Hypertension has a relatively high incidence rate among adults in our country, exceeding 20%. There is a belief circulating among friends with hypertension, saying: “Try not to take medication when blood pressure is high; once you start taking antihypertensive drugs, you can’t stop.”
Friends with some medical knowledge know that this belief is not scientifically proven, but it still prevails among the population. What’s more worrying is that many friends with hypertension believe in this belief, some even regretting it only after experiencing a stroke. Today, let’s talk about it. Is it true that once you start taking antihypertensive drugs, you can’t stop?
To clarify this issue, we first need to have a certain understanding of the causes of hypertension.
What causes hypertension?
The main feature of hypertension is a chronic disease characterized by elevated arterial blood pressure. The incidence rates vary among different countries and ethnicities. There are many factors that contribute to hypertension, especially the interaction of genetic and environmental factors, leading doctors to consider hypertension as a non-uniform heterogeneous disease.
Simply put, although all present as high blood pressure, the reasons for elevated blood pressure are different. The common causes of hypertension include:
Genetic factors: Hypertension shows significant familial clustering; if both parents are hypertensive, the probability of children developing hypertension is as high as 46%. Among individuals with hypertension, around 60% have a family history of hypertension.
Environmental factors include diet: The prevalence of hypertension among different populations in various regions is significantly correlated with salt intake. Excessive salt intake leads to elevated blood pressure, mainly seen in salt-sensitive individuals. Excessive intake of saturated fatty acids in food is also a significant factor causing elevated blood pressure. Alcohol consumption is linearly related to blood pressure levels, especially with a stronger correlation with elevated systolic pressure. Psychological factors: Studies have found that the prevalence of hypertension is higher among mental laborers in urban areas than physical laborers; those engaged in occupations with high mental stress are more likely to develop hypertension; living in noisy environments with significant hearing loss also correlates with hypertension. Rest can lead to some improvement in symptoms and blood pressure in these patients. Smoking: Smoking can increase blood pressure by stimulating the sympathetic nervous system and impairing vascular dilation function, leading to increased blood pressure.
Other factors include obesity: Weight gain is an important risk factor for hypertension, and the type of obesity is closely related to hypertension occurrence. Obesity can be classified into central obesity and peripheral obesity. Central obesity, also known as abdominal obesity, is characterized by fat mainly distributed in the abdomen, hence called apple-shaped physique. Peripheral obesity refers to fat predominantly distributed subcutaneously, with a more prominent buttocks and thighs, hence called pear-shaped physique. Among these types of obesity, individuals with central obesity are more prone to hypertension. Medications: The occurrence and severity of hypertension in women taking oral contraceptives are related to the duration of medication. Hypertension induced by oral contraceptives is generally mild and reversible; blood pressure usually returns to normal 3-6 months after discontinuing the medication. Other factors such as ephedrine, corticosteroids, nonsteroidal anti-inflammatory drugs, licorice, etc., can also increase blood pressure. Sleep apnea syndrome: It refers to recurrent cessation of breathing during sleep, which is not uncommon in the population, especially among male friends. About 50% of these friends have hypertension, with the degree of blood pressure elevation related to the duration and severity of sleep apnea.
Secondary hypertension refers to elevated blood pressure caused by certain specific diseases or causes, common examples being renal parenchymal hypertension, renal vascular hypertension, primary aldosteronism, pheochromocytoma, Cushing’s syndrome, and aortic stenosis.
From these causes of hypertension, we can see that antihypertensive drugs do not worsen the condition of hypertension. The essential role of antihypertensive drugs is to reduce blood pressure, so how can they cause an increase in blood pressure?
Many friends may raise the question: Does long-term use of antihypertensive drugs lead to dependency?
Does long-term use of antihypertensive drugs lead to dependency?
Drug dependence, also known as drug addiction, is a mental state caused by the interaction of drugs with the body, sometimes including physical conditions, manifesting as compulsive behavior of continuous or regular drug use and other reactions. Sometimes, to avoid discomfort caused by drug withdrawal, tolerance may or may not develop. Users can develop dependence on one or more drugs.
Antihypertensive drugs do not lead to dependence; currently, there is no literature reporting that hypertensive patients develop dependence on antihypertensive drugs once used. Although antihypertensive drugs can control blood pressure within the normal range, it does not imply that the body develops dependence or addiction to the medication.
Using or injecting antihypertensive drugs does not lead to discomfort in the body after stopping the medication or create a psychological craving state, so theoretically, antihypertensive drugs do not lead to dependency.
What some friends may refer to as dependency may be that some drugs cannot be stopped once started. In such cases, using the drug for long-term blood pressure control is necessary but that does not qualify as dependency.
This is somewhat different from the scientific clinical concept. Since hypertension is a lifelong disease, often requiring lifelong medication, this only involves treatment compliance and persistence mentioned rather than dependency.
Friends should note that antihypertensive drugs only control symptoms but cannot cure hypertension fundamentally. Currently, there is no medication that can completely cure hypertension.
The five main classes of antihypertensive drugs commonly used clinically are diuretics, beta-blockers (such as metoprolol), calcium channel blockers (such as amlodipine), angiotensin-converting enzyme inhibitors (such as enalapril), and angiotensin receptor blockers (such as losartan).
In the early stages of hypertension, single drug therapy is usually preferred. A 2010 survey results showed that among patients on monotherapy, a majority favored amlodipine-type antihypertensive drugs at 53.4%, followed by enalapril type at 19.1%, losartan type at 10.1%, diuretics at 9.5%, and metoprolol type at 7.9%.
It’s important to note that the most commonly used antihypertensive drug isn’t always the best; different antihypertensive drugs are suitable for different hypertensive patients.
Furthermore, the use of antihypertensive drugs is closely related to regional economic level, community, medical institution grade, doctors’ knowledge level, and drug use habits. The higher prevalence of amlodipine-type drugs is due to the high incidence of hypertension in the elderly population, where amlodipine-type antihypertensive drugs have unique effectiveness. Thus, the utilization rate is higher than other types of antihypertensive drugs.
Conclusion:
Among friends with hypertension, the belief that “antihypertensive drugs cannot be taken; once taken, they cannot be stopped” is clearly unscientific. Antihypertensive drugs do not worsen the condition of hypertension, and taking them does not lead to dependency. Hypertension is a chronic disease, and antihypertensive drugs can effectively control the progression of hypertension and prevent complications. Therefore, friends with hypertension should believe in science, adhere to medication when necessary, and not shy away from seeking medical advice. Regretting after complications occur will be too late.
That concludes our discussion today. If you found this helpful, please follow me for the latest medical knowledge in the country. I am Dr. Zhang, until next time.
References:
[1] Wang Z, Wang X, Chen Z, et al. Hypertension Control in Community Health Centers Across China: Analysis of Antihypertensive Drug Treatment Patterns[J]. Am J Hypertens, 2014,27(2):525-259.
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