Antihypertensive drug with a diuretic effect. Antihypertensive drugs: classification, how they work. How ACE inhibitors protect the kidneys

The initial stage of hypertension is difficult to determine, because there are practically no symptoms. But high blood pressure can lead to a stroke or heart attack. Therefore, you need to seek medical help in a timely manner, the doctor can prescribe medications for hypertension from the list of the latest generation.

Combined categories of drugs for high blood pressure

Medications designed to eliminate the symptoms of hypertension can only be prescribed by a doctor. Medicinal compositions are selected taking into account the individual characteristics of the body, the presence of concomitant diseases, general well-being.

Do not self-prescribe medications to lower your blood pressure. Self-medication will make the condition worse, and may lead to unpredictable side effects.

With hypertension, it is customary to prescribe complex drug therapy. Each of the prescribed drugs is taken according to a certain scheme.

When diagnosing hypertension, prescribed medications must be taken constantly, even with normal blood pressure parameters. The active substances of medicinal formulations, gradually accumulating in the body, have a lasting effect, and help lower blood pressure.

If some medicinal composition is addictive, then it is gradually replaced with a similar antihypertensive agent, or they try to increase the dosage.

All modern drugs prescribed for hypertension are divided into the following categories:

1. diuretics that have a diuretic effect, and are prescribed in the first place;
2. beta-blockers that affect the frequency of contraction of the heart muscle;
3. alpha blockers used against vascular spasms;
4. ACE inhibitors that inhibit the enzyme responsible for vasoconstriction;
5. calcium channel blockers that keep the flow of the microelement to the cells;
6. sartans. This category refers to the latest drugs prescribed for the treatment of various forms of hypertension.

The listed medicines are combined in the process of complex treatment, due to which they increase the result.

• minimize the risk of heart attack and stroke;
• reduce pain in the heart;
• reduce the likelihood of developing kidney pathologies;
• eliminate headaches, flies before the eyes, and other symptoms of high blood pressure;
• prevent nosebleeds.

Modern combined antihypertensive drugs differ from the drugs of the previous generation in the smallest amount side effects. Such medicinal formulations are well tolerated, have a long therapeutic effect, and after their withdrawal there is no risk of a hypertensive crisis.

Diuretics

After seeking medical help for high blood pressure, the patient is immediately prescribed diuretics. These are drugs that have a pronounced diuretic effect, are used to lower blood pressure.

Diuretics are used to rid the body of excess water and salt, thereby reducing swelling. The heart muscle experiences less stress, and blood pressure decreases.

When exposed to diuretics, along with excess water and salt, magnesium, calcium and potassium are simultaneously washed out of the body. Therefore, when prescribing diuretics, drugs are prescribed that replenish these elements.

Among the modern diuretics prescribed to lower high blood pressure, the following drugs:

• Diuver, Furosemide. These drugs give a strong diuretic effect, and actively excrete calcium with magnesium in the urine;
• Indapamide and Hypothesiad. They have a slow action, but with fewer side effects;
• Veroshpiron. A weak diuretic, but does not flush out potassium from the body. It is prescribed for severe forms of hypertension.

Diuretic drugs for lowering blood pressure can be purchased at pharmacy chains without a prescription, the drugs are inexpensive. But this does not mean that you can use diuretics without medical supervision, use medicines for combination with other medicines. Only a doctor can prescribe the necessary diuretic, and calculate the correct dosage to avoid side effects from diuretics.

Uncontrolled use of this type of diuretic compounds provokes disruptions in the hormonal system, causes fainting, and can increase cholesterol levels to a critical level.

Medications from the group of beta-blockers

The mechanism of action of beta-blockers is to reduce the frequency of contraction of the heart muscle, due to the effect on adrenaline receptors. Due to less oxygen consumption, the diastolic contraction of the heart muscle lengthens, and the pressure stabilizes.

A decrease in blood pressure is facilitated by a reduced volume of blood passing through relaxed vessels.

It is not recommended to take beta-blockers when the patient complains of pain in the area of ​​the heart muscle. Among the frequently prescribed modern beta-blockers are drugs such as Concor, Metaprolol, Nebivalol, Nebilet, Bisoprolol.

Alpha blockers

Hydralazine, Minoxidil belong to the category of alpha-blockers. Drug formulations from this group are prescribed for more severe cases of hypertension, when other medications do not improve well-being.

Modern pills lower blood pressure by relaxing the muscle tissue around the vessels. Alpha blockers are usually given in combination with beta blockers to avoid swelling and headaches during treatment.

Alpha blockers are often addictive and have many side effects, including increased heart rate.

Calcium channel blockers

Medicinal formulations from the category of calcium antagonists do not allow calcium to penetrate to vascular cells. Due to this action of the active components, the vessels expand, and the heart muscle is saturated with oxygen and nutrients.

Calcium antagonists are indicated for hypertensive crises, arrhythmias, pressure drops. Assign calcium channel blockers and the elderly to stabilize blood pressure parameters.

Among the list of calcium antagonists are the following medicinal formulations:

• Verapamil;
• Amlodipine;
• Falipamil;
• Riodipine;
• Nifedipine and other drugs.

ACE inhibitors

Among the drugs belonging to the new generation, and prescribed for increased pressure measurement, there are special medicinal formulations prescribed for ischemia, heart failure and diabetes mellitus.

Inhibitors have a vasodilating effect, reduce the risk of strokes, heart attacks, excluding renal pathologies.

Inhibitors for the normalization of blood pressure are taken according to a specially calculated scheme, because the drugs give an effect quickly, but for a short time. Treatment may be accompanied by dry cough, swelling of the face. But, compared to other antihypertensive drugs, inhibitors have few side effects and the drugs take effect quickly.

Among modern drugs from the group of ACE inhibitors, the following drugs:

• Captopril;
• Kapoten;
• Lysonorm;
• Enalapril;
• Enap;
• Lisinopril.

Inhibitors are prescribed in combination with diuretics and calcium channel blockers. With such complex therapy, a significant reduction in pressure parameters can be achieved. How to treat, increase or lower the dosage, only the doctor decides.

Inhibitors belong to the category of antihypertensive drugs that provide a quick result. For example, taking Captopril, after 15 minutes or half an hour, there is a decrease in pressure and then relief.

Despite the fact that the decrease in blood pressure parameters occurs quickly, the effect of normalization of parameters is short-lived. Therefore, inhibitors will have to be taken several times a day. Inhibitors are selected individually, according to age and general condition.

Sartans

The most effective antihypertensive drugs are sartans - new medicinal formulations. This is a group of drugs belonging to the latest generation. There are practically no contraindications to sartans, but only a doctor accepts the question of their appointment.

List of drugs from the new generation of antihypertensive drugs:

• Walz;
• Losartan;
• Valsacor;
• Nortivan;
• Atakand;
• Vasotens;
• Tantordio;
• Edarbi, and other compositions.

An important advantage of sartan is the absence of side effects after discontinuation of the drug, and the effect of prolonged action. The positive effect of blockers on angiotensin II is manifested as follows:

• cerebral blood flow is normalized;
• reduces the likelihood of a stroke;
• stabilizes the rhythm of the heart muscle;
• the level of uric acid in the blood decreases, which affects blood pressure.

Any of the drugs from the new generation of antihypertensive drugs indicated for hypertension has a long, mild and stable effect in normalizing blood pressure.

Angiotensin blockers made in Japan

Although tablets belonging to a new generation of antihypertensive drugs, and used for hypertension, effectively reduce pressure indicators, such drugs still have enough side effects:

• dizziness;
• stomach upset;
• allergic reactions, manifested by itching;
• nausea;
• general weakness;
• low pressure parameters;
• altered blood composition indicators, manifested by low hemoglobin and increased creatinine;
• puffiness.

There are no antihypertensive drugs, even among the latest generation drugs, that are absolutely safe. But, modern tablets have the following advantages over obsolete ones:

1. have a prolonged effect. As a result, the dosage of the drug is minimal, and the possibility of developing side effects is also reduced;
2. when developing new generation drugs, the active combined components are selected in such a way as to minimize side effects during the treatment course;
3. thanks to modern technologies in the production of tablets for hypertension, treatment becomes as effective as possible.

Pharmacists are developing modern drugs for hypertension, with such a small possibility of side effects that some medicines can be called practically safe.

Modern antihypertensive drugs that do not cause cough

Cough is not always associated with the pathology of the respiratory organs. The airways can be irritated due to a problem caused by a vascular or cardiac pathology. Cough, combined with high blood pressure, is a serious symptom in violation of the heart muscle.

The main cause of cardiac cough are pathological processes that develop in the tissues of the heart muscle. As a result, hypertension develops.

Coughing can occur due to high blood pressure for the following reasons:

• the process of cardiac blood flow is disturbed, arteries suffer;
• the structure of the connective, vascular tissue changes;
• increased pressure in the lungs.

When a cough occurs due to problems with blood flow, a hypertensive crisis can occur, a heart attack can develop.

When prescribing treatment, tablets are prescribed that belong to the new generation and are included in the list of drugs that exclude cough from hypertension. Additionally, expectorant medications are shown.

Tablets that block the occurrence of coughing at high pressure belong to the group of calcium channel blockers. List of medicines:

• Nimodipine;
• Lacidipine;
• Riodipine;
• Nicardipine.

During treatment with calcium blockers, the vessels dilate due to the blockade of calcium when it enters the cells. If you take drugs, then the pressure decreases, the cough is eliminated.

Such drugs are indicated for use in elderly patients with arterial hypertension who have concomitant diseases associated with the respiratory system.

In combination with calcium channel blockers, it is customary to prescribe diuretics and inhibitors.

High blood pressure and gout

Many diseases develop together, increasing each other's symptoms. Often hypertension occurs against the background of gout. The risk group includes men over 40 and women over 50.

The main reason for the development of gout in men is a violation of metabolic processes, due to which uric acid accumulates in the articular tissues.

An important point in the treatment of gout in men and women is the constant monitoring of blood pressure. If the patient suffers from hypertension, then the combination of gouty attacks with high pressure parameters can lead to serious consequences.

The main cause of death in hypertensive patients diagnosed with gout is the pathology of the heart muscle, provoked by high blood pressure.

Antihypertensive drugs for gout

When prescribing a complex treatment for hypertension, patients with gout are less likely to recommend or completely exclude diuretics. Diuretic drugs will lower blood pressure, but can cause an attack of gout.

Modern antihypertensive drugs prescribed for gout include the following categories of drugs:

• beta-blockers prescribed with caution;
• inhibitors;
• calcium antagonists;
• sartans.

A remedy from a new generation that helps against hypertension should have a prolonged action, while protecting blood vessels and the heart muscle.

In the list of new drugs for high blood pressure - Losartan. It is the most effective and safe antihypertensive drug used for gout. The active components of Losartan are completely eliminated from the body after an hour, through the intestines. The pressure stabilizes within 6 hours after taking the medicinal composition.

The drug Amlodipine from the category of calcium antagonists helps to maintain stable pressure throughout the day, and acts as follows:

1. dilating blood vessels, effectively reduces pressure;
2. does not affect the level of cholesterol and glucose, which is important in the diagnosis of gout;
3. does not affect the heart rate;
4. reduces the possibility of developing heart attacks and strokes;
5. with a sharp withdrawal of the drug, pressure drops are excluded.

Side effects of amlodipine include swelling of the extremities, nausea, redness skin faces.

Of the inhibitors, with gout, enalapril is indicated. In addition to stabilizing pressure, the drug normalizes blood flow, stabilizes the work of the heart muscle.

These drugs are used under strict medical supervision. Self-medication is excluded.

A combined drug is a pharmacological form that contains at least 2 active pharmacological substances.

A similar concept is also combined treatment - the simultaneous administration of 2 or more single-component drugs.

Combined drugs for the treatment of hypertension have been used for a long time and make up one fifth of all medicines sold in Russian pharmacies. They have a number of advantages, but are not without disadvantages.

Combined drugs for hypertension has the following advantages:

• ease of use (no need to make a schedule for taking several drugs);
• social and psychological comfort(one tablet can be easily taken even in public places);
• saving Money(the cost of the combined medicine is lower than the total cost of its components);
• reducing the likelihood of side effects.

The combination of drugs for the treatment of arterial hypertension aims to:

• reduction in the duration of treatment;
• enhancing the therapeutic effect;
• prevention of various complications;
• reduction in the amount of medication taken.

Combinations of drugs for hypertension have some disadvantages:

• a fixed ratio of the volumes of the components of the CP, which does not allow changing, if necessary, the concentration of one of them;
• the inability to combine with food intake, if the incoming components should be taken before and after meals;
• The maximum effect of exposure to various medicinal components does not coincide, and the duration of action is also different.

Combination drugs can also be used to reduce or completely prevent side effects that occur during treatment with individual drugs.

For example, with prolonged use of diuretics based on thiazide, the patient's body begins to lose much-needed potassium.

To avoid this effect, the patient is prescribed medications that combine in their composition with thiazides.

When therapeutic active substances are used in combination, their main effects often become different. This leads to interaction at the level of pharmacological processes (isolation, absorption, distribution, transformation).

The components of combined preparations can both reinforce each other and reduce or completely eliminate the negative effects of their effects on the body.

List of combined antihypertensive drugs

If we talk about the most commonly prescribed combination antihypertensive drugs, the list is as follows:

• Atakand;
• Amzaar;
• Logimax;
• Lodoz;
• Ko-renitek;

Hypertensive patients are often prescribed drugs, one of the components is the angiotensin receptor blocker valsartan. The combined drugs for pressure in this group are as follows: Exforge, Co-Exforge, Co-Diovan.

Any combination drug for hypertension should only be taken as directed by a doctor.

Synergy

If the substances of the CP have an effect on the body in one direction, reinforcing each other, then this phenomenon is called synergism. From Greek, this word is translated as "acting together."

Synergy can be:

• direct if the actions of the CP components are directed to the same receptors. Example, adrenaline + norepinephrine. At the same time, the therapeutic effect of the medicines included in the CP is summed up. In this case, there is a total or additive effect;
• indirect if the substances that make up the CP act on different receptors. In clinical practice, droperidol + fentanyl is used for pain relief. The effect exceeds the total effect of the individual components. This is called potentiation or superadditive action.

Synergism, especially providing a superadditive effect, allows you to reduce the dose of the drugs used, while maintaining the level of their therapeutic effect. But sometimes, it can lead to increased toxic effects. For example, calcium preparations used in conjunction with cardiac glycosides can increase the toxicity of the latter.

Synergism can give not only a positive, but also a negative effect, so you need to take CP very carefully and only as prescribed by doctors.

Antagonism

If the impact of a component that is part of the CP is reduced or completely eliminated by its other component, this phenomenon is called antagonism, which is translated from Greek as “opposition”. CPs with an antagonistic effect are used, for example, in the treatment of various poisonings or when it is necessary to eliminate the negative impact of a component.

Antagonism of drugs is of 3 types:

• physical;
• chemical;
• physiological (functional).

Physical antagonism manifests itself during the adsorption of various toxic substances by sorbents. For example, in some types of blood purification or adsorption activated carbon poisons that enter the body.

Chemical antagonism occurs during chemical reactions between components that produce inactive compounds. Antidotes used in the treatment of poisoning are a striking example of such antagonists. For example, unitiol is an antagonist of heavy metal salts.

Physiological or functional antagonism uses the functional systems of the body, mediated by biosubstrates. They may be direct or indirect in nature.

Atacand - a combination drug for the treatment of hypertension

Direct physiological antagonism is the action of drugs on the same receptors (cell elements) in the opposite direction. For example, acetylcholine + atropine. Such antagonism can be reversible if it can be overcome by changing the concentration of the substances involved in the process, or irreversible otherwise.

Indirect physiological antagonism is the same type of action of the components on different receptors with opposite functions.

Due to the presence of synergy and antagonism in the treatment of combination drugs or when using combination therapy, physicians must adhere to certain rules:

• prescribe only drugs with clear indications in the patient;
• prescribe a CP if there are clear indications for combination therapy;
• use combined drugs only with a typical course of the disease;
• use combined drugs only as maintenance therapy, but not at the stage of the acute period of the disease;
• explain to the patient how to combine CP with meals, other drugs;
• use CP when long-term (lifelong) treatment of patients is required.

Before taking combined drugs, the patient should carefully read the instructions, clarify the doses and the presence of contraindications, side effects.

SARS treatment

The types of medicines that are part of the combined preparations depend on the disease for which they are intended.

Here is a group of pharmacological agents that are most often included in various CPs used for colds:

• Paracetamol- analgesic, has an antipyretic effect, affecting the centers of regulation of the hypothalamus. May act as a mild anti-inflammatory agent;
• Phenylephrine- relieves swelling, hyperemia of the mucosa, reduces lacrimation, runny nose, sneezing, facilitates breathing;
• Chlorpheniramine- interferes with the action of histamine (allergy mediator), reduces the conjunctiva of the eyes and swelling of the mucous membrane, relieves bronchospasm, relieves cough;
• Dextromethorphan- eliminates dry irritating cough;
• Guaifenesin - reduces the viscosity of sputum, stimulates its separation;
• Vitamin C- is a moderate antioxidant, regulates oxidative processes, carbohydrate metabolism stabilizes capillary permeability.

Due to the high density and mobility of the population, SARS and influenza are the cause of 90% of all infectious diseases in the world. Combined drugs allow you to simultaneously affect the entire symptomatic complex of the disease with minimal doses of medications, quickly and significantly alleviating the condition of sick people.

Related videos

And yet, what pills for hypertension are considered the best? Answer in video:

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

Principles of classification

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

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

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

List of sedative drugs (some with a prescription):

• Bromide;
• Adalyn;
• Bromural.

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

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

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

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

The second group of medicines

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

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

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

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

Antiadrenergic substances

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

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

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

At the same time, a decrease in venous pressure and a decrease in the motor activity of the intestines are observed in various organs.

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

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

Ganglioblockers are contraindicated:

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

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

Medicines of other groups

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

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

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

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

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

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

In the treatment of hypertension, calcium channel blockers are indicated. Amlodipine can be distinguished from the last generation. Such blockers are taken alone or in combination with other drugs. Any antihypertensive medications are used after consulting a doctor.

Valid treatment combinations

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

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

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

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

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

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

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

Features of taking combined antihypertensive drugs:

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

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

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

The interval between stages of therapy is more than 4 weeks, if there is no need for faster normalization of blood pressure.

At the heart of the drug course, which helps to cope with hypertension, are antihypertensive drugs. They are prescribed to patients whose pressure systematically rises above 160 per 100 mm Hg. Art. On sale you can find a huge number of drugs that lower blood pressure. All of them are divided into several groups according to their composition and mechanism of action.

For many decades, physicians have conducted clinical studies that have helped them formulate the main features of drug treatment and its administration to patients with high blood pressure. They came up with the following principles:

1. Drugs prescribed by a cardiologist are required to start taking with a minimum dose. Preference should be given to those drugs that have a small list of side effects;
2. If a person tolerates the minimum dosage of the drug well, but his blood pressure is still elevated, then the amount of the drug is increased;
3. To get a positive result, it is necessary to take several groups of drugs at the same time, which help to lower the values ​​\u200b\u200bof upper and lower pressure;
4. If one of the drugs prescribed by the doctor does not give the desired effect or causes serious adverse reactions, then it is replaced with another remedy.

Cardiologists recommend that people with hypertension take antihypertensive drugs that have a long-lasting effect. They are able to keep blood pressure in a normal state for a long time. This is how the development of complications against the background of problems with blood pressure is prevented.

Classification

All antihypertensive drugs that have been developed for patients with high blood pressure are usually divided into 2 large groups.

First line drugs

1. angiotensin-converting enzyme inhibitors;
2. Diuretics;
3. Angiotensin II receptor inhibitors;
4. Beta blockers or beta blockers;
5. calcium antagonists.

These tools are usually used in combination with each other.

Usually several drugs from different groups are prescribed at once.

Second line drugs

These funds are intended for long-term therapy to suppress essential hypertension. They are suitable for certain classes of patients. For example, second-line drugs are usually prescribed to pregnant women or those patients who cannot afford to spend money on expensive drugs.

1. Alpha-blockers;
2. Rauwolfia alkaloids;
3. Alpha-2 agonists of the central action;
4. Direct acting vasodilators.

The classification also contains neurotropic antihypertensive drugs of the combined type. They combine the action of different groups of medicines to suppress the signs of hypertension.

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

This group of drugs for high blood pressure occupies a leading position in the classification.

Medicines effectively lower blood pressure due to the fact that their active substances dilate blood vessels. As a result of this action, the total peripheral resistance decreases, and therefore blood pressure decreases.

At the same time, ACE inhibitors do not affect the frequency of heart contractions and the magnitude of its ejection. Therefore, they are relevant for patients with chronic heart failure.

A decrease in blood pressure is observed after taking the first dose of the drug. If you drink ACE inhibitors for a long time, you can achieve stable stabilization of blood pressure.

The most popular angiotensin-converting enzyme inhibitors are:

• "Enalapril";
• "Captopril";
• "Quinapril";
• "Moexipril";
• "Lisinopril";
• Fosinopril.

Very rarely, patients complain of the appearance of side effects after taking drugs in this category. Most often, negative reactions are limited to the development of an obsessive dry cough, a change in taste, and symptoms of hyperkalemia. Medicines of this type are not suitable for pregnant women and patients with bilateral renal artery stenosis. Hyperkalemia is also one of the contraindications.

Enalapril should not be taken during pregnancy or if she is just being prescribed.

Angiotensin receptor blockers (ARBs)

Physicians offer patients with hypertension to take antihypertensive drugs of a new generation, which belong to the group of angiotensin receptor blockers.

These funds have almost the same effect as ACE inhibitors. Only in this case, the drug has a wider effect, and does not focus on one enzyme.

ARBs provide a powerful hypotensive effect due to the fact that they disrupt the binding of angiotensin to receptors located on the cells of the internal organs. Due to this, it is possible to achieve relaxation of the walls of blood vessels and further enhance the excretion of unnecessary fluid and salts by the kidneys that have accumulated in the body of hypertensive patients.

In hypertension, the following representatives of angiotensin receptor blockers are usually prescribed:

• "Irbesartan";
• "Losartan";
• "Valsartan".

ARBs are highly effective in dealing with high blood pressure. They work well in the presence of heart or kidney disease. They also have virtually no side effects, so these drugs can be taken for a long period. As for contraindications, ARBs are prohibited for pregnant women, people with hyperkalemia, renal artery stenosis, and allergies to drug components.

The advantage of this group of drugs is a minimum of side effects.

calcium antagonists

Muscle fibers contract with the participation of calcium. The same can happen with the vascular walls. Therefore, for the treatment of hypertension, drugs have been developed that several times reduce the penetration of calcium ions into the muscle cells of blood vessels. Due to this, their sensitivity to vasopressor elements, which lead to vasospasm, decreases.

The most popular drugs with an antihypertensive effect, which belong to the group of calcium antagonists, were included in this list:

• "Verapamil";
• "Diltiazem";
• "Felodipine";
• "Amlodipine".

Calcium antagonists do not have any effect on the conduct of metabolic processes. At the same time, they reduce the level of left ventricular hypertrophy in hypertension and reduce the likelihood of stroke.

Beta blockers

Beta-blockers are usually prescribed to hypertensive patients who have tachycardia.

Modern means of the latest generation with antihypertensive action lower the values ​​of upper and lower blood pressure by blocking the influence of beta-adrenergic receptors.

There are several types of beta blockers. They can be cardioselective or non-cardioselective. Representatives of the first class are such medicines:

• "Bisoprolol";
• "Atenolol";
• "Betaxolol";
• "Metoprolol";
• "Cileprolol".

Non-cardioselective drugs among beta-blockers are:

• "Propranolol";
• "Labetalol";
• "Carvedilol".

Since beta-blockers cause a decrease in heart rate, such drugs should not be taken by patients with bradycardia.

Beta-blockers are not prescribed for low heart rate

Diuretics

Cardiologists promise hypertensive patients to improve their condition after taking diuretic drugs, due to their hypotensive effect on the cardiovascular system. The mechanism of action of these agents has been studied for a very long time. Diuretics were among the first to be used to treat hypertension. With their help, it is possible to quickly remove excess fluid from the body, which puts a great strain on the heart and blood vessels.

There are several types of diuretics, each of which performs a specific function. Thiazide diuretics are in no way inferior in their effectiveness to other groups of antihypertensive drugs. Their representatives are:

• "Chlortalidone";
• "Hypothiazil";
• "Indapamide".

An increased concentration of thiazide diuretics leads to a change in electrolyte metabolism and metabolism, which involves carbohydrates and lipids. Although doctors usually prescribe a low dose of such drugs, since in this case they can be taken for a long time.

Thiazide drugs are usually combined with ACE inhibitors and angiotensin receptor antagonists. They are suitable for patients who suffer from various metabolic disorders and diabetes. Gout is an absolute contraindication to taking them.

Potassium-sparing diuretics are milder than other types of these drugs. They block the effect that aldosterone gives. The diuretic removes salt and fluid from the body, thereby lowering blood pressure.

Popular potassium-sparing drugs in this category are:

• "Amiloride";
• "Eplerenone";
• "Spironolactone".

They are suitable even for those patients who have been diagnosed with chronic heart failure. But these drugs are contraindicated in people with renal insufficiency or hyperkalemia.

The drug removes water and sodium, but retains potassium

Loop diuretics are considered the most aggressive. At the same time, they help lower blood pressure in a short period of time. Most often prescribed:

• "Edecrin";
• "Lasix".

Direct acting vasodilators

Antihypertensive drugs of central action are characterized by a mild effect on blood vessels. Therefore, they carry out their moderate expansion. The most useful for the body are drugs that are injected.

Direct acting vasodilators include:

• "Hydralazine";
• "Bendazol".

The main disadvantage of vasodilators is that they cause the "steal" syndrome. Because of this, they disrupt the blood supply to the brain. So such medicines are strictly forbidden to be taken by patients with atherosclerosis.

Alpha blockers

Today, alpha-blockers are mentioned less and less in the prescriptions of patients who have high blood pressure. This is because their long-term use can lead to heart failure, as well as acute cerebrovascular accidents. Sudden death is also a complication.

The group of alpha-blockers include:

• "Terazosin";
• "Doxazosin";
• "Phentolamine".

The main advantage of alpha-blockers is their main property. They significantly improve lipid and carbohydrate metabolism. Therefore, these drugs are suitable for people with diabetes and dyslipidemia.

Antispasmodic drugs

Special place in drug therapy with hypertension allocated to antispasmodics. These myotropic antihypertensive vasodilators help to relax vascular smooth muscle. They reduce the workload that is placed on the heart and reduce the viscosity of the blood, so that its platelets no longer stick together.

The most popular antispasmodics recommended for high blood pressure are:

• "Eufillin";
• "Dibazol";
• "Phenicaberan";
• "Theophylline".

Antispasmodic drugs are taken only in combination with other antihypertensive drugs.

In hypertension, diuretics are not prescribed as monotherapy.

Central alpha-2 receptor agonists

After taking an antihypertensive drug in this category, a decrease in blood pressure occurs. This is because it acts on the central nervous system and reduces sympathetic hyperactivity.

The main representatives of central alpha-2 receptor agonists are:

• "Methyldopa";
• "Clonidine".

It must be remembered that drugs cause side effects. Most often, after taking them, patients complain of fatigue and drowsiness.

Rauwolfia preparations

Drugs have a pronounced antihypertensive effect. After about 1 week of their regular intake, the patient's problems with blood pressure drops disappear.

Representatives of this category are:

• "Raunatin";
• "Reserpine".

These medicines are often taken by elderly patients, as they are satisfied with the low cost of Rauwolfia products.

Combined drugs

Among the combined drugs, the most popular are:

• "Enap-N";
• "Tonorma";
• "Vazar-N";
• "Ziak";
• "Kaptopress".

When choosing a treatment regimen, a cardiologist takes into account contraindications and side effects of antihypertensive drugs that can help a particular patient cope with the signs of hypertension. The selected medicines should be as effective and safe as possible for the person, as he will have to take them for a long time.

Hypertension is considered one of the most common diseases of cardio-vascular system. Without adequate therapy, it can be fatal. To avoid this, you need to contact a specialist. The doctor will conduct the necessary diagnostic tests and select the appropriate medicine. Many people are interested in: antihypertensive drugs - what is it? Namely, these tools are used for.

Antihypertensive (antihypertensive) drugs are drugs that help lower blood pressure. The increase in this indicator is caused by a number of factors:

• an increase in blood volume in the vessels - this leads to an increase in pressure on their walls;
• increase in peripheral vascular resistance;
• features of the pumping function of the myocardium.

Depending on these violations, the doctor chooses a specific medicine. All drugs for hypertension have a different mechanism of action and are divided into several categories.

The antihypertensive effect of such drugs not only helps to keep the pressure normal, but also helps prevent dangerous complications of hypertension. These include heart attacks, strokes, aneurysms. In addition, such drugs perfectly prevent.

Indications

The principle of action of such drugs is aimed at lowering blood pressure. Therefore, the absolute indication for the use of such drugs is hypertension.
Also, similar substances are prescribed for diseases that are accompanied by this symptom:

• angina;
• heart failure;
• ischemia.

From the category of antihypertensive drugs, the optimal substance should be selected. If the patient tolerates therapy well, but the effect is not sufficiently pronounced, this medicine should be combined with other medicines.

At mild degree pathology, it is sufficient to use combined preparations. When choosing a specific substance, the specialist must take into account the origin of the disease, the severity of hypertension, the presence of sharp pressure fluctuations.

Rules for prescribing drugs

In order for the treatment of arterial hypertension with the help of drugs to give results, you need to follow a number of recommendations:

AT human body pressure regulation is carried out in different ways. They are equally important in the homeostasis system.

Important: The pressure increases as a result of an increase in vascular resistance, the amount of circulating blood and the minute volume of blood. Medical treatment aimed at correcting one or more elements at once.

Classification of drugs for hypertension

Many drugs have antihypertensive properties, but not all of them can be used for the treatment of hypertension. This is due to the high likelihood of side effects and the need to use such substances for a long time.

When choosing antihypertensive drugs, the following classification is applied:

• diuretics ();
• angiotensin-converting enzyme (ACE) inhibitors;
• angiotensin II receptor blockers (ARBs);
• calcium antagonists;
• beta blockers.

These drugs for the treatment of arterial hypertension are highly effective. They can be used for initial therapy - alone or in various combinations.

When choosing specific drugs, the doctor must take into account the exact indicators of pressure, the characteristics of the course of the disease, the presence of concomitant pathologies. Of particular importance are lesions of the cardiovascular system.

In any situation, the risk of adverse reactions should be assessed, the possibility of a combination of substances from different categories and existing experience in the treatment of hypertension in a particular patient.

Angiotensin converting enzyme inhibitors

Such drugs for arterial hypertension are highly effective. They are issued by different groups patients with high pressure. The list of such funds includes:

• Lisinopril;
• Prestarium;
• Enalapril.

Pressure indicators are regulated by the kidneys, namely, the renin-angiotensin-aldosterone system. The tone of the walls of the vessels and the final pressure indicators depend on the correctness of its functioning. With an excess of angiotensin II, vascular spasm of the systemic circulation is observed. This is fraught with an increase in peripheral vascular resistance.

To ensure normal blood circulation in internal organs, the heart begins to function with increased loads. As a result, blood enters the vessels under high pressure.

To slow down the synthesis of angiotensin II from angiotensin I, drugs should be used that block the enzyme involved in this stage of biochemical transformations. In addition, ACE inhibitors reduce the release of calcium, which is involved in the contraction of the walls of blood vessels. This helps reduce their spasm.

The use of ACE inhibitors reduces the risk of complications from the heart and blood vessels - stroke, complex heart failure, heart attack. Also, these drugs can reduce the level of damage to target organs - especially the kidneys and heart. If the patient already has heart failure, the prognosis of pathology with the use of such substances improves significantly.

Due to the characteristics of this category of drugs, they should be prescribed to people who have kidney disease and chronic heart failure. Also, these tablets are used to treat patients with arrhythmia, a history of myocardial infarction.

They can be used by the elderly and those with diabetes. In some situations, these drugs are prescribed even for pregnant women. However, only a doctor can prescribe them.

The disadvantage of ACE inhibitors is the frequent occurrence of adverse reactions. They appear as a dry cough. Its occurrence is due to a violation of the metabolism of bradykinin. In addition, there are situations when the synthesis of angiotensin II occurs without a special enzyme - outside the kidneys. Therefore, the effectiveness of ACE inhibitors is significantly reduced, and therapy consists in the selection of another substance.

Contraindications to the use of such drugs to lower blood pressure include the following:

• significant content of potassium in the blood;
• angioedema with the use of such drugs in the past;
• sudden stenosis of the renal arteries.

Angiotensin II receptor blockers

These are quite modern and effective tools. Just like ACE inhibitors, they help reduce the action of angiotensin II. However, the point of application of such drugs is not limited to a single enzyme.

Angiotensin II receptor blockers have a broader spectrum of action. The antihypertensive effect is due to a violation of the binding of angiotensin to the receptors of cells of various organs. Thanks to the directed action, it is possible to relax the walls of blood vessels and stimulate the excretion of excess salt and fluid through the kidneys.

The list of antihypertensive drugs in this category includes the following:

Such substances can achieve good results in kidney and heart damage. In addition, they almost do not provoke adverse reactions and are well tolerated with prolonged use. Due to this, doctors prescribe this category of drugs quite often.

Key contraindications to the use of such drugs include pregnancy, allergies, stenosis of the arteries of the kidneys, and an increased content of potassium in the body.

Diuretics

This is a fairly large group of drugs, which is often prescribed for the development of hypertension. With the help of diuretics, it is possible to cleanse the body of excess salt and fluid. This allows you to reduce the amount of circulating blood, reduce the load on the vessels and the heart and achieve their relaxation.

There are several categories of such funds, each of which is characterized by certain features. Thiazide diuretics are very popular. These include Hypothiazid, Chlortalidone, Indapamide. In terms of their effectiveness, they are not inferior to beta-blockers, ACE inhibitors and other categories of antihypertensive drugs, but are often used in combination with them.

Elevated concentrations of such agents can provoke a violation of electrolyte metabolism. There is also a risk of changes in the metabolism of carbohydrates and lipids. However, a small amount of such drugs is completely safe even with prolonged use.

Thiazide drugs are usually prescribed in combination with ACE inhibitors and angiotensin II receptor antagonists. They can be used in old age, diabetes and metabolic disorders. The main contraindication to the use of such substances is the presence of gout.

The next category of diuretics are potassium-sparing drugs. They are softer. The principle of action of such drugs is based on blocking the action of aldosterone. This substance is an antidiuretic hormone that retains fluid in the body. Pressure reduction is achieved by removing salt and fluid. But magnesium, calcium and potassium ions are preserved.

Drugs in this category include Amiloride, Spironolactone, Eplerenone. They are prescribed to people who have chronic heart failure and severe swelling of cardiac etiology. They can be used for refractory hypertension that is difficult to treat with other drug categories.

Potassium-sparing diuretics affect the renal aldosterone receptors and can lead to hyperkalemia. Therefore, they are forbidden to use in acute and chronic insufficiency kidneys.

Loop remedies such as Edecrine and Lasix are more aggressive. However, they help reduce pressure much faster than other drugs.

This category of drugs should not be used for a long time, since there is a high probability of metabolic disorders. This is due to the excretion of electrolytes with the liquid. Such substances can be successfully used to relieve hypertensive crises.

calcium antagonists

Calcium is involved in contraction muscle fibers, and vessel walls are no exception. The action of funds from this category is aimed at reducing the ingress of calcium ions into vascular smooth muscle cells. This reduces their sensitivity to vasopressor components that provoke vasospasm.

The list of calcium antagonists includes the following drugs:

Antihypertensive agents from these categories differ in the nature of the action on the walls of blood vessels, the conduction system and the myocardium. So, Felodipine and Amlodipine mainly act on the vessels, provoking a decrease in their tone. In this case, the functioning of the heart does not change.

Verapamil and Diltiazem, in addition to hypotensive effects, affect the functioning of the heart. They lead to a decrease in heart rate, therefore they can be used for arrhythmia. By reducing the need for oxygen, verapamil relieves the pain of angina pectoris.

When prescribing non-dihydropyridine agents, possible bradycardia and other types of bradyarrhythmias should be taken into account. These substances are prohibited for use in severe heart failure and atrioventricular blockade. Also, they cannot be combined with intravenous administration of beta-blockers.

Calcium antagonists do not affect metabolism, reduce the level of left ventricular hypertrophy and help minimize the risk of stroke.

Beta blockers

This category includes drugs such as Nebivolol, Bisoprolol, Atenolol. Such substances have a hypotensive effect by reducing cardiac output and the formation of renin in the kidneys, which provokes vascular spasm.

This category of drugs allows you to regulate the rhythm of the heart and produces an antianginal effect. Therefore, beta-blockers are often prescribed to hypertensive patients who have coronary heart disease and chronic heart failure.

This category of antihypertensive drugs provokes a change in the metabolism of carbohydrates and fats, and can also increase body weight. Therefore, they should not be used by people who suffer from diabetes and other metabolic disorders.

Means that have adrenoceptor blocking properties provoke bronchospasm and lead to a slowdown in the frequency of heart contractions. Therefore, they cannot be used by people who have bronchial asthma, complex forms of arrhythmia, which include atrioventricular block II-III degree.

Centrally acting drugs

Centrally acting drugs that reduce the excitability of the vasomotor center include tranquilizers and sedatives. They reduce emotional reactions such as fear, anxiety, irritability.

Medicines in this category are used in the early stages of the disease. For a long time, Clonidine was considered the main remedy from this group. However, its use leads to many side effects associated with depression of the central nervous system.

Therefore, doctors usually write a prescription for other drugs from this group. These include the following:

• Tenzotran;
• Estulik;
• Physiotens;
• Rilmenidine.

Other medicines to lower blood pressure

Other medications can be used to eliminate hypertension. Pathology can be treated with the help of such drugs:

Imidazoline receptor agonists affect nerve receptors that are located in the medulla oblongata. They provoke a decrease in the activity of sympathetic vascular stimulation.

Important: Moxonidine improves metabolic processes, reduces the content fatty acids and triglycerides in the blood, increases tissue susceptibility to insulin. The use of the drug by overweight people helps to reduce weight.

Aliskiren is a direct renin inhibitor. This tool provides a decrease in the content of renin, angiotensin-converting enzyme and angiotensin in the blood. Due to this, it is possible to reduce the pressure. In addition, the substance has a cardioprotective and nephroprotective effect.

Aliskiren is allowed to be combined with diuretics, calcium antagonists, beta-blockers. In this case, the combination of the substance with angiotensin receptor antagonists and ACE inhibitors can provoke a violation of the functioning of the kidneys. This is due to the similarity of their mechanism of action.

Alpha-blockers cannot be called drugs of choice. They are prescribed as part of combination therapy as a third or fourth agent. With the help of such substances, it is possible to normalize the metabolism of fats and carbohydrates, improve blood circulation in the kidneys. However, they are prohibited for use in diabetic neuropathy.

Rasilez and Olmesartan are among modern and harmless means for reducing pressure. The first is a renin inhibitor, the second is from the category of angiotensin II receptor antagonists. Of the diuretics, Torasemide is highly effective. It is allowed to use for a long time. The medicine is safe for the elderly and people with diabetes.

Also very popular are combined substances, which include several categories of substances at once. They include the Equator. It contains lisinopril and amlodipine.

Antihypertensive drugs help to cope with high blood pressure and improve the patient's condition. A specific medicine should be selected by a specialist, taking into account the clinical picture and the individual characteristics of the organism. No self-treatment options in this case are unacceptable.

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