High blood pressure control drugs

There is currently no "universal antihypertensive drug" suitable for all patients with hypertension. The five major categories of first-line antihypertensive drugs commonly used in clinical practice each have their own applicable groups and advantages and disadvantages. The medication plan must be customized based on the patient's age, underlying diseases, blood pressure fluctuation characteristics, tolerance and even economic conditions. There is no such thing as a certain type of drug that is absolutely better.

This is not something I say out of thin air. Last week at a community free clinic, I met a 62-year-old Uncle Zhang. His systolic blood pressure was 152mmHg. He grabbed the amlodipine pill box that his old neighbor took and came over and asked, "Can I just copy his homework?" His blood pressure is very stable after taking this." I stopped him on the spot. Amlodipine is a calcium channel blocker, which is often referred to as the "dipine". It is indeed friendly to elderly patients with simple elevated systolic blood pressure, atherosclerosis, and coronary heart disease. It has a stable blood pressure-lowering effect and has few absolute contraindications. However, it cannot withstand some people who are intolerant to it. In the past two months, an old patient came to me and said that after taking amlodipine for more than half a year, his gums were so swollen that he had to struggle to chew an apple, and there was a pit in his ankle when he pressed it. After switching to a satan, it disappeared in half a month.

Oh, by the way, a few years ago, there was a debate in the field of hypertension at home and abroad about whether angiotensin inhibitors such as Sartan and Prilim should be promoted to the first-line priority. Those who support it have come up with a lot of research data, saying that this type of drug has a clearer protective effect on target organs such as the heart, kidneys, and blood vessels, and is suitable for patients with diabetes, chronic kidney disease, and proteinuria. ； Opposition voices are also very real: the incidence of dry cough in Asians can reach 15%. Many people are unable to sleep all night long after eating and coughing. They think they have lung cancer, which makes them a lot more anxious. Although Sartan does not cause dry cough, its price is generally higher than that of Dipine. For ordinary elderly patients without target organ damage, the cost-effectiveness is not that high.

Don't just focus on these two categories, there is another "veteran" that is often ignored by everyone: beta blockers, also known as "lorols". A few years ago, some guidelines kicked it out of first-line medication, saying that the antihypertensive effect was not as good as other types, and the long-term prognostic benefit was unclear. As a result, there is now a new consensus: for young hypertensive patients aged 30-50, especially those with resting heart rates exceeding 80 beats, prone to anxiety, and those with atrial fibrillation or coronary heart disease, using lorols is particularly symptomatic. I met a 28-year-old Internet programmer before. His physical examination showed a high pressure of 148 and a low pressure of 95. His heart rate would soar to over 100 when he was working on a project. I prescribed him the minimum dose of bisoprolol. After only three weeks of taking it, his blood pressure dropped to 125/75. His resting heart rate was stable at around 70. Even the previous problem of feeling flustered was gone.

There are also many people who wave their hands when they hear that diuretics are prescribed, thinking that "diuresis is harmful to the kidneys." In fact, small doses of thiazide diuretics are a golden combination for refractory hypertension, especially for salt-sensitive patients who usually eat a lot of salt and elderly patients with lower limb edema. Adding half a tablet of hydrochlorothiazide will have a better blood pressure-lowering effect than taking more of the main drug. The only thing you need to pay attention to is to check your blood potassium regularly. Last year, an aunt secretly took more diuretics. She didn't check again for half a year, and her blood potassium dropped to 2.9mmol/L. Her body was so weak that she even had to go downstairs to buy groceries. She took potassium supplements for a week before she recovered.

Oh, by the way, there is another category that is quite controversial now, which is the single-pill compound preparation, which combines two antihypertensive drugs in one tablet. The supporting doctors think this is very suitable for elderly people with poor memory. They used to take two tablets but now they only take one. The probability of missing a dose has been reduced by more than half. With high compliance, blood pressure will naturally stabilize. ； The objections are justified: if the patient needs to adjust the dosage, for example, if he only wants to take half of the diuretic tablets, the compound preparation cannot be separated at all and is not flexible enough.

In the final analysis, the core function of antihypertensive drugs is not only to lower the blood pressure, but more importantly, to reduce heart, brain, and kidney complications. Don’t always copy other people’s medication plans, and don’t just blindly change medicines after listening to the “miracle medicines” mentioned on the Internet. See a doctor for evaluation before each medicine adjustment, and don’t forget to eat less pickles and stay up late while taking medicine. No matter how expensive the medicine is, it will work. By the way, don’t be too anxious when you just adjust the medicine. Generally, it takes 2-4 weeks for the medicine to reach a stable blood concentration. If you rush to change the medicine if it does not drop after two or three days, it will easily lead to blood pressure fluctuations, which is not worth the gain.