Author: Gcplive
Source: Center for Drug Evaluation< /p>
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Types of antihypertensive drugs:1. Dihydrogen Pyridine calcium channel blocker (CCB); 2. Angiotensin-converting enzyme inhibitor (ACEI); 3. Angiotensin receptor antagonist (ARB); 4. Thiazide diuretic; 5. β-receptor body blockers; 6. α1-receptor blockers; 7. central antisympathetic drugs. Commonly used antihypertensive drugs:1.CCB: amlodipine, felodipine, cilnidipine, nifedipine, nitrendipine; 2.ACEI: enalapril, fosinopril, lisinopril, perindopril, imidapril; 3.ARB: losartan , valsartan, irbesartan, telmisartan, olmesartan;4. Thiazide diuretics: hydrochlorothiazide, indapamide;5. Beta-blockers: metoprolol, bisoprolol, atenolol, labetalol, propranolol. Basic principles for the application of antihypertensive drugs1. Five types of antihypertensive drugs can be used as initial treatment drugs, and the recommendations are based on the type of special population, comorbidities Select targeted drugs;2. Priority is given to using long-acting antihypertensive drugs to effectively control 24-hour blood pressure and prevent cardiovascular and cerebrovascular complications more effectively. 01. Young and middle-aged isolated diastolic hypertensionRecommendation: Young and middle-aged (<65 years old) isolated diastolic hypertension For blood pressure, if the heart rate is ≤80 beats/min, ACEI/ARB is preferred; if the heart rate is >80 beats/min, β-blockers are preferred. Explanation:The level of renin in young and middle-aged patients with isolated diastolic hypertension is often higher, and it is often accompanied by increased sympathetic tone. Consider using ACEI or ARB, beta-blockers can lower heart rate. Reminder:Beta-blockers can reduce libido; thiazide diuretics can cause erectile dysfunction, decreased libido, and ejaculation in men obstacle. 02. Elderly isolated systolic hypertensionRecommendation: Elderly (≥65 years old) isolated systolic hypertension, Long-acting dihydropyridine calcium channel blockers (CCBs) are preferred. Explanation: About 2/3 of the elderly hypertensive patients are only elevated systolic blood pressure. Compared with diastolic blood pressure, systolic blood pressure is more closely related to the damage of target organs such as heart, brain and kidney. CCB can improve the function of vascular endothelial cells, increase the synthesis and release of NO from endothelial cells, and improve the compliance of large arteries; CCB has antioxidant and anti-atherosclerotic effects; CCB significantly reduces systolic blood pressure, but has no effect on diastolic blood pressure. obvious. Tips:Common adverse reactions of CCB include rapid heartbeat, facial flushing, ankle edema, and gingival hyperplasia. CCB has no absolute contraindications, but it should be used with caution in patients with tachycardia and heart failure. 03. Hypertension with hyperlipidemiaRecommendation: Dihydropyridine CCB, ACEI/ARB are preferred, especially Is a long-acting preparation. Explanation:In CCB, the half-life of amlodipine is as long as 35~50 hours, and there are more Evidence-based medicine for antihypertensive and anti-arteriosclerosis. In ACEI, perindopril has a half-life of >30 hours, and large studies also provide evidence that perindopril reduces the risk of all-cause mortality. Among the ARBs, olmesartan has better antihypertensive efficacy than other ARBs, and also has evidence-based anti-arteriosclerosis, but lacks the benefit of reducing all-cause mortality evidence of. Warm reminder: Diuretics and beta-blockers have adverse effects on lipid metabolism, and they are not suitable for patients with hypertension complicated by hypercholesterolemia. Patients should take small doses. 04. Hypertension with hyperuricemiaRecommendation: Losartan and long-acting CCB are the first choice, avoid using Thiazide diuretics. Explanation:So faronly losartan and calcium channel blockers (amlodipine, cilnidipine) have been found to reduce uric acid and may reduce the risk of gout attacks. Thiazide diuretics increase the reabsorption of uric acid in the proximal convoluted tubules, reduce the secretion of uric acid in the renal tubules, and increase serum uric acid. Reminder:Thiazide diuretics, beta-blockers, ACEIs, and non-losartan ARBs increase the risk of gout attacks . 05. Hypertension with apnea syndromeRecommendation: ACEI/ARB with 24h long-acting blood pressure is preferred , Avoid using reserpine, clonidine and other central antihypertensive drugs. Explanation:Patients with apnea syndrome have excessive activation of the renin-angiotensin system. ACEI/ARB can not only significantly reduce blood pressure, but also It can improve the apnea and sleep structure of patients. Central antihypertensive drugs such as reserpine and clonidine have central sedative effects, which may increase the risk of apnea. Reminder:Clonidine is a central α2 receptor agonist. Long-term use may cause drug resistance due to fluid retention and blood volume expansion. The antihypertensive effect is weakened; sudden withdrawal of the drug or continuous missed doses can lead to a rebound increase in blood pressure. 06. Hypertension with hyperthyroidism or migraineRecommendation: β-blocker is the first choice. Explanation:Propranolol blocks both β1 and β2 receptors and can be used to control hyperthyroidism’s rapid heart rate and also Can be used to treat thyroid storm. β-blockers have a clear effect on the preventive treatment of migraine, supported by the results of a number of randomized controlled trials. The most well-documented of these are propranolol and metoprolol. Reminder:Beta-blockers may worsen symptoms of peripheral vascular disorders such as intermittent claudication. 07. Hypertension with asthma, chronic bronchitis, emphysemaRecommendation: CCB, ACEI/ARB are preferred , Diuretics, β-blockers should not be used. Explanation:β-blockers can constrict bronchial smooth muscle and increase airway resistance. For patients with bronchial asthma or chronic obstructive pulmonary disease, Sometimes it can exacerbate or induce an acute exacerbation of asthma. Reminder: β-blockers mainly work by inhibiting over-activated sympathetic nerve activity, inhibiting myocardial contractility, and slowing down heart rate. The antihypertensive effect is especially suitable for hypertensive patients with tachyarrhythmia, coronary heart disease, chronic heart failure, increased sympathetic nerve activity and hyperdynamic state. 08. Hypertension with depressionRecommendation: CCB, ACEI/ARB are optional, and it is not suitable to use blood pyridoxine, methyldopa, and compound preparations containing reserpine. Explanation: Research at home and abroad reported that the incidence of depression in hypertensive patients was about 20%~30%. Reserpine and methyldopa can reduce the concentration of neurotransmitters such as serotonin, norepinephrine, and metanephrine, and long-term use can cause depressive symptoms. Reminder:Reserpine works by depleting peripheral sympathetic nerve endings of norepinephrine, catecholamines and 5 – Depletion of serotonin stores achieves antihypertensive, heart rate and central nervous system depletion effects. The adverse reactions that are easy to occur when taking a large amount of reserpine orally include excessive sedation, inability to concentrate, depression, and suicide, and may appear unresponsive for several months after the drug is discontinued. 09. Hypertension with peptic ulcerRecommendation: Reserpine and its compound preparations should not be used. Explanation:Reserpine is an adrenergic blocker, the function of the sympathetic nervous system is inhibited after medication, while the function of the parasympathetic nervous system Relatively dominant, resulting in increased gastric acid secretion and aggravation of ulcers. Reminder:Contraindications for reserpine include active gastric ulcer, ulcerative colitis, depression, especially those with suicidal tendencies depression. 10. Hypertension with benign prostatic hyperplasiaRecommendation: Alpha-blockers can be used, preferably Choose a controlled release formulation. Explanation:The commonly used alpha-blockers are terazosin, doxazosin, alfuzosin, tamsuol Rosin. Alpha-blockers should not be the drug of choice for the treatment of hypertension because alpha-blockers can cause tachycardia, arrhythmias, and induce or exacerbate angina pectoris. α-blockers can antagonize phenylephrine-induced contraction of prostate tissue, improve urethral function and symptoms, and are suitable for patients with hypertension and benign prostatic hyperplasia. Reminder:Alpha-blockers should be taken before bedtime to prevent orthostatic hypotension. 11. Hypertension and diabetes mellitusRecommendation: ACEI/ARB is preferred. High-dose diuretics and beta-blockers should not be used. Explanation:ACEI and ARB can prevent the progression of microalbuminuria to macroalbuminuria in patients with diabetes, reduce urinary protein excretion, delay the progression of kidney disease, and reduce the risk of kidney disease. Large clinical studies confirm the protective effect. A sufficient dose of ACEI/ARB is more helpful to improve the antihypertensive effect and protect target organs. High-dose diuretics can raise blood sugar, and beta-blockers may mask hypoglycemic reactions (eg, palpitations, sweating). Reminder: The most common adverse reaction of ACEI is dry cough, which is more common in the early stage of medication. Those with mild symptoms can insist on taking the medicine, and those who cannot tolerate it can Use ARBs instead. Long-term use may lead to elevated serum potassium, and serum potassium and serum creatinine levels should be monitored regularly. 12. Hypertension with strokeRecommendation: The first choice for preventing stroke recurrence is diuretics, ACEI or Combine the two. Explanation:The prevention of stroke by antihypertensive drugs mainly comes from the lowering of blood pressure itself, and it is not that certain drugs have a special protective effect over other drugs . Prevention of stroke recurrence Diuretics and ACEIs, especially the combination of the two, are recommended. The strength of evidence for β-blockers is weak. Reminder:PATS study confirmed that indapamide treatment can significantly reduce the risk of recurrent stroke. Low-dose thiazide diuretics (hydrochlorothiazide 6.25-25mg) have little effect on metabolism, and combined use with ACEI or ARB can significantly increase the antihypertensive effect of the latter. 13. Hypertension with left ventricular hypertrophyRecommendation: ACEI/ARB is the first choice. Explanation:ACEI can inhibit the production of angiotensin II (Ang II), and reduce the promotion of myocardial and vascular smooth muscle cells by Ang II Effect; reduce the effect of aldosterone on promoting myocardial interstitial fibrosis. Long-term application of ACEI can inhibit and reverse cardiovascular remodeling, reduce left ventricular weight and improve myocardial stiffness. Those who cannot tolerate ACEI can choose ARB.
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