ru/447/117.htm(text from a textbook on normal physiology for medical universities).

The vasomotor center is important for us because there is a group of drugs that act on its receptors and thus reduce blood pressure.

Divisions of the brain.

Classification of centrally acting drugs

For drugs that act predominantly on sympathetic activity in the brain. relate:

• clonidine (clonidine) ,
• Moxonidine (Physiotens) ,
• methyldopa(can be used in pregnant women),
• guanfacine ,
• guanabenz .

There are no pharmacies in Moscow and Belarus in the search methyldopa, guanfacine and guanabenza. but they are for sale clonidine(strictly according to the prescription) and moxonidine .

The central component of action is also present in serotonin receptor blockers. about them in the next part.

Clonidine (clonidine)

Clonidine (clonidine) inhibits the secretion of catecholamines by the adrenal glands and stimulates alpha 2 -adrenergic receptors and I 1 -imidazoline receptors of the vasomotor center. It reduces blood pressure (by relaxing blood vessels) and heart rate (heart rate). Clonidine also has hypnotic and analgesic effect .

Scheme of regulation of cardiac activity and blood pressure.

In cardiology, clonidine is used mainly for treatment of hypertensive crises. This drug is loved by criminals and... retired grandmothers. Attackers like to mix clonidine into alcohol and, when the victim “passes out” and is fast asleep, they rob fellow travelers ( Never drink alcohol on the road with strangers!). This is one of the reasons why clonidine (clonidine) has been available in pharmacies for a long time only with a doctor's prescription .

Popularity of clonidine as a remedy for arterial hypertension in grandmothers who are “clonidine addicts” (who cannot live without taking clonidine, like smokers without a cigarette) is due to several reasons:

1. high efficiency drug. Local doctors prescribe it for the treatment of hypertensive crises, as well as out of despair, when other drugs are not effective enough or the patient cannot afford it, but something needs to be treated. Clonidine reduces blood pressure even if other drugs are ineffective. Gradually, older people develop mental and even physical dependence on this drug.

Clonidine is recommended to be used only for the treatment of hypertensive crises. for regular use 2-3 times a day, it is undesirable, since rapid significant fluctuations in blood pressure levels are possible during the day, which can be dangerous for blood vessels. Basic side effects. dry mouth, dizziness and lethargy(not for drivers), development is possible depression(then clonidine should be discontinued).

Orthostatic hypotension (decrease in blood pressure in an upright body position) clonidine does not cause .

Most dangerous side effect of clonidine - withdrawal syndrome. Grandmothers who are clonidine addicts take many tablets per day, bringing the average daily intake to high daily doses. But since the drug is purely prescription, it is impossible to create a six-month supply of clonidine at home. If for some reason local pharmacies experience interruptions in the supply of clonidine. these patients begin to experience severe withdrawal symptoms. Like a binge. Clonidine, which is absent in the blood, no longer inhibits the release of catecholamines into the blood and does not reduce blood pressure. Patients are worried agitation, insomnia, headache, palpitations and very high blood pressure. Treatment consists of the administration of clonidine, alpha-blockers and beta-blockers.

Remember! Regular taking clonidine should not be stopped abruptly. The drug needs to be discontinued gradually. replacing α- and β-blockers.

Moxonidine (Physiotens)

Moxonidine is a modern, promising drug that can be briefly called “ improved clonidine" Moxonidine belongs to the second generation of drugs acting on the central nervous system. The drug acts on the same receptors as clonidine (clonidine), but the effect on I 1 is imidazoline receptors much stronger than the effect on alpha2-adrenergic receptors. Due to stimulation of I 1 receptors, the release of catecholamines (adrenaline, norepinephrine, dopamine) is inhibited, which reduces blood pressure (blood pressure). Moxonidine maintains a reduced level of adrenaline in the blood for a long time. In some cases, as with clonidine, in the first hour after oral administration, before a decrease in blood pressure, an increase of 10% may be observed, which is due to stimulation of alpha1- and alpha2-adrenergic receptors.

In clinical studies Moxonidine reduced systolic (upper) pressure by 25-30 mmHg. Art. and diastolic (lower) pressure by 15-20 mm without developing drug resistance during 2 years of treatment. The effectiveness of treatment was comparable to a beta blocker atenolol and ACE inhibitors captopril and enalapril .

Antihypertensive effect Moxonidine lasts 24 hours, the drug is taken 1 time per day. Moxonidine does not increase blood sugar and lipid levels, and its effect does not depend on body weight, gender and age. Moxonidine reduced LVH ( left ventricular hypertrophy), which allows the heart to live longer.

The high antihypertensive activity of moxonidine made it possible to use it for the complex treatment of patients with CHF (chronic heart failure) with II-IV functional class, but the results in the MOXCON study (1999) were dismal. After 4 months of treatment, the clinical study had to be terminated early due to high mortality in the experimental group compared to the control group (5.3% vs. 3.1%). Overall mortality increased due to an increase in the incidence of sudden death, heart failure and acute myocardial infarction.

Moxonidine causes fewer side effects compared to clonidine. although they are very similar. In comparative cross A 6-week study of moxonidine with clonidine ( each patient received both compared drugs in random order) side effects led to treatment discontinuation in 10% of patients receiving clonidine, and only in 1.6% of patients. taking moxonidine. More often disturbed dry mouth, headache, dizziness, fatigue or drowsiness .

Withdrawal syndrome was observed on the first day after discontinuation of the drug in 14% of those receiving clonidine, and only in 6% of patients receiving moxonidine.

Thus it turns out:

• clonidine is cheap, but has many side effects,
• moxonidine It costs significantly more, but is taken once a day and is better tolerated. It may be prescribed if drugs from other groups are not effective enough or are contraindicated.

Conclusion. if financial situation allows, between clonidine And moxonidine for continuous use, it is better to choose the latter (once a day). Clonidine should be taken only in case of hypertensive crises; it is not a drug for every day.

Treatment of arterial hypertension

What methods are used to treat arterial hypertension? In what cases is hospitalization necessary for hypertension?

Non-drug methods for treating arterial hypertension

• Low-calorie diet (especially if you are overweight). With a decrease in excess body weight, a decrease in blood pressure is observed.
• Limit salt intake to 4 - 6 g per day. This increases sensitivity to antihypertensive therapy. There are “substitutes” for salt (potassium salt preparations - sanasol).
• Inclusion in the diet of foods rich in magnesium (legumes, millet, oatmeal).
• Increased physical activity (gymnastics, measured walking).
• Relaxation therapy, autogenic training, acupuncture, electrosleep.
• Elimination of harmful substances (smoking, drinking alcohol, taking hormonal contraceptives).
• Employment of patients taking into account his illness (exclusion of night work, etc.).

Non-drug treatment carried out in mild forms of arterial hypertension. If after 4 weeks of such treatment the diastolic pressure remains 100 mmHg. Art. and higher, then switch to drug therapy. If diastolic pressure is below 100 mmHg. Art. then non-drug treatment is continued for up to 2 months.

In persons with a complicated medical history, with left ventricular hypertrophy, drug therapy is started earlier or combined with non-drug therapy.

Drug treatments for arterial hypertension

There are many antihypertensive drugs. When choosing a drug, many factors are taken into account (gender of the patient, possible complications).

• For example, centrally acting drugs that block sympathetic influences (clonidine, dopegit, alpha-methyl-DOPA).
• Women in menopause, when there is low renin activity, relative hyperaldosteronism, and a decrease in progesterone levels, often experience hypervolumic states and develop “edematous” hypertensive crises. In such a situation, the drug of choice is a diuretic (saluretic).
• There are powerful drugs - ganglion blockers, which are used to relieve a hypertensive crisis or together with other antihypertensive drugs in the treatment of malignant hypertension. Ganglion blockers should not be used in elderly people who are prone to orthostatic hypotension. When administering these drugs, the patient must remain in a horizontal position for some time.
• Beta-blockers provide a hypotensive effect by reducing cardiac output and plasma renin activity. In young people they are the drugs of choice.
• Calcium antagonists are prescribed when hypertension is combined with coronary heart disease.
• Alpha adrenergic blockers.
• Vasodilators (eg minoxidil). They are used in addition to the main therapy.
• Angiotensin-converting enzyme inhibitors (ACEIs). These drugs are used for all forms of hypertension.

When prescribing drugs, the condition of the target organs (heart, kidneys, brain) is taken into account.

For example, the use of beta-blockers in patients with renal failure is not indicated, since they impair renal blood flow.

There is no need to strive to quickly reduce blood pressure, as this can lead to a deterioration in the patient’s well-being. Therefore, the drug is prescribed starting with small doses.

Treatment regimen for arterial hypertension

There is a treatment regimen for arterial hypertension: at the first stage, beta-blockers or diuretics are used; at the second stage “beta-blockers + diuretics”, it is possible to add an ACE inhibitor; in case of severe hypertension, complex therapy is carried out (possibly surgery).

Hypertensive crisis often develops when treatment recommendations are not followed. During crises, the most commonly prescribed drugs are clonidine, nifedipine, captopril.

Indications for hospitalization

• Clarification of the nature of arterial hypertension (if it is impossible to perform studies on an outpatient basis).
• Complication of arterial hypertension (crisis, stroke, etc.).
• Refractory arterial hypertension that does not respond to antihypertensive therapy.

High blood pressure does not always have clearly defined symptoms. A sick person can walk without noticing its symptoms and continues to live, getting used to this condition. Increased pressure on the walls of blood vessels causes dangerous complications - heart attack and stroke. It is necessary to pay close attention to the first signs of the disease and visit a doctor who will prescribe pills for hypertension. Their task is not to relieve an attack; they do not affect the cause of the disease. Their main goal is to reduce and stabilize blood pressure. That's what

Main groups of drugs for hypertension

Tablets to lower blood pressure are selected for the patient by the attending physician, taking into account his condition. There are several groups of medications that can regulate blood pressure. They all act according to different schemes, have their own characteristics, contraindications, and side effects. The tablets should be taken constantly, regardless of the tonometer readings. They have a peculiarity - they accumulate in the body and have a long-lasting effect. Many drugs are addictive, so the doctor changes them periodically. If you have hypertension, prepare to drink them for the rest of your life.

Drugs that can regulate blood pressure solve the main problems:

• reduce headaches;
• prevent nosebleeds;
• remove flies from before the eyes;
• prevent kidney failure;
• reduce heart pain;
• prevent the risk of stroke and heart attack.

Let's take a closer look at these medications. The main groups of drugs that solve the problems of high blood pressure:

• beta blockers;
• alpha blockers;
• calcium antagonists;
• angiotensin 2 antagonists;
• diuretics;
• ACE inhibitors.

Beta blockers

Tablets of this group can affect the heart rate, reducing it. At the same time, the walls of the blood vessels relax, reducing the volume of blood entering them over a certain period of time. This leads to a decrease in blood pressure. Drugs are prescribed in the presence of concomitant heart diseases: tachycardia, coronary artery disease, rhythm disturbances. Tablets in this group have side effects. It is not advisable to take them if you have complaints of heart pain and seizures. The group includes: “Concor”, “Nebivalol”, “Metaprolol”.

Alpha blockers

Tablets of this group have an antispasmodic effect, dilate blood vessels, relaxing the muscles along them. This helps reduce blood pressure. If you take the drugs separately from diuretics, beta blockers, swelling and headaches are possible. Alpha blockers are used in severe cases when other means are powerless. The tablets are addictive and can cause increased heart rate and hyperhairiness. These drugs include: Hydralazine, Minoxidil.

Calcium antagonists

This group of drugs has another name - calcium channel blockers. The tablets interfere with the flow of calcium into the vascular cells, which at the same time expand, and a decrease in pressure occurs. The top drug rating is Nifedipine, which can quickly relieve a hypertensive crisis. For high blood pressure, which is accompanied by diseases - arrhythmia, diabetes mellitus, kidney disease, Verapamil and Amlodipine are prescribed. These drugs do not cause lethargy and help withstand physical activity. Often prescribed to older people.

Angiotensin 2 antagonists

Modern drugs of the group that have minimal side effects are called sartans. The effect of use is enhanced when combined with diuretics. Stable results of use are visible within a few weeks. Popular tablets of this group: “Lozap”, “Valz”, “Losartan”. They are not addictive, have a long-lasting effect - you need to take them once a day. Thanks to their use:

• the risk of stroke and heart attack is reduced;
• the likelihood of kidney failure is reduced.

Diuretics (diuretics)

Among the tablets for hypertension, diuretics are one of the first drugs prescribed. They help remove excess water and salts from the body and reduce swelling. This reduces blood volume and puts less strain on the heart. All this helps normalize blood pressure. Diuretics are prescribed only by a doctor - this is due to the fact that they remove calcium, potassium and magnesium from the body. They have contraindications for use. Along with diuretics, drugs are prescribed that restore the balance of potassium, calcium and magnesium.

Effective diuretics for high blood pressure:

• Furosemide and Diuver are potent drugs that actively remove calcium and magnesium and are not recommended during pregnancy.
• “Hypotheazid”, “Indapamide” - act slowly and have few side effects.
• "Veroshpiron" - has a weak diuretic effect, but is a potassium-sparing drug, helps with the highest, third degree of arterial hypertension.

You should be wary of diuretic tablets for hypertension. They are sold without prescriptions, the drugs are cheap, but you should take them only as directed and under the supervision of a doctor. This is due to side effects:

• the risk of diabetes increases;
• cholesterol levels rise;
• problems with potency appear;
• fatigue becomes higher;
• hormonal disruptions occur;
• loss of consciousness is possible.

Angiotensin-converting enzyme (ACE) inhibitors

Such drugs are prescribed to patients with hypertension who have heart failure, diabetes mellitus, and coronary heart disease. ACE inhibitors dilate blood vessels and contribute to decreased tonometer readings. They reduce the risk of stroke and heart attack, protect the kidneys, and reduce the likelihood of developing diabetes. The drugs have a short duration of action, so they are taken according to the regimen prescribed by the doctor.

These medications have few side effects. Sometimes a dry cough and slight swelling of the face appear. They should be taken at the dose indicated in the instructions, due to the possibility of a sharp decrease in blood pressure. The drugs are prescribed together with diuretics, calcium antagonists - with this option a strong therapeutic effect is obtained. ACE inhibitors are often used:

• "Enalapril";
• "Captopril";
• "Lisinopril";
• "Ramipril."

How to choose the right treatment for high blood pressure

You should not self-medicate if you have high blood pressure. To choose the right pills for hypertension, it is important to consult a doctor. He will find out what your blood pressure is now and what levels you need to achieve after treatment. This is especially important for older people - properly selected antihypertensive drugs prolong life and improve its quality.

Modern methods of treating hypertension are aimed at reducing and normalizing blood pressure. Only a qualified doctor is able to correctly select, from all the variety, the necessary drugs, taking into account the tests and the age of the patient. During the reception he:

• learns about concomitant diseases;
• determines contraindications;
• will select medications for blood pressure experimentally;
• will prescribe dosage, starting with small values;
• determine the dosage regimen, depending on the duration of action of the drugs;
• will monitor the effectiveness of treatment.

List of the best drugs for hypertension of the new generation

Modern drugs for lowering blood pressure are distinguished by the fact that they have few side effects. The pharmaceutical industry offers the latest developments that have received excellent reviews from doctors. The list of the new generation of tablets for hypertension includes combination drugs that simultaneously have a vasodilator, diuretic and antispasmodic effect: “Andipal”, “Twinsta”.

Modern tablets for hypertension - new items on the market of pharmacological medications - require mandatory medical supervision. Each group of drugs has innovations:

• calcium antagonists – “Amlodipine”, “Riodipine”;
• sartans - “Valsartan”, “Cardosal”;
• diuretics - Torasimide, Rolofilin;
• alpha and beta blockers - Nebivolol, Carvedilol;
• ACE inhibitors - Enalapril, Lisinoproil and its analogue - Dapril.

Fast acting high blood pressure tablets

How to bring down the pressure if it suddenly rises sharply? For urgent relief of a hypertensive crisis, it is necessary to dissolve a Nifedipine tablet under the tongue. Taking Capoten quickly normalizes blood pressure. It is also placed under the tongue until dissolved - the action begins after 10 minutes. It is very important that the decrease in pressure does not occur very sharply - otherwise there may be a stroke. If an attack is accompanied by pain in the heart, first aid is provided by a Nitroglycerin tablet under the tongue. With an increased heart rate, Esmolol helps well. The newest remedy is also widely recommended

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 mmHg. 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 blood 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 chlorine ions in the ascending 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.

(otherwise called hypertension) is a stable increase in blood pressure above 140/90, for no apparent reason. It is one of the most common diseases in the world, especially among our compatriots. We can safely say that after fifty years, almost every citizen of the post-Soviet space suffers from high blood pressure. This is explained by excess body weight, smoking, alcohol abuse, constant stress and other unfavorable factors. What is most unpleasant in this situation is that hypertension begins to “get younger” - every year more and more cases of high blood pressure are registered in people of working age, and the number of cardiovascular accidents (myocardial infarction, strokes) is growing, which leads to chronic disability with subsequent disability . Thus, arterial hypertension becomes a problem not only medical, but also social.

No, there are, of course, cases when a stable increase in blood pressure figures becomes a consequence of some primary disease (for example, caused by pheochromocytoma, a neoplasm that affects the adrenal glands and is accompanied by a high release of hormones into the blood that activate the sympathoadrenal system). However, there are very few such cases (no more than 5% of clinically registered conditions characterized by a stable increase in blood pressure) and it should be noted that the approaches to the treatment of both primary and hypertension are approximately the same. The only difference is that in the second case it is necessary to eliminate the root cause of this disease. But the normalization of blood pressure figures is carried out according to the same principles, with the same medications.

Today, hypertension is treated with drugs from different groups.

Medicines

Which are used in the treatment of arterial hypertension, as well as their classification.

Of greater importance for practitioners is the conditional division of antihypertensive drugs into drugs for routine use and drugs whose action allows them to be used as emergency aid for hypertensive crises.

Angiotensin-converting enzyme inhibitors (ACEIs)

Medicines belonging to this group are the number one drugs of choice in the treatment of both primary and secondary arterial hypertension. This is mainly due to their protective effect on the blood vessels of the kidneys. This phenomenon is explained by the mechanism of their biochemical action - under the influence of ACE inhibitors, the action of the enzyme that converts angiotensin 1 into its active form angiotensin 2 (a substance that leads to a narrowing of the lumen of blood vessels, thereby increasing blood pressure) slows down. Naturally, if this metabolic process is inhibited by medication, then an increase in blood pressure also does not occur.

Representatives of drugs in this group are:

1. Enalapril (trade name Berlipril);
2. Lisinopril (trade name - Linotor, Diroton);
3. Ramipril (trade name - Ramizes, Cardipril);
4. Fosinopril;

These drugs are representatives of this pharmacological group, which have found the most widespread use in practical medicine.

In addition to them, there are also a lot of medicines with similar effects that have not found such widespread use due to various reasons.

It is important to note one more point - all drugs from the ACE inhibitor group are prodrugs (with the exception of Captopril and Lisinopril). That is, this means that a person uses an inactive form of a pharmacological agent (the so-called prodrug), and under the influence of metabolites, the drug turns into an active form (becomes a drug), which realizes its therapeutic effect. Captopril and Lisinopril, on the contrary, fall into the body and immediately exert their therapeutic effect, due to the fact that they are already metabolically active forms. Naturally, prodrugs begin to act more slowly, but their clinical effect lasts longer. While Captopril has a faster and at the same time short-term effect.

Thus, it becomes clear that prodrugs (for example, Enalapril or Cardipril) are prescribed for the routine treatment of arterial hypertension, while Captopril is recommended for the relief of hypertensive crises.

The use of ACE inhibitors is contraindicated in pregnant women and while breastfeeding.

Beta blockers

The second most frequently used group of pharmacological drugs. The principle of their action is that they block adrenergic receptors, which are responsible for the implementation of the effect of the sympathoadrenal system. Thus, under the influence of drugs of this pharmacological group, there is not only a decrease in blood pressure, but also a decrease in heart rate. It is customary to divide beta-adrenergic blockers into selective and non-selective. The difference between these two groups is that the former act only on beta1 adrenergic receptors, while the latter block both beta1 and beta2 adrenergic receptors. This explains the phenomenon that when using highly selective beta blockers, asthma attacks do not occur (this is especially important to consider when treating hypertension in patients suffering from bronchial asthma). It is important to note that when selective beta blockers are used in high doses, their selectivity is partially lost.

Non-selective beta blockers include Propranolol

Selective - Metoprolol, Nebivolol, Carvedilol.

By the way, these drugs are best used if the patient has a combination of hypertension and coronary heart disease - both effects of beta blockers will be in demand.

Slow calcium channel blockers

Another pharmacological group of drugs used to treat arterial hypertension (what is most interesting is that in Western countries these drugs are used only for the treatment of angina pectoris). Similar to beta blockers, they reduce pulse and blood pressure, but the mechanism for realizing the therapeutic effect is somewhat different - it is realized by preventing the penetration of Calcium ions to the smooth myocytes of the vascular wall. Typical representatives of this pharmacological group are amlodipine (used for routine treatment) and (emergency drug).

Diuretics

Diuretics. There are several groups:

1. Loop diuretics – Furosemide, Torasemide (Trifas – trade name);
2. Thiazide diuretics – Hydrochlorothiazide;
3. Thiazide-like diuretics – Indapamide;
4. Potassium-sparing diuretics – (Spironolactone).

Today, for hypertension, Trifas (from diuretics) is most often used - due to the fact that it is highly effective and after its use there are not as many side effects as when using Furosemide.

The remaining groups of diuretic drugs are used, as a rule, as auxiliary drugs due to their unexpressed effect or in general, so that potassium is not washed out of the body (in this case, Veroshpiron is ideal).

Sartans

Drugs that are similar in their action to angiotensin-converting enzyme inhibitors with the only difference being that they affect not the enzyme itself, but the receptors for it. They are used if the patient has a cough after using an ACE inhibitor.

Examples of drugs for the treatment of hypertension from this group are Losartan, Valsartan.

We should not forget about the old proven remedy - magnesium sulfate 25% solution (Magnesia) - an emergency drug for hypertensive crisis, administered intramuscularly. It should not be used to treat hypertension constantly, but for a one-time reduction in blood pressure it is an ideal remedy.

conclusions

There are many drugs for the treatment of hypertension and, as a rule, they are used in combination (if resistant hypertension occurs, a combination with second-line drugs is often used).

Suitable groups of drugs are selected by the attending physician based on the patient’s condition, medical history, the presence of concomitant pathology and many other factors.

Video

In recent years, hypertension has occupied a leading place among diseases of the heart and blood vessels. If previously elderly patients suffered from increased blood pressure, now the pathology is detected in young people. The long course of the disease leads to dystrophic disorders in the tissues of the heart, kidneys, brain and organs of vision. The most dangerous complications of hypertension are myocardial infarction and cerebral stroke, which can lead to severe disability and death. The modern pharmacological industry produces a wide variety of drugs that help normalize the general condition of patients and improve the quality of life.

When is antihypertensive therapy administered?

Tablets for hypertension should be prescribed by a specialist after a comprehensive diagnosis, taking into account blood pressure numbers, the presence of concomitant diseases, contraindications, and the age of the patients. The combination of these components during therapy is of great importance for achieving positive results and maintaining health at the proper level. When the pressure rises to 140/90 mm Hg. Art. and above we can talk about the development of hypertension.

Risk factors for disease progression include:

• diabetes;
• hypercholesterolemia;
• obesity;
• physical inactivity;
• chronic stress;
• decreased glucose tolerance;
• bad habits;
• hereditary predisposition.

The onset of the disease begins with a periodic increase in blood pressure, usually against the background of a stressful situation. This causes headaches, drowsiness, weakness, and sometimes “floaters” flashing before the eyes. Often this condition is associated with overwork and does not seek medical attention. Over time, hypertension forms in the body the activation of compensatory reactions, which significantly smooth out the clinical picture. Patients no longer feel the pathological spasm of blood vessels, but the disease is constantly progressing.

Basic non-pharmacological measures for the treatment of hypertension

If episodes of hypertension are detected in the early stages, drug therapy is not prescribed. Improvement of the condition can be achieved by rational nutrition, physical exercise, giving up bad habits, and normalizing the work and rest regime. After a persistent increase in blood pressure occurs, it is recommended to take one drug under the constant supervision of a doctor. If monotherapy is ineffective, several antihypertensive drugs or tablets with a combined composition are prescribed.

Drugs affecting the reninangiotensin system

In the kidneys, when pressure decreases, the substance prorenin is produced, which, entering the bloodstream, is converted into renin, and after interacting with a special protein, it is synthesized into the inactive substance angiotensin 1. Under the influence of permissive factors, it reacts with angiotensin-converting enzyme (ACE) and acquires active properties - angiotensin 2. This substance has a vasoconstrictor effect, causes an increase in cardiac activity, promotes water retention in the body, and stimulates the centers of the sympathetic nervous system. Depending on the effect of the drug on a specific link of the reninangiotensive system, two groups of drugs are distinguished.

ACE inhibitors

The active substance in the medicine blocks the work of the enzyme of the same name. As a result, blood pressure and pulse normalize, the excitability of the nervous system decreases, and the removal of fluid from the body increases.

List of funds:

• captopril;
• ramipril;
• enalapril;
• quinopril;
• zofenopril.

The use of drugs is contraindicated in pregnancy, diabetes, severe autoimmune pathologies, renal and liver failure. Captopril is not used for long-term treatment of the disease, especially in elderly patients with symptoms of cerebral artery atherosclerosis. It is usually used to relieve hypertensive crises - a sharp increase in blood pressure. Every third patient experiences a dry cough while taking medications from this group. If a side effect occurs, the product must be replaced.

Sartans

The active substance in the drug blocks receptors sensitive to angiotensin 2. Sartans are new generation drugs that were created in the last decade. They gently normalize blood pressure in hypertension, do not cause withdrawal symptoms, and can have a therapeutic effect for several days.

List of funds:

• candesartan;
• losartan;
• valsartan;
• telmisartan.

Medicines are contraindicated during breastfeeding, pregnancy, in childhood, with significant fluid loss and increased potassium levels in the blood.

Valsacor is a modern drug for the treatment of hypertension from the sartan group

Calcium channel blockers

In the cell membrane of muscle fibers there are special channels through which calcium enters and causes their contractility. This leads to vasospasm and increased heart rate. Drugs in this group close the pathways for calcium to move into the cell, thereby causing a decrease in the tone of the vascular wall, a decrease in the pulse, and a decrease in the load on the myocardium.

List of funds:

• diltiazem;
• verapamil;
• nifedipine;
• amlodipine;
• diltiazem;
• nifedipine;
• lacidipine.

Medicines are prescribed for hypertension combined with angina pectoris and heart rhythm disturbances. Verapamil and diltiazem cause a decrease in heart rate. In recent years, nifedipine has ceased to be used in medical practice due to its short duration of action and the ability to cause side effects. Drinking tablets of this group is not recommended in old age, childhood and puberty, with liver failure, hypersensitivity to the active substance, acute myocardial infarction. At the beginning of treatment, swelling of the limbs may be observed, which usually disappears within a week. If edema persists for a long time, the drug must be replaced.

Beta blockers

In the tissues of the kidneys, bronchi, and heart there are beta receptors, which, when excited, can cause an increase in blood pressure. The hypotensive effect is achieved by combining the substance in the drug with these receptors, preventing biologically active substances from influencing their work. For hypertension, selective drugs are recommended that interact exclusively with myocardial receptors.

List of funds:

• bisaprolol;
• atenolol;
• metoprolol;
• carvedilol;
• nebivolol;
• Celiprolol.

The drugs are prescribed for resistant forms of hypertension, concomitant angina, cardiac arrhythmias, and previous myocardial infarction. Non-selective drugs such as carvedilol, nebivalol, celiprolol are not prescribed for diabetes mellitus or signs of bronchial asthma.

Nebilet controls not only blood pressure, but also heartbeat

Diuretics

Diuretics affect filtration in the glomeruli, promoting the removal of sodium from the body, which draws fluid with it. Thus, the effect of the drug is associated with the loss of water, which reduces the filling of the bloodstream and normalizes high blood pressure in hypertension.

List of funds:

• spironolactone;
• indapamide;
• hydrochlorothiazide (hypothiazide);
• triampur;
• furosemide

Diuretics are not prescribed for monotherapy; they are combined with drugs from other groups. Diuretics can remove potassium ions from sodium; in such cases, it is necessary to monitor the concentration of this chemical. Usually, when treating with such medications, you are additionally prescribed to drink potassium.

If potassium-sparing diuretics, such as spironoloctone and triampur, are used, replacement therapy will not be required. Furosemide is recommended for the relief of acute attacks, as it has a pronounced but short-lived effect. The drugs are contraindicated in cases of anuria, lactose intolerance, electrolyte imbalance, and severe diabetes mellitus.

Centrally acting drugs

Medicines in this group prevent overexcitation of the nervous system and normalize the functioning of the vasomotor center, which helps reduce high blood pressure.

List of funds:

• methyldopa;
• moxonidine;
• rilmenidine.

Tablets are prescribed to patients with emotional instability, as well as to patients under stress and increased excitability. Additionally, it is recommended to take tranquilizers, sleeping pills and sedatives.

If the first symptoms of hypertension occur, you should consult a specialist. After a comprehensive examination, the doctor will tell you what medications need to be used to normalize your overall health. He will correctly select a combination of medications and their dosage, prescribe the time for taking the pills and monitor their effectiveness. Only this approach can stop further progression of the pathology and eliminate the occurrence of severe consequences. To maintain health, self-medication is strictly contraindicated.