The basis of the medication course, which helps to cope with hypertension, are antihypertensive drugs. They are prescribed to patients whose blood pressure systematically rises above 160 per 100 mm Hg. Art. You can find a huge number of drugs that lower blood pressure on sale. All of them are divided into several groups according to their composition and mechanism of action.

For many decades, doctors have conducted clinical studies that have helped them formulate the main features of drug treatment and its prescription for patients with high blood pressure. They derived the following principles:

1. Medicines prescribed by a cardiologist must be started at a minimum dose. Preference should be given to those drugs that have a small list of side effects;
2. If a person tolerates the minimum dosage of the medication well, but his blood pressure still remains elevated, then the amount of medication is increased;
3. To get a positive result, it is necessary to take simultaneously several groups of drugs that help lower the values ​​of upper and lower pressure;
4. If one of the drugs prescribed by the doctor does not give the desired effect or causes serious side reactions, then it is replaced with another drug.

Cardiologists recommend that people with hypertension take antihypertensive medications that have a long-lasting effect. They are able to keep blood pressure in a normal state for a long time. This is how the development of complications due to problems with blood pressure is prevented.

Classification

All drugs with a hypotensive effect that have been developed for patients with high blood pressure are usually divided into 2 large groups.

First line drugs

1. Angiotensin-converting enzyme inhibitors;
2. Diuretics;
3. Angiotensin P receptor inhibitors;
4. Beta blockers or beta blockers;
5. Calcium antagonists.

These funds are usually used in combination with each other.

Usually several drugs from different groups are prescribed at once

Second line drugs

These drugs are intended for long-term therapy to suppress essential hypertension. They are suitable for certain classes of patients. For example, second-line drugs are usually prescribed to pregnant women or those patients who cannot afford to spend money on expensive medications.

1. Alpha blockers;
2. Rauwolfia alkaloids;
3. Centrally acting alpha-2 agonists;
4. Direct acting vasodilators.

The classification also contains neurotropic antihypertensive drugs of the combined type. They combine the action of different groups of medications to suppress the signs of hypertension.

Angiotensin-converting enzyme inhibitors (ACEIs)

This group of drugs for high blood pressure occupies a leading position in the classification.

Medicines effectively lower blood pressure due to the fact that their active substances dilate blood vessels. As a result of this action, the overall peripheral resistance decreases, and therefore blood pressure decreases.

At the same time, ACE inhibitors do not affect the heart rate and the magnitude of its ejection. Therefore, they are relevant for patients with chronic heart failure.

A decrease in blood pressure is observed after taking the first dose of the medicine. If you take an ACE inhibitor for a long time, you can achieve sustainable stabilization of blood pressure.

The most popular angiotensin-converting enzyme inhibitors are:

• "Enalapril";
• "Captopril";
• "Quinapril";
• "Moexipril";
• "Lisinopril";
• "Fosinopril."

It is extremely rare for patients to complain of side effects after taking drugs in this category. Most often, negative reactions are limited to the development of an obsessive dry cough, changes in taste and symptoms of hyperkalemia. Medicines of this type are not suitable for pregnant women and patients with bilateral renal artery stenosis. Hyperkalemia is also a contraindication.

Enalapril should not be taken during pregnancy or if pregnancy is just beginning

Angiotensin receptor blockers (ARBs)

Doctors suggest that patients with hypertension take new generation antihypertensive medications, which belong to the group of angiotensin receptor blockers.

These drugs have almost the same effect as ACE inhibitors. Only in this case, the drug has a broader effect, rather than focusing on one enzyme.

ARBs provide a powerful hypotensive effect due to the fact that they disrupt the binding of angiotensin to receptors located on the cells of internal organs. Due to this, it is possible to achieve relaxation of the walls of blood vessels and further enhance the kidneys’ excretion of unnecessary fluid and salts that have accumulated in the body of a hypertensive patient.

For hypertension, the following representatives of angiotensin receptor blockers are usually prescribed:

• "Irbesartan";
• "Losartan";
• "Valsartan".

ARBs show high effectiveness in the fight against high blood pressure. They work well if you have heart or kidney disease. They also have virtually no side effects, so these drugs can be taken for an extended period. As for contraindications, ARBs are prohibited for pregnant women, people with hyperkalemia, renal artery stenosis and allergies to the components of the drug.

The advantage of drugs in this group is a minimum of side effects

Calcium antagonists

Muscle fibers contract with the participation of calcium. The same can happen with vascular walls. Therefore, for the treatment of hypertension, drugs have been developed that several times reduce the penetration of calcium ions into vascular muscle cells. This reduces their sensitivity to vasopressor elements, which lead to vasospasm.

The most popular drugs with an antihypertensive effect, which belong to the group of calcium antagonists, are included in this list:

• "Verapamil";
• "Diltiazem";
• "Felodipine";
• "Amlodipine."

Calcium antagonists do not have any effect on metabolic processes. At the same time, they reduce the level of left ventricular hypertrophy in hypertension and reduce the likelihood of developing a stroke.

Beta blockers

Beta blockers are usually prescribed to patients with hypertension who have tachycardia.

Modern drugs of the latest generation with antihypertensive effects lower the values ​​of upper and lower blood pressure by blocking the influence of beta-adrenergic receptors.

There are several types of beta blockers. They can be cardioselective or non-cardioselective. Representatives of the first class are the following medications:

• "Bisoprolol";
• "Atenolol";
• "Betaxolol";
• "Metoprolol";
• "Cileprolol."

Non-cardioselective drugs among beta-blockers are:

• "Propranolol";
• "Labetalol";
• "Carvedilol".

Since beta blockers lead to a decrease in heart rate, such medications should not be taken by patients with bradycardia.

Beta blockers are not prescribed for low heart rates

Diuretics

Cardiologists promise hypertensive patients an improvement in their condition after taking diuretics, due to their hypotensive effect on the cardiovascular system. The mechanism of action of these drugs has been studied for a very long time. Diuretics were among the first to be used to treat hypertension. With their help, it is possible to quickly remove excess fluid from the body, which puts a lot of stress on the heart and blood vessels.

There are several types of diuretics, each of which has its own specific function. Thiazide diuretics are in no way inferior in their effectiveness to other groups of antihypertensive medications. Their representatives are:

• "Chlorthalidone";
• "Hypothiazil";
• "Indapamide".

Increased concentrations of thiazide diuretics lead to changes in electrolyte metabolism and metabolism in which carbohydrates and lipids are involved. Although doctors usually prescribe a low dose of such drugs, since in this case they can be taken for a long time.

Thiazide drugs are usually combined with ACE inhibitors and angiotensin receptor antagonists. They are suitable for patients who suffer from various metabolic disorders and diabetes. Gout is an absolute contraindication to their use.

Potassium-sparing diuretics have a milder effect than other types of these drugs. They block the effect that aldosterone gives. A diuretic removes salts and fluid from the body, thereby reducing blood pressure.

Popular potassium-sparing drugs in this category are:

• "Amiloride";
• "Eplerenone";
• "Spironolactone".

They are suitable even for patients diagnosed with chronic heart failure. But these drugs are contraindicated in people with renal failure or hyperkalemia.

The drug removes water and sodium, but retains potassium

Loop diuretics are considered the most aggressive. At the same time, they help lower blood pressure in a short period of time. Most often prescribed:

• "Edecrine";
• "Lasix."

Direct acting vasodilators

Centrally acting antihypertensive medications have a mild effect on blood vessels. Therefore, they carry out their moderate expansion. The most beneficial for the body are drugs that are administered by injection.

Among the direct-acting vasodilators are:

• "Hydralazine";
• "Bendazole".

The main disadvantage of vasodilators is that they cause steal syndrome. Because of this, they disrupt the blood supply to the brain. So such medications are strictly prohibited for patients with atherosclerosis.

Alpha blockers

Today, alpha-blockers are mentioned less and less often in prescriptions for patients with high blood pressure. This is because their long-term use can lead to heart failure, as well as acute cerebrovascular accidents. Sudden death is also a complication.

The group of alpha-blockers includes:

• "Terazosin";
• "Doxazosin";
• "Phentolamine."

The main advantage of alpha-blockers is their main property. They significantly improve lipid and carbohydrate metabolism. Therefore, these drugs are suitable for people with diabetes and dyslipidemia.

Antispasmodic drugs

A special place in drug therapy for hypertension is given to antispasmodics. These hypotensive myotropic vasodilators help relax vascular smooth muscle. They reduce the load on the heart and reduce the viscosity of the blood, so its platelets stop sticking together.

The most popular antispasmodics that are recommended for high blood pressure are:

• "Eufillin";
• "Dibazol";
• "Phenicaberan";
• "Theophylline."

Antispasmodic drugs are taken only in combination with other antihypertensive drugs.

For hypertension, diuretics are not prescribed as monotherapy

Central alpha-2 receptor agonists

After taking an antihypertensive drug of this category, a decrease in blood pressure occurs. This is because it affects the central nervous system and reduces sympathetic hyperactivity.

The main representatives of central alpha-2 receptor agonists are:

• "Methyldopa";
• "Clonidine."

It must be remembered that drugs cause side effects. Most often, after taking them, patients complain of fatigue and drowsiness.

Rauwolfia preparations

Medicines have a pronounced hypotensive effect. After about 1 week of regular use, the patient’s problems with blood pressure changes disappear.

Representatives of this category are:

• "Raunatin";
• "Reserpine".

These medications are often taken by elderly patients, as they are satisfied with the low cost of rauwolfia.

Combination drugs

Among combination drugs, the most popular remain:

• "Enap-N";
• "Tonorma";
• "Vazar-N";
• "Ziak";
• "Captopress".

When choosing a treatment regimen, the cardiologist takes into account contraindications and side effects of antihypertensive drugs, which can help a particular patient cope with the signs of hypertension. The chosen medications must be as effective and safe as possible for the person, since he will have to take them for a long time.

Article update 01/30/2019

Arterial hypertension(AH) in the Russian Federation (RF) remains one of the most significant medical and social problems. This is due to the widespread prevalence of this disease (about 40% of the adult population of the Russian Federation has high blood pressure), as well as the fact that hypertension is the most important risk factor for major cardiovascular diseases - myocardial infarction and cerebral stroke.

Constant persistent increase in blood pressure (BP) up to 140/90 mm. rt. Art. and higher- a sign of arterial hypertension (hypertension).

Risk factors contributing to the manifestation of arterial hypertension include:

• Age (men over 55, women over 65)
• Smoking
• sedentary lifestyle,
• Obesity (waist circumference more than 94 cm for men and more than 80 cm for women)
• Familial history of early cardiovascular disease (men under 55 years of age, women under 65 years of age)
• The value of pulse blood pressure in the elderly (the difference between systolic (upper) and diastolic (lower) blood pressure). Normally it is 30-50 mmHg.
• Fasting plasma glucose 5.6-6.9 mmol/l
• Dyslipidemia: total cholesterol more than 5.0 mmol/l, low-density lipoprotein cholesterol 3.0 mmol/l or more, high-density lipoprotein cholesterol 1.0 mmol/l or less for men, and 1.2 mmol/l or less for women, triglycerides more than 1.7 mmol/l
• Stressful situations
• alcohol abuse,
• Excessive salt intake (more than 5 grams per day).

The development of hypertension is also promoted by diseases and conditions such as:

• Diabetes mellitus (fasting plasma glucose 7.0 mmol/l or more with repeated measurements, as well as postprandial plasma glucose 11.0 mmol/l or more)
• Other endocrinological diseases (pheochromocytoma, primary aldosteronism)
• Diseases of the kidneys and renal arteries
• Taking medications and substances (glucocorticosteroids, non-steroidal anti-inflammatory drugs, hormonal contraceptives, erythropoietin, cocaine, cyclosporine).

Knowing the causes of the disease, you can prevent the development of complications. Elderly people are at risk.

According to the modern classification adopted by the World Health Organization (WHO), hypertension is divided into:

• 1st degree: Increased blood pressure 140-159/90-99 mm Hg
• 2nd degree: Increased blood pressure 160-179/100-109 mm Hg
• 3rd degree: Increase in blood pressure to 180/110 mmHg and higher.

Blood pressure readings obtained at home can be a valuable addition to monitoring the effectiveness of treatment and are important in identifying hypertension. The patient’s task is to keep a diary of self-monitoring of blood pressure, where blood pressure and pulse values ​​are recorded when measured at least in the morning, at lunch, and in the evening. It is possible to make comments on lifestyle (getting up, eating, physical activity, stressful situations).

Blood pressure measurement technique:

• Quickly inflate the cuff to a pressure level 20 mmHg above systolic blood pressure (SBP) when the pulse disappears
• Blood pressure is measured with an accuracy of 2 mmHg
• Reduce cuff pressure at a rate of approximately 2 mmHg per second
• The pressure level at which the 1st sound appears corresponds to SBP
• The pressure level at which sounds disappear corresponds to diastolic blood pressure (DBP)
• If the tones are very weak, you should raise your hand and perform several squeezing movements with the hand, then repeat the measurement, but do not squeeze the artery too much with the membrane of the phonendoscope
• During the initial measurement, blood pressure is recorded in both arms. In the future, the measurement is carried out on the arm on which the blood pressure is higher
• In patients with diabetes mellitus and in those receiving antihypertensive drugs, blood pressure should also be measured after 2 minutes of standing.

Patients with hypertension experience pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, possible pain in the heart, and blurred vision.
The disease is complicated by hypertensive crises (when blood pressure rises sharply to high numbers, frequent urination, headache, dizziness, palpitations, and a feeling of heat occur); impaired renal function - nephrosclerosis; strokes, intracerebral hemorrhage; myocardial infarction.

To prevent complications, patients with hypertension need to constantly monitor their blood pressure and take special antihypertensive drugs.
If a person is bothered by the above complaints, as well as blood pressure 1-2 times a month, this is a reason to contact a therapist or cardiologist, who will prescribe the necessary examinations and subsequently determine further treatment tactics. Only after carrying out the necessary set of examinations can we talk about prescribing drug therapy.

Self-prescription of medications can lead to the development of unwanted side effects, complications and can be fatal! It is prohibited to independently use medicines on the principle of “helping friends” or resort to the recommendations of pharmacists in pharmacy chains!!! The use of antihypertensive drugs is possible only as prescribed by a doctor!

The main goal of treating patients with hypertension is to minimize the risk of developing cardiovascular complications and death from them!

1. Lifestyle change measures:

• To give up smoking
• Normalization of body weight
• Consumption of alcoholic beverages less than 30 g/day of alcohol for men and 20 g/day for women
• Increasing physical activity - regular aerobic (dynamic) exercise for 30-40 minutes at least 4 times a week
• Reducing table salt consumption to 3-5 g/day
• Changing your diet with an increase in the consumption of plant foods, an increase in the diet of potassium, calcium (found in vegetables, fruits, grains) and magnesium (found in dairy products), as well as a decrease in the consumption of animal fats.

These measures are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow you to: lower blood pressure, reduce the need for antihypertensive drugs, and have a beneficial effect on existing risk factors.

2. Drug therapy

Today we will talk about these drugs - modern drugs for the treatment of arterial hypertension.
Arterial hypertension is a chronic disease that requires not only constant monitoring of blood pressure, but also constant use of medications. There is no course of antihypertensive therapy; all drugs are taken indefinitely. If monotherapy is ineffective, drugs are selected from various groups, often combining several drugs.
As a rule, the desire of a patient with hypertension is to purchase the strongest, but not expensive, drug. However, it is necessary to understand that this does not exist.
What medications are offered for this purpose to patients suffering from high blood pressure?

Each antihypertensive drug has its own mechanism of action, i.e. influence one or another "mechanisms" of increased blood pressure :

a) Renin-angiotensin system— the kidneys produce the substance prorenin (with a decrease in pressure), which passes into renin in the blood. Renin (a proteolytic enzyme) interacts with the blood plasma protein angiotensinogen, resulting in the formation of the inactive substance angiotensin I. Angiotensin, when interacting with angiotensin-converting enzyme (ACE), is converted into the active substance angiotensin II. This substance increases blood pressure, constricts blood vessels, increases the frequency and strength of heart contractions, excites the sympathetic nervous system (which also leads to increased blood pressure), and increases the production of aldosterone. Aldosterone promotes sodium and water retention, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictor substances in the body.

b) Calcium channels of the cells of our body— calcium in the body is in a bound state. When calcium enters the cell through special channels, a contractile protein, actomyosin, is formed. Under its influence, the blood vessels narrow, the heart begins to contract more strongly, the pressure rises and the heart rate increases.

c) Adrenoreceptors— in our body, in some organs, there are receptors, the irritation of which affects blood pressure. These receptors include alpha-adrenergic receptors (α1 and α2) and beta-adrenergic receptors (β1 and β2). Stimulation of α1-adrenergic receptors leads to an increase in blood pressure, α2-adrenergic receptors - to a decrease in blood pressure. α-adrenergic receptors are located in arterioles. β1-adrenergic receptors are localized in the heart, in the kidneys, their stimulation leads to an increase in heart rate, an increase in myocardial oxygen demand and an increase in blood pressure. Stimulation of β2-adrenergic receptors located in the bronchioles causes dilation of the bronchioles and relief of bronchospasm.

d) Urinary system- as a result of excess water in the body, blood pressure increases.

e) Central nervous system- stimulation of the central nervous system increases blood pressure. The brain contains vasomotor centers that regulate blood pressure levels.

So, we have examined the main mechanisms of increasing blood pressure in the human body. It's time to move on to blood pressure lowering agents (antihypertensives), which affect these same mechanisms.

Classification of drugs for arterial hypertension

1. Diuretics (diuretics)
2. Calcium channel blockers
3. Beta blockers
4. Agents acting on the renin-angiotensin system
   1. Angiotensin receptor blockers (antagonists) (sartans)
5. Neurotropic agents of central action
6. Drugs acting on the central nervous system (CNS)
7. Alpha blockers

1. Diuretics (diuretics)

As a result of the removal of excess fluid from the body, blood pressure decreases. Diuretics prevent the reabsorption of sodium ions, which as a result are excreted and carry water with them. In addition to sodium ions, diuretics flush out potassium ions from the body, which are necessary for the functioning of the cardiovascular system. There are potassium-sparing diuretics.

Representatives:

• Hydrochlorothiazide (Hypothiazide) - 25 mg, 100 mg, included in combination preparations; Long-term use at a dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes!
• Indapamide (Arifonretard, Ravel SR, Indapamide MV, Indap, Ionic retard, Acripamidretard) - most often the dosage is 1.5 mg.
• Triampur (a combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide);
• Spironolactone (Veroshpiron, Aldactone). It has a significant side effect (in men it causes the development of gynecomastia and mastodynia).
• Eplerenone (Inspra) - often used in patients with chronic heart failure, does not cause the development of gynecomastia and mastodynia.
• Furosemide 20 mg, 40 mg. The drug is short but fast acting. Inhibits the reabsorption of sodium ions in the ascending limb of the loop of Henle, proximal and distal tubules. Increases the excretion of bicarbonates, phosphates, calcium, magnesium.
• Torsemide (Diuver) - 5 mg, 10 mg, is a loop diuretic. The main mechanism of action of the drug is due to the reversible binding of torasemide to the sodium/chlorine/potassium ion contransporter located in the apical membrane of the thick segment of the ascending limb of the loop of Henle, as a result of which the reabsorption of sodium ions is reduced or completely inhibited and the osmotic pressure of intracellular fluid and water reabsorption are reduced. Blocks myocardial aldosterone receptors, reduces fibrosis and improves myocardial diastolic function. Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its action is longer lasting.

Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used independently for hypertension.
Rapid-acting diuretics (furosemide) are not advisable to use systematically for hypertension; they are taken in emergency conditions.
When using diuretics, it is important to take potassium supplements in courses of up to 1 month.

2. Calcium channel blockers

Calcium channel blockers (calcium antagonists) are a heterogeneous group of drugs that have the same mechanism of action, but differ in a number of properties, including pharmacokinetics, tissue selectivity, and effect on heart rate.
Another name for this group is calcium ion antagonists.
There are three main subgroups of AKs: dihydropyridine (the main representative is nifedipine), phenylalkylamines (the main representative is verapamil) and benzothiazepines (the main representative is diltiazem).
Recently, they have been divided into two large groups depending on their effect on heart rate. Diltiazem and verapamil are classified as so-called “rhythm-slowing” calcium antagonists (non-dihydropyridine). The other group (dihydropyridine) includes amlodipine, nifedipine and all other dihydropyridine derivatives that increase or do not change the heart rate.
Calcium channel blockers are used for arterial hypertension, coronary heart disease (contraindicated in acute forms!) and arrhythmias. For arrhythmias, not all calcium channel blockers are used, but only pulse-lowering ones.

Representatives:

Pulse reducers (non-dihydropyridine):

• Verapamil 40 mg, 80 mg (extended: Isoptin SR, Verogalid EP) - dosage 240 mg;
• Diltiazem 90 mg (Altiazem RR) - dosage 180 mg;

The following representatives (dihydropyridine derivatives) are not used for arrhythmia: Contraindicated in acute myocardial infarction and unstable angina!!!

• Nifedipine (Adalat, Cordaflex, Cordafen, Cordipin, Corinfar, Nifecard, Phenigidine) - dosage 10 mg, 20 mg; NifecardXL 30mg, 60mg.
• Amlodipine (Norvasc, Normodipin, Tenox, Cordi Cor, Es Cordi Cor, Cardilopin, Kalchek,
• Amlotop, Omelarcardio, Amlovas) - dosage 5 mg, 10 mg;
• Felodipine (Plendil, Felodip) - 2.5 mg, 5 mg, 10 mg;
• Nimodipine (Nimotop) - 30 mg;
• Lacidipine (Latsipil, Sakur) - 2 mg, 4 mg;
• Lercanidipine (Lerkamen) - 20 mg.

Side effects of dihydropyridine derivatives include swelling, mainly lower extremities headache, redness of the face, increased heart rate, and increased urination. If swelling persists, it is necessary to replace the drug.
Lerkamen, which is a representative of the third generation of calcium antagonists, due to its higher selectivity to slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.

3. Beta blockers

There are drugs that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other drugs selectively block only the beta receptors of the heart - selective action. All beta blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels dilate, blood pressure decreases.

Representatives:

• Metoprolol (Betalok ZOK 25 mg, 50 mg, 100 mg, Egilok retard 25 mg, 50 mg, 100 mg, 200 mg, Egilok S, Vasocardin retard 200 mg, Metocard retard 100 mg);
• Bisoprolol (Concor, Coronal, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Aritel) - most often the dosage is 5 mg, 10 mg;
• Nebivolol (Nebilet, Binelol) - 5 mg, 10 mg;
• Betaxolol (Locren) - 20 mg;
• Carvedilol (Carvetrend, Coriol, Talliton, Dilatrend, Acridiol) - mainly dosage 6.25 mg, 12.5 mg, 25 mg.

Drugs in this group are used for hypertension combined with coronary heart disease and arrhythmias.
Short-acting drugs, the use of which is not rational for hypertension: anaprilin (obzidan), atenolol, propranolol.

Main contraindications to beta blockers:

• bronchial asthma;
• low pressure;
• sick sinus syndrome;
• pathology of peripheral arteries;
• bradycardia;
• cardiogenic shock;
• atrioventricular block of the second or third degree.

4. Drugs acting on the renin-angiotensin system

The drugs act on different stages of angiotensin II formation. Some inhibit (suppress) angiotensin-converting enzyme, others block the receptors on which angiotensin II acts. The third group inhibits renin and is represented by only one drug (aliskiren).

Angiotensin-converting enzyme (ACE) inhibitors

These drugs prevent the conversion of angiotensin I to active angiotensin II. As a result, the concentration of angiotensin II in the blood decreases, blood vessels dilate, and pressure decreases.
Representatives (synonyms are indicated in brackets - substances with the same chemical composition):

• Captopril (Capoten) - dosage 25 mg, 50 mg;
• Enalapril (Renitek, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam) - dosage is most often 5 mg, 10 mg, 20 mg;
• Lisinopril (Diroton, Dapril, Lysigamma, Lisinoton) - dosage is most often 5 mg, 10 mg, 20 mg;
• Perindopril (Prestarium A, Perineva) - Perindopril - dosage 2.5 mg, 5 mg, 10 mg. Perineva - dosage 4 mg, 8 mg;
• Ramipril (Tritace, Amprilan, Hartil, Pyramil) - dosage 2.5 mg, 5 mg, 10 mg;
• Quinapril (Accupro) - 5mg, 10mg, 20mg, 40mg;
• Fosinopril (Fosicard, Monopril) - in a dosage of 10 mg, 20 mg;
• Trandolapril (Hopten) - 2 mg;
• Zofenopril (Zocardis) - dosage 7.5 mg, 30 mg.

The drugs are available in different dosages for the treatment of varying degrees of increased blood pressure.

A feature of the drug Captopril (Capoten) is that, due to its short duration of action, it is rational only for hypertensive crises.

A prominent representative of the group, Enalapril and its synonyms are used very often. This drug does not have a long duration of action, so it is taken 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of drug use. In pharmacies you can find a variety of generics (analogues) of enalapril, i.e. Cheaper enalapril-containing drugs produced by small manufacturers. We discussed the quality of generics in another article, but here it is worth noting that generic enalapril is suitable for some, but does not work for others.

ACE inhibitors cause a side effect - dry cough. In cases of cough development, ACE inhibitors are replaced with drugs from another group.
This group of drugs is contraindicated during pregnancy and has a teratogenic effect in the fetus!

Angiotensin receptor blockers (antagonists) (sartans)

These drugs block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, and blood pressure decreases

Representatives:

• Losartan (Cozaar 50 mg, 100 mg; Lozap 12.5 mg, 50 mg, 100 mg; Lorista 12.5 mg, 25 mg, 50 mg, 100 mg; Vasotens 50 mg, 100 mg);
• Eprosartan (Teveten) - 400 mg, 600 mg;
• Valsartan (Diovan 40mg, 80mg, 160mg, 320mg; Valsacor 80mg, 160mg, 320mg, Valz 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; Valsafors 80mg, 160mg);
• Irbesartan (Aprovel) - 150 mg, 300 mg;
  Candesartan (Atacand) - 8 mg, 16 mg, 32 mg;
  Telmisartan (Micardis) - 40 mg, 80 mg;
  Olmesartan (Cardosal) - 10 mg, 20 mg, 40 mg.

Just like its predecessors, it allows you to evaluate the full effect 1-2 weeks after the start of administration. Does not cause dry cough. Should not be used during pregnancy! If pregnancy is detected during treatment, antihypertensive therapy with drugs of this group should be discontinued!

5. Centrally acting neurotropic agents

Centrally acting neurotropic drugs affect the vasomotor center in the brain, reducing its tone.

• Moxonidine (Physiotens, Moxonitex, Moxogamma) - 0.2 mg, 0.4 mg;
• Rilmenidine (Albarel (1 mg) - 1 mg;
• Methyldopa (Dopegit) - 250 mg.

The first representative of this group is clonidine, which was previously widely used for hypertension. This drug is now available strictly by prescription.
Currently, moxonidine is used both for emergency treatment of hypertensive crisis and for planned therapy. Dosage 0.2 mg, 0.4 mg. The maximum daily dosage is 0.6 mg/day.

6. Drugs acting on the central nervous system

If hypertension is caused by prolonged stress, then drugs that act on the central nervous system are used (sedatives (Novopassit, Persen, Valerian, Motherwort, tranquilizers, sleeping pills).

7. Alpha blockers

These agents attach to alpha adrenergic receptors and block them from the irritating effects of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin (Cardura, Tonocardin) - is often available in dosages of 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many alpha blocker drugs have been discontinued.

Why do you take several medications at once for arterial hypertension?

In the initial stage of the disease, the doctor prescribes one drug, based on some research and taking into account the patient’s existing diseases. If one drug is ineffective, other drugs are often added, creating a combination of blood pressure-lowering drugs that target different mechanisms of blood pressure lowering. Combination therapy for refractory (stable) arterial hypertension can combine up to 5-6 drugs!

Drugs are selected from different groups. For example:

• ACE inhibitor/diuretic;
• angiotensin receptor blocker/diuretic;
• ACE inhibitor/calcium channel blocker;
• ACE inhibitor/calcium channel blocker/beta blocker;
• angiotensin receptor blocker/calcium channel blocker/beta blocker;
• ACE inhibitor/calcium channel blocker/diuretic and other combinations.

There are combinations of drugs that are irrational, for example: beta blockers/calcium channel blockers, pulse-lowering drugs, beta blockers/central acting drugs and other combinations. It is dangerous to self-medicate!!!

There are combination drugs that combine in 1 tablet components of substances from different groups of antihypertensive drugs.

For example:

• ACE inhibitor/diuretic
  • Enalapril/Hydrochlorothiazide (Co-Renitec, Enap NL, Enap N,
  • Enap NL 20, Renipril GT)
  • Enalapril/Indapamide (Enzix duo, Enzix duo forte)
  • Lisinopril/Hydrochlorothiazide (Iruzid, Lisinoton, Liten N)
  • Perindopril/Indapamide (NoliprelA and NoliprelAforte)
  • Quinapril/Hydrochlorothiazide (Accusid)
  • Fosinopril/Hydrochlorothiazide (Fosicard N)
• angiotensin receptor blocker/diuretic
  • Losartan/Hydrochlorothiazide (Gizaar, Lozap plus, Lorista N,
  • Lorista ND)
  • Eprosartan/Hydrochlorothiazide (Teveten plus)
  • Valsartan/Hydrochlorothiazide (Co-diovan)
  • Irbesartan/Hydrochlorothiazide (Co-aprovel)
  • Candesartan/Hydrochlorothiazide (Atacand Plus)
  • Telmisartan / HCTZ (Micardis Plus)
• ACE inhibitor/calcium channel blocker
  • Trandolapril/Verapamil (Tarka)
  • Lisinopril/Amlodipine (Equator)
• angiotensin receptor blocker/calcium channel blocker
  • Valsartan/Amlodipine (Exforge)
• calcium channel blocker dihydropyridine/beta blocker
  • Felodipine/metoprolol (Logimax)
• beta blocker/diuretic (not recommended for diabetes and obesity)
  • Bisoprolol/Hydrochlorothiazide (Lodoz, Aritel plus)

All drugs are available in different dosages of one and another component; the dose must be selected for the patient by the doctor.

Achieving and maintaining target blood pressure levels requires long-term medical supervision with regular monitoring of the patient’s compliance with recommendations for lifestyle changes and compliance with prescribed antihypertensive drugs, as well as adjustment of therapy depending on the effectiveness, safety and tolerability of treatment. During dynamic monitoring, the establishment of personal contact between the doctor and the patient and patient education in schools for patients with hypertension, which increases the patient’s adherence to treatment, are crucial.

– a pressing problem for the majority of the population, regardless of age and gender.

Blood pressure pills without side effects will help eliminate high blood pressure, the list of which has recently been supplemented with new generation drugs.

The main feature of the newest products is quick help in reducing tonometer readings and the almost complete absence of negative effects on the body.

Any medications against hypertension must be prescribed by a doctor; new generation blood pressure medications are no exception.

Letters from our readers

Subject: Grandma's blood pressure has returned to normal!

From: Christina ( [email protected])

To: Site Administration

Christina
Moscow

My grandmother's hypertension is hereditary - most likely, I will have the same problems as I grow older.

Any therapy involves medication with various drugs; in the case of hypertension, this means taking antihypertensive drugs according to the correct regimen. Each person is individual, and therefore there is no universal scheme for getting rid of high blood pressure, even if we are talking about taking the latest generation of tablets.

Only a doctor can choose drugs to safely lower blood pressure without negative side effects after a preliminary examination of the patient. He will also create an effective dosage regimen with the optimal dosage.

It is not recommended to take pills for high blood pressure on your own, even if they are new-generation drugs with long-term effects. At best, such treatment will be ineffective, at worst, it will lead to...

Since the fight against hypertension is a complex undertaking, independent therapeutic actions can only be carried out using traditional medicine recipes. But a preliminary consultation with a doctor is necessary.

The list of new generation high blood pressure medications for each individual patient depends on the history of his disease. To control blood pressure surges and stabilize the condition, the patient will have to take several options of pills for high blood pressure from different groups.

According to the composition and principle of action, the tablets are divided into the following groups:

• diuretics, also called diuretics;
• angiotensin 2 receptor antagonists;
• beta blockers;
• calcium antagonists;
• inhibitors whose action is focused on the angiotensin-converting enzyme.

All the latest generation drugs that make up these groups have a minimum of side effects for both men and women. They were created to reduce the negative impact on the body and reduce the number of medications taken per day.

Pharmacology includes several groups of diuretics, but only a few of them are used to stabilize blood pressure.

The table shows a list of the most effective medications in this category:

Name	Group	Peculiarities
Hypothiazide	thiazide	It has a quick effect. In addition to lowering blood pressure, it blocks the formation of stones and eliminates swelling
Torasemide	loopback	Easier to tolerate than previous analogues. The number of urinations is limited, which allows therapy to be carried out in any conditions. Prevents the reabsorption of salts.
Arifon	thiazide	Effective even with one kidney. It has a gentle effect, removes excess fluid from the body without affecting the volume of diuresis.
Spironolactone	potassium-sparing	Indicated for heart failure. Reduces urine acidity and has a mild diuretic effect.
Diuver	loopback	More active among other representatives of diuretics in its group. Able to eliminate edema syndrome in various diseases, including hypertension.

On average, the antihypertensive effect occurs 4-5 weeks after the start of therapy.

New generation diuretic medications for blood pressure are used in relatively low dosages, which reduces the diuretic effect. The decrease in blood pressure occurs without washing out the necessary substances from the body, as was the case with the previous generation of drugs.

This group of drugs belongs to a new generation of drugs and is distinguished by its unique effectiveness with a reduced negative effect on the body. Beta blockers can stop the mechanism of action of catecholamines on beta adrenergic receptors in the heart. It is this phenomenon that becomes a common cause of a jump in blood pressure.

The new generation of drugs with this function is distinguished by its ability to act simultaneously on beta 2 and 1 receptors, while previous drugs blocked only beta 1.

The list of catecholamine action blockers without side effects is as follows:

• Sotalol. It can not only block the effect on receptors, but also inhibits potassium channels. In addition to lowering blood pressure, a modern drug for hypertension normalizes heart rhythm and prolongs myocardial potential.
• Propranolol. In addition to its main function - lowering blood pressure, the new generation of hypertension pills have a sedative effect, fears and anxieties go away, the functioning of the heart muscle is normalized and cardiac output decreases. At the same time, intraocular pressure decreases and the digestive process even normalizes.
• Anaprilin. The main active ingredient of the drug is propranolol; the actions of the new generation medicine for high blood pressure are similar to the original version.
• Timolol. Blocks receptors, having a beneficial effect on the functioning of the heart and blood vessels. Lowers blood pressure and is one of the best drugs of the new generation with minimal side effects.

In addition to the second and first generation, there are third-generation beta receptor blockers, the action of which is aimed at regulating vascular tone.

The latest development among the drugs in this group is Labetalol. A hybrid blocker that can inhibit not only beta, but also alpha receptors. A new generation medicine can be used both for emergency relief of a hypertensive crisis, and in case of need for prolonged treatment.

Another type of the latest pharmacological development among blockers is Nebivolol. The medicine does not affect the frequency of contractions of the heart muscle and does not increase glucose. The expansion of the walls of blood vessels occurs due to the active production of nitric oxide.

ACE inhibitor drugs are used for hypertension, when high blood pressure is caused by heart failure, kidney disease and diagnosed diabetes mellitus. Pressure under the influence of drugs of this group is reduced due to changes in the balance of blood components with biological activity. The balance changes in a positive direction for the cardiovascular system.

Inhibitors are not usually prescribed concomitantly with non-steroidal anti-inflammatory drugs, since they can reduce their hypotensive effect.

Drugs in this group are divided according to their chemical composition into the following groups:

• Phosphinyl with long-term effect: Perindopril, Ramipril and Fosinopril.
• Carboxylic acids with a relatively short duration of action: Hortil, Perindopril, Lisinopril and Quinapril.
• Sulfhydryls, the duration of action of which is minimal: Lotensin, Zofenopril, Capoten and Captopril.

Long-term treatment involves the combined use of drugs from various drug groups. The main remedy of the new generation of this group is Diroton, the use of which is indicated even for liver and kidney diseases. The active component of the drug is lisinopril, but the effect of the original drug is more severe due to the too rapid release of the active substance after administration.

A relatively new group of medications consists of these effective medications for hypertension. Their action is based on blocking the level of the anti-renin system. Antiogensin ultimately does not narrow the vascular system and reduces the number of hormones that cause fluid to accumulate in the body.

Treatment with sartans takes a long period of time; on average, a positive effect occurs 3-4 weeks after the start of therapy. The optimal effect of the drugs can be assessed in the 8th week of use.

The most effective sartans:

• Valsartan. The effect of a single use can occur in 2 hours, and its duration is a day. Indicated for chronic heart failure, as it quickly relieves swelling. It is often prescribed simultaneously with Captopril, especially during the period of resuscitation after a heart attack.
• Losartan. The active substance in the product is dimethicone. This is the first drug from the sartan group approved for use. The drug is usually prescribed to lower blood pressure in the presence of diabetic nephropathy and chronic heart muscle failure.
• Cardosal. This medicine, according to doctors, is one of the best drugs that can lower blood pressure. The number of contraindications and side effects of Cardosal is minimized, while a persistent positive effect is observed during its administration. The drug is part of a group of drugs for mild forms of hypertension; for more complicated forms of the disease, Cardosal Plus is prescribed.
• Olmesartan. Good blood pressure pills without side effects are well tolerated and have a quick effect. During therapy, the risk of dry cough, characteristic of antihypertensive drugs, is minimized.

The newest drug among sartans is Edarbi. The primary effect of taking it occurs in the first days of use, and optimal activity appears after a month of continuous use. The medicine has almost no contraindications, but is not recommended for use in the presence of severe diseases of the heart, liver and excretory system.

Sartans are a large group of effective new generation blood pressure medications.

Medicines whose action is aimed at inhibiting calcium channels are usually prescribed in the complex therapy of hypertension. What is best to take for high blood pressure should be determined by the doctor after collecting a history of the disease, and he will also decide on the advisability of supplementing the treatment regimen with calcium blockers.

The main principle of action of this group of drugs is based on blocking the production of calcium ions, which, penetrating into muscle cells, constrict blood vessels. As a result of the action of the active components of the drugs, the lumen of the blood vessels expands and the tonometer readings decrease.

The most famous drug of the new generation among calcium inhibitors is Calcigard retard. The main feature of the product is the slow release of the active ingredient and high lipophilicity. This allows us to classify Calcigrad as a long-acting medication.

The effect of the drug is mild, which allows it to be used even for Raynaud's disease. The main substance of the product is nifedipine, however, unlike the original product, Calcigrad is characterized by a slow release of the main ingredient.

The drug Alixiren has a direct effect on renin and has pronounced activity.

A decrease in blood pressure is observed due to a decrease in the effect of renin on angiotensinogen in both groups.

The new generation drug is not used for independent therapy, but only as an adjuvant in complex treatment.

Drugs characterized by a cumulative effect constitute a specific pharmacological group and are used for a long course of therapy.

The active effect of drugs of this type begins over a certain period of time, during which the drug accumulates in the body.

The following drugs have a weak antihypertensive effect:

• Veroshpiron. Refers to a type of mild diuretics. Does not remove potassium from the body, gradually reducing blood pressure.
• Nimodipine. Inhibits the production of calcium, dilates blood vessels, primarily related to the brain.
• Felodipine. Gradually blocks calcium channels, resulting in vasodilation.
• Lercanidipine. Another calcium blocker, but it does not have a negative effect on the kidneys. Used in the treatment of hypertension due to renal failure.

It makes no sense to use these medications to quickly lower blood pressure, since they all have a prolonged effect.

A sharp jump in blood pressure requires immediate medical intervention, which will quickly stop a hypertensive attack.

As a sedative for this condition, it is recommended to take tincture of valerian or motherwort.

With prior agreement with a doctor, a hypertensive crisis should be treated with the following medications:

• Anaprilin;
• Nefidipine;
• Captopril;
• Raunatin - acts on the nervous system and has almost no contraindications;
• Reserpine - during a crisis, the maximum dosage of the drug is required - 0.5 mg.

The use of drugs in this group is a preventive measure to reduce blood pressure and quickly normalize the pulse.

All chemical medications have side effects; the risk of their occurrence can only be reduced through comprehensive treatment.

The most common medications in this category:

• . The maximum side effects from the drug are slight dry mouth, drowsiness and slight weakness. The medicine is effective for hypertension, and at the same time practically safe. Patients do not note any severe discomfort during Physiotens therapy; in addition, it increases the body's sensitivity to insulin, which makes it possible to use it for diabetes.
• . The action of the drug allows it to be classified as an inhibitor; its effectiveness is increased due to the diuretic component contained in the composition.
• Rilmenidin and . Medicines of one group, their action is aimed at suppressing imidazoline receptors. They have almost no contraindications or side effects.
• , and Labetalol are representatives of new blockers among drugs. Promptly and safely eliminate high blood pressure and the possible negative consequences of this phenomenon. At the same time, they do not cause side effects.

Any of the new generation drugs, despite the minimum possible negative effects on the body, requires a doctor’s prescription.

Since it is possible to minimize side effects from drug therapy using combination treatment, in medical practice it is customary to prescribe several drugs at once for one treatment regimen.

An example of the correct combination is presented in the table:

Type of drug	Approximate combination of drugs
Sartans + diuretics	Hydrochlorothiazide + Valsartan or Losartan
Beta blocker + diuretics	Bisoprolol+Hydrochlorothiazide or Atenolol+Chlorthalidone
Diuretic + ACE inhibitors	Captopril + Hydrochlorothiazide or Perindopril+Indopamide
Calcium blockers + beta blockers	Felodipine with Metoprolol
Calcium blockers and inhibitors	Diltiazem with Enalapril

The presented combination treatment regimens require regular use throughout the life of the hypertensive patient.

The main preventive measures against hypertension are maintaining a correct lifestyle, which includes giving up bad habits and regular examination by a doctor. This is especially important for those patients who are at risk.

Angiotensin-converting enzyme (ACE) inhibitors are a group of hypertension medications that affect the activity of the renin-angiotensin-aldosterone system. ACE is an angiotensin-converting enzyme that converts a hormone called angiotensin-I into angiotensin-II. And angiotensin-II increases the patient’s blood pressure. This happens in two ways: angiotensin II causes a direct constriction of blood vessels, and also causes the adrenal glands to release aldosterone. Salt and liquid are retained in the body under the influence of aldosterone.

ACE inhibitors block the angiotensin-converting enzyme, as a result of which angiotensin-II is not produced. They can enhance the effects of diuretics (water medications), reducing the body's ability to produce aldosterone when salt and water levels are reduced.

Efficacy of ACE inhibitors for the treatment of hypertension

ACE inhibitors have been successfully used to treat hypertension for more than 30 years. A 1999 study assessed the effect of the ACE inhibitor captopril on reducing blood pressure in patients with hypertension compared with diuretics and beta blockers. There were no differences between these drugs in terms of reducing cardiovascular morbidity and mortality, but captopril was significantly more effective in preventing the development of complications in patients with diabetes.

• The best way to recover from hypertension (quickly, easily, healthy, without “chemical” drugs and dietary supplements)
• Hypertension - a popular way to cure it at stages 1 and 2
• Causes of hypertension and how to eliminate them. Tests for hypertension
• Effective treatment of hypertension without drugs

Also watch a video about the treatment of coronary artery disease and angina pectoris.

The results of the STOP-Hypertension-2 study (2000) also showed that ACE inhibitors are not inferior to diuretics, beta blockers and calcium antagonists in preventing complications from the cardiovascular system in patients with hypertension.

ACE inhibitors significantly reduce patients' mortality, risk of stroke, heart attack, all cardiovascular complications and heart failure as a cause of hospitalization or death. This was also confirmed by the results of a 2003 European study, which showed the advantage of ACE inhibitors in combination with calcium antagonists compared with the combination of a beta blocker and a thiazide diuretic in the prevention of cardiac and cerebral events. The positive effect of ACE inhibitors on patients exceeded the expected effect of lowering blood pressure alone.

ACE inhibitors, along with angiotensin II receptor blockers, are also the most effective drugs in reducing the risk of developing diabetes.

Classification of ACE inhibitors

ACE inhibitors, according to their chemical structure, are divided into drugs containing a sulfhydryl, carboxyl and phosphinyl group. They have different half-lives, different ways of being eliminated from the body, dissolve differently in fats and accumulate in tissues.

ACE inhibitor - name

Half-life from the body, hours

Renal excretion, %

Standard doses, mg

Dose for renal failure (creatine clearance 10-30 ml/min), mg

ACE inhibitors with a sulfhydryl group
Benazepril	11	85	2.5-20, 2 times a day	2.5-10, 2 times a day
Captopril	2	95	25-100, 3 times a day	6.25-12.5, 3 times a day
Zofenopril	4,5	60	7.5-30, 2 times a day	7.5-30, 2 times a day
ACE inhibitors with a carboxyl group
Cilazapril	10	80	1.25, 1 time per day	0.5-2.5, 1 time per day
Enalapril	11	88	2.5-20, 2 times a day	2.5-20, 2 times a day
Lisinopril	12	70	2.5-10, 1 time per day	2.5-5, 1 time per day
Perindopril	>24	75	5-10, 1 time per day	2, 1 time per day
Quinapril	2-4	75	10-40, once a day	2.5-5, 1 time per day
Ramipril	8-14	85	2.5-10, 1 time per day	1.25-5, 1 time per day
Spirapril	30-40	50	3-6, 1 time per day	3-6, 1 time per day
Trandolapril	16-24	15	1-4, 1 time per day	0.5-1, 1 time per day
ACE inhibitors with a phosphinyl group
Fosinopril	12	50	10-40, once a day	10-40, once a day

The main target of ACE inhibitors is the angiotensin-converting enzyme in blood plasma and tissues. Moreover, plasma ACE is involved in the regulation of short-term reactions, primarily in the increase in blood pressure in response to certain changes in the external situation (for example, stress). Tissue ACE is essential in the formation of long-term reactions, regulation of a number of physiological functions (regulation of circulating blood volume, sodium, potassium balance, etc.). Therefore, an important characteristic of an ACE inhibitor is its ability to influence not only plasma ACE, but also tissue ACE (in blood vessels, kidneys, heart). This ability depends on the degree of lipophilicity of the drug, i.e. how well it dissolves in fats and penetrates into tissues.

Although hypertensive patients with high plasma renin activity experience a more dramatic reduction in blood pressure with long-term treatment with ACE inhibitors, the correlation between these factors is not very significant. Therefore, ACE inhibitors are used in patients with hypertension without first measuring plasma renin activity.

ACE inhibitors have advantages in the following cases:

• concomitant heart failure;
• asymptomatic left ventricular dysfunction;
• renoparenchymal hypertension;
• diabetes;
• left ventricular hypertrophy;
• previous myocardial infarction;
• increased activity of the renin-angiotensin system (including unilateral renal artery stenosis);
• non-diabetic nephropathy;
• atherosclerosis of the carotid arteries;
• proteinuria/microalbuminuria
• atrial fibrillation;
• metabolic syndrome.

The advantage of ACE inhibitors lies not so much in their special activity in lowering blood pressure, but in the unique features of protecting the patient’s internal organs: beneficial effects on the myocardium, walls of resistive vessels of the brain and kidneys, etc. We now turn to the characterization of these effects.

How ACE inhibitors protect the heart

Hypertrophy of the myocardium and blood vessel walls is a manifestation of the structural adaptation of the heart and blood vessels to high blood pressure. Hypertrophy of the left ventricle of the heart, as has been repeatedly emphasized, is the most important consequence of hypertension. It contributes to the occurrence of diastolic and then systolic dysfunction of the left ventricle, the development of dangerous arrhythmias, the progression of coronary atherosclerosis and congestive heart failure. Based on 1 mm Hg. Art. decreased blood pressure, ACE inhibitors reduce the muscle mass of the left ventricle 2 times more intensely compared to other medications for hypertension. When treating hypertension with these drugs, there is an improvement in the diastolic function of the left ventricle, a decrease in the degree of its hypertrophy and an increase in coronary blood flow.

The hormone angiotensin II enhances cell growth. By suppressing this process, ACE inhibitors help prevent or inhibit the remodeling and development of myocardial and vascular muscle hypertrophy. In implementing the anti-ischemic effect of ACE inhibitors, it is also important to reduce the myocardial oxygen demand, reduce the volume of the heart cavities, and improve the diastolic function of the left ventricle of the heart.

• Causes, symptoms, diagnosis, medications and folk remedies for heart failure
• Diuretic medications for edema in heart failure: detailed information
• Answers to frequently asked questions about heart failure - fluid and salt restriction, shortness of breath, diet, alcohol, disability
• Heart failure in the elderly: treatment features

Watch also the video.

How ACE inhibitors protect the kidneys

The most important question, the answer to which determines the doctor’s decision whether to use ACE inhibitors in a patient with hypertension, is their effect on renal function. So, it can be argued that among drugs for lowering blood pressure, ACE inhibitors protect the kidneys best of all. On the one hand, about 18% of patients with hypertension die from kidney failure, which develops as a result of increased blood pressure. On the other hand, a significant number of patients with chronic kidney disease develop symptomatic hypertension. It is believed that in both cases there is an increase in the activity of the local renin-angiotensin system. This leads to kidney damage and their gradual destruction.

The US Joint National Committee on Hypertension (2003) and the European Society of Hypertension and Cardiology (2007) recommend prescribing ACE inhibitors to patients with hypertension and chronic kidney disease to slow the progression of renal failure and lower blood pressure. A number of studies have demonstrated the high effectiveness of ACE inhibitors in reducing the incidence of complications in patients with hypertension in combination with diabetic nephrosclerosis.

ACE inhibitors best protect the kidneys in patients with significant protein excretion in the urine (proteinuria more than 3 g/day). It is currently believed that the main mechanism of the renoprotective effect of ACE inhibitors is their effect on renal tissue growth factors activated by angiotensin II.

It has been established that long-term treatment with these drugs improves renal function in a number of patients with signs of chronic renal failure, if there is no sharp decrease in blood pressure. At the same time, a reversible deterioration in renal function can occasionally be observed during treatment with ACE inhibitors: an increase in plasma creatinine concentration, depending on the elimination of the effect of angiotensin-2 on the efferent renal arterioles, which maintain high filtration pressure. It is appropriate to point out here that with unilateral renal artery stenosis, ACE inhibitors can deepen disorders on the affected side, but this is not accompanied by an increase in plasma creatinine or urea levels as long as the second kidney functions normally.

For renovascular hypertension (i.e., a disease caused by damage to the renal vessels), ACE inhibitors in combination with a diuretic are quite effective in controlling blood pressure in most patients. True, isolated cases of the development of severe renal failure in patients who had one kidney have been described. Other vasodilators (vasodilators) can also cause the same effect.

The use of ACE inhibitors as part of combination drug therapy for hypertension

It is useful for doctors and patients to have information about the possibilities of combination therapy for hypertension with ACE inhibitors and other blood pressure medications. The combination of an ACE inhibitor with a diuretic in most cases ensures rapid achievement of blood pressure levels close to normal. It should be taken into account that diuretics, by lowering the volume of circulating blood plasma and blood pressure, shift pressure regulation from the so-called Na-volume dependence to the vasoconstrictor renin-angiotensin mechanism, which is affected by ACE inhibitors. This sometimes leads to an excessive decrease in systemic blood pressure and renal perfusion pressure (renal blood supply) with deterioration of kidney function. In patients who already have such disorders, diuretics together with ACE inhibitors should be used with caution.

A clear synergistic effect, comparable to the effect of diuretics, is provided by calcium antagonists prescribed together with ACE inhibitors. Calcium antagonists can therefore be prescribed instead of diuretics if the latter are contraindicated. Like ACE inhibitors, calcium antagonists increase the distensibility of large arteries, which is especially important for elderly patients with hypertension.

Therapy with ACE inhibitors as the only treatment for hypertension gives good results in 40-50% of patients, perhaps even in 64% of patients with mild to moderate forms of the disease (diastolic pressure from 95 to 114 mm Hg). This indicator is worse than when treating the same patients with calcium antagonists or diuretics. It should be borne in mind that patients with the hyporenin form of hypertension and the elderly are less sensitive to ACE inhibitors. Such individuals, as well as patients in stage III of the disease with severe hypertension, sometimes becoming malignant, should be recommended combined treatment with ACE inhibitors with a diuretic, calcium antagonist or beta blocker.

The combination of captopril and a diuretic, prescribed at regular intervals, is often extremely effective, i.e., blood pressure is reduced to almost normal levels. With this combination of drugs it is often possible to achieve complete control of blood pressure in very sick patients. When combining ACE inhibitors with a diuretic or calcium antagonist, normalization of blood pressure is achieved in more than 80% of patients with advanced hypertension.

See also the article “ACE inhibitors: side effects”.

• Captopril
• Enalapril
• Lisinopril
• Moexpril
• Perindopril (Prestarium)
• Spirapril (quadropril)
• Fosinopril (monopril)
• ACE inhibitors - other drugs

A combination drug is a pharmacological form that contains at least 2 active pharmacological substances.

A similar concept is also combination treatment - the simultaneous use of 2 or more single-component drugs.

Combination drugs for the treatment of hypertension have been used for quite a long time and make up a fifth of all medications sold in Russian pharmacies. They have a number of advantages, but are not without disadvantages.

Combination drugs for hypertension have the following advantages:

• ease of use (no need to create a schedule of taking several medications);
• social and psychological comfort (one tablet can be easily taken even in public places);
• saving money (the cost of the combined medicine is lower than the total cost of its components);
• reducing the likelihood of side effects.

The combination of drugs for the treatment of arterial hypertension aims to:

• reducing the duration of treatment;
• enhancing the therapeutic effect;
• prevention of various complications;
• reducing the amount of medications taken.

Combinations of drugs for hypertension also have some disadvantages:

• a fixed ratio of volumes of CP components, which does not allow changing the concentration of one of them if necessary;
• inability to combine with meals, if the incoming components should be taken before and after meals;
• The maximum effect of various medicinal components does not coincide, and the duration of action is also different.

Combination medications can also be used to reduce or completely prevent side effects that occur during treatment with individual medications.

For example, with long-term use of thiazide-based diuretics, the patient’s body begins to lose much-needed potassium.

To avoid this effect, the patient is prescribed medications that combine thiazides.

When medicinal active substances are used in combination, their main effects often become different. This is caused by interaction at the level of pharmacological processes (excretion, absorption, distribution, transformation).

The components of combined drugs can both enhance each other and reduce or completely eliminate the negative effects of their effects on the body.

List of combination antihypertensive drugs

If we talk about the most commonly prescribed combination antihypertensive drugs by doctors, the list is as follows:

• Atakand;
• Amzaar;
• Logimax;
• Lodoz;
• Co-Renitec;

Hypertensive patients are often prescribed medications, one of the components is the angiotensin receptor blocker valsartan. The combined blood pressure medications of this group are as follows: Exforge, Co-Exforge, Co-Diovan.

Any combination drug for hypertension should be taken only as prescribed by a doctor.

Synergy

If CP substances have an effect on the body in one direction, reinforcing each other, then this phenomenon is called synergism. This word is translated from Greek as “acting together.”

Synergy can be:

• direct, if the actions of the components of the CP are directed to the same receptors. Example, adrenaline + norepinephrine. In this case, the therapeutic effects of the drugs included in the CP are summed up. In this case, a total or additive effect is observed;
• indirect, if the substances included in the CP affect different receptors. In clinical practice, droperidol + fentanyl is used for pain relief. The effect exceeds the total impact of the individual components. This is called potentiation or superadditive action.

Synergism, especially providing a superadditive effect, allows you to reduce the dose of the drugs used, while maintaining the level of their therapeutic effect. But sometimes, it can lead to increased toxic effects. For example, calcium supplements used in conjunction with cardiac glycosides can increase the toxicity of the latter.

Synergism can give not only a positive, but also a negative effect, so you need to take KP very carefully and only as prescribed by doctors.

Antagonism

If the impact of a component included in the CP is reduced or completely eliminated by another component, this phenomenon is called antagonism, which is translated from Greek as “confrontation.” CPs that have an antagonistic effect are used, for example, in the treatment of various poisonings or when it is necessary to eliminate the negative effects of some component.

There are 3 types of drug antagonism:

• physical;
• chemical;
• physiological (functional).

Physical antagonism manifests itself during the adsorption of various toxic substances by sorbents. For example, with some types of blood purification or with the adsorption of poisons that have entered the body with activated carbon.

Chemical antagonism occurs during chemical reactions between components in which inactive compounds are formed. A striking example of such antagonists are antidotes used in the treatment of poisoning. For example, unithiol is an antagonist of heavy metal salts.

Physiological or functional antagonism uses the functional systems of the body and is mediated by biosubstrates. By their nature, it can be direct or indirect.

Atacand is a combination drug for the treatment of hypertension

Direct physiological antagonism is the effect of drugs on identical receptors (cellular elements) in the opposite direction. For example, acetylcholine + atropine. Such antagonism can be reversible if it can be overcome by changing the concentration of the substances involved in the process, or irreversible otherwise.

Indirect physiological antagonism is the same type of action of the components on different receptors with opposite functions.

Due to the presence of synergy and antagonism when treating with combination drugs or when using combination therapy, doctors must adhere to certain rules:

• prescribe only medications with clear indications for the patient;
• prescribe CP if there are clear indications for combination therapy;
• use combination drugs only during the typical course of the disease;
• use combination drugs only as maintenance therapy, but not at the acute stage of the disease;
• explain to the patient how to combine CP with meals and other medications;
• use CP when long-term (lifelong) treatment of patients is necessary.

Before taking combined drugs, the patient should carefully read the instructions, check the dosage and the presence of contraindications and side effects.

Treatment of ARVI

The types of drugs included in combination drugs depend on the disease for which they are intended to treat.

Here is a group of pharmacological agents that are most often included in various CPs used for colds:

• Paracetamol– an analgesic, has an antipyretic effect, affecting the regulation centers of the hypothalamus. May act as a mild anti-inflammatory agent;
• Phenylephrine– relieves swelling, hyperemia of the mucous membrane, reduces lacrimation, runny nose, sneezing, facilitates breathing;
• Chlorpheniramine– prevents the action of histamine (allergy mediator), reduces the conjunctiva of the eyes and swelling of the mucous membrane, relieves bronchospasm, relieves cough;
• Dextromethorphan– eliminates dry irritating cough;
• Guaifenesin – reduces the viscosity of sputum, stimulates its separation;
• Ascorbic acid– is a moderate antioxidant, regulates oxidative processes, carbohydrate metabolism, stabilizes capillary permeability.

Due to the high density and mobility of the population, acute respiratory viral infections and influenza are the cause of 90% of all infectious diseases in the world. Combination drugs allow you to simultaneously influence the entire symptomatic complex of the disease with minimal doses of medications taken, quickly and significantly alleviating the condition of sick people.

Video on the topic

And yet, which pills for hypertension are considered the best? Answer in video: