Hypertension, of course, cannot be treated casually. In fact, no disease can be treated casually. Eating the wrong medication will not cure the disease; rather, it can worsen the condition.
1. Not all cases of hypertension require medication to control blood pressure
For newly diagnosed stage 1 hypertension, which is not above 160/100 and is not accompanied by diabetes or cardiovascular diseases, medication may not be necessary temporarily. Blood pressure can be managed initially through healthy lifestyle choices such as low-salt diet, weight management, regular exercise, and adequate rest to lower blood pressure. A significant number of individuals can achieve normal blood pressure through these methods and may not need medication.
It could be excessive to start medication at this stage. If after 3 months blood pressure remains elevated, then it is advisable to start taking antihypertensive medication.
2. There are various types of antihypertensive drugs, and it is important to choose the appropriate one under medical guidance
The common classes of antihypertensive drugs include calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, diuretics, beta-blockers, and others; there are hundreds of variations. Each type of medication has different mechanisms, strengths, and side effects. Therefore, it is not advisable to randomly choose and start taking any antihypertensive drug once high blood pressure is detected, as it does not guarantee normalizing the blood pressure.
At times, a certain antihypertensive drug may not be suitable or may cause side effects, or its effectiveness may be inadequate, or it may not be compatible with other existing health conditions. All these factors need to be considered before beginning antihypertensive medication.
3. Monitoring drug side effects is crucial
Common antihypertensive drugs have side effects. Before taking such medication, it’s impossible to predict if one would experience side effects. Hence, it is essential to be aware of the common side effects of the chosen antihypertensive drug and monitor oneself for any adverse reactions. If any side effects occur, immediate consultation with a physician is necessary to find appropriate solutions or consider changing the medication.
Calcium channel blockers: Common adverse reactions include facial flushing, headache, increased heart rate, nausea, low blood pressure, gingival hypertrophy, etc.;
Low blood pressure often arises from excessive dosage or when combined with other antihypertensive drugs; peripheral edema is a common adverse effect, mainly seen in the ankles or hands;
ACE inhibitors: Common adverse effects include dry cough, vascular edema, low blood pressure, renal impairment, hyperkalemia, with occasional occurrences of headache, dizziness, fatigue, nausea, hair loss, decreased sexual function, cholestatic jaundice, acute pancreatitis, muscular cramps, etc.;
Angiotensin receptor blockers: Adverse effects include elevated blood potassium and creatinine levels, with lower incidences compared to ACE inhibitors. They can cause teratogenic effects, thus contraindicated in pregnant women; prohibited in bilateral renal artery stenosis.
Diuretics: Side effects may include low blood potassium, magnesium, hyperuricemia, impaired glucose tolerance, and insulin resistance.
Beta-blockers: Side effects may involve bradycardia, nausea, vomiting, mild diarrhea, digestive symptoms, rash, thrombocytopenia, allergic reactions, conduction block, acute heart failure, exacerbation of bronchial asthma, fatigue, insomnia, depression, and male sexual dysfunction.
4. Combination therapy requires expertise
For most individuals with high blood pressure, a single antihypertensive drug may not suffice to normalize blood pressure. At this point, increasing the dosage of one type of antihypertensive drug is not the solution; combining different antihypertensive drugs is recommended.
However, not all combinations of antihypertensive drugs are suitable. For instance, ACE inhibitors and angiotensin receptor blockers are considered within the same class of drugs; hence, they should not be used together, i.e., one should not take both an ACE inhibitor and an angiotensin receptor blocker simultaneously.
Common combination therapy regimens:
Step 1: Low-dose ACE Inhibitor/Angiotensin Receptor Blocker + Calcium Channel Blocker;
Step 2: Full-dose ACE Inhibitor/Angiotensin Receptor Blocker + Calcium Channel Blocker;
Step 3: Adding a diuretic on top of ACE Inhibitor/Angiotensin Receptor Blocker + Calcium Channel Blocker;
Step 4: ACE Inhibitor/Angiotensin Receptor Blocker + Calcium Channel Blocker + Diuretic + Spironolactone.
5. Combining medications for co-occurring conditions requires specialized antihypertensive drug selection
Hypertension may not always be isolated but can often be accompanied by heart disease, kidney disease, diabetes, or if not controlled promptly, could lead to coronary heart disease, heart failure, arrhythmias, kidney disease, etc. Choosing antihypertensive drugs in such cases becomes crucial, as most medications not only lower blood pressure but also have other significant effects.
Hypertension + Diabetes: ACE Inhibitors or Angiotensin Receptor Blockers are preferred;
Hypertension + Coronary Heart Disease: Prefer ACE Inhibitors or Angiotensin Receptor Blockers, for rapid heartbeat select beta-blockers;
Hypertension + Angina: Prefer Verapamil or beta-blockers;
Hypertension + Myocardial Infarction: Prefer ACE Inhibitor and beta-blockers, or certain types of angiotensin receptor blockers (Valsartan, Candesartan, Losartan);
Hypertension + Heart Failure: Prefer ACE Inhibitor and beta-blockers, or certain types of angiotensin receptor blockers (Valsartan, Candesartan, Losartan);
Hypertension + Rapid Arrhythmia: Prefer beta-blockers;
Hypertension + Impaired Kidney Function: Initially, focus on ACE Inhibitors or Angiotensin Receptor Blockers, though with deteriorating kidney function, using ACE Inhibitors or ARBs may become challenging.
Therefore, while hypertension may require medication, it does not always necessitate antihypertensive drugs. And even if medication is needed, selection, administration, and monitoring entail a complex, professional approach.
For matters requiring expertise, always consult a professional and avoid casual medication.
