6 best drugs for high blood pressure

*Overview of the best according to the editors of Healthy Food Near Me. About selection criteria. This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.

This article will be useful to many people. After all, up to 30% of the adult population suffers from an increase in blood pressure, and upon reaching the age of 65, the percentage of cases gradually increases, and begins to be compared with the number of years lived. If you take 100 people who are 65 years old, then 65% of them will have symptoms of a persistent increase in blood pressure. And this is a normal value, the average in the human population. But first, before listing good and effective drugs for high blood pressure, we will introduce the reader to important concepts, without knowing which the effect of the article read will be incomplete.

Essential hypertension or arterial hypertension?

Are the concepts of “arterial hypertension” and “hypertension” identical? Should they be separated? If we explain in simple terms the difference between these concepts, then hypertension is a condition when it is impossible to explain a steady increase in blood pressure by any clear reasons. If these causes are known and fundamentally eliminated, then they speak of the “hypertension syndrome”. It occurs in the pathology of large vessels (coarctation of the aorta), endocrine glands (thyrotoxicosis), kidney disease (glomerulonephritis) and other conditions. When do people talk about high blood pressure? What numbers does at least I, the initial and easiest stage of hypertension, begin with? With blood pressure numbers over 140 to 90. More precisely, 139/89.

Dealing with risk factors is the basis of hypertension treatment

Why reduce pressure at all? It would seem that the simplest answer is this: so that the blood pressure is normal, there is no hypertensive crisis, and the person feels good. However, this is not entirely correct. Long-term therapy for hypertension is necessary in order to reduce the patient’s risk of cardiovascular complications, such as heart attack and stroke, and ideally reach the normal risk that is characteristic of people of his age and sex under the conditions of maintaining a healthy lifestyle in the area. Therefore, those patients who believe that by starting to take pills for high blood pressure, they immediately become completely protected from heart attack and stroke, are wrong.

Ideally, treatment of hypertension should put the patient at a low risk of cardiovascular complications and death. What does “low risk” mean? This means that over the next 10 years, the patient has a chance of these adverse complications and a lethal outcome of less than 15%. If we talk about a very high risk, then this figure doubles: 30% for the fact that in ten years it turns out that the patient had a heart attack, a stroke, or he had already died. Our task is for the reader to understand how to make the risk less than 15%.

Modifiable and non-modifiable factors

Before moving on to the issues of pharmacotherapy of high blood pressure, it is necessary to recall which risk factors can be changed, and eliminated altogether. This will be a very big help in the treatment of high blood pressure, and every competent cardiologist will start working with the patient with this.

There are risk factors that are beyond our control and that cannot be changed. Such factors are called non-modifiable. It’s first of all age, and then–it’s gender. And if now the sex, in principle, can be changed (but not the heart and not the vessels), then the age cannot be changed. Therefore, these risk factors can be ignored.

But it is necessary to eliminate or minimize the influence of all risk factors, which are called modifiable, changeable. These include the following states:

1. physical inactivity, or a sedentary lifestyle, sedentary, “office” work;

2. eating high amounts of salt.

Table salt, or rather sodium, tends to linger in the body, and it retains water along with it. The excess volume of fluid has to be pumped to the heart, it overflows the vessels, and the heart must exert more force and spend more time “distilling” the excess volume of circulating blood. As a result, over time, myocardial hypertrophy develops, one of the important criteria for high blood pressure, which objectively allows this diagnosis to be made during ultrasound.

If you switch to a salt-free diet, or limit the amount of salt to 5 g per day, then within a few days such a patient, a salt lover, will experience increased diuresis, that is, more urine will flow. After the excess fluid leaves the body, the heart will feel better, blood pressure will decrease, peripheral edema will disappear, and this will be a very good start in the fight against hypertension and high blood pressure. It is possible that after re-measuring blood pressure, it will be possible not to prescribe medications, and this will be the best way out of this situation.

1. alcohol abuse, smoking, not to mention drug addiction, are incompatible with a healthy lifestyle. If a person consumes a large amount of beer, then, in addition to the harmful effects of alcohol, he also overloads the cardiovascular system with an excessive volume of fluid, and this is a direct load on the myocardium;

2. Obesity and overweight are one of the most common risk factors.

If the doctor is dealing with alimentary obesity, from overeating and lack of movement, then it is necessary to start treating high blood pressure by normalizing body weight, increasing the level of physical activity, and prescribing medications at this initial stage is necessary only with really high pressure figures, or unsuccessful attempts to lose excess weight within a few weeks. But the emphasis still needs to be on healthy lifestyle activities. These are swimming, cycling, hiking, and other types of activities that are not critical. That is, swimming for an hour will be much more beneficial than running, and walking at a leisurely pace for two hours will be much more beneficial than trying to lift heavy weights in the gym.

Diabetes.

Associated with arterial hypertension, first of all, diabetes mellitus of mature age, or diabetes of the second type. It is in this case that a combination of diabetes with an increase in body weight is most often observed, and high blood sugar is not associated with insulin deficiency at all, but with insulin resistance, that is, the inability of tissues to respond to the signals of this hormone and utilize glucose. Therefore, the fight against blood pressure in patients with diabetes will be incomplete and insufficient without the normalization of glucose, again the normalization of body weight and lifestyle changes.

A high concentration of atherogenic cholesterol fractions – a large amount of “bad cholesterol”, the presence of cholesterol plaques in large vessels according to Doppler sonography, as well as heredity.

But hereditary forms of arterial hypertension are a special and serious topic, and here in this article we will not touch on these issues. Let us only draw the reader’s attention to the fact that the combination of overweight, diabetes, “pre-diabetes”, or impaired glucose tolerance with “high” cholesterol and high blood pressure is very common. And this grouping of risk factors is called the metabolic syndrome.

This patient, who has risk factors and a regular or persistent increase in blood pressure, should not be offended by a doctor if he did not prescribe him a medicine from the very first appointment. In some cases, especially if the patient’s arterial hypertension ranges from no higher than 160 to 100 mm. Hg, then it is considered arterial hypertension of the 1st degree, it is quite possible to try to start treating it by eliminating the modified risk factors. But in the event that drug treatment is necessary, then this article will be very useful to you. But before moving on to the pharmacotherapy of hypertension in general and high blood pressure in particular, it is necessary to tell in general why and how high blood pressure should be treated.

Goals and objectives of treatment

As mentioned above, the main, long-term goal is to achieve the target pressure indicators that you need to strive for. The result of successful work is a reduction in the risk of mortality, the risk of heart attacks and strokes. We will assume that the patient got a competent cardiologist, and the doctor got an obedient and stubborn patient.

We will take it for granted that the patient successfully treats all comorbidities, such as diabetes, works to eliminate all risk factors, he stopped smoking, changed his diet, increased his level of physical activity, behaves correctly, and the doctor can not get enough of this. patient. However, we will assume that the patient is shown additional drug treatment. When should the medicine be added? Such data are known, but not all doctors, unfortunately, know about them, and patients – even more so:

1. if patients have one or two risk factors that can be modified, but no diagnoses, such as smoking and overweight, and their blood pressure does not exceed 180 over 110, then treatment with blood pressure drugs should be started if the target is not reached blood pressure levels a few weeks after lifestyle changes;

2. if the patient has an additional diagnosis, for example, diabetes, and grade III hypertension is diagnosed, when the blood pressure numbers exceed 180 over 110, then in any case, treatment should be started immediately;

3. moreover, even if the patient has arterial hypertension of the first degree, or even does not have high blood pressure at all, but has the so-called high normal pressure, not higher than 140 to 90, but at the same time there is kidney pathology, diabetes or other clinical conditions, then also start treatment is needed immediately;

4. in the event that the patient has arterial hypertension of the 160st degree, that is, not higher than 100 per XNUMX, and there are no risk factors, then for several months he must follow the rules of a healthy lifestyle, and only if after a few months these measures will be ineffective , it will be necessary to start drug treatment.

If a patient has a metabolic syndrome, i.e. overweight or obesity, high triglycerides, impaired glucose tolerance, or insulin resistance, then these patients should be prescribed medication when the fight against risk factors has been unsuccessful for several weeks.

How to treat hypertension: pharmacotherapy

When listing representatives of classes of drugs, the international non-proprietary name, or INN, will be presented first, then the name of the original drug, and then commercial copies, or generics, will be listed. The original drug is always more expensive, but it should be preferred. The original product is always made from the purest chemical substance, which is the standard.

All other commercial copies, or generics, can purchase a cheaper substance, which, although it meets international standards for tolerances of various impurities, is usually still cheaper than the original product. The original drug always has the largest number of studies on its effectiveness and safety, interaction and application features, it has been studied “from all sides”.

The cheapest generics, which don’t even have a name, have the only advantage – a low price, even a very low one. If we compare their effectiveness with the original drug, then, alas, it is often much lower, or simply “none”. Therefore, make a choice towards the cheapest drug only in hopeless cases. There is a good compromise: these are modern generics produced in Eastern Europe or Indian. There’s some pretty good stuff in there.

The list of medicines below is, of course, far from complete. The author did not set the task of creating advertising or anti-advertising for any drug or manufacturer by not including it in the list. The selection criterion was the presence of the drug in international and national clinical guidelines for the treatment of arterial hypertension, the presence of this drug in the Pharmacopoeia, and in pharmacies. The following will be a range of prices relevant for pharmacies of all forms of ownership in the Russian Federation for March 2020.

Before you start treating high blood pressure with drugs, you need to remember that if we are talking about an elderly patient, then the initial dose of any drug should preferably be half that of a middle-aged person from the very beginning.

Modern treatment of high blood pressure can be carried out in the form of two approaches. It can be monotherapy, that is, taking only one medication, this is convenient. The second option is a combination treatment, a “fine-tuning” treatment that is usually given if one high blood pressure drug is not working well enough.

It is very important to understand that long-term use will be much more effective if the patient’s high adherence to treatment is observed. And adherence, or compliance, will be much higher if the patient only needs to take the drug once a day, and it will act throughout the day. Then he will not miss doses, and the duration of the drug will lead to smaller pressure surges within 24 hours. What classes of drugs are currently available to treat high blood pressure?

Rating of drugs for high blood pressure

ACE inhibitors (angiotensin converting enzyme)

One of the most popular treatments for high blood pressure is ACE inhibitors, or angiotensin-converting enzyme inhibitors.

Their beneficial effect is due to the fact that they “return back” the state of a hypertrophied left ventricle. Hypertrophy decreases, its dilatation decreases, that is, the cavity of the left ventricle becomes normal again, and not so large. If the patient did not have hypertrophy, then a correctly and timely prescribed ACE inhibitor prevents its development. The work of the heart improves in diastole, that is, during the period of relaxation of the ventricles. The degeneration of the myocardium decreases, the synthesis of fibrous fibers decreases.

ACE inhibitors also have an angioprotective effect. Smooth muscle cells cease to grow in the vessels, and in the arteries, as well as in the left ventricle, hypertrophy and thickening of their walls do not occur.

In addition, ACE inhibitors increase the concentration of nitric oxide on the vascular endothelium, and therefore it inhibits the synthesis of angiotensin on the same walls.

If the patient receives therapy with one of the following drugs, then this helps to defeat insulin resistance: the sensitivity of tissues to the action of insulin increases, glucose metabolism returns to normal, although ACE inhibitors are not used to treat diabetes in its pure form.

Aldosterone synthesis decreases, diuresis increases, sodium excretion increases and the level of potassium in the blood plasma increases. This leads to the normalization of water-salt metabolism. We list the main and most popular drugs in Russia along with their names from the group of ACE inhibitors:

1. Captopril (Capoten);

2. Lisinopril (Diroton);

3. Perindopril (Prestarium, Perineva);

4. Ramipril (Tritace);

5. Quinapril (Accupro);

6. Enalapril (Berlipril, Renitek, Ednit, Enam, Enap).

Consider a typical modern representative of ACE inhibitors, which is good in various combinations, and, above all, for the purposes of high blood pressure monotherapy. This is Prestarium.

Peridopril (Prestarium)

Rating: 4.9

Prestarium, or Perindopril, is converted in the body into its active metabolite, and produces all of these effects, which were mentioned above. It is indicated for use, first of all, in various forms of arterial hypertension, that is, high blood pressure, for the prevention of recurrent strokes, in chronic heart failure and in stable angina, primarily, again, for risk prevention.

Perindopril is taken in the morning, on an empty stomach, one tablet once a day. It can be used as monotherapy, and at the beginning of treatment it is desirable to prescribe it at a dose of 5 mg, and the dose can be increased only after a month, the dose of 10 mg per day is the maximum. It should be borne in mind that at the very beginning of treatment, the opposite may develop, lowering blood pressure below normal, or hypotension. Especially often it can occur in patients taking diuretics. In this case, it will be desirable to reduce the dose to 2,5 mg per day. The same minimum dose of 2,5 mg daily is required in elderly patients to initiate treatment. A month later, you can raise it to 5 mg, and then to 10 mg per day, but always under the control of kidney function and with the ineffectiveness of a small dose.

Prestarium is produced by the French company Laboratory Servier, and a package of 10 mg No. 30, designed for a month of use, will cost in March 2020 from 500 to 800 rubles.

Advantages and disadvantages

The advantages of Prestarium have all been described above. We can add that they are still in a mild action, the ability to use it once a day, in a large evidence base for its effectiveness, as well as in the ability to prevent heart attack and stroke. However, there are also contraindications. But they are few. These are pregnant women, nursing mothers and children, and these categories just suffer the least from hypertension and high blood pressure.

Prestarium is contraindicated for intolerance to ACE inhibitors, and for lactase deficiency. But there are quite a lot of special instructions when you need to use the drug carefully. These are stenosis of the renal arteries, systemic diseases of the connective tissue, taking antidepressants, a salt-free diet, severe forms of heart failure, being on hemodialysis, the presence of valvular defects such as aortic and mitral stenosis. Side effects of Prestarium are also possible, and most often there are dizziness, tinnitus, a decrease in blood pressure above normal, coughing and shortness of breath. It is important to consider the use of other drugs by patients. There are quite a few of them, and the interaction of Prestarium with them must be taken into account, there is an extensive section of drug interactions in the official instructions.

Angiotensin receptor antagonists

A modern group of drugs for the treatment of high blood pressure are angiotensin receptor antagonists, or their blockers. They act by influencing the function of the so-called renin-angiotensin-aldosterone system (RAAS).

In short, and in simple terms, a special enzyme is formed in the kidneys, called renin. The liver produces special substances called angiotensinogens. And under the influence of renin, angiotensinogen is converted into angiotensin, which causes an increase in blood pressure and has a pronounced, strong, vasoconstrictive effect.

In order for angiotensin to affect tissues and show its pressor effect, it must bind to special receptors that are located in the smooth muscles of blood vessels, and in the heart, in the adrenal cortex and other organs. It is by affecting these receptors that angiotensin II causes a pronounced arterial spasm, including the vessels of the renal glomeruli, an increase in blood pressure, and an increase in the secretion of aldosterone in the adrenal glands. All this leads to high blood pressure, and all the signs of hypertension.

Scientists have long been looking for experimental means that can block the action of angiotensin, and the very first substance that was introduced into medical practice appeared back in 1971. But the real drug, which did not have critical side effects and could be taken orally, was losartan, the original Cozaar drug. Currently, there are several generations of prescription angiotensin receptor antagonists, one of the most modern, will be presented below.

Since all these drugs block the pressor action of angiotensin by binding to specific receptors, it is very important that the drug has selectivity, that is, the ability to bind to these specific receptors and not to any others. For example, there are also type 2 angiotensin receptors that we don’t need for the drug to work. The selectivity, or affinity, in the case of losartan is a thousand times greater than its ability to bind to unnecessary receptors, making a mistake. In valsartan, this ability is 20 times better than in losartan.

It should be noted that all these drugs have pharmacokinetic features that are very popular with patients and make these drugs convenient. Firstly, they all act gradually, and the effect of blockade of receptors develops very smoothly. This effect lasts up to 24 hours, and if a person starts taking the drug, then the maximum effect, which is expressed in lowering blood pressure, is achieved, on average, one month after the start of treatment.

It is very convenient that angiotensin receptor blockers can be taken regardless of the meal, and at any time, and the dose can be a single dose. It makes no difference whether the patient is male or female, and no matter what age he is, the effect of the drug will be the same.

Naturally, the main indication for the appointment is arterial hypertension, hypertension. Drugs in this group are prescribed as monotherapy, especially if the patient has mildly elevated blood pressure, or in combination with severe forms of hypertension. In the last section of the article, we will consider which drugs are combined with angiotensin receptor antagonists. The most effective and successful combination is their combination with thiazide diuretics. Their addition in small doses increases the effectiveness of treatment, and the first drug that was created according to this principle was Gizaar, losartan + hydrochlorothiazide.

After many years of experience with the use of these drugs, it turned out that they not only effectively lower pressure, but also reduce left ventricular hypertrophy. This regression is very important because it increases myocardial contractility and improves exercise tolerance. Here are some of the most well-known angiotensin receptor blockers:

1. Valsartan (Valz);

2. Losartan (Kozaar, Lozap, Bloktran, Vazotenz, Lorista);

3. Eprosartan (Teveten).

Consider one of the modern representatives of this class, the French drug – the original Teveten.

Eprosartan (Teveten)

Rating: 4.9

Teveten has a high selectivity and affinity for the desired angiotensin receptors. These are organs such as the kidneys, heart, blood vessels, adrenal cortex. It binds strongly with them, and then slowly dissociates. Teveten dilates blood vessels, lowers blood pressure, and stimulates diuresis. It is shown only for the treatment of arterial hypertension, and lowering blood pressure. This is a highly selective drug that is used in the morning, regardless of food intake, once a day, at the recommended dose of 1 mg. To develop the most pronounced effect, it is necessary that 600 weeks of treatment have passed. The drug is very well tolerated, it can be administered alone, that is, as monotherapy or together with other drugs, such as calcium blockers or thiazide diuretics.

This is Abbott’s original drug and is not cheap. One package of 14 tablets, 600 mg each, designed for two weeks of use at a standard dose, will cost from 1350 to 2100 rubles. accordingly, a monthly course of treatment will cost about 3000 rubles. However, there are other, cheaper drugs from this group. And although Teveten does not have generics, it is quite possible to use the Lozap drug, of good European quality at prices from 250 to 400 rubles. for a monthly course, and the cheapest, apparently, will be the generic losartan, produced by the domestic company Pranapharm. A monthly course with this tool will cost you only 145 rubles.

But keep in mind that the original losartan – Cozaar – is currently being sold very cheaply, due to the fact that it is on the list of vitally important drugs, and the state bears the cost of acquiring it. In 2020, its monthly course will cost, on average, about 200 rubles per month, and at the same time this medicine is produced by the English company Merck Sharp. So do not run to buy domestic pills! Talk to your doctor and tell him that there is an opportunity to purchase the original English Cozaar, taking advantage of temporarily low prices. Doctors are often not informed about prices, and may prescribe a drug that is both more expensive and of lower quality, being sure that the patient does not have money for the original drug.

Advantages and disadvantages

Teveten is a very good, powerful and convenient drug, with high safety of use, which helps to achieve a mild and high-quality decrease in blood pressure, dilate blood vessels, and reduce the risk of heart attack and stroke. In addition, it eliminates excess water from the body. Perhaps the disadvantage will be the high price, and the contraindications to it are minimal: these are children, pregnancy and breastfeeding, as well as hypersensitivity. Yes, the drug should be taken carefully in severe forms of heart failure, or in people on hemodialysis, but you must admit that these categories of patients are not so common. Teveten may also have side effects: headache, dizziness most often occurred, they disappeared shortly after the continuation of treatment. Interaction with other drugs is also possible, but it is necessary for the attending physician to study this section in the official instructions.

Calcium antagonists (more correctly – CCBs, or calcium channel blockers)

Calcium antagonists are very popular in the treatment of high blood pressure. Why is this group of drugs called so? In various organs and tissues, there are calcium channels through which ionized calcium atoms enter the cells. They are very active, in high concentration they can increase tissue oxygen demand, and cause various pathological changes in cells, for example, increase pressure to improve blood flow.

If the concentration of calcium ions, for example, in the cells of the myocardium and vascular smooth muscles is low, then the coronary arteries of the heart and peripheral arteries will expand, which means that the pressure will decrease. Since calcium channels are located in various organs and tissues, there is some selectivity of drugs in this group. So, Nifedipine acts on the vessels, Verapamil has a greater effect on the myocardium, and Diltiazem occupies an intermediate position, affecting both receptors, but weaker than in the first two groups.

All calcium antagonists lower blood pressure, protect the heart and kidneys, lower cholesterol levels and are able to restore heart rhythm (especially Verapamil and Diltiazem, which are even real remedies for treating arrhythmias). In some cases, these drugs can be used for coronary heart disease, and angina attacks. The most effective drugs are the following:

1. Amlodipine (Norvask, Stamlo);

2. Verapamil (Isoptin, Finoptin, Lekoptin);

3. Diltiazem (Cardil);

4. Nifedipine (Adalat, Kordafen, Kordaflex, Corinfar, Nicardia);

5. Felodipine (Plendil).

Norvasc is often used to treat hypertension, consider it in more detail.

Amlodipine (Norvasc)

Rating: 4.9

This drug is produced by the American company Pfizer, and the amount that you will spend on a monthly course of treatment will be approximately 900 rubles. For comparison, the domestic analogue of the drug, domestic amlodipine manufactured by Roslex Pharm from the Tver region, will cost only 36 rubles. for the same package. Of course, one can understand that customs duties, the difference in exchange rates between the ruble and the dollar, and other obstacles make imported original drugs quite expensive. But still, the difference in price by 22 times makes us point to certain thoughts. Is there a significant reduction in quality here? Therefore, we will continue to talk about the original drug.

Norvasc is indicated primarily for the treatment of high blood pressure, as well as in the presence of some forms of angina in the patient, for example, stable angina or Prinzmetal’s spontaneous angina, which causes a particular risk to life. It is necessary to apply Norvasc once a day, at high pressure, first they start treatment with a dose of 5 mg, and then, if necessary, double it, 10 mg, this is the maximum daily dose. If the patient takes it along with diuretics, beta-blockers or ACE inhibitors, then there is no need to reduce the dose.

Advantages and disadvantages

A big plus is the fact that the elderly do not require dosage adjustment. It should not be prescribed for low blood pressure, but this is understandable, in our article we are talking about the treatment of arterial hypertension. It is contraindicated in obstructive processes in the left ventricle, such as severe aortic stenosis (but such patients are usually operated on in early childhood), unstable heart failure, childhood, and hypersensitivity. It should be used with caution in acute myocardial infarction, as well as in the presence of hepatic and chronic heart failure. Of the side effects, palpitations, headaches, and abdominal pain are often felt. It is possible to develop an overdose, with the appearance of a persistent decrease in pressure, and even with the development of shock. Amlodipine can be used not only as monotherapy, but together with ACE inhibitors, beta-blockers and thiazide diuretics.

Beta-blockers

Beta-blockers are a group of drugs that have long been used to lower blood pressure, reduce heart rate, and treat tachycardia. Many beta-blockers can be combined with other drugs, and have a secure place in the high blood pressure niche. The fact is that these drugs are indispensable if the patient has a persistent increase in heart rate, tachycardia, or the presence of a hyperkinetic type of blood circulation, in which an attempt to expand the vessels in the periphery and thus reduce blood pressure is unsuccessful. Therefore, it remains to go the other way: to reduce pressure not by reducing resistance in the periphery by expanding the vascular bed, but by reducing the work of the heart: reducing cardiac output, and slowing the heart rate. For this, a large group of so-called selective beta-blockers is used:

1. Metoprolol (Betalok, Vasocardin, Corvitol, Egilok);

2. Atenolol (Betacard, Tenormin);

3. Betaxolol (Lokren);

4. Bisoprolol (Aritel, Bidop, Konkor);

5. Nebivolol (Nebilet);

6. Talinolol (Cordanum).

Perhaps the most popular of the original beta-blockers in Russia is Egilok, as well as Concor, but we will describe a modern and recently marketed drug like nebivolol, or Nebilet.

non-ticket

Rating: 4.9

The original drug is produced by Berlin-Chemie, and a monthly course will cost from 900 to 1400 rubles. However, you can always choose a medicine from the Berezovsky Chemical Pharmaceutical Plant, and then within a month you will have to pay only 250 rubles. It is a cardioselective (non-vascular) drug that reduces blood pressure, normalizes rhythm and reduces symptoms of myocardial ischemia. Nebilet reduces pressure both at rest and during physical exertion, and, most importantly, during stress. It is necessary to apply Nebilet once a day, eating does not matter, but still you need to take it at the same time. For the treatment of high blood pressure, 2,5 or 5 mg is needed, that is, half a tablet or tablet. In elderly patients, it is necessary to start treatment with a minimum dosage. If necessary, the dose is increased, and the maximum daily dose is 10 mg, that is, two tablets.

Advantages and disadvantages

Nebilet is contraindicated in sinoatrial blockade, hypotension and systolic pressure less than 90 mm Hg, with high-grade atrioventricular blockade, the presence of bronchial asthma, and bradycardia less than 60 beats per minute. Side effects often include headache, nausea, and dizziness. Since the drug reduces the work of the heart, it can also cause overdose symptoms, these are very rare heart contractions, a sharp drop in blood pressure, loss of consciousness, up to cardiogenic shock and death.

Diuretics

We have described in detail the group of drugs, or diuretics, in a recently released article called “6 drugs for the treatment of edema”, so we will not characterize this group of drugs in detail, and refer those interested to this material. Let’s just say in general terms that if beta-blockers lower blood pressure, reducing the work of the pump, that is, the heart, then diuretics, or diuretics, reduce the pressure in the system, releasing excess fluid from it, that is, increasing diuresis.

Of the diuretics, not all are suitable for long-term therapy, as a treatment for high blood pressure. To do this, the diuretic should be mild, act slowly, and not cause a sharp leaching of potassium, calcium, and other elements from the body. Most suitable for the role of diuretics for lowering blood pressure, most often in complex therapy, are thiazide diuretics, of which hydrochlorothiazide (Hypothiazide) and indapamide (Arifon) can be called. Powerful diuretics, such as furosemide, are used to relieve a hypertensive crisis in an emergency. Consider Arifon, this wonderful drug that is often used in combination with other remedies.

Indapamide (Arifon)

Rating: 4.9

Arifon is also an original French drug, and a monthly package containing 2,5 mg tablets will cost you an average of 380 rubles. per month. Of course, if you can’t afford the original drug, and you don’t really think about quality, then the cheapest domestic indapamide may suit you, and then within a month you will have to pay only 25 rubles.

Arifon slows down sodium reabsorption, and it can be used as monotherapy, it has an interesting property: small doses that do not yet cause a diuretic effect, allow you to lower blood pressure gently and keep it low throughout the day. What is the effect? Indapamide improves the elasticity of large vessels, and reduces the total vascular resistance in the periphery, mainly due to the arterial link. It is able to reduce left ventricular hypertrophy, and, remarkably, works in small doses that do not cause stimulation of urination, and do not affect carbohydrate and lipid metabolism. This means that it can be used in patients with diabetes mellitus, metabolic syndrome and atherosclerosis. Arifon should be used one tablet per day, preferably in the morning, daily.

Advantages and disadvantages

A big plus of Arifon is the impossibility of an overdose. Even if you swallow a lot of pills, it will simply show its diuretic effect, and that’s it. However, it is contraindicated in severe renal failure, a marked decrease in potassium in the blood plasma and liver pathology, as well as in children under 18 years of age. It should be used with caution in the treatment of patients with elevated levels of uric acid, or hyperfunction of the parathyroid glands.

Conclusion: drug combination

Finally, in conclusion of the list of drugs for the treatment of high blood pressure, consider popular combinations, that is, drugs containing two components at once. An excellent combination gives a diuretic, for example the same indapamide or hydrochlorothiazide, with an angiotensin receptor inhibitor. This combination is called Gizaar, Lozap plus, Lorista N, and contains hydrochlorothiazide and losartan. The hypotensive effect of the drug is due to the effect of two components at once, affecting various links in the pathogenesis of high blood pressure.

The same medicinal substance, which contains more than one active element, can be Prestanz, released in the laboratory of Servier. It contains the beta-blocker amlodipine (Norvasc), in combination with perindopril (Prestarium), which we discussed above. So, the drug Lorista N can cost you from 600 rubles. per month, and Prestans – about the same price. Naturally, the presence of two components also allows you to influence two links of pathogenesis at once, for example, Perindopril affects receptors and eliminates the vasoconstrictor effect on the periphery. At the same time, amlodipine, by reducing the work of the heart, allows the drug to work in another direction. Thus, when taking Prestanza, the influence on the central link of hemodynamics, that is, on the work of the heart, and on the peripheral one is blocked.

Cardiologists are confident that the future of modern therapy for high blood pressure and hypertension lies with combined drugs, consisting of two or three components. However, an extremely important and basic way of treating mild and borderline arterial hypertension, which always precedes severe forms, is not drug therapy, but a healthy lifestyle and modification of risk factors.

Attention! This material is subjective, is not an advertisement and does not serve as a guide to the purchase. Before buying, you need to consult with a specialist.