Antihypertensive medications are the primary treatment method used to control blood pressure within a safe range, aiming mainly to reduce the risk of complications such as heart disease, stroke, and kidney disease. These drugs work by regulating vascular tone, fluid balance, or the endocrine system to help patients maintain blood pressure within normal limits. Treatment plans are usually personalized based on the patient's age, underlying conditions, and drug tolerance.
Antihypertensive drugs can be divided into five main categories: diuretics (such as furosemide), which reduce blood volume by increasing urine output; calcium channel blockers (such as amlodipine), which relax vascular smooth muscle; beta-blockers (such as metoprolol), which slow heart rate and reduce myocardial contractility; angiotensin-converting enzyme inhibitors (ACEIs, such as enalapril), which block vasoconstrictive substances; and angiotensin receptor blockers (ARBs, such as losartan), which inhibit vasoconstrictive signaling. Different mechanisms can be used alone or in combination to enhance effects.
Emerging drugs like aldosterone antagonists and peripheral adrenergic blockers target the kidneys and sympathetic nervous system for regulation. Physicians select the most suitable drug type based on the patient's medical history; for example, ACEIs or ARBs are often preferred for patients with heart failure.
Mainly used for primary hypertension (over 90% of cases) and secondary hypertension (such as renal artery stenosis). Indications include sustained blood pressure over 140/90 mmHg that is not controlled by medication, or high-risk patients with existing cardiovascular or cerebrovascular lesions. Certain drugs may be designed for specific comorbidities; for instance, ARBs are commonly used in diabetic nephropathy patients to protect renal function.
Most medications are administered orally, with some, like nitroglycerin spray, used for acute relief. Initial doses are usually low, with gradual adjustments every week or two to monitor response. For example, amlodipine may start at 2.5 mg once daily, while diuretics might be discontinued on weekends to avoid electrolyte imbalance. Elderly patients or those with renal impairment should have reduced doses and require regular blood tests to monitor serum electrolytes and creatinine levels.
Long-term regular use helps maintain arterial elasticity and reduces arteriosclerosis progression. New fixed-dose combination drugs (such as amlodipine + valsartan) can improve patient adherence to medication.
Common side effects include dizziness, headache, lower limb edema (especially with CCBs), and long-term use of diuretics may lead to hypokalemia or hyperuricemia. Serious side effects include cough caused by ACEIs, angioedema from ARBs, and potential worsening of peripheral vascular disease with beta-blockers.
Contraindications include allergy to drug components, severe hepatic or renal dysfunction, and pregnancy (especially ACEI/ARB, which may cause fetal malformations). Patients with diabetes should be aware that some drugs may affect blood glucose control; for example, beta-blockers may mask hypoglycemia symptoms.
Avoid concurrent use with non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), which may reduce drug efficacy. Elderly patients over 65 should have dose adjustments due to increased plasma concentrations that can lead to hypotension.
When combined with lipid-lowering drugs (such as statins), monitoring for muscle toxicity is necessary. Co-administration with diabetic medications (such as insulin) may produce synergistic blood pressure lowering effects, requiring dose adjustments. Certain traditional Chinese medicine ingredients like licorice may diminish diuretic effects; patients should disclose all herbal and Western medications used.
Large clinical trials show that regular use of antihypertensive drugs can reduce the risk of heart attack by 25% and stroke by 35%. The 2017 SPRINT study confirmed that controlling blood pressure below 120/80 mmHg further reduces cardiovascular events. Combination therapy (using three drugs) achieves control rates of 60-70% in resistant hypertension cases.
Non-pharmacological treatments include a low-sodium diet (<5 grams daily), aerobic exercise (150 minutes of moderate-intensity activity per week), and alcohol restriction. Other therapies include renal nerve ablation and, for hypertensive patients with obstructive sleep apnea, CPAP therapy can improve blood pressure control.
Patients with moderate to severe hypertension may require both medication and lifestyle modifications, such as combining drugs with the DASH diet plan. New devices like wearable arterial stimulators are in clinical trials but are not yet widely available.
Common side effects may include dizziness, itchy legs, nocturia, or muscle pain. If these occur, record the timing and severity, and inform your doctor during visits. Serious side effects like difficulty breathing or persistent chest pain require immediate medical attention. Your doctor may adjust the medication type or dosage to reduce risks.
Do I need to restrict certain foods or drinks while taking antihypertensive medications?Some drugs (like diuretics) may require increased potassium intake (e.g., bananas, spinach), while beta-blockers may interact with alcohol, worsening dizziness. Avoid high-sodium diets to enhance drug efficacy and refrain from alcohol for at least one hour before or after taking medication. Specific restrictions should be based on the medication type and your doctor's instructions.
Do I need to adjust my exercise routine after starting antihypertensive medication?Regular exercise helps lower blood pressure, but initial medication use may cause rapid blood pressure drops affecting endurance. Choose moderate to low-intensity activities (such as brisk walking or swimming) and avoid sudden intense exercise. Monitor blood pressure before and after exercise; if dizziness or chest discomfort occurs, stop immediately and consult your doctor.
Is it necessary to regularly change medications if I am on long-term antihypertensive therapy?The need for medication adjustment depends on blood pressure control and side effects. Regular check-ups every 3-6 months are recommended. If blood pressure remains high or side effects occur, your doctor may adjust the dose or switch medications. Regular blood tests are essential to ensure liver and kidney functions are compatible with the medications.
Can I reduce my medication dosage on my own if my blood pressure stabilizes?Self-reduction of medication may cause rebound hypertension and increase the risk of cardiovascular events. If you wish to adjust the dose, discuss with your doctor and monitor your blood pressure. Your doctor may gradually reduce the dose once blood pressure is stable, but this should only be done under professional guidance to avoid self-medicating.
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