Medicines for hypertension: drugs with different mechanisms of action
The content of the article:
- Drugs affecting the vasomotor centers
- Adrenergic blockers
- Angiotensin-converting enzyme blockers
- Diuretics
- Calcium channel blockers (calcium antagonists)
- Myotropic drugs and others
- Hypertension problem
- General principles of hypertension treatment
- Video
According to the mechanism of action, drugs for hypertension are divided into several groups. Each group affects a certain link in the pathological process, therefore, to achieve a lasting effect, complex therapy is usually prescribed, taking into account the origin of hypertension. Any antihypertensive drugs should be prescribed by a doctor, he also controls the course of therapy, if necessary, adjusts the dose or replaces the drug. With arterial hypertension, self-medication is strongly discouraged, since there is a high risk of deterioration of the cardiovascular system.
Medicines for blood pressure cannot be taken on the advice of friends or because of advertising, they must be selected by the attending physician
Drugs affecting the vasomotor centers
The mechanism of action of the drugs of this group is as follows - by inhibiting the vasomotor (vasomotor) centers, predominantly of the medulla oblongata, they lower the general vascular tone, lead to relaxation of the smooth muscles of the vascular wall, have a vasodilating effect, thereby reducing the peripheral resistance of the bloodstream and, consequently, reducing blood pressure (arterial pressure).
This group includes:
- Clonidine is an agonist of central alpha2-adrenergic receptors, an adrenergic agonist. Some time after administration, it causes short-term hypertension, but after penetrating into the brain through the blood-brain barrier, it affects alpha2-adrenergic receptors, causing relaxation of vascular smooth muscles. Suitable for the relief of hypertensive crises, while it can be quite dangerous - a very accurate dosage of the drug is required due to its high activity and the ability to reduce pressure below normal levels, causing a collapse.
- Methyldopa (methyldopa) is an adrenergic agonist, metabolized in the body, turning into chemical analogs of norepinephrine, which provide a smoother action compared to clonidine (Clonidine). The decrease in pressure occurs more slowly, which allows predicting the therapeutic effect of the drug. Since, if used correctly, this remedy has practically no side effects, it can even be prescribed to pregnant women. A popular drug, the active ingredient of which is methylope - Dopegit.
- Moxonidine is an agonist of central imidazoline receptors. It has a similar action to adrenomimetics, but due to the activation of another group of receptors, it does not directly affect the vessels and bronchi, has fewer side effects from the adrenergic system, and does not cause short-term hypertension after application. The drug in the same group is Physiotens.
Dopegit is a drug from the group of adrenergic agonists
Adrenergic blockers
Adrenergic receptors are located throughout the body and perform different functions, but in the context of the treatment of hypertension, the most important are alpha1 and beta1 adrenergic receptors, the former of which are located in the vascular wall, and the latter in the heart.
- Anaprilin is a non-selective beta-blocker that has an inhibitory effect on the heart, causing a decrease in heart rate and strength, and a decrease in stroke volume. It has an antiarrhythmic effect. Due to the effect on the beta-receptors of the heart, the drug reduces blood pressure quickly and effectively, but during therapy with this agent, contraindications should be taken into account, in particular - bronchial asthma and bronchospasm, since the effect of Anaprilin is non-selective, affecting the bronchial tree.
- Metoprolol is a selective beta-blocker, that is, it has almost the same mechanism of action as Anaprilin, while blocking only receptors in the heart, without affecting the bronchi in any way. It also reduces myocardial oxygen demand, acting as an antianginal agent. Due to this, it is considered a good and safe drug for lowering blood pressure and normalizing the cardiac cycle in diseases of the cardiovascular system. This group also includes Nebivolol, Bisoprolol, Talinolol and others.
- Prazosin is a popular alpha-blocker drug for hypertension. By blocking receptors located in the wall of peripheral vessels, it provides a pronounced vasodilator effect, leading to a persistent decrease in blood pressure.
Anaprilin - adrenergic blocker
Angiotensin-converting enzyme blockers
Under conditions of hypoxia, the kidneys intensively produce renin, a biologically active substance that is converted into angiotensin I. It has a vasoconstrictor effect and raises blood pressure, but in the lungs, thanks to the angiotensin-converting enzyme (ACE), it is transformed into angiotensin II - the most powerful vasoconstrictor (a substance that causes vasospasm) in the human body. It is the stages of transformation of one angiotensin into another that block the ACE inhibitor.
- Captopril is a classic ACE inhibitor that is widely used in the treatment of hypertension. In addition to inhibition, it also promotes the release of vasodilators of the bradykinin class, which provide a persistent vasodilator effect. The action begins quickly - an hour after taking the pill.
- Enalapril is a modern remedy, to the main action of which efficiency is added in low-root hypertension, the drug inhibits every link of the renin-angiotensin-aldosterone system. Provides a long lasting effect that can last up to 24 hours. The same group of drugs includes Lisinopril, which has an even more pronounced antihypertensive effect, which is why it is dispensed only for medical reasons and on a doctor's prescription. A complex tool that combines Lisinopril and Amlodipine (calcium channel blocker) is Equator, a Hungarian drug with high efficiency.
Bisoprolol - angiotensin-converting enzyme blocker
Diuretics
The mechanism of action of these drugs against hypertension is as follows - they act on the kidney nephron, stimulating the formation and excretion of urine.
When fluid is excreted from the body, the volume of circulating blood (BCC) decreases, and therefore blood pressure decreases.
- Furosemide is one of the fast acting diuretics that is used for forced diuresis. Together with drugs from other groups, it is effective in the relief of hypertensive crisis. The use of Furosemide requires control of the level of electrolytes, since the ions necessary for the body, in particular, potassium, are washed out together with water, and therefore it is not prescribed for a long course. Special care is required for its appointment for the elderly.
- Hydrochlorothiazide is a medium-strength diuretic that acts more slowly than Furosemide, but it also has fewer side effects. With prolonged therapy, it is easier to control. In addition, with the use of thiazide diuretics, electrolyte loss is less.
- Indapamide, aka Arifon, is an imported means of production in France. A diuretic of medium strength, which has a pronounced antihypertensive effect, supplemented by a reflex effect on the smooth muscles of the vascular wall: the drug reduces the strength of its contractions due to the inhibitory effect on the transmembrane transport of calcium ions.
- Spironolactone (Veroshpiron) is an aldosterone antagonist. It is active, retains potassium and has few side effects. It can also be used to treat secondary hypertension associated with hypersecretion of aldosterone.
Veroshpiron, a diuretic used in the treatment of hypertension
Calcium channel blockers (calcium antagonists)
The drugs of this group block the transmembrane transport of ions, preventing them from reacting with proteins in the smooth muscles of the vessel wall, due to which the tone decreases and is fixed at a reduced level under any factors.
These are potent drugs of a new generation that relieve hypertension with maximum efficiency.
- Nifedipine is used for vasospastic angina pectoris, combined with beta-blockers, and also relieves essential hypertension. Reduces blood pressure not only at rest, but also during exertion, by expanding the collateral blood circulation pathways and peripheral arterioles.
- Amlodipine, inhibiting the contraction of smooth muscles, has a vasodilating effect. It produces the most powerful effect on the smooth muscles of peripheral vessels, and to a lesser extent affects the contractions of the heart and their strength. Amlodipine affects the speed of the reaction and can cause it to slow down, reduce attention, which must be taken into account by patients whose work is associated with the need to concentrate.
Amlodipine - calcium channel blocker
Myotropic drugs and others
Myotropic agents act directly on the vascular wall, causing it to relax. It is to this group that the classic antispasmodics No-Shpa and Papaverine belong. Possessing a strong antispasmodic effect, they are used to lower blood pressure, their effect is complemented by a mild sedative effect.
The most effective way to reduce blood pressure is to influence the renin-angiotensin-aldosterone system, since it is this system that plays a major role in the mechanism of hypertension. Therefore, renin inhibitors are highly effective, blocking the chain of biological transformations at the earliest stage of increasing blood pressure. Aliskiren belongs to such means. A similar mechanism is found in angiotensin receptor blockers. They provide a fairly quick therapeutic effect, while lowering blood pressure smoothly. This group includes the popular drug Losartan (Cozaar).
Hyperolekt and Gelarium Hypericum, herbal preparations (hypericum is the name of St. John's wort in Latin), are actively advertised as effective drugs for the treatment of hypertension that have no contraindications for use. They are said to be able to completely heal hypertension in a short time. However, this is not true - it is impossible to completely cure hypertension with any one medicine. Such drugs are classified as homeopathic, and although they really practically do not cause side effects, they also have no proven therapeutic effect.
No-shpa provides pressure reduction due to antispasmodic action
Hypertension problem
Over the past half century, hypertension has become the most common pathology of the cardiovascular system. The symptoms of the disease are well known, many people have their own blood pressure monitors and monitor their blood pressure. But there is no comprehensive understanding of the pathogenetic treatment of hypertension in patients with this disease. Prescribing treatment on their own, on the advice of friends or under the influence of unfair advertising, they randomly take drugs for hypertension with a large set of side effects, after which they suffer from unwanted complications for a long time, while the disease progresses. The official position of modern medicine, expressed in the updated protocols for the treatment of hypertension, states that the priority is to eliminate the main links of pathogenesis, and not only to relieve symptoms. For this, after a thorough diagnosis,complex treatment is prescribed, which, moreover, must necessarily include lifestyle modification, because without this, while maintaining all the prerequisites for hypertension, any therapy will have only a temporary effect.
General principles of hypertension treatment
There are several fundamentally different approaches to the treatment of hypertension, and it is on them that the selection of a drug to combat this disease depends.
First of all, you should consider the cause of the increase in blood pressure. Distinguish between primary and secondary arterial hypertension. If the increase in pressure does not depend on the pathologies of other organs and systems, but arises on its own against the background of emotional stress, stress, lack of sleep, bad habits, and other factors of an improper lifestyle (in particular, in patients with concomitant diabetes mellitus), then such hypertension called primary. This is the most common type of hypertension. At a young and mature age, this form of the disease is more relevant for men, since women have natural protection from high blood pressure in the form of estrogens, and after menopause, women are compared with men in terms of incidence. Primary hypertension is characterized by a prolonged and persistent increase in blood pressure,can be complicated by dangerous changes on the part of the most sensitive organs - the heart, brain, kidneys, liver, spleen (they have an abundant blood supply due to the branched vascular system, therefore, they are damaged in the first place). Primary hypertension is treated by acting on different stages of pathogenesis - opening the process at the stage of the heart, bloodstream, peripheral resistance, total circulation, biologically active substances.total circulation, biologically active substances.total circulation, biologically active substances.
At a young and mature age, men are more likely to suffer from pressure
If hypertension occurs against the background of diseases of the endocrine system (hormones are secreted strongly that greatly increase blood pressure or counteract its physiological decrease) or kidney disease (when the filtration barrier is impassable and fluid is retained in the body), they talk about secondary hypertension. Its symptoms are relieved by antihypertensive drugs, but the main treatment is aimed at eliminating the factor that triggered the pathological process - endocrine or renal dysfunction.
Video
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Nikita Gaidukov About the author
Education: 4th year student of the Faculty of Medicine No. 1, specializing in General Medicine, Vinnitsa National Medical University. N. I. Pirogov.
Work experience: Nurse of the cardiology department of the Tyachiv Regional Hospital No. 1, geneticist / molecular biologist in the Polymerase Chain Reaction Laboratory at VNMU named after N. I. Pirogov.
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