Different schemes of drug treatment of hypertension

1 Classification of the pathology

Arterial hypertension is divided into two types:

1. Primary( essential) or hypertensive disease is a disease that manifests itself by increasing pressure in the absence of an obvious cause, accompanied by a progressive lesion of the arteries. This type of hypertension is detected in 90% of patients with high blood pressure.
2. Secondary arterial hypertension is a disease characterized by increased pressure, and arises as a complication of another disease.

2 General principles of therapy

Drugs used to treat hypertension are very diverse. They are represented by several pharmacological groups. Each group of drugs has its own effect on the body.

The main drugs for the treatment of hypertension:

1. Angiotensin converting enzyme( ACE) inhibitors. Representatives of this group: enalapril( renitek, enap), perindopril( prestarium A), ramipril( pyramidal, tritatse).
2. Antagonists of AT1 receptors( renin-angiotensin blockers): losartan( cosaar), valsartan( diovan), irbesartan( aprovel), eprosartan, telmisartan.
3. Calcium channel blockers( BCC): nifedipine( corinfar), amlodipine-dihydropyridine;verapamil, diltiazem - non-dihydropyridine.
4. Diuretics: hydrochlorothiazide, indapamide.
5. Beta-adrenoblockers: metoprolol, bisoprolol, nebivolol, carvedilol.
6. Combined preparations: tenorik, korenitek, enap-N, gisaar, ko-diovan, prestan.

Important: Only a doctor can prescribe any of the above medicines!

3 Rational combinations of drugs

Doctors have developed special schemes for the treatment of hypertension. Combinations of various drugs lead to increased pressure reduction.

The following drug combinations are most commonly used as the therapy for essential hypertension:

1. ACE inhibitor( enap) + dihydropyridine BCA( amlodipine) + thiazide diuretic( hydrochlorothiazide) - this combination is the best combination of drugs and is most commonly used in patients with essential hypertension 2 and3 stages.
2. Antagonist of AT1 receptors( cosaar) + thiazide diuretic + non-dihydropyridine BCC( verapamil).
3. Dihydropyridine BCC + beta adrenoblocker + AT1 receptor antagonist.
4. Beta-adrenoblocker( bisoprolol) + thiazide diuretic + dihydropyridine calcium antagonist( corinfar).

Each of these treatment regimens has its own nuances in the appointment:

• ACE inhibitors are indicated for chronic heart failure, ischemic heart disease, after myocardial infarction, left ventricular hypertrophy, hypertensive nephropathy, diabetes mellitus, arrhythmia. There are few contraindications to the use of this group of drugs( age under 18, pregnancy and lactation), but there are a lot of restrictions to use - narrowing of the renal arteries, systemic lupus erythematosus, age over 65, oncological diseases, kidney disease and gout.
• Angiotensin receptor( AT1 receptor) blockers are used at the same indications for hypertension if cough or other side effects from taking ACE inhibitors appear. In this group of drugs, contraindications and restrictions to use are the same as in the past.
• Beta-blockers are used in IHD, CHF, tachycardia, after a heart attack. The means of this group have a lot of contraindications to the use: atrioventricular, sinoatrial block, bradycardia, bronchial asthma, COPD, pheochromocytoma, peripheral vascular disease, age of 18 years.
• Dihydropyridine calcium antagonists are used in the elderly, with IHD, atherosclerosis of the carotid arteries, an isolated increase in systolic( "cardiac") pressure. These drugs can not be used until two weeks after myocardial infarction, with unstable angina, bradycardia, and during pregnancy.

4 Therapeutic tactics for secondary hypertension

Treatment of secondary hypertension is not only to reduce the increased pressure, but also to eliminate the causes of its causes.

For the treatment of secondary renal hypertension are prescribed as antihypertensives( clonidine, beta-adrenoblockers in combination with furosemide), and antiplatelet agents( trental or quarantil), NSAIDs( indomethacin or ibuprofen).

As a medicamental therapy for renovascular secondary hypertension, tablets are used: BCC, diuretics, and beta-blockers. ACE inhibitors in this case are used with great caution, since they can cause acute renal failure.

If the increase in blood pressure is caused by adrenal gland diseases( adenoma or hyperplasia), spironolactone tablets are used - a potassium-sparing diuretic, most often in conjunction with captopril, which enhances the hypotensive effect. In addition to antihypertensive drugs, glucocorticoids are always prescribed. Another dangerous disease of the adrenal gland, in which the pressure can rise to 300/160 mm.gt;Art.and more, is a pheochromocytoma. The only method that allows you to get rid of hypertension with this disease is surgical. Drug treatment is performed for preoperative preparation, or in case of patient's refusal from surgery. As a therapy, tablets of alpha-blockers are used - phentolamine or doxazosin.

Pituitary tumors cause Isenko-Cushing's disease, which causes hypertension. In this case, a tablet of veroshpiron is used. In hypertensive crisis, or malignant course of hypertension, a hood or coronfar is prescribed. Drug treatment with antihypertensive drugs( tablets) is used until an operation or radiation therapy of the pituitary adenoma is performed.

Since hypertension occurs as a result of a large number of causes, it can be diagnosed in both children and adults.

When complaints of frequent headaches, general weakness, fatigue, nosebleeds, blood pressure should be measured.

Tonometry can be performed at home or in a clinic - in a pre-hospital room, as well as with a therapist. If high blood pressure occurs frequently, this is cause for concern. In such cases, it is necessary to undergo a qualitative examination, follow the doctor's recommendations, and be treated with the necessary medications. This can greatly prolong your life and improve its quality.