Which of the five commonly used antihypertensive drugs is the safest?

Currently commonly used clinical antihypertensive drugs mainly include five categories: calcium channel blockers represented by amlodipine, angiotensin converting enzyme inhibitors represented by enalapril, Angiotensin 2 receptor antagonists represented by telmisartan, diuretics represented by hydrochlorothiazide, and β receptor blockers represented by metoprolol, the adverse reactions of the five major drugs are also different

Calcium channel blockers

This class of drugs mainly includes short-acting nifedipine tablets, nifedipine The adverse reactions of fendipine sustained-release tablets and long-acting amlodipine, felodipine, nifedipine controlled-release tablets, lacidipine, and dipine mainly include flushing, headache, and edema of lower limbs caused by vasodilator effects. , and palpitations caused by gingival hyperplasia and reflex rapid heart rate. Dipine drugs are mainly metabolized by the liver. Patients with poor liver function should pay attention to dose adjustment. Short-acting dipine drugs have more adverse reactions. Therefore, long-acting drugs are more recommended. preparation.

Angiotensin-converting enzyme inhibitors (ACEI)

This type of drug acts on the renin-angiotensin-aldosterone system (RAAS) to inhibit vascular tension It reduces the formation of angiotensin 2, relaxes blood vessels and exerts antihypertensive effect. The common adverse reaction is dry cough caused by inhibiting the degradation of bradykinin. Long-term use will lead to increased blood creatinine level and hyperkalemia. It is not recommended for patients with creatinine levels greater than 265umol/L and blood potassium levels greater than 5.5umol/L. It is contraindicated for patients with bilateral renal artery stenosis and for pregnant women. These drugs can also cause angioneurotic edema and laryngeal edema in severe cases life threatening.


Angiotensin 2 receptor blockers (ARBs)

This class of drugs also acts on renin vessels The tensin-aldosterone system (RAAS) inhibits the combination of angiotensin 2 and its specific receptor to play a role in lowering blood pressure. It acts on different targets of the same system with ACEI and other pleil drugs, and its adverse reactions and contraindications are also similar to those of common The difference is that the adverse reactions of dry cough and angioneurotic edema caused by sartan drugs are rare.


Currently clinically used diuretics for lowering blood pressure mainly include hydrochlorothiazide and indapamide. The adverse reactions of diuretics are dose-related. The higher the dose, the more adverse reactions Therefore, diuretics are rarely used alone in clinical practice, and are often used in small doses in combination with other antihypertensive drugs. The combination of diuretics, such as losartan potassium hydrochlorothiazide, benazepril hydrochlorothiazide, etc., the adverse reactions of long-term high-dose use of diuretics are adverse effects on blood sugar, blood lipids, uric acid and other metabolic factors, and may also cause electrolyte disturbances such as hypokalemia, Thiazide-type diuretics are contraindicated in gout patients, and thiazide-type diuretics are contraindicated in patients with sulfonamide allergies.

ß receptor blockers,

The commonly used varieties of this kind of drugs include metoprolol, bisoprolol and other selective ß1 receptors Blockers and Carvedilol, Arolol, etc., which have both α-receptor blocker effects, β-receptor blockers have many adverse reactions and contraindications, and long-term use will have adverse effects on blood sugar and blood lipids. Metabolic abnormalities and obesity should be used with caution. This type of drug will constrict peripheral blood vessels and bronchi. Patients with intermittent claudication and severe COPD should use it with caution. Patients with bronchial asthma are contraindicated. β receptor blockers slow down the heart rate, and the heart rate is less than The elderly with 80 beats/min should be used with caution, and those with more than 2 degrees of atrioventricular block and severe bradycardia are contraindicated. In addition, it is not recommended to use β-receptor blockers for stroke-prone and stroke patients.

In short, each of the five major classes of antihypertensive drugs has its own adverse reactions. Generally speaking, dipine calcium channel blockers There are only relative contraindications and no absolute contraindications, but the high drug safety is not the only reason for choosing antihypertensive drugs. Appropriateness is also very important. Good, suitable for elderly hypertensive patients with high degree of atherosclerosis, poor blood vessel elasticity, and high systolic blood pressure, while the characteristics of young and middle-aged hypertensive patients are related to the overactivation of the sympathetic nervous system and RAAS system, so it is suitable to choose to act on the RAAS system The puril class or sartan class, or choose β receptor blockers that inhibit sympathetic activity. No matter which type of antihypertensive drug you choose, close observation during the medication process, timely medical treatment after adverse reactions occur, and reasonable adjustment of the treatment plan are the basic guarantees for safe medication