Medicines for high blood pressure

One of the main risk factors for the onset of hypertension is considered to be a high rate of blood pressure, the norms of which differ for patients of different age categories. Modern doctors consider blood pressure above 140/90 at any age to be pathological and require control. However, medical treatment is not necessary in every case.

So, in the absence of concomitant pathologies – endocrine disorders, diabetes mellitus, cardiac disorders, when constantly elevated blood pressure is observed, it is possible to correct the patient’s condition without resorting to drugs. In the early stages of the disease, it is enough to change the diet, lose weight, and exercise more often. Psychotherapy, reflexology, massage, and meditation are considered effective methods of non-drug treatment of arterial hypertension in the early stages. However, with an increase in pressure above the border of 160 to 90, such treatments are no longer enough.

Another factor that is taken into account when compiling a course of treatment is blood pressure targets, that is, the results that need to be achieved. Targets for most patients range from 140-135 to 90-85. If earlier a slight increase in the norms for elderly patients was allowed, now these figures are universal for all patients with arterial hypertension.

There are differences in the approach to the treatment of patients of the older age group with complications in the form of atherosclerotic plaques – it is necessary to reduce the pressure to the target values ​​gradually in order to avoid health problems.

Classification of risk factors for arterial hypertension:

• The presence of endocrine disorders and systemic diseases, diabetes mellitus;

• Hereditary factors – relatives with coronary heart disease at an early age and other pathologies;

• Elevated cholesterol level (more than 6,5 mmol / l);

• Bad habits – excessive drinking, smoking;

• Cardiac disorders, ischemic disease, myocardial infarction;

• Age over 55 for men and over 65 for women;

• Persistent increase in blood pressure.

Factors contributing to the development of arterial hypertension:

• Renal failure, nephropathy;

• Environmental factors – life in the urbanized space of large cities;

• Obesity and a sedentary lifestyle, lack of a minimum level of physical activity;

• Disorders of glucose metabolism;

• Microalbuminuria.

Factors that increase the risk of mortality in patients with arterial hypertension:

• Cerebral circulation disorders – stroke, history of ischemia;

• Cardiac disorders – ischemic heart disease, myocardial infarction;

• Circulatory disorders in the retina, hemorrhagic disorders, optic nerve edema.

“Death Quartet” of symptoms:

• Pathological overweight;

• Elevated cholesterol;

• Increased blood sugar levels;

• Obesity.

Most underestimate the risks of the disease, do not get regular physical examinations and refuse medication and other lifestyle changes. With exacerbations of high blood pressure, they prefer to endure discomfort and refuse medical intervention, which poses a threat to life and increases the risk of sudden death from a catastrophe in the cardiovascular system.

There is another group of patients who are aware of the risk of the disease on the example of the experience of relatives and friends who got a heart attack or stroke. They resort to self-medication, buying up all the newfangled drugs for high blood pressure in pharmacies without a doctor’s prescription, and try these drugs on themselves. However, they do not want to entrust their treatment to a specialist.

At the same time, in both cases, the best solution would be an examination by a specialist who has extensive practice in the treatment of arterial hypertension and can draw up an individual course of treatment using modern drugs. This avoids irreversible changes in the internal organs and reduces the risk of sudden death.

Drugs for hypertension

Drug treatment of hypertension is necessary with a persistent increase in pressure above 160 by 90 mm Hg, for patients with concomitant pathologies – cardiac disorders and renal failure – indicators from 130 to 85 mm Hg are dangerous. and higher.

In most cases, multiple drugs are used to treat hypertension. Combination therapy allows you to comprehensively influence the mechanisms of the development of the disease and softens the severity of side effects. At the same time, the dosage of drugs for high blood pressure can be reduced due to their synergistic action, which ensures maximum effectiveness. However, in the case of mild arterial hypertension with elevated heart pressure, one single-acting drug can be dispensed with, which is taken once a day.

How to choose pills for high blood pressure

Even if a person knows exactly the cause of high blood pressure, one should not independently engage in the selection of medicines. The pharmaceutical industry offers 6 classes of drugs to reduce blood pressure. They have a different mechanism of action, indications and contraindications. After listening to the advice of a relative, reading articles on the Internet, or simply choosing the drug you like at the pharmacy, you can seriously harm your health.

When prescribing therapy, the doctor takes into account many factors. What matters is the patient’s age, his state of health, comorbidities, cholesterol levels, kidney function, weight, hormonal status, the presence or absence of diabetes mellitus, and more. Be sure to take into account the initial indicators of blood pressure, as well as how the vessels react to the drug. After analyzing all the data, the doctor will prescribe one drug from 6 groups:

• Beta blockers. They lower blood pressure by affecting heart rate. If the heart rate is slow, blood is pumped slowly, causing it to enter the vessels under less pressure. This group of medicines has a number of side effects, including: allergic reactions, a significant slowdown in heart rate, which leads to poor health and weakness.

• Diuretics or diuretics. Their intake leads to the fact that fluid is excreted from the body. It leaves the tissues and blood vessels, thereby lowering the level of blood pressure. Among the undesirable effects from taking diuretics: nausea, dizziness, numbness of the fingers and toes. Also, patients complain of a crawling sensation, which occurs due to excessive excretion of salts from the body.

• ACE-I or angiotensin-converting enzyme inhibitors. In people suffering from high blood pressure, an excess amount of angiotensin is produced in the body. This is a special hormone that affects the blood vessels, causing them to spasm. In addition, it promotes fluid retention, thereby increasing pressure. The less of this hormone in the body, the more relaxed the vessels. As a result, blood pressure decreases. When taking ACE inhibitors, the enzymes responsible for the synthesis of angiotensin are blocked. The drugs of this group have a minimum number of contraindications, among them: allergic reactions and cough (sometimes its attacks significantly reduce the quality of life of people taking ACE inhibitors).

• Angiotensin antagonists. These drugs inhibit the activity of angiotensin, which stimulates vasospasm and increases blood pressure. Among the side effects of taking angiotensin antagonists are dizziness, nausea, decreased vascular tone and a sharp drop in blood pressure.

• calcium antagonists. Calcium ions maintain vascular tone. Taking drugs from the group of calcium antagonists will allow you to relax them, relieve excessive stress, which helps to lower blood pressure. Side effects include heart palpitations and dizziness.

In addition to the main drugs, the doctor recommends additional drugs to be taken during a crisis (a sharp increase in blood pressure). The dose also depends on the individual characteristics of the patient. Therefore, for each patient, only a certain drug will be the best.

Top 7 pills for high blood pressure

We made a selection of 7 drugs that are most often prescribed to reduce pressure, painted their mechanisms of action, as well as the main advantages and disadvantages.

Verapamil

Verapamil tablets to reduce pressure from the group of “slow” calcium channel blockers – the price is 100 rubles. The main active ingredient is verapamil hydrochloride at a dosage of 40 and 80 mg. Taking the drug allows you to normalize the pulse, eliminate the symptoms of myocardial ischemia, relieve the load on the heart muscle, improve blood circulation, and reduce pressure. Verapamil is considered the best drug in the treatment of Prinzmetal’s angina and exertional angina. It is prescribed for various cardiac arrhythmias, as well as for the prevention of angina pectoris.

Pros:

• Quick effect that develops 1-2 hours after taking the dose.

• Complex action. The drug not only reduces blood pressure, but also normalizes the work of the heart.

• Possibility of prophylactic use.

• Доступная цена.

Cons:

• Prohibited admission for pregnant and lactating women, as well as for persons under 18 years of age.

• The need to take during or after meals.

• Multiple contraindications, including heart failure stage II B-III, very high blood pressure, cardiogenic shock, myocardial infarction and others.

• Side effects in the form of a sharp drop in blood pressure, tachycardia, angina pectoris, arrhythmia, nausea, vomiting, increased appetite, headache, dizziness and fainting.

• Allergic reactions, as well as weight gain, are not excluded.

• Avoid abrupt discontinuation of therapy.

Capoten

Tablets Kapoten from the group of ACE inhibitors – 200 rubles. The main active ingredient is captopril. Taking the drug reduces the concentration of angiotensin II and eliminates its negative effect on the veins and arteries, which reduces blood pressure. It is prescribed for hypertension, chronic heart failure, myocardial infarction, left ventricular dysfunction, diabetic nephropathy.

Pros:

• With a decrease in pressure, there is no increase in heart rate, fluid and sodium ions do not linger in the body.

• The effect develops quickly – after 1-1,5 hours. Its intensity does not depend on the position of the patient’s body.

• Accumulative action, without a sharp decrease in blood pressure. Optimal results can be achieved after a few weeks of continuous therapy.

• Absence of a withdrawal syndrome in case of refusal to take the drug.

Cons:

• A frequent side effect is a pronounced dry cough.

• Released by prescription only.

• Numerous contraindications.

• Communication with food intake (the drug is taken strictly one hour before meals).

Veroshpiron

Veroshpiron tablets from the group of potassium-sparing diuretics – the price is 100 rubles. The main active ingredient is spironolactone. Taking the drug prevents fluid retention, increases the excretion of water, chlorine and sodium ions in the urine. The decrease in pressure occurs due to the diuretic effect. Veroshpiron is used in the treatment of hypertension, in chronic heart failure accompanied by edema, in cirrhosis of the liver, to prevent potassium and magnesium deficiency during treatment with other diuretics.

Pros:

• Providing a diuretic effect with minimal excretion of potassium ions from the body.

• The drug begins to act gradually, as it accumulates in the body, due to which there is no sharp decrease in pressure. The maximum effect develops on the 2-5th day from the start of therapy.

• High bioavailability, which reaches 100% when taken with food.

• A small list of contraindications for admission.

• Reducing the toxicity of cardiac glycosides while taking.

Cons:

• The ban on admission during pregnancy, lactation, with severe renal failure, anuria, Addison’s disease.

• Numerous side effects in the form of diarrhea, vomiting, nausea, changes in the blood picture, headache, drowsiness, menstrual irregularities, decreased potency, allergic reactions, etc.

• A ban on taking many drugs, for example, anticoagulants, phenosol, norepinephrine, digoxin, salicylates, indomethacion, etc.

• Prohibition of drinking alcohol during therapy.

Metoprolol

Metoprolol tablets from the group of selective beta1-blockers – the price is 80 rubles. The main active ingredient is metoprolol tartrate. Taking the drug reduces blood pressure, stops and prevents angina attacks, normalizes heart rate, and eliminates arrhythmia. Metoprolol is prescribed for hypertension, tachycardia, ischemic heart disease, for the prevention of angina pectoris and migraine, for heart rhythm disturbances, for hyperthyroidism.

Pros:

• Numerous effects and indications for admission.

• Decreased blood pressure during physical exertion and stress.

• The rapid development of the effect – 15 minutes after taking the dose. The action lasts up to 6 hours.

• Increases exercise tolerance.

• Restores heart rhythm in sinus tachycardia.

• High bioavailability. When taken with food, its rate can reach 100%.

• May be used during pregnancy.

• Low price.

Cons:

• Multiple contraindications, including: cardiogenic shock, sick sinus syndrome, bradycardia, Prinzmetal’s angina, acute infarction, etc.

• Do not use in the treatment of persons under 18 years of age, lactating women.

• Relationship with food.

• Side effects from most body systems (CNS, gastrointestinal tract, skin, endocrine glands, respiratory organs, heart and blood vessels).

• Released by prescription.

Moxonidine

Moxonidine tablets from the group of antihypertensive drugs of central action – the price is 550 rubles. The main active ingredient is moxonidine. Its reception allows you to reduce systolic and diastolic pressure, both with a single and with prolonged use. The drug is prescribed for arterial hypertension.

Pros:

• In addition to reducing pressure, when taking the drug, the signs of myocardial fibrosis are eliminated, the capillary blood supply of the heart muscle returns to normal, without changing the heart rate.

• Tissue resistance to insulin is reduced by 21%.

• Therapy does not affect metabolic processes.

• High bioavailability of 88%, without connection with food intake.

• A quick effect, which is achieved half an hour after the start of therapy (maximum – after 3 hours). The action lasts up to 12 hours.

• May be used to treat pregnant women.

• Common side effects include dizziness, fatigue, dry mouth, and fatigue. They disappear within a few weeks from the start of treatment.

Cons:

• High price.

• Contraindications in the form of severe renal failure, with bradycardia, heart failure, sick sinus syndrome.

• Do not prescribe to persons under 18 years of age and when breastfeeding.

Thiazide diuretics and sulfonamides

Saulretics contain sulfonamides and thiazide diuretics, which work together to improve urination and reduce swelling. When the edema of the vascular wall subsides, the lumen of the vessel increases and blood flow is facilitated, respectively, the pressure decreases.

Thiazides

• Cyclomethiazide;

• Hydrochlorothiazide;

• Hypothiazide.

The mechanism of action is based on blocking the reabsorption of sodium and chlorine, which occurs in the renal tubules. Thus, excess fluid does not linger in the body, and swelling subsides.

When used by people with normal blood pressure, its performance does not change.

The first effect occurs one and a half hours after administration, the duration of action is from 6 to 12 hours.

The dosage of the drug for monotherapy is 25-50 mg, with combination therapy, the doses range from 12,5-25 mg. Take the drug in the morning.

Contraindications: electrolyte imbalance, pregnancy and lactation, anuria, renal and hepatic insufficiency, age under 3 years, Addison’s disease.

Side effects: nausea, dry mouth and dizziness, cramps and muscle pain, electrolyte imbalance, allergic rashes, anaphylactic shock, photodermatitis, temporary visual impairment, numbness of the extremities, pulmonary edema, Steven-Johnson syndrome, pneumonitis, hemolytic anemia, impaired potency, arrhythmia, diarrhea, nausea and vomiting, exacerbations of gout and cholecystitis, renal failure, interstitial nephritis.

Sulfonamides

Sulfonamides are well tolerated by patients, prevent cardiovascular complications and reduce the risk of sudden death. Completely excreted from the body through the liver and kidneys, do not accumulate in organs and tissues.

• Chlorthalidone or Oxodoline;

• Indapamide – prescribed to patients with diabetes, as it does not change blood sugar levels;

• Chlorthalidone and Atenolol as part of a combination drug.

Drugs of this group are prescribed in severe cases of arterial hypertension, in which other medicines have been ineffective. It is used as part of combination therapy, and Chlortalidone in Russia can only be purchased as a complex with other drugs.

Method of application and dosage: Indapamide is taken once a day, regardless of meals, a single dosage is 2,5 mg, the duration of action is 24 hours. The effect of the drug appears after 7 days from the start of administration.

Contraindications: the period of pregnancy and lactation, a decrease in the level of potassium in the blood, electrolyte imbalance, lactose intolerance and severe forms of renal and hepatic insufficiency.

Side effects: on the part of the digestive system, nausea and vomiting, stomach pain and stool disturbance can be observed; from the nervous system – insomnia or drowsiness, nervousness, depression. Other possible side effects are allergic rashes, a sharp decrease in blood pressure, palpitations, dry cough, rhinitis and pharyngitis.

Beta-blockers

In this group are drugs for which the ability to reduce the risk of cardiovascular problems has been reliably determined. The use of beta-blockers is possible for patients who have experienced myocardial infarction, suffer from angina pectoris, chronic heart failure or permanent atrial fibrillation. The therapeutic effect is achieved by blocking beta receptors and reducing the intensity of the release of angiotensin 2 and renin, hormones that cause vasoconstriction.

Beta-blockers can be taken as part of both mono and combination therapy. The period of isolated use of these drugs usually does not exceed one month – after this period, a combination with calcium channel blockers or diuretics is required.

Beta-blockers are divided into two groups:

• Non-selective: carvedilol, oxprenolol, sotalol (SotaGeksal), nadolol (Korgard 80), propranolol (Anaprilin);

• Selective: atenolol, betaxolol, nebivolol, bisoprolol, metoprolol, celiprolol.

If long-term treatment is needed, meto- and bisoprolol, nebivalol, betaxolol and carvedilol are the best, which significantly affect the risk of death in hypertension. Betaxolol (Lokren) is recognized as the drug of choice for managing hypertension in menopausal women.

Carvedilol

It is the most common of non-selective blockers and the main active ingredient in a wide range of drugs:

• Carvedilol;

• Cariol;

• Cardivas;

• Dilatrend;

• Acridilol;

• Bagodilol;

• Vedicardol;

• Carvidyl;

• Carvenal;

• Talliton;

• Perfume;

• Recardium.

The effectiveness of carvedilol, in comparison with other beta-blockers, is increased by blocking vascular receptors, not only beta, but also alpha type.

Reception of funds is calculated from the daily need for 25-50 mg of carvedilol.

Contraindications relate to such heart problems as blockade, a rare rhythm and decompensated insufficiency, as well as pathologies such as bronchial asthma and various liver lesions. The drug is not prescribed if the patient is under 18 years of age, and women during lactation. In depression, pregnancy, renal failure, psoriasis, diabetes mellitus and thyrotoxicosis, the appointment of drugs with carvedilol is possible only with caution on the recommendation of the attending physician.

The most likely side effects of the drug:

• a sharp drop in blood pressure;

• drying of the oral mucosa, vomiting and violations of the regimen and quality of the stool are also possible;

• bradycardia;

• various allergic reactions: runny nose, spasms of the upper respiratory tract, redness and rashes on the skin, sneezing, weight gain, flu-like syndrome and pain in the limbs.

Bisoprolol

Available in the following pharmaceuticals:

• Aritel;

• bisoprolol;

• Biol;

• Bisogamma;

• Biprol, Bidop Cor;

• Coronal;

• Concours;

• Cordynorm;

• Nipperten.

Bisoprolol should be taken in the morning in an amount of 5 to 10 mg, although a dose of more than 2,5 mg per day is not required for mild hypertension. A feature of the drug is the need to gradually reduce the dosage within two weeks, since an abrupt cessation of the course often provokes sharp jumps in blood pressure. Due to similar pharmacokinetics, contraindications and a list of side effects of bisoprolol are similar to those for carvedilol.

Angiotensin-converting enzyme inhibitors

They act on the enzyme responsible for converting the vasoconstrictor hormone angiotensin into renin. As a result, there is a decrease in blood flow through the heart, restoration of the myocardium in the presence of hypertrophy, and prevention of its thickening.

ACE inhibitors with a sulfhydryl group

This category includes substances such as:

• Captopril (drugs Kapoten, Epsitron, Captopril, Alkadil);

• Benazepril (Potensin drug);

• Zofenopril (Zocardis drug).

Captopril is one of the best means of dealing with hypertensive crises, but due to its strong effect, it is better not to take it to older people with atherosclerosis of the vessels.

Contraindications: angioedema during therapy with ACE inhibitors in history, pregnancy, lactation, children under 18 years of age, after kidney transplantation, difficulty in outflow of blood from the left ventricle, with caution in diabetes mellitus, cerebral ischemia, coronary artery disease, old age, severe autoimmune diseases.

ACE inhibitors with a carboxyl group

This group of ACE inhibitors includes:

• Enalapril – represented by drugs Enalapril, Enap, Enam, Edith, Berlipril, Renipril, Renitek;

• Lisinopril – Lisinopril, Lisinoton, Diroton. The drug of choice in patients with type XNUMX diabetes mellitus and metabolic syndrome.

• Perindopril – Prestarium, Perineva. In addition to the fight against hypertension, it has proven itself in the prevention of stroke, as well as a drug for hypertensive patients with chronic heart failure;

• Spirapril – Quadropril;

• Ramipril – Hortil, Tritace, Amprilan;

• Trandolapril – Three Retard;

• Cilazopril;

• Quinopril

Practice shows that in addition to the main action, enalapril is able to literally prolong the patient’s life. At the same time, among the side effects, the most unpleasant is a dry cough.

Contraindications: pregnancy, lactation, hypersensitivity, with caution – diabetes mellitus, liver, kidney failure, old age, children under 18 years of age, coronary artery disease, severe autoimmune diseases, after kidney transplantation, etc.

Application: initial dose of 5 mg. 1 r / day, if there is no effect after 2 weeks, the dose is increased to 10 mg. With moderate hypertension, the daily dose is 10 mg, the maximum daily dose is 40 mg.

Side effects: decrease in pressure, angina pectoris, arrhythmias, pulmonary embolism, headache, dizziness, depression, nervousness, fatigue, tinnitus, visual and hearing impairment, vestibular apparatus, loss of appetite, dyspepsia, pancreatitis, jaundice, dry cough, shortness of breath, pharyngitis , bronchospasm, angioedema, urticaria, photosensitivity, stomatitis, arthritis, arthralgia, impaired renal function, hair loss, decreased libido.

With phosphinyl group

These ACE inhibitors are found in the drugs Fosinopril, Fozicard.

Necessary for the treatment of hypertension in renal failure.

Sartans (angiotensin II receptor blockers)

Modern drugs for high blood pressure, which declared themselves on the pharmaceutical market in the early nineties. They are distinguished by an effective decrease in pressure for the whole day (maximum – for 48 hours), they act gently, dry cough manifests itself in very rare cases, there is no withdrawal syndrome. They relieve spasm of the walls of blood vessels, due to which they can be used for renal hypertension.

List of common sartans:

• Losartan – is considered the best original sartan available in the Russian Federation. The main active ingredient of such drugs as: Losartan, Lorista, Lozarel, Lozap, Blocktran, Vazotens, Kozar, Presartan, Teva;

• Valsartan – available in medicines Valsakor, Valz, Diovan;

• Eprosartan – Teveten;

• Candesartan – Atakand;

• Telmisartan – Twinsta and Micardis.

Calcium channel blockers

Specific drugs that positively affect the ability to tolerate physical activity. They play an important role in combination with ACE inhibitors, as they allow you to do without diuretic drugs. Can be used to treat patients with cerebral atherosclerosis and a combination of hypertension, angina pectoris and cardiac arrhythmias.

They are divided into three types:

• Dihydropyridines (eg, amlodipine, nifedipine);

• Benzodiazepines (eg, diltiazem);

• Phenylalkylamines (eg, verapamil).

The following drugs have proven themselves well:

• Amlodipine – available in the preparations Amlodipine, Amlotop, Amlovas, Tenox, Norvask, Kolchek, Cardilopin. Take 5 or 10 mg per day.

• Verapamil – medicines Verapamil, Isoptin, Verogalid;

• Nifedipine – Osmo-adalat, Nifecard, Kordaflex, Kordipin, Calcigard, Fenigidin;

• Diltiazem – Diltiazem, Diazem, Diacordin, Kardil.

Hypotensive central action

The most popular drugs for high blood pressure in this group are clonidine, moxonidine and andipal.

Why you shouldn’t use rauvolvia preparations?

Rauwolfia preparations, the most common of which are Raunatin and Reserpine, are one of the very first drugs for the treatment of arterial hypertension. They belong to the group of sympatholytics, retain sodium and excess fluid in the body.

The therapeutic effect of taking rauwolfia preparations occurs very slowly – the hypotensive effect becomes pronounced only in the second week of administration, and only 25% of patients achieve stable results in stabilizing normal blood pressure.

Moreover, this group of drugs does not meet the basic requirements for modern drugs for the treatment of arterial hypertension – improving the quality of life of the patient and minimizing the risks of complications from the cardiovascular and other body systems. So, modern drugs can prevent the development of atherosclerosis and the formation of plaques on the walls of blood vessels, prevent arrhythmia and sclerotic formations in the renal glomeruli, and reduce left ventricular hypertrophy.

Rauwolfia preparations are still used by many patients with arterial hypertension, focusing on their affordable price. However, the main reason why these drugs should be discarded is the pathologies that may occur after their use.

These include:

• High risk of developing malignant tumors in the mammary glands. The incidence of the disease increases 3 times in people who took drugs based on reserpine;

• Reserpine preparations contribute to the development of oncological formations in the pancreas, which has been proven by scientific studies. This is the main reason for the ban on rauwolfia preparations in several European countries, including France.

Side effects that occur after using reserpine drugs:

• Bronchial spasms, nasal congestion;

• Sleep disturbances, depression, in elderly patients while taking the drug, parkinsonism may occur;

• Cardiac disorders, arrhythmia;

• Peptic ulcer, gastrointestinal pathology;

• puffiness;

• Impotence.

There are combined forms of preparations based on rauwolfia, which increase the effectiveness of the main active ingredient. However, this happens mainly due to the diuretic components in the composition of the drug, while the number of side effects does not decrease, but is summed up from all the components of the drug.

Combined forms of rauwolfia include:

• Sinepres (reserpine, hydrochlorothiazide, dihydroergotoxin);

• Adelfan (a combination of reserpine and dihydralazine);

• Brainerdine (reserpine, dihydroergotoxine, clopamide and dihydroergocristine);

• Trirezide (contains reserpine, hydrochlorothiazide, digralazine and potassium chloride);

• Adelfan esidrex (reserpine with hydrochlorothiazide and dihydralazine).

Hypertension in the elderly

For the treatment of arterial hypertension in elderly patients, diuretics, hypothiazide and indapamide, are primarily prescribed. Indapamide is prescribed to patients with diabetes mellitus. Monotherapy with these drugs gives good results in mild forms of hypertension, and their low cost makes these drugs affordable for most people. In addition, these high blood pressure medications are effective in managing hypertension in menopausal women.

Second-line drugs include the dihydropyridine calcium channel blockers nifedipine and amlodipine. They are prescribed to patients with overweight and concomitant pathologies in the form of diabetes mellitus and atherosclerosis.

Third-line drugs are sartans and lisinopril.

Preparations for the combination therapy of arterial hypertension – tarka (trandolapril with verapamil) and prestans (perindopril with amlodipine).

Relief of a hypertensive crisis

Modern medicine no longer recognizes the classical method of stopping hypertensive crises using intramuscular injection of magnesium sulfate, since the injection requires too much time, special skills and resources (sterile syringe, container with the drug, etc.).

It is much more effective to stop the crisis with the help of modern pharmaceuticals:

• Nifedipine (or Corinfar) – a tablet with 10 or 5 mg of the active substance, dissolves under the tongue;

• Kapoten – is required in the amount of 25-50 mg, it is also taken in the form of tablets for resorption under the tongue, it is recognized as the best drug against a hypertensive crisis;

• Physiotens (or moxonidine) – 0,4 mg;

• Clonidine (or Clofelin) – 0,075 — 0,15 mg.

• Clonidine also does not meet modern quality standards for medicines, so it is prescribed only in case of chronic use by the patient.

Hypertension in the elderly

1. The most important drugs for high blood pressure are diuretics: hypothiazide or indapamide (for diabetes). Cheap but effective drugs allow them to be used as a one-component treatment for mild hypertension. They are also preferred for volume-dependent hypertension in menopausal women.

2. The second place in importance is occupied by calcium channel blockers of the dihydropyridine series (amlodipine, nifedipine), which are indicated for atherosclerosis and diabetes mellitus against the background of weight problems.

3. Third place – lisinopril and sartans.

4. Combination drugs: Prestans (Amlodipine + Perindopril), Tarka (Verapamil + Trandolapril).

Combination Therapy

Combination therapy for hypertension involves the simultaneous administration of drugs of various types, the most popular and effective of which are:

• Diuretics and ACE inhibitors. Combinations of drugs of these groups – ramipril-hypothiazide (amprilan, chartil), lisinopril-hypothiazide (iruzid), enalapril-indapamide (Enzix), enalapril-hypothiazide (Enap NL, berlipril plus), captopril-hypothiazide (caposide), perindopril-indapamide ( noliprel).

• Diuretics and sartans. Combinations of the following drugs: gizaar (losartan-hypothiazide), atakand plus (candesartan-hypothiazide), micardis plus (telmisartan-hypothiazide), coaprovel (iprosartan-hypothiazide).

• Diuretics and beta blockers. The combination of bisoprolol with hypothiazide (bisangil) is used to minimize the risk of complications from the cardiovascular system.

• Diuretics with calcium channel blockers. The most popular combination is chlorthalidone and atenolol.

• Calcium channel blockers with sartans. Combinations of the following drugs: telmisartan with amlodipine, losartan with amlodipine.

• Ca-channel blockers together with angiotensin-converting enzyme inhibitors. This combination can also be used for the treatment of resistant forms of hypertension, since the use of these drugs does not reduce the body’s sensitivity to drugs. Includes the following combinations: amlodipine with perindopril, trandolapril with verapamil.

When is it necessary to call a doctor at home?

A person with a diagnosis of hypertension should always have drugs in the medicine cabinet that will help him reduce his pressure. If it has risen sharply, it is necessary to take a standard dose and wait 1-2 hours. Subject to stabilization of the condition, you can contact the clinic at the place of residence and call the district police officer to the house.

If after 2 hours the pressure does not decrease, or continues to increase, and the mark on the tonometer exceeds 160/100 mm. rt. st., you need to call an ambulance. Urgently consult a doctor with loss of consciousness, nausea, vomiting, dizziness and pain in the chest.

Treatment of resistant hypertension

Resistant arterial hypertension is a form of the disease in which it is not amenable to treatment with monodrugs, and even therapy with a combination of drugs from two different groups does not give results.

To normalize pressure indicators, the following combinations of pharmaceuticals with different properties are used:

• Beta-blockers, dihydroperidine calcium channel blockers, ACE inhibitors;

• Blockers of beta receptors, calcium channels and sartan;

• Diuretics, angiotensin-converting enzyme inhibitors, Ca-channel blockers.

The third regimen, combining the use of diuretics and Ca-channel blockers with ACE inhibitors, is considered the best treatment for resistant hypertension. For these purposes, a combination of spironolactone and thiazide diuretics is also used.

Due to the existence of a huge list of drugs and treatment regimens for arterial hypertension with medications that are used for various forms of the disease and are prescribed individually, self-medication can be not only ineffective, but also dangerous to health. Timely access to a doctor minimizes the risk of stroke, heart attack (causes and symptoms of myocardial infarction) and other complications of the disease.

Can I treat myself?

Hypertension is classified as a serious disease, so self-medication is unacceptable. Without medical supervision, you can not take either folk or medicines. Failure to comply with this recommendation can cause serious complications, up to a vascular or cerebral catastrophe (stroke, heart attack). Self-medication increases the risk of sudden cardiac death. All pressure-reducing pills have multiple side effects, and only a doctor can assess their real risk for a particular patient.