Drug treatment of hypertension

According to the World Health Organization, the best blood pressure was 120 / 80mmHg, blood pressure is above 120 (systolic) and 80 is the bottom number (diastolic). Called hypertension when two numbers on - less than 140/90 high. One goal of the treatment of hypertension, including medication, was put under pressure to 130/85 for the middle-aged and below 130 / 80mmHg for people with diabetes or kidney disease, or bring about lower blood pressure 140 / 90mmHg in people aged 60 years and older.

SOME CHARACTERISTICS OF DRUG TREATMENT OF HIGH BLOOD PRESSURE

According to the classification of new hypertension (JNC 7 report the) It is noteworthy to pre-hypertension (prehypertension), expressed on blood pressure and blood pressure below 80-90 120-139, this period should be lifestyle changes (eating light, physical activity).
There are many antihypertensive drugs are used in our country, divided into several groups with the following characteristics:
1. Group diuretics: Include Hydroclorothiazid, Indapamide, Furosemide, spironolactone, amiloride, triamterene ... The mechanism of the drug is to reduce water retention in the body, which reduces the peripheral vascular resistance, leading to hypotension. Use single being mild, can be combined with other drugs for high blood pressure worse. Need to choose the appropriate type of waste by type as potassium, potassium-sparing type, increased blood uric acid, increased blood cholesterol.
2. The drugs acting on the central nervous system is composed reserpine, methyldopa, Clonidine ... The mechanism of the drug is activated some neurons hypotension. Currently little use due to side effects caused depression, the abrupt discontinuation will spike your blood pressure.
3. Group alpha blockers: These include prazosin, alfuzosin, Terazosin, phentolamin ... The mechanism of the drug blocks the release of noradrenaline at nerve endings (the biological substance raises blood pressure), thereby lowering blood pressure. There are side effects hypotension when standing up (orthostatic hypotension investment), especially when the first dose.
4. beta blockers Group: Includes propranolol, Pindolol, nadolol, Timolol, Metoprolol, Atenolol, Labetolol, acebutolol ... The mechanism of the drug to inhibit receptor beta - sympathetic heart, peripheral circuits, thereby bradycardia and hypotension. Good for Drugs included patients with low back pain, chest or migraine. Contraindications earners included asthma, heart failure, bradycardia.
5. Group calcium antagonists: Include Nifedipine, nicardipine, amlodipine, felodipine, isradipine, Verapamil, Diltiazem ... The mechanism of the drug is not blocking calcium ions flow to go into the smooth muscle cells of blood vessels, so cause vasodilation and thus lowering blood pressure. Use good for patients with angina associated, effective for elderly patients, does not affect the metabolism of sugars, fats in the body.
6. ACE inhibitor group is composed Captopril, Enalapril, Benazepril, Lisinopril, Perindopril, Quinepril, Tradola-pril ... The mechanism of the drug to inhibit an enzyme called ACE (angiotensin converting enzyme, write ACE off). Because angiotensin converting enzyme catalyzes the biology of angiotensin I into angiotensin II variables and the latter substance causing vasoconstriction increases blood pressure. If ACE inhibitors are (made inactive) will not generate angiotensin II, causing vasodilation and hypotension. Drugs effective in 60% of cases when used alone (ie, not in combination with other drugs). Is the drug of choice in patients with asthma were included (a contraindication to beta-blockers), diabetes (diuretics, beta-blockers). Side effects: increases in serum potassium and cause a dry cough.
7. The new class of drugs inhibits angiotensin receptor: Drugs used to treat high blood pressure above headings are still many disadvantages in terms of efficacy and side effects, so the research to find new drugs continues is in place. In particular, ACE inhibitors appear from early 1980 (recognized as indispensable drugs in the treatment of high blood pressure) has prompted scientists to find new drugs affect ACE . The recent study found that if the main effect on ACE, making this enzyme inactivates the drug will cause side effects such as dry cough (a side effect that many patients do not quit continued use). The reason is because not only ACE catalytic processing angiotensin I into angiotensin II causes hypertension but also play a role in the decomposition of a biological substance called bradykinin. If ACE inhibitors, bradykinin not be decomposed to the extent necessary, it is redundant and causes many effects, including dry cough. Instead of ACE inhibitors, new research is finding drugs that prevent angiotensin II attaches to its receptor (angiotensin II receptors, type 1) is in the blood vessels, heart, kidney, thereby lowering blood pressure. So, now there is a new group of antihypertensive drugs are inhibitors of angiotensin II receptor (angiotensin II receptors antagonists). The drug was first used as losartan, irbesartan then, Candesardan, Valsartan ... this new class of drugs to lower blood pressure, putting pressure on the normal value, equivalent to the calcium antagonist drugs group, blockers beta converting enzyme inhibitors. In particular, their antihypertensive effect better coordination with thiazide diuretics. The advantage of this group is not directly caused by ACE inhibitors should not cause a dry cough almost as ACE inhibitors, or edema as calcium antagonists. Side effects may experience dizziness, or diarrhea is very rare. Contraindications to the use of drugs is not pregnant women or people with allergies to medications.

SOME PRINCIPLES TO BE IN COMPLIANCE WITH THE medication hypertension

Drugs on the aforementioned groups are in our country. For drug treatment, the patient should consult a doctor and get treatment assigned, manual medicine. Because only doctors of medicine master features, direct examination and will select the appropriate medications, indications of drug use principles. The choice of antihypertensive drugs will depend on the risk factors of cardiovascular disease, there is damage to organs (such as kidney failure, heart failure, left ventricular wires ...), accompanied diabetes ... In particular, the doctor will help patients adhere to the following principles:
- First, low doses initially and gradually increase the dose to only one drug. When hypertension, new recommendations recommend first taking a diuretic group, especially thiazide group.
- If not effectively incorporate two new classes of drugs. Under the new recommendations (JNC 7), but get sick, but when the patient's blood pressure is higher than the need to achieve a lot (more than 20 mm Hg produces high blood pressure, higher blood pressure below 10 mm Hg), the patient should be 2 immediate treatment with the combination, usually with diuretics.
- If the first drug of choice less effective and cause many side effects, it should change the types of drugs, but do not increase the dose or add second drug combination.
- The use of drugs for long-acting, oral 1 times a day.
Please note, the group of drugs inhibiting angiotensin II receptor has now started to circulate in our country, but has not been widely used. Some patients are relatives from overseas posts on this kind of medicine feel free to use without consulting a doctor is directly treated. Doing so is not true, because according presented above, high blood pressure medication types and the use of quite complex. Only new therapist who is competent to appoint and medication guide how to safely and effectively. In particular, the doctor can decide whether to replace long treatment with a new drug or not, but not necessarily always have to use a new drug.