At present, there are six categories of first-line antihypertensive drugs commonly used in clinical practice. Earlier, there were five categories, which everyone is familiar with, such as calcium antagonists based on "dipine", angiotensin system inhibitors based on "Puli" and "sartan", receptor blockers based on "lol", and diuretics based on "thiazide". This year, a large class of new drugs has been added to China's hypertension guidelines, angiotensin receptor neprilysin inhibitors. It is said that it is a large category, and there is only one medicine at present, sacubitril-valsartan.
ccb::horizon class;acei: puri;arb: sartan class;Receptor blockers;Lol class;ARNI: angiotensin receptor neprilysin inhibitor.
The six major classes of antihypertensive drugs are all first-line drugs for lowering blood pressure, that is, if you start from lowering blood pressure, any class can be used as the starting drug. Because of high blood pressure and prevention of cardiocerebrovascular damage, the first thing is to lower blood pressure and lower it to the normal range, so lowering blood pressure is the first and last word.
However, people are different, and the condition of hypertension is different;There are also differences between drugs and drugs, the mechanism and target of drugs to lower blood pressure are different, and clinical studies have also found different characteristics and advantages of lowering blood pressure, which can help us focus on when choosing drugs.
Dipine" drugs can be said to be the most widely used antihypertensive drugs in China. The antihypertensive effect is clear, there are no absolute contraindications, and it can also be used if the kidney function is not good, and it can be used with other types of antihypertensive drugs, and it is also cheap. In particular, it is better to lower systolic blood pressure, and it is suitable for those who have high systolic blood pressure alone, which is more common in the elderly. Calcium antagonists can also improve angina pectoris, even in patients with coronary artery disease.
Puli" and "sartan" drugs can lower blood pressure and protect the heart and kidneys. At the same time, it can improve the blood flow of the kidneys, reduce the pressure in the glomeruli, reduce proteinuria, and protect kidney function. These two types of drugs also have the effect of inhibiting myocardial hypertrophy and improving cardiac function, so patients with hypertension combined with ventricular hypertrophy, poor cardiac function, or myocardial infarction are also more suitable. However, these two types of drugs act in the same system, and there are similarities and are generally not suitable.
Diuretics are actually very classic antihypertensive drugs. The most commonly used are thiazides, which are lowered in small doses, mainly not by diuresis. When used alone to lower blood pressure, indapamide is commonly used. Hydrochlorothiazide is often used in combination with other drugs, such as propril or sartan drugs are often combined with hydrochlorothiazide, often made into a tablet, such as benazepril hydrochlorothiazide, enalapril hydrochlorothiazide, lisinopril hydrochlorothiazide, losartan potassium hydrochlorothiazide, valsartan hydrochlorothiazide, irbesartan hydrochlorothiazide, olmesartan hydrochlorothiazide, etc., and with the horizon drugs. So when you see such a drug name, it means that there are two kinds of medicine in it. The combination of diuretics and other antihypertensive drugs can significantly increase the antihypertensive effect, and can also offset some of the best diuretics are also better for lowering systolic blood pressure.
Spironolactone alone is rarely used to lower blood pressure, but it can be used in patients with hypertension who have poor cardiac function or high blood pressure due to primary aldosteronism.
Because it can inhibit the contractility of the myocardium and slow down the heart rate, it is more suitable for patients with high diastolic blood pressure and fast heartbeat, and there are many such cases in young and middle-aged people. Because inhibiting myocardial contraction and slowing down the heart rate can reduce myocardial oxygen consumption, it is also good for improving myocardial ischemia, and it is also suitable for hypertensive patients with coronary heart disease and poor cardiac function.
A new class, sacubitril-valsartan. It was first used for heart failure**. There are neprilysin inhibitors in it, which can increase the level of natriuretic peptides in the body, the most direct is natriuretic water, plus valsartan, the effect of sartan drugs, has a good effect on the heart and kidney protection, and among the six major categories of antihypertensive drugs, the magnitude of reducing systolic blood pressure is the largest, it is understandable that there are two ingredients in it!
Therefore, clinicians often choose drugs like this:
For simple systolic hypertension, diuretics of dipine and thiazide are selected
For diabetes, renal impairment, and myocardial hypertrophy, sartan and pril are preferred
If it is accompanied by fast heart rate, low blood pressure, and coronary heart disease, blockers can be selected
For high blood pressure and poor heart and kidney function, sacubitril-valsartan is better.
These six classes of antihypertensive drugs also have different combination applications.
What is said here are the advantages and indications of antihypertensive drugs, and the drugs also have their own disadvantages and contraindications, so the medication must be under the guidance of a doctor, and do not take the medicine without authorization!
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