High blood pressure control drugs

There is no "optimal antihypertensive drug" suitable for all patients with hypertension. There are currently five major categories of first-line antihypertensive drugs that are mainstream in clinical practice around the world. The core logic of drug selection is never "choose the most expensive and latest", but to match the four major factors of the patient's age, comorbidities, tolerance, and economic conditions. As long as the blood pressure can be stabilized at the target value and there are no obvious adverse reactions after long-term use, it is a good drug for you.

I met 62-year-old Uncle Zhang when I was stationed at a community free clinic last year. I heard from my old friend downstairs that amlodipine is effective in lowering blood pressure. I bought it at the drugstore and took it for two months. His ankles were so swollen that he couldn't even take off his socks, and his gums always felt swollen. When I checked, his blood pressure dropped to 135/85. However, he had mild bilateral renal artery stenosis and was not suitable for dipinephrine. Within three weeks of switching to valsartan, the edema disappeared and his blood pressure was very stable.

Speaking of which, there are really a lot of controversies about antihypertensive drugs on the Internet. A couple of days ago, a patient came to me with the content of a short video and asked me whether he should stop taking the medicine immediately because he said that antihypertensive drugs cause cancer. This matter has actually been quarreling for almost three years. The earliest was a small-sample cohort study in the United States in 2021, which said that the incidence of bladder cancer in patients who took nifedipine controlled-release tablets for a long time was 32% higher than that in the control group. However, last year, the European Society of Hypertension released a large-sample data with a follow-up of 12 years, covering 127,000 patients, and clearly stated that there is no statistical correlation between the two. Now the attitudes of doctors from different schools are actually a bit different: some are particularly cautious and try to avoid patients with bladder polyps and family history of bladder cancer. ； Some people feel that there is no need to stop eating due to choking. After all, there are only a few cases in 100,000 people. It is better than losing control of blood pressure and exploding blood vessels. When I go to the outpatient clinic, I usually ask in advance if there are any underlying diseases of the urinary system. If not, I just use it. If I am really worried about taking it for a few years, I can just do a physical examination and a bladder B-ultrasound every year. I don’t have to stop taking the medicine privately.

In fact, dipinephrine is a very cost-effective type of drug, especially for patients with coronary heart disease and senile patients with simple high systolic blood pressure. It can not only lower blood pressure, but also relax coronary blood vessels and improve myocardial blood supply. I used to take care of 72-year-old Aunt Li, who has coronary heart disease and chronic bronchitis. She used to have dry cough after taking benazepril, which kept her awake all night. After switching to amlodipine, her blood pressure stabilized at around 130/70, and her chest tightness became less frequent. The only thing to remind is that ordinary nifedipine tablets should never be used to lower blood pressure for a long time. They are short-acting. If you take them, your blood pressure will drop and rise quickly, which is especially easy to induce stroke. Now they are only used in emergency situations. Don’t take controlled-release tablets or sustained-release tablets casually. If the outer sustained-release layer is broken, it will become ineffective. It is no different from taking ordinary tablets.

Many people say that Sartan is an upgraded version of Purin, but this is not entirely true. The advantage of PULA is the effect of lowering urinary protein. There are currently many small sample studies showing that for patients with diabetic nephropathy and high urinary protein, the urinary protein-lowering effect of PULA is about 10% higher than that of sartan at the same blood pressure lowering range. Therefore, many endocrinologists The Health Association gives priority to patients with diabetic kidney disease by prescribing Prilim, but Prilim has unavoidable side effects: about 10% of people will develop dry cough after taking it, either due to throat inflammation or itchy throat and eyes without phlegm. Many people cannot tolerate it. At this time, it is no problem to switch to Sartan. The current consensus among cardiology departments is that there is no need to worry about the 10% difference, tolerance is the first priority. After all, antihypertensive drugs need to be taken for a lifetime, and coughing all the time and not sleeping well will cause blood pressure to soar, which is not worth the loss.

When many people hear about diuretics, they think they are harmful to the kidneys and lack potassium, so they dare not take them. In fact, for elderly patients who eat a lot of salt and hypertensive patients with heart failure, low-dose diuretics are particularly effective. I met the 68-year-old Aunt Wang before. She had a bad mouth all her life. She had to eat pickled radish and pickled vegetables at every meal. She used to take valsartan and amlodipine, but her blood pressure was still stuck at 160/90 and could not be lowered. I added half a tablet of Inda to her. Pamine dropped to 130/80 in less than two weeks. As long as you check your blood potassium every three months and eat more oranges and bananas to replenish potassium, there will be basically no problems. Moreover, this medicine only costs a few cents a piece, so there is very little financial pressure.

Beta-blockers are even more controversial. A few years ago, the European Society of Hypertension updated its guidelines and removed beta-blockers from first-line antihypertensive drugs, saying that long-term use in young patients may increase the risk of abnormal glucose and lipid metabolism. However, China's guidelines still list them as first-line antihypertensive drugs. Why? Because many of China's young hypertensive patients have sympathetic nerve excitability, such as young men in their twenties and thirties, who often stay up late and work overtime, are under great pressure, have heart rates above 90 beats/min, have low blood pressure and are always flustered. Beta blockers such as Metoprolol Sustained Release Tablets are particularly effective. They can not only lower blood pressure, but also lower the heart rate to a suitable range and improve the symptoms of palpitation. I have a colleague who is 32 years old. Last year’s physical examination revealed high blood pressure, heart rate 102, and low blood pressure 100. After taking metoprolol for two months, and adjusting his work and rest, he has now reduced the dosage to half a tablet. His blood pressure and heart rate are normal, and he has no abnormal sugar and lipid problems. Therefore, we cannot completely copy foreign guidelines, but must combine them with our Chinese people’s physiques.

I have been working in outpatient clinics for almost ten years, and I have seen too many patients taking medicines blindly following their neighbors or reading popular science on the Internet. I have also seen many people who are afraid of taking medicines because they are afraid of side effects, and end up with myocardial infarction and renal failure. In fact, there is really no need to worry about choosing the "best medicine". After taking it, your blood pressure can be stabilized below 130/80 (for those with diabetes and kidney disease, it should be below 125/75), there is no obvious discomfort, and the price is affordable, then that is the best medicine. There are also many people who think that medication can be stopped once the blood pressure is normal. This is really a taboo. Last month I met a 58-year-old uncle who took medication for half a year and his blood pressure stabilized, but he secretly stopped. As a result, he suffered a sudden cerebral hemorrhage. He was unconscious when he was sent to the hospital. He was also paralyzed after being rescued. It was a pity.

Yesterday, a young man who just graduated came to ask me. He was just diagnosed with high blood pressure, 145/95. Can he adjust it by exercising without taking medicine? I told him, if you can guarantee to run 5 kilometers for half an hour every day, reduce your weight from 180 pounds to less than 150 pounds, eat no more than 5 grams of salt every day, and do not stay up late or drink alcohol, try 3 Months, if it can drop below 140/90, of course you don’t have to take it, but if you can’t, take medicine when you need to. Today’s antihypertensive medicines are very safe. There are many people who have been taking them for decades. There is really no need to feel a psychological burden. After all, compared with the possible side effects of taking medicine, the harm caused by long-term high blood pressure is really fatal.