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.

Despite the choice, scientists continue to work on antihypertensive drugs, so it is worth considering the features of the new generation of drugs.

Features of new generation antihypertensive drugs

To help the body in the fight for normal blood pressure and well-being, every year scientists release newer, more improved drugs. The causes of pressure surges are varied: nervous strain or kidney disease. Whatever leads to hypertension, the doctor prescribes antihypertensive drugs. Taking pills has the following purposes:

• dilate blood vessels to stabilize blood pressure;
• have a healing effect on the heart, eyes and kidneys;
• do not cause adverse reactions (or reduce their manifestation to a minimum).

Do not self-medicate; medications for high blood pressure include a list of contraindications and side effects that can only harm your health. Always consult your doctor.

Combination drugs are very popular among modern drugs. It is these drugs that effectively lower blood pressure, and, in addition, restore the functioning of the heart and kidneys and prevent the development of complications. The mechanism of action of such drugs is reduced to an effect on the central nervous system or to limiting the production of enzymes that are responsible for increasing blood pressure.

Names of types of new antihypertensive drugs

At the moment, a huge number of drugs have been developed, each of which is suitable for any situation. Selection factors depend on individual tolerance, underlying diseases and side effects. Modern doctors have the opportunity to combine the names of different groups:

• angiotensin-converting enzyme inhibitors;
• diuretics;
• calcium channel blockers;
• beta-adrenergic blockers;
• angiothesin-2 antagonists.

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ACE inhibitors

ACEIs are considered widely used drugs that are suitable for different patients. This group includes Captopril and Lisinopril. Modern ACE inhibitors are distinguished by a high probability of reducing exacerbations, including myocardial infarction, heart failure, as well as a positive effect on affected organs. In case of chronic heart failure, ACEI drugs are first prescribed; they are well tolerated by elderly people, with arrhythmia, diabetes mellitus, and after a heart attack.

The downside is cough as a consequence caused by changes in peptide metabolism. But if you have the following contraindications, it is better not to take it:

• increased potassium levels in blood plasma;
• renal artery stenosis;
• Quincke's edema caused by previous use of inhibitors;
• pregnancy.

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Diuretics

New generation diuretics are no less common than ACE inhibitors. The purpose of such funds is to help the body remove excess fluid and salts, which leads to easing the load on the heart and reducing the volume of circulating blood. Diuretics are such a diverse group that the classification includes several types of diuretics:

• allowed to be prescribed to elderly people and diabetics, with any metabolic disorders;
• The mechanism of action is based on changes in electrolyte metabolism, carbohydrate and lipid metabolism.

• allowed for people with heart failure at the chronic stage, in the presence of cardiac edema;
• Lowering blood pressure is carried out by synthesizing excess fluid and salts.

• are able to reduce blood pressure faster than other drugs in this group;
• are actively used to treat hypertensive crises.

Calcium channel blockers

CCBs help reduce calcium infiltration into muscle fibers, which reduces the sensitivity of blood vessels to substances, in particular to those that cause spasms (adrenaline). Medicines differ in the nature of their effect on blood vessels and myocardium. Antagonists do not disrupt metabolic processes and successfully resist hypertrophy in the presence of hypertension, reducing the risk of stroke. Calcium blockers include drugs of 3 groups:

• benzothiazepine antagonists (“Diltiazem”);
• dihydropyridines (“Amlodipine”, “Felodipine”);
• phenylalkylamines ("Verapamil").

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Beta blockers

You should be careful when choosing this group, since they can cause many side effects, although the undoubted advantage is the long duration of action, which is why the tablets should be taken once a day. Scientists are still actively developing and improving beta blockers. In the meantime, this group is actively used in the treatment of people suffering from ischemia and chronic heart failure. Widely used centrally acting drugs are Atenolol and Bisoprolol.

Angiotensin-2 antagonists

"Losartan" - as one of the representatives of the new generation AA-2, competes with the ACEI. The advantage of the drug is its ability to be almost completely absorbed by the body and produce a lasting effect. The advantage of the drug is that it is well tolerated by patients and eliminates the presence of side effects, unlike inhibitors.

What to give preference to?

The doctor decides which drug or group of drugs to give preference to. The decision depends on several factors: allergies to components, underlying diseases and blood pressure readings. Moreover, despite the common goal, each group of drugs includes side effects:

• beta-adrenergic receptor blockers inhibit the functioning of the central nervous system, and in large doses cause cardiac arrest;
• diuretics remove excess fluid, and with it potassium and magnesium necessary for the heart;
• Calcium channel blockers cause hypotension and can impair the functions of the liver, heart, and kidneys.

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List of the best drugs

Pharmacology continues to develop and scientists come up with more effective drugs. During this time, the following drugs of the latest generation have performed well:

• a group of angiotensin-2 antagonists: Aliskiren, Rasilez and Olmesartan;
• diuretics: “Torasemide”;
• combined means: “Equator”.

Representatives of the above groups are prescribed as primary or maintenance therapy, alone or in tandem with others. In any case, when choosing, the doctor is guided by blood pressure indicators, the presence of concomitant diseases or pathologies. The only drawback of the new drugs is their high cost. Because of this, the patient is forced to refuse combination therapy and look for an alternative.

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Combined antihypertensive drugs of the latest generation

S. Yu. Shtrygol, Doctor of Medical Sciences, Professor,

E. A. Gaidukova, pharmacist, National Pharmaceutical University, Kharkov

The unfavorable trend of decreasing life expectancy of the population in Ukraine is largely due to the high mortality rate from diseases of the cardiovascular system, among which the most important position is occupied by arterial hypertension. This is due to several reasons: insufficient detection of diseases characterized by high blood pressure (BP) - hypertension, symptomatic arterial hypertension; poor awareness of patients that they have high blood pressure (approximately every third patient does not know about this); lack of practical consideration of risk factors, primary and secondary prevention on a population scale; often an inadequate choice of pharmacotherapy and therefore its insufficient effectiveness. Even in countries with a high level of healthcare organization, the rate of adequate control of arterial hypertension does not exceed 27%. In Ukraine, unfortunately, it is much lower.

According to the criteria of the World Health Organization and the International Society of Hypertension, arterial hypertension is defined as a condition in which systolic blood pressure is 140 mmHg. Art. or higher and/or diastolic blood pressure - 90 mm Hg. Art. or higher in individuals not receiving antihypertensive therapy.

Large-scale studies have been conducted around the world that have made it possible to develop new classifications of arterial hypertension. Target levels of blood pressure reduction during antihypertensive therapy were determined, and stratification of risk levels for developing cardiovascular complications in patients was carried out. The principles of non-drug and drug therapy are formulated. The basis of treatment of arterial hypertension is pharmacotherapy. Until recently, a stepwise approach prevailed in the choice of treatment tactics for arterial hypertension, when, if the effect of monotherapy was insufficient, the dose of the drug was increased or moved to the next stage of treatment, adding another antihypertensive drug to the drug used. Today, based on the results of large multicenter studies, maximum individualization of antihypertensive pharmacotherapy is recommended. It has been shown that the least number of complications (acute cerebrovascular accidents, myocardial infarction, renal failure, circulatory disorders in the retina with decreased vision, etc.) occurs in patients with a diastolic pressure level not higher than 83 mm Hg. Art., achieved during treatment. After all, it is not the increased blood pressure value in itself that is dangerous (it is aimed at ensuring blood supply to various organs and tissue metabolism in changed circulatory conditions - during stressful maladjustment of the cardiovascular system, remodeling of the vascular wall, etc.). The danger comes primarily from the already mentioned progressive changes in target organs, especially hypertrophied myocardium (ischemia), brain (stroke), and kidneys (chronic renal failure).

The modern arsenal of drugs provides many opportunities for both monotherapy and combination antihypertensive treatment. An analysis of literature data shows that approximately 70% of patients require combination treatment; in a significantly smaller number of patients, monotherapy has a sufficient effect.

Effective blood pressure control, improvement of the condition of target organs, and increased quality of life are best achieved through the use of combination pharmacotherapy. The most convenient are official combination drugs. Their advantages are quite obvious:

• the combination of two or more components allows you to simultaneously influence different parts of the pathogenesis of the disease (for example, the activity of the renin-angiotensin-aldosterone and sympathoadrenal systems; calcium-dependent mechanisms of contraction of vascular and myocardial muscles, reducing vasoconstriction, and the state of the excretory function of the kidneys, which reduces sodium and water retention in the body), ultimately increasing the efficiency and reliability of blood pressure control;
• the combination of different mechanisms of action has a beneficial effect on the condition of target organs and prevents cerebrovascular and cardiac complications;
• components of combination drugs are used in moderate doses, which usually means that treatment is well tolerated, minimal side effects and their mutual leveling;
• the use of combination drugs is more convenient, since there is no need to evaluate the compatibility of components or take 2-3 drugs at the same time; In addition, as a rule, combination drugs, due to their long duration of action, are taken once a day, and this reduces the likelihood of skipping a medication and increases the patient’s compliance - his adherence to treatment, willingness to follow recommendations.

Fixed combinations of two or even three drugs in small doses are increasingly being used. Their use has the listed advantages and is most convenient for the patient. The following most rational combinations of antihypertensive drugs are recommended:

• β-blocker + diuretic;
• β-blocker + calcium channel blocker (dihydropyridine series only!);
• β-blocker + ACE inhibitor;
• ACE inhibitor (or angiotensin II receptor antagonist) + diuretic;
• calcium channel blocker + ACE inhibitor (or angiotensin II receptor antagonist);
• α-blocker + β-blocker;
• centrally acting drug + diuretic;
• Combinations of three or even four components, including hypotensive and hypocholesterolemic, are also possible.

Not all combination drugs with an antihypertensive profile of action available on the pharmaceutical market of Ukraine are focused on such combinations. Let's look at some of them in more detail.

Of the drugs containing three or more components (Table 1), only one - Tonorma - combines three first-line antihypertensive drugs: a cardioselective β 1-blocker that penetrates poorly into the brain (atenolol), a dihydropyridine vasodilator (nifedipine), a long-acting thiazide diuretic (chlorthalidone). The synergistic composition in question is quite effective: an open clinical study showed that taking one tablet per day reduced blood pressure to 140/90 mmHg in 66% of patients. Art. and lower values, in another 20% of patients the use of Tonorma gave a moderate result, i.e. the efficiency was 86%. Minor side effects that did not require discontinuation of the drug were observed in only 8% of patients.

Table 1. Examples of multicomponent antihypertensive drugs on the pharmaceutical market of Ukraine

As for the remaining drugs, only their diuretic component is considered a first-line drug. Peripheral vasodilators (dihydralazine, dihydroergocristine) and sympatholytics (reserpine) are second-line drugs. The sympatholytic of central and peripheral action, reserpine, has a large number of side effects: typical depression of the central nervous system up to mental depression, the development of parkinsonism due to depletion of monoamines, vagotonic disorders of the digestive tract (intense salivation, nausea, diarrhea, stomach pain). The use of a combination drug raunatin containing reserpine as part of a mixture of rauwolfia alkaloids is not a modern approach to the treatment of arterial hypertension. The drug "Andipal-B", which provides a predominantly antispasmodic and analgesic effect, is also not an effective antihypertensive drug.

The combination of a β-blocker and a diuretic is beneficial in the pharmacotherapy of arterial hypertension (Table 2). The β-adrenergic blocker, reducing the sympatho-adrenal effects on the myocardium, provides a decrease in stroke and cardiac output, and with long-term use, slightly reduces the total peripheral vascular resistance. The diuretic, by increasing the renal excretion of sodium and water, reduces the volume of circulating blood and also has a relaxing effect on the arterial vessels. Pindolol, which is part of viscaldix, is a non-selective β-blocker, clopamide is a thiazide diuretic with an average duration of action. The other two drugs (tenoret, atenol-N) contain the cardioselective β 1-blocker atenolol in combination with the thiazide diuretic chlorthalidone. When discussing these combinations that are synergistic with regard to the normalization of blood pressure, it should be noted that the possibility of their use is limited by broncho-obstructive diseases, especially bronchial asthma, and diabetes mellitus, since an adverse effect on carbohydrate metabolism is possible. However, small doses of thiazide diuretics included in combination drugs have little effect on metabolic processes. In addition, a decrease in calcium excretion during treatment with these drugs is a favorable point in the treatment of women suffering from postmenopausal hypertension. As shown in the SHEP study, treatment with beta-blockers and diuretics reduces the risk of cardiovascular complications by 34%.

Table 2. Two-component antihypertensive drugs containing a β-blocker and a diuretic

The next group of combined drugs is β-blockers and calcium channel blockers of the dihydropyridine series (Table 3). The β-blocker reduces heart function, and amlodipine provides a long-term decrease in the tone of resistive vessels. At the same time, there is no mutual enhancement of side effects from the heart - amlodipine, like other dihydropyridines, has little effect on the myocardium, does not cause bradycardia and conduction slowdown, like a β-blocker. Amlodipine prescribed separately (at an initial dose of 2.5 mg, then 5–10 mg) allows you to achieve a target pressure of 140/90 mm Hg within 8 weeks. Art. in 72.4% of patients, with side effects noted in 5% of cases. A β-blocker potentiates its hypotensive effect. In addition, this combination reduces the risk of withdrawal syndrome (remember that abrupt cessation of β-blockers is unacceptable due to the risk of developing a hypertensive crisis and exacerbation of coronary heart disease).

Table 3. Combination antihypertensive drugs containing a dihydropyridine calcium channel blocker and a β-blocker

The pronounced vasodilator and moderate diuretic, antiatherogenic effect of the calcium channel blocker, the absence of disturbances in the metabolism of carbohydrates and uric acid, are also favorable.

Combinations of angiotensin-converting enzyme (ACE) inhibitors with diuretics are becoming increasingly important in antihypertensive therapy. In terms of the number of trade names, they prevail over other combined antihypertensive drugs. Examples of such drugs are given in table. 4. They are effective antihypertensive combinations that reduce blood pressure both by reducing the work of the heart and by reducing vascular tone. It is important that ACE inhibitors (especially the latest generation - enalapril, lisinopril, perindopril, fosinopril) and indapamide have a cardioprotective effect - they effectively reduce left ventricular hypertrophy (by 13–25%), and also exhibit nephroprotective properties. Perindopril and indapamide are presented in the preparations Noliprel, Noliprel-Forte. The high effectiveness of combinations of ACE inhibitors and diuretics has been repeatedly confirmed in controlled studies. Thus, enalapril (starting dose 5 mg, then 10 and 20 mg per day) allowed 67% of patients to reach the target blood pressure level, while side effects were noted in 17% of cases. During 16 weeks of use in patients with moderate and severe forms of hypertension, Korenitec reduced daytime blood pressure by an average of 14.9/8.9 mm Hg. Art., night - by 18.8/11.4 mm Hg. Art., normalized the daily rhythm of blood pressure. Target systolic blood pressure was achieved in 77% of patients, diastolic blood pressure in 69%. In addition, Korenitek significantly reduced microalbuminuria, which confirms its nephroprotective properties. These data show that combination drugs containing an ACE inhibitor and a diuretic improve the effectiveness of the treatment of arterial hypertension.

Table 4. Drugs containing ACE inhibitor and diuretic

A less extensive range of combinations of ACE inhibitors with calcium channel blockers on the Ukrainian pharmaceutical market is presented in Table. 5. Verapamil (part of the drug Tarka) causes a rhythm-slowing effect, mainly reducing the work of the heart. Amlodipine has virtually no effect on heart rate, mainly reduces vascular resistance, potentiating the hypotensive effect of the ACE inhibitor. In these combinations, the metabolic neutrality of both components is attractive, which makes it possible to use them in patients with diabetes. The drug combinations under consideration have a beneficial effect on the hypertrophied myocardium and increase the quality of life.

Table 5. Two-component antihypertensive drugs containing an ACE inhibitor and a calcium channel blocker

One cannot help but pay attention to such combination drugs as angiotensin-II receptor blockers in combination with diuretics (Table 6). Angiotensin II receptor antagonists neutralize the effect of angiotensin on the cardiovascular system through selective blockade of AT1 type receptors. At the same time, candesartan becomes active only after a series of metabolic transformations in the liver; the rest of the drugs listed in the table themselves have pharmacological activity, and losartan also has several active metabolites with a strong and long-lasting effect. Eprosartan (teveten) has an additional mechanism of action that other representatives of this group do not have: it affects the sympathetic nervous system, inhibiting the release of norepinephrine from the endings of sympathetic nerve fibers, and thereby reduces the stimulation of adrenergic receptors in vascular smooth muscle. Treatment with hysaar, judging by the results of clinical studies, provides effective blood pressure control in 76% of patients. Similar efficacy values ​​for the combination of another angiotensin receptor antagonist, irbesartan, with hydrochlorothiazide (77% for systolic and 83% for diastolic blood pressure) were obtained in the INCLUSIVE study. Hyperuricemia is common in patients with arterial hypertension. The thiazide diuretic hydrochlorothiazide, which is part of combination drugs, can itself cause secondary hyperuricemia and gout. Angiotensin receptor blockers, especially losartan, which is part of hysaar, increase the excretion of uric acid and reduce the level of hyperuricemia.

Table 6. Antihypertensive drugs containing an angiotensin II receptor blocker and a diuretic

Diuretics, as already noted, are among the first-line antihypertensive drugs. Up to 30% of patients achieve target blood pressure using the most widely used hydrochlorothiazide. The disadvantage of this drug is the high incidence of electrolyte disturbances, primarily hypokalemia. Therefore, it is rational to combine it with potassium-sparing diuretics, such as triamterene and amiloride (Table 7). Possible hypomagnesemia, hyperuricemia, disorders of cholesterol and glucose metabolism (therefore, these drugs should not be used in patients with diabetes). Sometimes impotence occurs, which should be taken into account when choosing a drug for a particular patient.

Table 7. Combined diuretics

The development of arterial hypertension is promoted by hypercholesterolemia and atherosclerosis. Unfortunately, there are no combination antihypertensive drugs containing hypocholesterolemic agents on the Ukrainian pharmaceutical market yet.

It is extremely important to control the amount of table salt consumed by the patient and combine sodium restriction with drug treatment of arterial hypertension. Thus, according to the largest multicenter study INTERSALT, when the daily intake of sodium chloride is reduced to 100 mmol (6 g), systolic pressure in the population decreases by an average of 2.2 mm Hg, which reduces the risk of coronary death by 6%. And if, against this background, the consumption of potassium and magnesium salts increases, especially due to vegetables and fruits or table salt substitutes used to add salt to ready-made dishes, then systolic pressure decreases by 5 mm Hg. Art., the risk of death from coronary artery disease decreases by 14%, and in old age - by 23%. However, combination with potassium salts is unacceptable during treatment with ACE inhibitors or angiotensin receptor blockers. Much evidence has been obtained of enhancing the hypotensive effect, the possibility of reducing doses and reducing the side effects of saluretics, labetalol, visken, nifedipine against the background of a low-salt diet and additional intake of potassium salts. We have confirmed and expanded these data, studied the mechanisms of interaction of potassium, magnesium and calcium salts with antihypertensive drugs of different groups. In addition, the effectiveness of antihypertensive therapy, including combination drugs, increases significantly when the patient limits or stops smoking.

In conclusion, it should be noted that the modern range of antihypertensive drugs, especially combined formulations, makes it possible to improve the treatment of arterial hypertension and associated diseases. From the standpoint of evidence-based medicine, this is convincingly demonstrated by the results of clinical studies.

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3. Mareev V. Yu. A quarter of a century of the era of ACE inhibitors in cardiology // Breast Cancer. - 2000. - T. 8. - No. 15–16.
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5. Olbinskaya L.I., Andrushchishina T.B. Rational pharmacotherapy of arterial hypertension // Russian Medical Journal. - 2001. - T. 9, No. 15. - P. 615–621.
6. Recommendations for the prevention, diagnosis and treatment of arterial hypertension. - M., 2001.
7. Svishchenko E. P. Combined antihypertensive therapy: the original three-component drug TONORMA // Pharmacist, 2005. - No. 8. - P. 16.
8. Sidorenko B. A., Preobrazhensky D. V. Pharmacotherapy of hypertensive disease. Diuretics as antihypertensive drugs // World Medicine. - 2001. - Volume H. - pp. 93–98.
9. Chazova I. E., Ratova L. G., Dmitriev V. V. et al. Treatment of patients with moderate and severe hypertension with Korenitek // Therapeutic archive. - 2003. - T.75, No. 8. - P. 21–26.
10. Shtrygol S. Yu. Study of the modulation of pharmacological effects under different salt regimes: Abstract of thesis. dis. ... doc. honey. Sci. - M., 2000. - 37 p.
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12. Digiesi V., Pargi P. Associazone fra nifedipina e dieta iposodica con supplemento potassio nella terapia dell’ipertensione arteriosa essenziale // Min. Med. - 1987. - Vol. 78, No. 19. - P. 1427–1431.
13. INTERSALT Cooperative Research Group. INTERSALT: an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium excretion // Br. Med. J. - 1988. - Vol. 297. - P. 319–328.
14. Siani A., Strazzullo P., Giacco A. et al. Increasing the dietary potassium reduces the need for antihypertensive medications // Ann. Int. Med. - 1991. - Vol. 115, No. 7. - P. 753–759.
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Latest generation medications for hypertension: list

It is possible to stabilize blood pressure and improve the quality of life of hypertensive patients through conservative therapy. Typically, the patient is prescribed antihypertensive tablets for hypertension.

The doctor can prescribe diuretics, ACE inhibitors, calcium antagonists, centrally acting antihypertensives, sartans, and selective beta-1 blockers to the patient.

For resistant forms of hypertension, combination drugs can be taken. If a person has grade 1 hypertension, then it is possible to stabilize blood pressure through the use of dietary supplements.

be careful

Hypertension (pressure surges) - in 89% of cases kills the patient in his sleep!

We hasten to warn you that most drugs for hypertension and blood pressure normalization are a complete deception of marketers who overcharge hundreds of percent on drugs whose effectiveness is zero.

The pharmacy mafia makes a lot of money by deceiving sick people.

But what to do? How to treat if there is deception everywhere? Doctor of Medical Sciences Belyaev Andrey Sergeevich conducted his own investigation and found a way out of this situation. In this article about pharmacy chaos, Andrei Sergeevich also told how to protect yourself from death due to a bad heart and pressure surges practically for free! Read the article on the official website of the Center for Healthcare and Cardiology of the Russian Federation at the link.

The most effective drugs for hypertension

Hypertension, according to WHO, is the most common pathology of the cardiovascular system. Men and women suffer from the disease equally often. Moreover, hypertension is usually diagnosed in patients over 40 years of age.

Hypertension is a dangerous pathology. If not treated in a timely manner, the disease leads to cerebrovascular disorders, myocardial infarction, stroke, hypertensive crisis, and renal failure.

Arterial hypertension is difficult to compensate if the disease is accompanied by bradycardia, coronary heart disease, atherosclerosis (pathology accompanied by the deposition of cholesterol and lipoprotein fractions in the vessels).

Let's consider the classification of antihypertensive drugs:

1. Diuretic medications. By removing excess fluid from the body, the walls of blood vessels dilate, the vascular lumen increases, and, accordingly, favorable conditions are created for lowering blood pressure. The disadvantage of diuretics is the fact that they have many contraindications, including renal failure and diabetes mellitus in the stage of decompensation.
2. Beta blockers. By blocking beta-1 adrenergic receptors, medications reduce heart rate, lengthen diastole, reduce oxygen consumption by the heart muscle, and have an antiarrhythmic effect.
3. ACE inhibitors. They contribute to the inhibition of angiotensin-converting enzyme, due to which inactive angiotensin I is converted into angiotensin II, which in turn causes vasoconstriction.
4. Sartans. These new generation hypertension drugs are very effective. Medicines are in great demand even in the EU countries and the USA. The latest generation of antihypertensive drugs block angiotensin II receptors, providing a long-lasting and persistent hypotensive effect.
5. Calcium channel blockers. The tablets prevent the rapid entry of calcium into cells. Due to this, the coronary vessels dilate and blood flow in the heart muscle improves.

All tablets for high blood pressure are completely incompatible with alcohol. During the treatment period, drinking alcohol is strictly prohibited. Ethanol not only neutralizes the therapeutic effect of the drugs, but also increases the likelihood of side effects from the central nervous system and cardiovascular organs.

Trade names of the drugs are shown in the table below.

Clinical picture

What doctors say about hypertension

I have been treating hypertension for many years. According to statistics, in 89% of cases, hypertension results in a heart attack or stroke and death. Currently, approximately two thirds of patients die within the first 5 years of disease progression.

The next fact is that it is possible and necessary to reduce blood pressure, but this does not cure the disease itself. The only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension and is also used by cardiologists in their work is Giperium. The drug acts on the cause of the disease, making it possible to completely get rid of hypertension.

Antihypertensive medications must be taken daily. The dosage is selected by the attending physician. In resistant forms of hypertension, lifelong use may be indicated.

Centrally acting antihypertensives

Centrally acting antihypertensive drugs are rarely used today. The fact is that these medications often cause side effects. In addition, some drugs are addictive.

Antihypertensive tablets of central action, as a rule, are used when necessary to stop a hypertensive crisis. This need is due to the fact that the medications begin to act literally minutes after administration.

The most effective medications of this type are:

You can take the above vasodilator drugs on an ongoing basis. But it is still not recommended to do this. Why? The fact is that today there are many effective antihypertensive drugs that are much better tolerated. The same ACE inhibitors or sartans act more gently, are not addictive, and provide a longer therapeutic effect.

Centrally acting antihypertensives are contraindicated during pregnancy, cardiogenic shock, renal failure, and cerebral atherosclerosis.

Combined antihypertensive drugs

There are cases that medications for hypertension do not allow the patient to achieve stable stabilization of blood pressure. This phenomenon is usually observed in resistant forms of headache.

In this case, it is more advisable for the patient to take several antihypertensive drugs at once. But this is not very convenient and is expensive. In this case, antihypertensive combination tablets, which contain 2 active substances, help solve the problem.

Let's look at the most effective medications in this group:

Supplements for high blood pressure

Modern medications for hypertension have many contraindications and side effects. In view of this, some patients prefer to take plant-based dietary supplements (dietary supplements).

Such remedies are somewhat more effective than classic tinctures of hawthorn or motherwort. In addition, dietary supplements are not addictive, do not impair potency, and in some cases can even be prescribed to pregnant and lactating women.

The safest and most effective dietary supplements are:

• Normolife (erroneously called Normalif). Release form: tincture.
• BP-minus. Available in tablet form.
• Normaten. Release form: tablets.
• Hypertostop. Available in the form of drops.
• Cardimap. Release form: tablets.

The instructions for the above drugs say that the drugs can be used as part of complex therapy, that is, together with synthetic antihypertensive tablets. In addition, indications for the use of dietary supplements are neuroses, stress, and increased fatigue.

Dietary supplements should be taken with caution by hypertensive patients who are prone to allergic reactions.

Hypertensive drugs

It has already been noted above which drugs can be used to regulate high blood pressure. An equally common problem is arterial hypotension, that is, a decrease in blood pressure<90 на 60 мм.рт.ст.

Hypotensive patients have a question: which drug to choose to increase blood pressure? If we consider the most inexpensive means, we can mention Caffeine. It is enough to take 1-2 tablets once a day.

Effective means for normalizing blood pressure also include:

In conclusion, I would like to note that before using any hypo- or hypertensive drugs, you should first consult with your attending cardiologist.

Also, if you have diseases of the cardiovascular system, do not forget about diet, an active lifestyle, and complete cessation of bad habits (smoking, alcoholism). For auxiliary purposes, hypertensive and hypotensive patients can take multivitamin complexes - Aevit, Alphabet, Doppelhertz Active Omega-3, Magne B6, Complivit, etc.

Drawing conclusions

Heart attacks and strokes are the cause of almost 70% of all deaths in the world. Seven out of ten people die due to blockages in the arteries of the heart or brain.

What’s especially scary is the fact that a lot of people don’t even suspect that they have hypertension. And they miss the opportunity to fix something, simply dooming themselves to death.

• Headache
• Increased heart rate
• Black dots before the eyes (floaters)
• Apathy, irritability, drowsiness
• Blurred vision
• Sweating
• Chronic fatigue
• Facial swelling
• Numbness and chills in fingers
• Pressure surges

Even one of these symptoms should give you pause. And if there are two of them, then have no doubt - you have hypertension.

How to treat hypertension when there are a large number of medications that cost a lot of money?

Most medications will do no good, and some may even be harmful! At the moment, the only medicine that is officially recommended by the Ministry of Health for the treatment of hypertension is Giperium.

The Institute of Cardiology, together with the Ministry of Health, is conducting a “no hypertension” program. Within the framework of which the drug Giperium is available at a reduced price - 1 ruble, to all residents of the city and region!

Let's consider modern antihypertensive drugs of different pharmacological groups with rapid and prolonged action, their properties, side effects, and intercompatibility.

Classification of antihypertensive drugs

Medicines that correct blood pressure are divided into two large groups: first-line and second-line drugs. Moreover, they can be of rapid or prolonged action, belong to different pharmacological groups, that is, control different processes in the body.

First line

This is a large group of antihypertensive drugs, which are prescribed from the very beginning for the treatment of already confirmed hypertension, and includes 5 types of medications:

Group representatives	Pharmacological properties
: Rasilez, Captopril, Enalapril, Cardosal, Lisinopril, Quinapril, Losartan, Nifedipine, Ramipril, Dapril	Medicines reduce peripheral resistance by expanding the lumen of blood vessels, which leads to a decrease in pressure without changing heart rate or cardiac output - this makes the drugs relevant for CHF. The effect begins after taking the first dose, and over time, a stable stabilization of blood pressure values ​​occurs. Taking the latest generation of drugs improves the functioning of the kidneys and nervous system; the drugs show a minimum of side effects.
Diuretics : Indapamide, Hypothiazide, Chlorthalidone; : Furosemide, Lasix, Edecrine (the toughest); : Veroshpiron, Spironolactone, Amiloride (the mildest, prescribed as an addition to others to preserve potassium in the body)	The drugs have different mechanisms of action and point of application, but all quickly remove excess water from the body along with sodium, relieving the heart and blood vessels. They change water-salt metabolism and metabolism. Contraindicated for gout, but are the drugs of choice for diabetes.
(ARB): Valsartan, Telmisartan, Micardis, Irbesartan, Teveten Plus	The hypotensive effect is based on the ability of the drugs to disrupt the contact of angiotensin with the receptors of the cells of the internal organs, due to which the vascular wall relaxes, the pressure decreases, and the kidneys additionally stimulate the excretion of excess water and salts. Contraindicated for pregnant women and patients with individual intolerance to the components. They have virtually no complications.
Adrenergic blockers : Silodosin, Proroxan, Tropaphen, Prazosin cardioselective: Bisoprolol, Atenolol, Metoprolol; non-cardioclective: Carvedilol, Labetalol, Propranolol	They block adrenergic receptors, thereby reducing blood pressure, and at the same time slowing down the heart rate, therefore they are contraindicated for bradycardia.
: Amlodipine, Verapamil, Verapamil retard, Lercanidipine, Nifedipine retard, Felodipine, Diltiazem	They reduce the penetration of calcium ions into vascular muscle cells, thereby reducing their sensitivity to vasopressors and relieving vasospasm. Metabolic processes remain inert, while the level of left ventricular hypertrophy decreases, which reduces the risk of stroke.

Second line

Antihypertensive drugs of this group are recommended for the relief of essential (primary) hypertension only in certain patients, for example, pregnant women, the elderly, and all those for whom expensive drugs are an unbearable burden for a long time. There are also 5 types of them:

Group representatives	Mechanism of action
Rauwolfia preparations: Raunatin, Rauvazan, Reserpine	They demonstrate a pronounced hypotensive effect and have a low cost.
: Clonidine, Methyldopa, Moxonidine	They affect the central nervous system, reduce sympathetic hyperactivity, reducing blood pressure. Side effects include drowsiness and fatigue.
direct action: Nitroglycerin, Bendazole, Hydralazine, Nitrong, Milsidomin	Centrally acting drugs gently dilate blood vessels, reducing venous flow to the heart muscle, reducing oxygen deficiency in the myocardium, and increasing heart rate. They have many contraindications, so they are prescribed only by a doctor.
: Dibazol, Euphylline, Theophylline	They act on the smooth muscles of blood vessels, reduce pressure, dilate them, reduce blood viscosity, and prevent thrombosis.
: Tonorma, Ziak, Enap-N, Vazar-N, Kaptopress	They lower blood pressure in different ways, since they combine several antihypertensive drugs.

Most often, these drugs are not recommended as independent therapy; they are an auxiliary arsenal that purposefully enhances the effect of the main drugs.

List of fast and long-acting drugs

The increase in pressure can be spontaneous, sudden or gradual, but steady. This requires the use of rapid or long-acting antihypertensive drugs.

Fast acting drugs:

• Lasix (Furosemide) is a loop diuretic, the drug of choice for emergency care, corrects electrolyte metabolism, causes frequent urination, tablets are effective within an hour, injectable within the first 20 minutes;
• Atenolol (Anaprilin, Sotagestal) - slows down the heart rate while leveling blood pressure, acts after 15 minutes;
• Adelfan - antihypertensive tablets under the tongue, effective in 10 minutes;
• Clonidine – the effect is observed after half an hour, minus – dryness of the mucous membranes;
• Nifedipine – begins to work 5 minutes after sublingual administration;
• Captopril - under the tongue, works in 20 minutes, minus - three times a day.
• Nitroglycerin has a hypotensive effect after 5 minutes, prevents vasospasm, leading to heart attacks.

These antihypertensive drugs are indicated for the relief of hypertensive crises. Complicated crises require injection therapy.

The prolonged group was developed for the convenience of treating hypertension; lifelong use of drugs once or twice a day does not interfere with leading a normal lifestyle:

• Sotalol, Propranol, Carvedilol - non-selective beta receptor blockers;
• Atenolol, Bisoprolol, Betaxol - selective beta blockers;
• Amlodipine, Verapamil, Diltiazem – calcium antagonists;
• Enalapril, Lisinopril, Perindopril – ACE inhibitors;
• Indapamide, Hydrochlorothiazide, Hypothiazide – .

These drugs are used in the combination treatment of second or third degree hypertension.

Valid combinations

The compatibility of antihypertensive drugs is necessary during therapy. The most commonly used combinations are presented in the table:

Combination of drugs	Possible applications
Beta blockers + diuretics	High blood pressure, uncomplicated hypertensive crisis, hypertension without target organ damage
Diuretics + ACE inhibitors	Hypertension resistant to therapy, chronic heart failure (CHF)
Diuretics + angiotensin 1 receptor blockers	Isolated systolic hypertension (ISAH), CHF
Diuretics + imidazoline II receptor agonists	If beta blockers are contraindicated, but there is a need to add similar agents to the diuretic
Diuretics + calcium antagonists	CHF with a sharp rise in pressure, in elderly patients with ISAH
Alpha and beta blockers together	Malignant hypertension
Beta blockers + ACE inhibitors	Post-infarction condition, secondary prevention, patients with coronary heart disease (CHD), CHF
Beta blockers + calcium antagonists	Arterial hypertension (AH), ischemic heart disease
Calcium antagonists + ACE inhibitors	Hypertension, nephropathy in the initial stage, ischemic heart disease, signs of atherosclerosis
Calcium antagonists + angiotensin 1 receptor blockers	High blood pressure, nephropathy, progressive atherosclerosis

The effectiveness of any combination of antihypertensive drugs depends on the presence of certain indications, taking into account the metabolic and hemodynamic properties of each component.

Side effects

The negative consequences of taking antihypertensive drugs vary across groups. The main ones are presented in a table:

Group, individual representatives	Side effects
Diuretics - reduce blood pressure, enhancing the effect of other antihypertensive drugs
Thiazides have an average degree of activity: Hydrochlorothiazide, Cyclopenthiazide, Chlorthalidone	Complications after taking: decreased erectile function in men, acyclic menstruation in women; cumulation (accumulation) of uric acid, which causes the risk of developing gout; hypokalemia – dose-dependent development of arrhythmia; hyponatremia – life threatening; myalgia due to electrolyte imbalance; decreased glucose tolerance; penetration through the placental barrier
Loop diuretics - the strongest: Lasix, Furosemide, Indapamide	Call: excretion of sodium, calcium in urine disrupt water-salt metabolism; reduce glucose tolerance; worsen lipid profile
Potassium-sparing - weak diuretics: Veroshpiron, Spironolactone, Amiloride, Triamtren	The most dangerous side effect is hyperkalemia, which is life-threatening; other complications are similar to other diuretics
Drugs that block the sympathoadrenal system
Centrally acting drugs (virtually irrelevant in modern therapy, with the exception of natural remedies indicated for pregnant women): Methyldopa, Clonidine, Guanfacine, Moxonidine, Reserpine	Most of the negative consequences are associated with the central nervous system: drowsiness, fatigue, apathy; with abrupt withdrawal, there may be rebound syndrome: migraine, anxiety, arrhythmias, abdominal pain
Beta blockers: Betaloc, Propranolol, Atenolol, Metoprolol, Bisoprolol, Betaxolol, Nebivolol	There are three big problems associated with these antihypertensive drugs: metabolic disorders (dyslipidemia, glucose tolerance), therefore they are contraindicated in diabetes mellitus, which does not apply to highly selective blockers (Bisoprolol, metoprolol succinate delayed release) and drugs of the latest generation (Nebivolol, Carvedilol). impaired cardiac conduction, which precludes their use in case of weakness of the sinus node, blockade of the His bundle; bronchospasm, which makes them absolutely contraindicated for bronchial asthma
Alpha blockers: Prazosin, Terazosin, Doxazosin	They increase the risk: heart failure; drop in blood pressure during the first dose (before fainting)
Mixed type blockers: Labetalol, Carvedilol	Shows type 1 and type 2 side effects
Calcium antagonists
Antihypertensive drugs such as dihydropyridines: Nimodipine, Nifedipine, Amlodipine, Felodipine	Cause symptoms associated with excessive expansion of the lumen of the arteries: migraine; orthostatic hypotension; faintness; tides; nausea They go away on their own and do not require treatment.
Phenylamines: Verapamil	Provoke: constipation; bradycardia with cardiac arrest; heart failure
Benzodipines: Diltiazem	May lead to bradycardia, sinus node block
ACE inhibitors (angiotensin-converting enzyme)
Representatives: Captopril, Enalapril, Fosinopril, Lisinopril, Ramipril, Perindopril	Side effects: dry cough; Quincke's edema
Angiotensin II receptor blockers (ARBs, sartans)
Representatives: Losartan, Valsartan, Candesartan, Telmisartan	They are best tolerated among antihypertensive drugs and are considered the drugs of choice in the treatment of nephrotoxic hypertension. Overdose can cause, contraindicated for pregnant women

The latest generation of antihypertensive drugs listed in the table have a minimum number of side effects - this is a trend in modern pharmacological practice.

Last updated: January 24, 2020

Having identified arterial hypertension in a sick person, doctors often prescribe the latest generation of antihypertensive drugs, the list of which is not so long. Arterial hypertension is the most common pathology of the cardiovascular system, which affects millions of people. Most old generation drugs have many side effects. Recently they are used less and less.

Antihypertensive drugs are a large group of drugs that are used to lower blood pressure. The most commonly used groups of medications are:

• ACE inhibitors;
• diuretics;
• calcium channel blockers;
• beta-adrenergic blockers;
• angiotensin-2 antagonists.

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Angiotensin-2 antagonists are very popular. Most often they are used when ACE inhibitors are ineffective or intolerant. This group includes a medicine such as Losartan. The increase in blood pressure is caused by vasoconstriction. Angiotensin-2 has a vasoconstrictor effect.

Losartan blocks receptors for angiotensin-2, thereby promoting vasodilation and a drop in blood pressure. A distinctive feature of Losartan is that it does not disrupt the formation of angiotensin-converting enzyme. In this regard, this medicine does not cause side effects characteristic of ACE inhibitors.

Losartan is well tolerated by patients. Possible side effects include weakness, fatigue, swelling in the extremities, tachycardia, palpitations, abdominal pain, diarrhea-type bowel movements, nausea, back pain, convulsions, headache, sleep disturbance. There may be a cough, inflammation of the sinuses or nasal mucosa. Disorders of the heart and blood vessels, anorexia, gastritis, hepatitis, bowel problems such as constipation, allergic reactions, and changes in the blood occur much less frequently.

Losartan reduces the risk of complications due to hypertension. The medicine is excellent for patients who have arterial hypertension combined with type 2 diabetes. Losartan should not be prescribed to children, pregnant or lactating women. Contraindications to the use of Losartan include high potassium levels in the blood, intolerance to the active substance, lactase deficiency, and dehydration.

For arterial hypertension, centrally acting drugs are often used. Imidazoline receptors are located in the medulla oblongata. Excitation of these neurons leads to a hypotensive effect. These drugs include Moxonidine. This tool has the following features:

• does not have a strong sedative effect;
• used for various forms of arterial hypertension;
• lasts for a long time;
• gradually reduces systolic and diastolic blood pressure;
• does not cause withdrawal syndrome.

The indication for the use of this medication is arterial hypertension of central origin. This new generation antihypertensive drug is contraindicated if a person has heart block, bradycardia, heart and kidney failure, impaired liver function and hypersensitivity to the active substance. Moxonidine is not suitable for children, pregnant or breastfeeding women.

The product must be taken orally. The dose is selected by the attending physician. When using Moxonidine, the following adverse reactions are possible:

• dizziness;
• headache;
• drowsiness;
• insomnia;
• backache;
• asthenia;
• dry mouth;
• diarrhea;
• vomit;
• nausea;
• rash.

Rarely observed phenomena such as orthostatic hypotension, bradycardia, tinnitus, edema.

One of the most modern drugs against hypertension is Rasilez. It is a renin inhibitor. The latter refers to enzymes that regulate blood pressure. Renin takes part in the formation of angiotensin. In Russia, Rasilez was approved in 2008. It is produced in the form of tablets. The main active ingredient is aliskiren.

This medication has the following advantages:

• accessible to the public;
• has a rapid and pronounced hypotensive effect;
• well tolerated by patients;
• does not cause withdrawal syndrome.

Stopping use of this medication will not cause your blood pressure to rise suddenly. Rasilez can be used together with other antihypertensive drugs. In this case, the hypotensive effect is enhanced. In people with diabetes, blood pressure is reduced safely when using Rasilez. In this situation, it is recommended to combine Rasilez with Ramipril.

Rasilez should not be used in the following situations:

• with renal failure;
• with nephrotic syndrome;
• with renovascular arterial hypertension;
• with severe liver dysfunction;
• in case of individual intolerance to the drug.

Rasilez is not suitable for the treatment of children and persons requiring continuous hemodialysis. The most common side effect of the drug is diarrhea.

Cardosal is a new generation of drugs for the treatment of arterial hypertension.

The main component of the drug is olmesartan medoxomil. The drug reduces blood pressure gradually. The maximum effect is observed after 2 weeks from the start of therapy. The medicine is available in the form of tablets of 10, 20 and 40 mg. The degree of pressure reduction depends on the dose of the drug.

The medicine does not cause withdrawal syndrome or tachycardia. A pronounced hypotensive effect is observed 14 days after the first dose. The drug can be taken before, during or after meals. The medicine is effective for primary arterial hypertension (hypertension). Contraindications to the use of Cardosal include obstruction of the biliary tract, pregnancy and breastfeeding, childhood, individual intolerance, galactosemia, lactase deficiency, and renal failure. Cardosal should be used with caution if the patient has heart valve stenosis, hypertrophic cardiomyopathy, aldosteronism, or coronary heart disease.

Principles of drug therapy

Treatment of arterial hypertension is carried out only after consultation with a therapist or cardiologist. Self-medication is unacceptable. When choosing a new generation antihypertensive drug, the following factors are taken into account:

• presence of concomitant diseases;
• patient's age;
• form of arterial hypertension;
• degree of pressure increase;
• drug tolerance.

Treatment of this pathology is long-term. It is often necessary to take medications for life, since even the latest antihypertensive drugs are not able to completely cure the disease. In order to stabilize blood pressure and prevent possible complications, you need to adhere to the following recommendations:

• take medications at the time prescribed by your doctor;
• do not exceed the permissible dosage;
• do not take breaks;
• if the drug is ineffective, it should be replaced with another one;
• combine drug therapy with other treatment methods.

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Drug treatment alone is not enough. If you have arterial hypertension, you need to eliminate all risk factors: give up alcohol and cigarettes, eliminate stressful situations, and normalize your diet. Many new generation antihypertensive drugs have a long-lasting effect. In such a situation, it is enough to take the tablets once a day.

If new generation drugs do not have the desired effect, then they need to be replaced with products that have been proven over the years. The most commonly used drugs are: diuretics (Dichlorothiazide, Indapamide, Furosemide), calcium channel blockers (Nifedipine, Amlodipine), ACE inhibitors (Captopril, Prestarium, Capoten), adrenergic blockers (Atenolol, Propranolol, Labetalol), alpha-adrenergic agonists (Clonidine). Thus, few antihypertensive drugs have been introduced in recent years. The most modern antihypertensive drugs include Losartan, Rasilez, Moxonidine and Cardosal.

Drug treatment of hypertension is indicated for all patients with blood pressure higher than 160/100 mmHg. Art., and also when lifestyle modification measures have not led to normalization of blood pressure and it remains higher than 140/90 mm Hg. Art. There are a lot of drugs that lower blood pressure. Depending on their composition and mechanism of action, they are divided into groups and even subgroups.

These drugs are called antihypertensive or hypotensive drugs. We bring to your attention a review of drugs to lower blood pressure.

Principles of drug treatment of hypertension

Blood pressure-lowering medications for hypertension must be taken not in courses, but for life.

Before considering each group of drugs separately, let's talk briefly about the basic principles of drug treatment for essential hypertension, or hypertension.

1. Medicines that lower blood pressure must be taken by the patient continuously throughout his life.
2. An antihypertensive drug should be prescribed exclusively by a doctor. Its choice depends on the individual characteristics of the course of the disease of a particular patient, on the presence or absence of insufficiency of the coronary vessels of the heart or arrhythmia, the type of hemodynamics, target organ damage, the presence or absence of risk factors for heart and vascular diseases, concomitant pathology and, finally, on the tolerability of this drug drug for patients.
3. Treatment begins with the lowest possible dose of the drug, thus assessing the patient’s body’s response to it and reducing the severity of possible side effects. If the drug is well tolerated, but a decrease in pressure to the desired levels is not observed, then the dose of the drug is increased, but not immediately to the maximum possible, but gradually.
4. It is unacceptable to quickly reduce blood pressure: this can lead to ischemic damage to vital organs. This point is especially relevant for elderly and senile patients.
5. Long-acting medications are taken once a day. Preference should be given to these drugs, since when taken, daily fluctuations in blood pressure are less pronounced, plus it is easier for the patient to take 1 tablet in the morning and forget about it until tomorrow than to take it 3 times a day, periodically skipping doses due to their own carelessness.
6. If, when taking a minimum or average therapeutic dose of a drug containing only one active agent, the desired effect does not occur, the dose should not be increased to the maximum: it would be more correct (more effective) to add a small dose of an antihypertensive drug from another group (with a different mechanism of action) to the first drug. This will not only provide a faster hypotensive effect, but also minimize the side effects of both drugs.
7. There are drugs containing several active antihypertensive drugs from different groups. It is much more convenient for the patient to take such a drug than 2 or 3 separate tablets.
8. If there is no effect from the treatment at all or it is poorly tolerated by the patient (the side effects are pronounced and cause inconvenience to the patient), you should not combine this drug with another or, moreover, increase its dose: it would be more correct to cancel this drug and switch to drug treatment by another group. Fortunately, the choice of antihypertensive drugs is quite large, and, by trial and error, each individual patient will still be able to select adequate, effective antihypertensive therapy.

Classification of antihypertensive drugs

Drugs used to lower blood pressure can be divided into 2 large groups:
I. First-line drugs. They are the drugs of choice in the treatment of hypertension. The vast majority of hypertensive patients are recommended to prescribe them. This group includes 5 more groups of drugs:

• angiotensin-converting enzyme inhibitors (abbreviated as ACEIs);
• diuretics, or diuretics;
• angiotensin II receptor inhibitors;
• β-blockers, or β-blockers;
• calcium antagonists.

II. Second line drugs. For long-term treatment of essential hypertension, they are used only in certain classes of patients, for example, women, or people with low incomes who, for financial reasons, cannot afford first-line drugs. These drugs include:

• α-blockers;
• rauwolfia alkaloids;
• Centrally acting α2-agonists;
• direct acting vasodilators.

Let's consider each of these groups separately.

Angiotensin-converting enzyme inhibitors, or ACEIs

Group of the most effective antihypertensive drugs. A decrease in blood pressure when taking these medications occurs due to the dilation of blood vessels: their total peripheral resistance decreases, and therefore the pressure decreases. ACEIs have virtually no effect on cardiac output and heart rate, so they are widely used for concomitant chronic heart failure.

Already after taking the first dose of this group of drugs, the patient notices a decrease in blood pressure. When used for several weeks, the hypotensive effect increases and, having reached a maximum, stabilizes.

Adverse reactions to ACE inhibitors are quite rare and are manifested mainly by an obsessive dry cough, taste disturbance and signs of hyperkalemia (increased potassium levels in the blood). Hypersensitivity reactions to ACE inhibitors in the form of angioedema are rarely observed.

Since ACE inhibitors are eliminated primarily by the kidneys, if the patient is severely ill, the dose of these drugs should be reduced. Drugs of this group are contraindicated during pregnancy, in case of bilateral stenosis of the renal arteries, as well as in case of hyperkalemia.

The main representatives of the class of ACE inhibitors are:

• enalapril (Enap, Berlipril, Renitek) - the daily dose of the drug ranges from 5-40 mg in 1-2 doses;
• captopril - taken in a dose of 25-100 mg per day in 2-3 doses;
• quinapril (Accupro) – daily dose is 10-80 mg in 1-2 doses;
• lisinopril (Lopril, Diroton, Vitopril) – it is recommended to take 10-40 mg per day, the frequency of administration is 1-2 times;
• moexipril (Moex) – 7.5-30 mg daily dose, frequency of administration – 1-2 times; It is worth noting that this drug is one of the ACE inhibitors recommended for use by persons with severe chronic renal failure;
• perindopril (Prenesa, Prestarium) – daily dose is 5-10 mg in 1 dose;
• ramipril (Tritace, Ampril, Hartil) – daily dose 2.5-20 mg in 1-2 doses;
• spirapril (Quadropril) – taken in a dose of 6 mg once a day;
• trandolapril (Hopten) – taken in a dose of 1-4 mg 1 time per day;
• fosinopril (Fosicard) – take 10-20 mg 1-2 times a day.

Diuretics, or diuretics

Like ACE inhibitors, they are widely used in the treatment of hypertension. These drugs increase the volume of urine excreted, resulting in a decrease in the volume of circulating blood and extracellular fluid, a decrease in cardiac output, and dilation of blood vessels, all of which result in a decrease in blood pressure. It is worth noting that while taking diuretics, development is possible.

Diuretics are often used as part of combination therapy for hypertension: they remove excess water from the body, which is retained when taking many other antihypertensive drugs. They are contraindicated for.

Diuretics can also be divided into several groups.
1. Thiazide diuretics. They are most often used for antihypertensive purposes. Low dosages are generally recommended. They are ineffective in cases of severe renal failure, which is also a contraindication to their use. The most commonly used thiazide diuretic is hydrochlorothiazide (Hypothiazide). The daily dose of this drug is 12.5-50 mg, the frequency of administration is 1-2 times a day.
2. Thiazide-like diuretics. The most prominent representative of this group of drugs is indapamide (Indap, Arifon, Ravel-SR). It is usually taken at 1.25-2.5-5 mg once a day.
3. Loop diuretics. Drugs of this group do not play a significant role in the treatment of hypertension, however, in the case of concomitant or renal failure in a hypertensive patient, they are the drugs of choice. Often used in acute conditions. The main loop diuretics are:

• furosemide (Lasix) - the daily dose of this drug ranges from 20 to 480 mg, depending on the severity of the disease, the frequency of administration is 4-6 times a day;
• torasemide (Trifas, Torsid) – taken in a dose of 5-20 mg twice a day;
• ethacrynic acid (Uregit) - daily dose ranges from 25-100 mg in two doses.

4. Potassium-sparing diuretics. They have a weak hypotensive effect and also remove a small amount of sodium from the body, preserving potassium. They are rarely used alone for the treatment of hypertension, more often in combination with drugs from other groups. Not applicable when. The most prominent representatives of this class are the following potassium-sparing diuretics:

• spironolactone (Veroshpiron) – the daily dose of the drug is 25-100 mg, the frequency of administration is 3-4 times a day;
• triamterene - take 25-75 mg 2 times a day.

Angiotensin II receptor inhibitors

The second name for drugs in this group is sartans. This is a relatively new class of antihypertensive drugs that are highly effective. Provide effective 24-hour blood pressure control when taking the drug once a day. Sartans do not have the most common side effect of ACE inhibitors - a dry hacking cough, therefore, those with intolerance to ACE inhibitors, as a rule, replace them with sartans. Drugs of this group are contraindicated during pregnancy, bilateral renal artery stenosis, and hyperkalemia.

The main representatives of sartans are:

• irbesartan (Irbetan, Converium, Aprovel) – it is recommended to take 150-300 mg once a day;
• candesartan (Candesar, Kasark) – taken in a dose of 8-32 g 1 time per day;
• losartan (Lozap, Lorista) – daily dose of the drug 50-100 mg in 1 dose;
• telmisartan (Praytor, Micardis) – recommended daily dose of 20-80 mg, in 1 dose;
• valsartan (Vazar, Diovan, Valsacor) - taken at a dose of 80-320 mg per day for 1 dose.

β-blockers

Beta blockers are especially indicated for people who have hypertension combined with tachycardia.

They reduce blood pressure due to a blocking effect on β-adrenergic receptors: cardiac output and renin activity in the blood plasma decrease. Especially indicated for arterial hypertension, combined with angina pectoris and certain types. Because one of the effects of beta blockers is to decrease heart rate, these drugs are contraindicated in bradycardia.
Drugs in this class are divided into cardioselective and non-cardioselective.

Cardioselective β-blockers act exclusively on receptors of the heart and blood vessels, and do not affect other organs and systems.
Drugs in this class include:

• atenolol (Atenol, Tenolol, Tenobene) - the daily dose of this drug is 25-100 mg, the frequency of administration is twice a day;
• betaxolol (Betak, Betakor, Lokren) – taken in a dose of 5-40 mg once a day;
• bisoprolol (Concor, Coronal, Biprol, Bicard) - taken in a dose of 2.5-20 mg per day at a time;
• metoprolol (Betalok, Corvitol, Egilok) - the recommended daily dose of the drug is 50-200 mg in 1-3 doses;
• nebivolol (Nebilet, Nebilong, Nebil) – take 5-10 mg once a day;
• celiprolol (Celiprol) – take 200-400 mg once a day.

Cardiononselective β-blockers affect receptors not only of the heart, but also of other internal organs, therefore they are contraindicated in a number of pathological conditions, such as chronic obstructive pulmonary disease, intermittent claudication.

The most commonly used representatives of this class of drugs are:

• propranolol (Anaprilin) ​​– taken 40-240 mg per day in 1-3 doses;
• carvedilol (Coriol, Medocardil) - the daily dose of the drug is 12.5-50 mg, the frequency of administration is 1-2 times a day;
• labetalol (Abetol, Labetol) – it is recommended to take 200-1200 mg per day, dividing the dose into 2 doses.

Calcium antagonists

They reduce blood pressure well, but due to their mechanisms of action they can have very serious side effects.

1. Phenylalkylamine derivatives. Verapamil (Finoptin, Isoptin, Veratard) – it is recommended to take a dose of 120-480 mg per day in 1-2 doses; may cause bradycardia and atrioventricular block.
2. Benzothiazepine derivatives. Diltiazem (Aldizem, Diacordin) - its daily dose is equal to that of verapamil and is 120-480 mg in 1-2 doses; causes bradycardia and AV block.
3. Dihydropyridine derivatives. They have a pronounced vasodilator effect. May cause an acceleration of the heart rate. The main representatives of this class of calcium antigonists are as follows:

• amlodipine (Azomex, Amlo, Agen, Norvasc) - the daily dose of the drug is 2.5-10 mg in one dose;
• lacidipine (Latsipil) – take 2-4 mg per day at a time;
• lercanidipine (Zanidip, Lerkamen) – take 10-20 mg once a day;
• nifedipine (retard - long-acting - forms: Corinfar retard, Nifecard-XL, Nicardia) - take 20-120 mg per day at a time;
• felodipine (Felodip) – the daily dose of the drug is 2.5-10 mg in one dose.

Combination drugs

Often, first-line antihypertensive drugs are included in combination drugs. As a rule, they contain 2, less often 3, active substances belonging to different classes, which means they lower blood pressure in different ways.

Here are examples of such drugs:

• Triampur – hydrochlorothiazide + triamterene;
• Tonorma – atenolol + chlorthalidone + nifedipine;
• Captopress – captopril + hydrochlorothiazide;
• Enap-N – enalapril + hydrochlorothiazide;
• Liprazide – lisinopril + hydrochlorothiazide;
• Vazar-N – valsartan + hydrochlorothiazide;
• Ziac – bisoprolol + hydrochlorothiazide;
• Bi-Prestarium – amlodipine + perindopril.

α-blockers

Currently, they are used relatively rarely, usually in combination with first-line drugs. The main very serious disadvantage of drugs in this group is that long-term use of them increases the risk of developing heart failure, acute cerebrovascular accidents (stroke) and sudden death. However, α-blockers also have a positive property that distinguishes them from other drugs: they improve carbohydrate and lipid metabolism, which is why they are the drugs of choice for the treatment of hypertension in people with concomitant diabetes mellitus and dyslipidemia.

The main representatives of drugs in this class are:

• prazosin - take it 1-20 mg 2-4 times a day; This drug is characterized by the effect of the 1st dose: a sharp decrease in blood pressure after the first dose;
• doxazosin (Cardura, Zoxon) – recommended dose – 1-16 mg 1 time per day;
• terazosin (Cornam, Alfater) – 1-20 mg per day for 1 dose;
• phentolamine – 5-20 mg per day.

Rauwolfia preparations

They have a good hypotensive effect (develops after about 1 week of regular use of the drug), but have many side effects, such as drowsiness, depression, nightmares, insomnia, dry mouth, anxiety, bradycardia, bronchospasm, weakened potency in men, vomiting , allergic reactions, . Of course, these drugs are cheap, which is why many elderly hypertensive patients continue to take them. However, among the 1st line drugs there are also options that are financially accessible to most patients: they should be taken if possible, and rauwolfia drugs should be gradually abandoned. These drugs are contraindicated in cases of severe epilepsy, parkinsonism, depression, bradycardia and severe heart failure.
Representatives of rauwolfia preparations are:

• reserpine - recommended to take 0.05-0.1-0.5 mg 2-3 times a day;
• raunatin - taken according to the scheme, starting with 1 tablet (2 mg) per day at night, increasing the dose by 1 tablet every day, bringing it to 4-6 tablets per day.

Combinations of these drugs are most often used:

• Adelphan (reserpine + hydralazine + hydrochlorothiazide);
• Sinepres (reserpine + hydralazine + hydrochlorothiazide + potassium chloride);
• Neocristepine (reserpine + dihydroergocristine + chlorthalidone).

Central α2 receptor agonists

Drugs in this group reduce blood pressure by acting on the central nervous system, reducing sympathetic hyperactivity. They can cause quite serious side effects, but in certain clinical situations they are irreplaceable, for example, the drug methyldopa for arterial hypertension in pregnant women. Side effects of central α2-receptor agonists are due to their effect on the central nervous system - drowsiness, decreased attention and reaction speed, lethargy, depression, weakness, fatigue, headache.
The main representatives of drugs in this group are:

• Clonidine (Clonidine) – used 0.75-1.5 mg 2-4 times a day;
• Methyldopa (Dopegit) – single dose is 250-3000 mg, frequency of administration – 2-3 times a day; drug of choice for the treatment of arterial hypertension in pregnant women.

Direct acting vasodilators

They have a mild hypotensive effect due to moderate vasodilation. More effective in injection form than when taken orally. The main disadvantage of these drugs is that they cause “steal” syndrome - roughly speaking, they disrupt the blood supply to the brain. This limits their use in people suffering from atherosclerosis, and this is the majority of patients with high blood pressure.
Representatives of this group of drugs are:

• bendazole (Dibazol) - 0.02-0.05 g is used orally 2-3 times a day; more often used intramuscularly and intravenously to quickly reduce blood pressure - 2-4 ml of a 1% solution 2-4 times a day;
• hydralazine (Apressin) - initial dose - 10-25 mg 2-4 times a day, average therapeutic dose - 25-50 g per day in 4 divided doses.

Medicines for the treatment of hypertensive crises

In order to treat uncomplicated cases, it is recommended to reduce the pressure not immediately, but gradually, over 1-2 days. Based on this, drugs are prescribed in tablet form.

• Nifedipine - administered orally or sublingually (this method of administration is equivalent in effectiveness to intravenous administration) 5-20 mg; when taken orally, the effect occurs within 15-20 minutes, while when taken sublingually, the effect occurs within 5-10 minutes; possible side effects such as headache, severe hypotension, tachycardia, redness of the facial skin, symptoms of angina pectoris;
• Captopril - used 6.25-50 mg sublingually; begins to act within 20-60 minutes;
• Clonidine (Clonidine) – taken orally at 0.075-0.3 mg; the effect is observed within half an hour or an hour; Side effects include sedation and dry mouth; Caution should be exercised when using this drug in patients with;
• Nitroglycerin - recommended dose - 0.8-2.4 mg sublingually (under the tongue); The hypotensive effect occurs quickly - within 5-10 minutes.

When treating complicated hypertensive crises, the patient is prescribed intravenous infusions of drugs. At the same time, blood pressure is constantly monitored. Most drugs used for this purpose begin to act within a few minutes after administration. Typically, the following medications are used:

• Esmolol - administered intravenously; the onset of action is noted within 1-2 minutes after the start of the infusion, the duration of action is 10-20 minutes; is the drug of choice for dissecting aortic aneurysm;
• Sodium nitroprusside – used intravenously; the effect is noted immediately after the start of the infusion, lasts 1-2 minutes; During the administration of the drug, nausea, vomiting, as well as a sharp decrease in blood pressure may occur; Caution should be exercised when using sodium nitroprusside in individuals with azotemia or high intracranial pressure;
• Enalaprilat - administered intravenously at 1.25-5 mg; the hypotensive effect begins 13-30 minutes after the injection and lasts for 6-12 hours; This drug is especially effective for acute left ventricular failure;
• Nitroglycerin – administered intravenously; the effect develops 1-2 minutes after infusion, duration of action is 3-5 minutes; During the infusion, intense headache and nausea often occur; direct indications for the use of this drug are signs of ischemia of the heart muscle;
• Propranolol - administered intravenously, the effect develops after 10-20 minutes and lasts for 2-4 hours; This drug is especially effective in acute coronary syndrome, as well as in the case of dissecting aortic aneurysm;
• Labetalol - administered intravenously in a stream of 20-80 mg every 5-10 minutes or intravenously by drip; a decrease in blood pressure is observed after 5-10 minutes, the duration of the effect is 3-6 hours; while taking the drug, a sharp decrease in blood pressure, nausea, bronchospasm is possible; it is contraindicated in case of acute heart failure;
• Phentolamine - administered intravenously at 5-15 mg, the effect is observed within 1-2 minutes and lasts for 3-10 minutes; tachycardia, headache, and facial flushing may occur; This drug is especially indicated for a hypertensive crisis against the background of an adrenal tumor - pheochromocytoma;
• Clonidine - 0.075-0.3 mg is administered intravenously, the effect develops after 10 minutes; Side effects include nausea and headache; it is possible to develop tolerance (insensitivity) to the drug.

Since complicated hypertensive crises are often accompanied by fluid retention in the body, treatment should begin with intravenous jet administration of a diuretic - furosemide or torsemide at a dose of 20-120 mg. If the crisis is accompanied by increased urination or severe vomiting, diuretics are not indicated.
In Ukraine and Russia, during a hypertensive crisis, drugs such as magnesium sulfate (popularly known as Magnesia), papaverine, dibazol, aminophylline and the like are often administered. Most of them do not have the desired effect, lowering blood pressure to certain numbers, but, on the contrary, lead to rebound hypertension: increased blood pressure.

Which doctor should I contact?

Complicated hypertensive crises require infusion of blood pressure-lowering drugs.

To prescribe antihypertensive therapy, you must consult a physician. If the disease is discovered for the first time or is difficult to treat, the physician may refer the patient to a cardiologist. Additionally, all patients with hypertension are examined by a neurologist and ophthalmologist to exclude damage to these organs, and an ultrasound of the kidneys is performed to exclude renovascular or renal secondary hypertension.