How to Choose the Right Blood Pressure Medicine?

1. Which blood pressure medicine are most suitable for you?

For patients with hypertension, the most difficult thing is to find the right blood pressure medicine for them. Especially for some people who just found themselves suffering from hypertension, the doctor prescribed antihypertensive drugs to eat for a while, found that the effect of lowering blood pressure is not obvious, it is a little anxious, want to try a new antihypertensive drug, but there are a variety of antihypertensive drugs on the market, and do not know how to choose. In response to this problem, today I talk to you about the advantages and disadvantages of various antihypertensive drugs.

2. A classification of antihypertensive drugs

First of all, I would like to tell you that when patients buy drugs, many of them say the trade name, such as dihydro cotrimoxazole, captopril tablets, and so on. But doctors generally classify antihypertensive drugs according to the chemical name of the drug, for example, metoprolol and bisoprolol belong to the beta-blocker class of drugs. The classification of drugs I am talking about today is also based on their chemical names. Regardless of the number of trade names of antihypertensive drugs, they can be divided into five main categories based on their chemical composition.

1. Diuretics
2. Beta-blockers
3. Calcium channel blockers
4. Angiotensin-converting enzyme inhibitors
5. Angiotensin II receptor blockers

Does it feel difficult to remember? Don't worry, I'll introduce them to you one by one,then can help you choose the right blood pressure medicine.

1. Diuretics

The so-called diuretics are drugs that accelerate urination to achieve the effect of lowering blood pressure. Commonly used are double gram (hydrochlorothiazide), rapid diuretic tablets (furosemide), spironolactone, and indapamide.

Efficacy characteristics: 

• These antihypertensive drugs have a smooth and slow onset of action, but the duration of the effect is also longer, mainly for mild hypertension and moderate hypertension, for salt-sensitive hypertension, combined with obesity or diabetes, menopausal women ,and elderly hypertension effect is better.

Adverse effects:

• The main adverse effect of diuretics is that they can cause hypokalemia and affect the metabolism of blood lipids, blood sugar, and blood uric acid, and may cause an increase in uric acid, so they should be used with caution if patients have gout.

In addition, when taking these antihypertensive drugs, patients may experience increased urine output and weakness. Potassium-protective diuretics such as spironolactone can cause hyperkalemia and should not be used in combination with angiotensin-converting enzyme inhibitors (ACEI), and should be used with caution in patients with renal insufficiency. 

2. β-blockers

Most of these antihypertensive drugs have "Lol" in their trade names. For example  metoprolol, bisoprolol, etc.

Efficacy characteristics: 

• these antihypertensive drugs have a rapid onset and strong effect, and the duration of the effect varies depending on the product. It is suitable for various severity of hypertension, especially for middle-aged and young patients with fast heart rates, or patients with coronary artery disease or heart failure.

Adverse effects:

• Adverse reactions mainly include slowed heart rate, weakness, and chills in the extremities.

Beta-blockers inhibit myocardial contractility, atrioventricular conduction, and sinus rhythm, and can increase airway resistance, so they are contraindicated in patients with acute heart failure, bronchial asthma, sick sinus node syndrome, high atrioventricular block and peripheral vascular disease.

3. calcium channel blockers

Most of these antihypertensive drugs have the word "diphenhydramine" in their trade names. For example: nifedipine, felodipine, amlodipine, etc.

Efficacy characteristics: 

• These drugs have few contraindications except for heart failure and have a wide range of applications. There is no significant effect on the metabolism of blood lipids and blood sugar, and the ability to control blood pressure in the long term and compliance with medication is better.

Advantages : 

• Better antihypertensive effect for elderly patients; high sodium intake does not affect the antihypertensive efficacy; non-steroidal anti-inflammatory drugs do not interfere with the antihypertensive effect; significant antihypertensive effect in patients with alcoholism; can be used in patients with combined diabetes, coronary artery disease, or peripheral vascular disease; also has an anti-atherosclerotic effect during long-term treatment.

Adverse effects:

• The main drawback is that it may cause increased heart rate, facial flushing, headache, and edema of the lower limbs. Some of these antihypertensive drugs should not be used in patients with heart failure, sinus node hypofunction, or heart block.

4. Angiotensin-converting enzyme inhibitors (ACEI)

Most of these antihypertensive drugs have the trade name "Pulley" in them. Commonly used are captopril, enalapril, benazepril, lenopril, cilazepril, perindopril, ramipril, and fosinopril.

Efficacy characteristics: 

• These drugs have the effect of improving insulin resistance and reducing urinary protein, and have relatively good efficacy in hypertensive patients with obesity, diabetes and impaired cardiac, and renal target organs, especially for hypertensive patients with heart failure, post-myocardial infarction, impaired glucose tolerance, or diabetic nephropathy.

Adverse effects:

• Mainly irritating dry cough and angioedema contraindicated in patients with hyperkalemia, pregnant women, and bilateral renal artery stenosis. Caution is required when using in patients with blood creatinine over 3 mg.

5. Angiotensin II receptor blockers (ARB)

Most of these antihypertensive drugs have the word "sartan" in their trade names. For example: coxsartan, valsartan, irbesartan, irbesartan, temisartan and candesartan.

Efficacy characteristics: 

• These antihypertensive drugs, with increasing doses of antihypertensive effect, few adverse reactions, does not cause irritating dry cough, high compliance with continuous treatment.

Adverse reactions: 

• ARB is the same as ACEI in terms of treatment targets and contraindications and is not only a replacement drug for ACEI adverse reactions, but also has its own efficacy characteristics.

3. 5 suggestions for choose the right blood pressure medicine

1. Choose Blood Pressure Medicine that are not contraindicated

Contraindication refers to the condition that the drug is not suitable for certain diseases, conditions or specific people. For example, "renal artery stenosis" has become a consensus among doctors that "Prilosec" and "Sartan" drugs are contraindicated; "severe sinus bradycardia, atrioventricular block The concept that "beta-blockers" and other such heart-rate slowing drugs are prohibited in patients with "severe sinus bradycardia and atrioventricular block" is well known.

2. Select individualized antihypertensive drugs

I'm afraid we all agree that antihypertensive drugs need to be individualized. For example, for hypertensive patients with a fast heart rate, "beta-blockers" are preferred because they slow down the heart rate, thus slowing down the patient's heart rate while treating hypertension. The selection of medication according to the individual patient can also be targeted to improve other conditions while treating hypertension and avoid adverse side effects!

3. Choose the Blood Pressure Medicine with the least adverse reactions

There are many adverse reactions to hypertension medications, and the reactions are not the same in different people, for example, the adverse reaction of coughing occurs when using "Priligy" type of antihypertensive drugs, but some people are obvious, some are not, and most people do not react. For example, some people may experience flushing, panic attacks, headaches and ankle edema with "diphenhydramine" antihypertensive drugs, so such patients need to choose other drugs with less adverse effects instead.

4. Choose the antihypertensive drug with the best compliance

Compliance is very important because hypertension requires long-term medication, and there is no good compliance if you can't take the medication on time and in sufficient quantity, after all, being able to take the antihypertensive medication on time and in sufficient quantity is the basis for treating hypertension. According to the comprehensive situation of the patient to choose long-acting, simple oral, the number of times a day to take less, reasonably priced antihypertensive drugs.

5. Choose Blood Pressure Medicine that can lower blood pressure smoothly

The so-called stable antihypertensive is to make the blood pressure fall gradually and steadily through the rational use of drugs, so that the body gradually adapts and tolerates it, in order to avoid the symptoms of dizziness and lack of blood supply to the brain caused by too rapid a fall in blood pressure, while keeping the blood pressure at a basic constant level for 24 hours, reducing fluctuations and minimizing the occurrence of various complications.

4. When is the best time to take antihypertensive tablets? 

Blood pressure varies with the time of day. In a normal person, blood pressure is highest in the morning at 8 o'clock and then decreases slowly. It then slowly decreases and then peaks again at about 4:00 pm. 

Therefore, for general hypertension patients, it is recommended that the first blood pressure peak occurs in the morning when the antihypertensive medication is used.

Blood Pressure Medicine is usually taken at 8 a.m. However, because the state of the disease is always varied, there are some patients whose blood pressure is higher in the afternoon, and the blood pressure value of the whole day shows a reverse spoon curve. In this case, the blood pressure medicine should be taken at 4 pm.

It is recommended that patients must make some special adjustments to their medication schedule based on their blood pressure monitoring curve throughout the day. If there are no special circumstances, it is generally recommended to take antihypertensive medication early in the morning, and if there are special circumstances, medication should be administered according to the special circumstances.

Many patients forget to take the medication or take the medication habit, they want to know whether it is okay to take the antihypertensive medication at night again in the end?

It is generally not recommended to take Blood Pressure Medicine before going to bed. 

First of all, taking antihypertensive drugs before going to bed is not in line with our normal physiological rules. When the human body sleeps at night, the blood pressure is usually low. If you take antihypertensive drugs at this time, it is more likely to occur hypotensive events. Once the low blood pressure occurs, but because you can't notice that you have low blood pressure during sleep, then it is likely to cause some adverse events.

Secondly, the body position is changed because, during sleep, the body position is different from the position in daily life. This can affect the blood pressure of hypertensive patients. Therefore, taking antihypertensive drugs before going to bed is likely to cause postural hypotension to occur. Also, because when we get up, the patient is also susceptible to hypotension due to the change in position from doing it lying down. Therefore, it is not recommended that hypertensive patients go to take antihypertensive 

Before using antihypertensive drugs, you should first go to the hospital for a comprehensive examination to understand your health condition and then choose the drug treatment reasonably under the guidance of your doctor.

additional resources

• Patients with hypertension must take their medication on time and in the right amount, but also consciously adjust their lifestyle and diet.

• Patients with hypertension should control their diet as well as regulate their lifestyle, which can be combined with some non-pharmaceutical treatments, such as drinking green tea, which can remove the waste from the blood and blood vessel walls and improve cardiovascular function from the root.

• Develop a good diet, low-fat and low-salt diet, do not stay up late, do not sit still, moderate exercise, etc.

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