High blood pressure pills: basic and additional medicines
The content of the article:
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Medicines for pressure of the main group
- Diuretics
- Beta-blockers
- Angiotensin-converting enzyme (ACE) inhibitors
- Angiotensin receptor blockers
- Calcium antagonists
- Tablets for high blood pressure additional group
- Why is hypertension treatment important?
- Basic principles of high blood pressure treatment
- Video
Pills for high blood pressure act on different elements of regulation of this parameter in the body, they differ in the mechanism of action, duration, strength of the effect. When used for other purposes, they can be dangerous to the body, therefore, self-treatment of hypertension is highly discouraged - safety is guaranteed only by a medical appointment and medical supervision of therapy.
You can take any drugs for pressure only as directed by a doctor.
Modern medicine allows to normalize high blood pressure (BP) of various etiologies, the main principle of treatment is the pathogenetic use of drugs. This means that high pressure pills do not just act on some of the stages of the biological mechanism, but on the link that caused the dysfunction. Therefore, the list of medicines is extensive and is represented by different groups of medicines. They work in different ways, and are often combined to provide optimal benefits.
All drugs for high blood pressure are divided into two groups - drugs of the main group, the most effective and safest (provided they are used correctly), as well as drugs of the additional group that have limited areas of application, for example, an urgent decrease in blood pressure during resuscitation, with a hypertensive crisis and etc.
How to choose a therapy, combine drugs correctly? This can only be done by a specialist, you need to contact him.
We will consider each group of medicines separately.
Medicines for pressure of the main group
Diuretics
These are drugs with a diuretic effect that increase urine output in different ways. The main mechanism for lowering pressure is a decrease in the volume of circulating blood; it is this effect that diuretics provide. They have a fast action, but they have a number of side effects - from the inconvenience associated with frequent visits to the toilet during the period of increased urine output, to electrolyte disturbances. This is due to the fact that together with the water, many trace elements necessary for it are washed out of the body.
Furosemide is a diuretic that effectively and quickly reduces blood pressure
The main diuretics used to treat hypertension include:
- Hydrochlorothiazide is a moderately potent diuretic. The mechanism of its action is provided by blocking the enzyme carbonic anhydrase, due to which potassium ions are retained, and sodium reabsorption (reuptake) decreases. Water follows sodium and urine output increases. The primary effect does not come too quickly, so it should be drunk with a persistent increase in pressure. The action begins in about 2 hours, and the maximum effect occurs in 4-5 hours. Usually, hydrochlorothiazide is given continuously for weeks. It helps well, however, when taken for a long time, it causes hypokalemia, that is, a decrease in the concentration of potassium ions in the blood plasma. To compensate for this side effect, potassium supplements are prescribed in addition to hydrochlorothiazide and other drugs of a similar effect.
- Indapamide (Indap, Arifon) is a moderately active non-thiazide diuretic. It has a pronounced antihypertensive effect against the background of a slight diuretic, as it reduces the force of contractions of the vascular wall due to the inhibitory effect on the transmembrane transport of calcium ions. The maximum effect is observed 10-12 hours after a single dose. The drug circulates for a long time, since it binds to blood proteins. Recommended for permanent use. This remedy for lowering blood pressure can also be used in case of kidney dysfunction - it retains its effect even with renal failure. It can increase the content of uric acid in the blood, which is undesirable with prolonged use and is stopped by taking uricosuric drugs. It is the drug of choice for the elderly who suffer from arterial hypertension for a long time.
- Furosemide is a fast and powerful diuretic. The effect after the injection occurs within 15 minutes and is accompanied by massive diuresis, and as a result, a rapid decrease in blood pressure. It acts systemically, reducing the overstrain of the heart volume, affects the ionic transporters in the kidney tubules, reduces the sensitivity of the vascular wall to catecholamines (it is due to the action of adrenaline that hypertension develops during stressful situations). Furosemide leads to a significant decrease in the volume of circulating blood, and this must be corrected by replenishing it after the onset of the hypotensive effect. In addition, it disrupts the electrolyte composition of the blood, so it cannot be taken for a long time. Nevertheless, the drug has the largest number of positive medical reviews, it can be used both at 40 and at 70. Its disadvantage is its outdated mechanism of action.
Beta-blockers
The drugs of this group have a systemic effect on blood vessels and indirectly regulate the work of the heart. The names of drugs in this group have the ending "-olol". Which ones are the most commonly used?
- Propranolol (Anaprilin on the Russian market) is a non-selective (i.e., non-selective, acting on all beta-receptors) beta-blocker, which exhibits a pronounced antiarrhythmic effect, lowers blood pressure, and normalizes heart function. It is strictly contraindicated in bronchial asthma or conditions close to it, as it narrows the lumen of the bronchi.
- Atenolol is a selective beta-receptor blocker that acts on the heart and blood vessels, while not affecting the tone of the smooth muscles of the bronchi. An effective remedy for hypertension, cardiac arrhythmias, angina pectoris. Not applicable during pregnancy.
- Talinolol (Cordanum) is an effective remedy, belongs to potent drugs, is included in list B, therefore it is dispensed with a prescription.
- Metoprolol - has a wide spectrum of action. Reduces pressure also reflexively after exercise, reducing the stress overload of the heart muscle, affects the sensitivity of the vascular wall to catecholamines, and reduces the plasma activity of renin.
Anaprilin is an antihypertensive drug of the beta-blocker group
Angiotensin-converting enzyme (ACE) inhibitors
The list of these drugs is quite extensive, for almost every letter of the alphabet, they are one of the best drugs that lower blood pressure, due to the point of application of action - they do not allow renin renin to turn into angiotensin I, and then into angiotensin II. These biologically active substances are the strongest vasoconstrictor substances in the body, in most cases providing the mechanism of arterial hypertension.
This group includes medicines:
- Captopril (Kapoten) - in addition to blocking the transformation of some forms of endogenous vasoconstrictors into others, it enhances the production of vasodilators in the form of bradykinin and prostaglandin A The maximum pressure drop occurs quite quickly, 60-70 minutes after taking the pill. Contraindicated in severe forms of renal failure and under the age of 18.
- Enalapril (Enap, Renitek) - inhibits the work of the renin-angiotensin-aldosterone system, while a pronounced therapeutic effect is manifested even in patients with low-root hypertension. It has one of the longest-lasting effects; in a therapeutic dosage, it maintains normal blood pressure for up to 24 hours. Use in children is limited.
- Lisinopril (Diroton) - is used most often in cases of essential hypertension, its effect is complemented by the intake of diuretics. Do not take this medicine in combination with lithium preparations, anti-diabetes drugs in order to avoid unwanted side effects in the form of increased toxicity and hypoglycemia.
Captopril belongs to the angiotensin-converting enzyme inhibitors, is included in the main group of drugs for the treatment of hypertension
Angiotensin receptor blockers
These are new generation high blood pressure pills with long-lasting effect. They also block the biological action of angiotensin I and II, but not at the stage of conversion, but at the stage of reception. That is, the drug occupies the angiotensin receptor, preventing angiotensin itself from attaching to it and triggering hypertension. There are few drugs of this kind, they are effective and generally safe. Lozartan (Kozaar) is a representative of this group. These are German tablets that can be taken regardless of age (except for children under 6 years old) and food intake. Not recommended during pregnancy and lactation.
Calcium antagonists
Contraction of vascular smooth muscles is produced by calcium ions. The drugs related to calcium antagonists competitively inhibit this element, filling the active centers of the receptors, while calcium does not directly bind to them and does not cause a cascade of reactions that lead to vasoconstriction.
Nifedipine is a popular calcium antagonist drug
The tone of the peripheral vessels is one of the most important factors on which the peripheral resistance of the bloodstream depends, and hence the lower diastolic pressure. Such drugs have the ending "-dipin":
- Nifedipine is used for vasospastic angina pectoris, combined with beta-blockers, and also relieves essential hypertension. Despite its high efficiency, it has a number of contraindications for use: it cannot be taken in childhood, during lactation or pregnancy, with hypovolemia, aortic stenosis, after myocardial infarction, and also in conjunction with Rifampicin. The drug helps to lower blood pressure not only at rest, but also during exercise by expanding the collateral blood circulation and peripheral arterioles.
- Amlodipine has a different mechanism of action: it does not allow ions to penetrate into the cell and vice versa, thereby preventing the contraction of smooth muscles and producing a vasodilating effect. The drug has 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 reaction rate, slowing it down, so it is not recommended for people working with potentially dangerous machinery, drivers, industrial plant operators, i.e. those who need to maintain a high concentration of attention in the workplace.
Tablets for high blood pressure additional group
What drugs are included in the supplementary group? These are antihypertensive drugs that are used in special cases or in combination with drugs of the main group, although this does not cancel their high (sometimes even too much) activity in reducing blood pressure. These drugs are rarely used due to their side effects or difficult dosage.
Doxazosin blocks alpha-adrenergic receptors and is quite effective, but difficult to dose
If you ask a question to the ambulance team: "How to lower the pressure in an emergency?" from the entire available arsenal of means, most likely they will choose magnesium sulfate (Magnesia), however, it has an antihypertensive effect in the form of injections, and not in the form of tablets. Intramuscular administration of Magnesia solution can quickly and effectively lower blood pressure. The injection is accompanied by unpleasant sensations - heat in the limbs, head, tinnitus, flashing of flies before the eyes, so the drug is administered only while sitting or lying down. It has a strong vasodilator effect, but its biological effects do not end there - it changes the tone of smooth muscles throughout the body, including the gallbladder and uterus. Therefore, it is not used during pregnancy.
Prazosin and Doxazosin lower blood pressure by vasodilation due to blockade of alpha-adrenergic receptors. Therefore, the hypotensive effect occurs rather quickly, within 30-60 minutes, and holds on steadily. Unfortunately, it is difficult to accurately dose drugs of this type, therefore periods of hypotension are possible, especially in older people, against the background of an insufficient amount of sodium in the blood and hypovolemia (small volume of circulating blood). The drug also causes drowsiness, so it is not recommended for people whose activities involve potentially hazardous work.
Clonidine has a complex mechanism of action and an extremely low active dose. First, it activates peripheral alpha2-adrenergic receptors, which increases hypertension for 40 minutes. After that, it crosses the blood-brain barrier and activates the central alpha2-adrenergic receptors in the medulla oblongata. This provides an inhibitory effect of regulatory structures on the tone of the vascular wall, the vessels expand sharply. If the dose of Clonidine is exceeded, the onset of collapse is possible - a sharp decrease in blood pressure up to loss of consciousness. It also has a sedative and analgesic effect. Methyldopa has a similar effect, but a slightly different mechanism - it is metabolized and in the central nervous system it activates alpha2-adrenergic receptors in the form of a form of norepinephrine. The further mechanism of action is similar to Clonidine.
Moxonidine is an agonist (activator) of imidazoline receptors, an important link in the formation of arterial hypertension. Causing their excitement, it inhibits the work of the vasomotor (vasomotor) center, which reduces the peripheral resistance of the vascular bed. A popular drug containing moxonidine as an active ingredient is Physiotens, it is he who is often asked in the pharmacy as "red pills".
Physiotens is a popular moxonidine-based blood pressure lowering drug
In special cases, Aliskiren, a human renin inhibitor, is used. It is used in the case of an increased activity of the renin-angiotensin-aldosterone system and when ACE blockers do not achieve the desired therapeutic effect.
Why is hypertension treatment important?
Almost every second inhabitant of developed countries is familiar with arterial hypertension. It is a disease of civilization that develops due to the high pace of life and constant stress.
With hypertension, not only the patient's well-being suffers - long periods of high pressure injure the inner lining of the vessels, worsen blood circulation in the capillary bed, and disrupt tissue trophism (nutrition). The longer the pathological condition lasts, the more often there are bouts of hypertension, the more deeply the body is affected, primarily the sensitive, so-called shock organs. These are the organs whose function is provided by abundant blood supply - the heart, brain, kidneys. It is for this reason that arterial hypertension is the basis of the most lethal ailments - it is complicated by strokes, heart attacks, atherosclerotic changes and other severe pathologies. Therefore, it is so important to control the level of your blood pressure and, if necessary, take pills to lower your blood pressure.
Basic principles of high blood pressure treatment
Understanding the pathogenesis of a particular case of arterial hypertension is crucial in lowering pressure. There can be many reasons for the development of pathology. The most common and well-known essential hypertension, which occurs due to a dysregulation of the tone of peripheral vessels. It is caused by emotional stress and stress, which are complemented by a harmful lifestyle. So, smoking causes constant microspasm of blood vessels throughout the body, excessive consumption of fats affects the elasticity of the vascular wall, a large amount of salt reduces daily diuresis and directly increases blood pressure. This is only a small part of the factors that directly or indirectly affect blood pressure.
There is also secondary hypertension that occurs due to a disorder of a particular organ or organ systems. These types include secondary renal hypertension (occurs against the background of renal failure, inflammatory process of the kidneys), endocrine hypertension (manifested due to a violation of the synthesis of hormones responsible for maintaining normal blood pressure), cardiac hypertension (excessive cardiac output, which is observed in some conditions, causes an increase in the upper, systolic blood pressure). Such pathologies are treated differently, in this case, you must first get rid of the primary pathology, a symptom of which is an increase in blood pressure.
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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