Mr. Liu has been suffering from hypertension and recently found that his blood pressure was not well controlled while using amlodipine. His neighbor, who is also a hypertensive patient, is using nitrendipine and has good control over the condition. Mr. Liu asked the doctor if he could switch to nitrendipine, but his request was declined.
Mr. Liu was puzzled because both are antihypertensive medications, so why can others use it well but not him? The doctor explained that although both are used for treating hypertension, the choice of medication needs to be individualized.
Currently, commonly used antihypertensive drugs in clinical practice are divided into five categories, including ACE inhibitors, angiotensin II receptor blockers, beta-blockers, calcium channel blockers, and diuretics.
1. ACE inhibitors:
ACE inhibitors such as benazepril, fosinopril, captopril, enalapril, and ramipril lower blood pressure by inhibiting the production of angiotensin-converting enzyme. The main advantage is the ability to reduce urinary protein, slow down kidney damage, and have beneficial effects on uric acid, lipids, and glucose metabolism. Therefore, these drugs are suitable for patients with hypertension combined with diabetes and kidney disease.
2. Angiotensin II receptor blockers:
The mechanism of action of angiotensin II receptor blockers is similar to ACE inhibitors. Main drugs include candesartan, eprosartan, and losartan. The advantage is the absence of cough side effects, with other side effects similar to ACE inhibitors.
3. Beta-blockers:
Beta-blockers such as metoprolol, bisoprolol, and carvedilol lower blood pressure by slowing heart rate and reducing myocardial contraction. The advantage of this class of drugs is the ability to reduce the overall mortality of heart failure, alleviate arrhythmias, and have good effects on hypertension caused by anxiety and psychological factors.
4. Calcium channel blockers:
Calcium channel blockers, commonly known as dihydropyridines, include nitrendipine, nifedipine, and amlodipine. They work by blocking calcium ion channels to dilate blood vessels and reduce myocardial oxygen consumption. These drugs are powerful and safe, suitable for hypertensive patients with other underlying conditions.
5. Diuretics:
Diuretics are the earliest antihypertensive drugs, mainly including hydrochlorothiazide and indapamide, which lower blood pressure by excreting sodium from the body. The action of these drugs is slow and steady, and they are effective for patients with edema and heart failure.
How to choose antihypertensive drugs?
In specific selection, hypertensive patients should consider their own actual situation comprehensively. Ideal antihypertensive drugs should not only have good antihypertensive effects and long duration but also have fewer side effects, no harm to the liver and kidneys, and do not interfere with the treatment of other diseases. Each person’s physiological characteristics and conditions are different, so choosing the appropriate antihypertensive drugs is crucial.
The optimal timing for taking antihypertensive drugs varies depending on the type of drug and should be arranged rationally based on the time of peak blood pressure. Since blood pressure peaks in the morning from 6-10 a.m. and in the evening from 4-8 p.m., medication is best taken within these time periods.
Antihypertensive drugs taken once a day:
For those requiring once-daily antihypertensive medication, such as sustained-release nitrendipine tablets, indapamide, enalapril, it is best to take them around 7 a.m. This can effectively control blood pressure and avoid discomfort during peak periods.
Antihypertensive drugs taken twice a day:
For antihypertensive drugs that need to be taken twice a day, it is recommended to take them in the morning at 7 a.m. and in the afternoon at 4 p.m. Avoiding before bedtime is to prevent low blood pressure and reduce the occurrence of complications such as cerebral thrombosis, angina, and myocardial infarction.
Taking medication at the right time helps improve the effectiveness of antihypertensive drugs, ensuring effective control of blood pressure and reducing potential risks. When taking antihypertensive drugs, it is best to adjust under the advice of a doctor to ensure a rational and effective treatment plan.
Hypertension is a chronic disease that accompanies individuals for life, so long-term, active, and regular medication is the best way to control blood pressure and prevent complications. Some patients stop taking medication after their blood pressure decreases, but this is irresponsible to their health.
According to international hypertension guidelines, patients with stage 1 hypertension (140-159/90-99 mmHg) and stage 2 hypertension (BP ≥ 160/100 mmHg) require long-term and compliant drug therapy. Stopping medication without authorization during treatment can lead to unstable blood pressure, thereby inducing complications and causing damage to target organs.
Most hypertensive patients usually need to take medication for life unless specific circumstances arise where stopping antihypertensive drugs could be considered:
– Secondary hypertension: including hypertension caused by pregnancy, highly stressful situations, or certain inflammatory conditions. After removing the inducing factors, the blood pressure can return to normal, and antihypertensive drugs can be discontinued.
– Effective lifestyle interventions: if hypertension is caused by poor lifestyle habits such as obesity, high-sodium diet, excessive alcohol consumption, correcting these factors may lower blood pressure to normal levels, leading to a possible discontinuation of medication.
– Developing severe diseases resulting in hypotensive states: in cases of acute myocardial infarction, acute pulmonary embolism, critical illnesses, hypotension might occur, requiring the discontinuation of antihypertensive drugs.
However, any decision to stop medication should be made under the guidance of a doctor to ensure a rational and effective treatment plan. Abruptly stopping antihypertensive drugs may lead to rebound hypertension and increase the risk of cardiovascular events.
