There are five types of antihypertensive drugs commonly used by doctors: calcium antagonists (such as nifedipine), ACEI (such as enalapril), ARB (such as telmisartan), diuretics (such as hydrochlorothiazide) and receptor blockers (such as metoprolol). These five types of drugs are basically doctors’ main weapons against hypertension.
These five drugs are not good or bad, only suitable or inappropriate. That kind of drug can not only effectively reduce blood pressure, but also protect organs such as heart, brain, lung and kidney, which is the appropriate drug.
Generally speaking, high-salt diet, elderly patients and patients with simple systolic hypertension have better antihypertensive response to calcium antagonists and thiazide diuretics. Middle-aged and young patients have better response to ACEI or ARB and receptor blockers. Patients with metabolic system abnormalities, such as diabetes, hyperlipidemia and gout, are more suitable for ACEI or ARB drugs.
When one drug is not effective in lowering blood pressure, a combination of multiple drugs can be used.
Doctors generally give priority to the combination of the two drugs, such as:
- Calcium antagonist + ACEI or ARB; ACEI or ARB + diuretics; Calcium antagonist + receptor blocker; Calcium antagonist + diuretic.
If the control is not good, three drugs can be combined: calcium antagonist + ACEI or ARB + diuretic.
Fixed ratio compound preparation
This is also a way of combined medication, usually composed of two small doses of antihypertensive drugs with different mechanisms of action, which is convenient to use.
The new type of preparation mainly includes:
ACEI + thiazide diuretics;
ARB + thiazide diuretics, such as valsartan + hydrochlorothiazide;
Dihydropyridine calcium channel blockers + ARB, such as valsartan + amlodipine tablets;
Dihydropyridine calcium channel blockers + receptor blockers;
Thiazine diuretics + potassium-preserving diuretics.
On the basis of lifestyle improvement, when three antihypertensive drugs with different mechanisms of action (one of which is diuretic) are taken regularly and in sufficient quantities, the blood pressure still cannot reach the standard (below 140/90 mmHg), which is generally found in patients with elderly, obese, diabetes and kidney diseases.
This part of hypertension patients account for about 10% of the patients treated by standard methods.
However, before diagnosing refractory hypertension, we should first see if there is [standard] treatment and exclude [pseudo refractory hypertension].
The following points are mainly excluded:
1. Improper blood pressure measurement method
If the measurement posture is not correct, cuff size is not appropriate, etc.
2. Drug factor:
Irregular medication, not in accordance with the doctor’s advice prescribed dosage, times of medication;
The choice of antihypertensive drugs is inappropriate, such as low dose, or unreasonable combination medication scheme;
Take drugs with boosting effect, such as oral contraceptives, glucocorticoids, etc.
3. Bad lifestyle or failure to control other risk factors
High salt diet, obesity, smoking, heavy drinking, hyperlipidemia, long-term psychological stress, insomnia, etc.
4. Other conditions that may cause blood pressure to rise
Abnormal renal function and long-term chronic pain;
Psychological diseases such as anxiety and depression have not been well controlled.