Hypertension is a common disease, and the widespread use of antihypertensive drugs is crucial for effectively controlling blood pressure. However, there are many types of antihypertensive drugs, which can be classified into several categories based on their mechanisms of action. Choosing the right medication has become a highly discussed topic.
Currently, one of the most widely used antihypertensive drugs in clinical practice belongs to the “dihydropyridine” class, with a particular emphasis on amlodipine and nifedipine.
Why do dihydropyridine antihypertensive drugs stand out among many competitors?
Dihydropyridine antihypertensive drugs have some unique advantages. Compared to other antihypertensive drugs, they typically exhibit the following advantages:
Suitable for elderly hypertensive patients: Dihydropyridine drugs show good adaptability in elderly hypertensive patients.
Improves myocardial ischemia: These drugs not only help dilate blood vessels but also improve myocardial ischemia, making them suitable for patients with angina pectoris.
No impact on glucose and lipid metabolism: Unlike some other antihypertensive drugs, dihydropyridine drugs do not have a negative impact on sugar and lipid metabolism, making them suitable for patients with diabetes.
No interaction with other drugs: When taken alongside certain other drugs (such as nonsteroidal anti-inflammatory drugs), dihydropyridine drugs do not reduce their effectiveness.
Relatively safe: When taken correctly, these drugs do not pose a risk to pregnant women and fetuses, making them a safer choice for hypertensive pregnant women.
What are the differences between amlodipine and nifedipine?
Both nifedipine and amlodipine belong to the dihydropyridine class of antihypertensive drugs, also known as calcium channel blockers. They have similar mechanisms of action but still have some differences. Here are their main characteristics:
Nifedipine:
Fast onset, short duration of action: Nifedipine acts quickly, but its effects last relatively briefly. As a result, patients may experience blood pressure fluctuations and often need to take it three times a day or more. Suitable populations: Nifedipine is commonly used to treat hypertension and angina pectoris. Pregnant and lactating women can use it under medical guidance. Precautions: The common dosage form is extended-release nifedipine tablets, which must be swallowed whole and should not be chewed, bitten, or split in half to avoid affecting its effectiveness. Additionally, it should be avoided to take it in conjunction with certain drugs like grapefruit, diltiazem, simvastatin, amiodarone, and verapamil, to prevent serious adverse reactions. Attention for heart failure patients: Nifedipine may worsen heart failure; therefore, heart failure patients are advised to choose other drugs, such as amlodipine.
Amlodipine:
Slow onset, long duration of action: Amlodipine has a relatively slow onset, typically requiring 1-2 weeks of medication for stable blood pressure reduction. It has a steady effect, making blood pressure fluctuations less likely, usually requiring only once-daily dosing. Suitable populations: Amlodipine is commonly used to treat hypertension, stable and variant angina. Pregnant and lactating women are generally not recommended to use it and should decide after consulting with a doctor. Precautions: It should not be used in combination with drugs like amiodarone and diltiazem to avoid increased adverse reactions.
In summary, nifedipine may be more effective in emergency situations, while amlodipine shows better performance in daily blood pressure control. However, the specific choice still needs to be based on individual circumstances and medical advice, as blind use is not recommended.
What are the common side effects of dihydropyridine antihypertensive drugs?
1. Edema: This is one of the common side effects of dihydropyridine drugs. These drugs dilate the peripheral blood vessels in the lower extremities, which may cause edema, especially concentrated in the ankles, feet, and lower legs. For mild edema, consider combining with ACE inhibitors, ARBs, or adding low-dose diuretics to alleviate symptoms. If the edema is severe, it may be necessary to consider switching to other types of antihypertensive drugs.
2. Headache: The strong dilation of peripheral blood vessels by dihydropyridine drugs may cause some patients to experience symptoms like headaches, head fullness, and facial flushing. Mild headaches can continue medication, but if the pain is severe, consider switching medications.
3. Palpitations: Some patients may experience tachycardia due to a drop in blood pressure. In such cases, consider using beta-blockers based on individual conditions to lower heart rate and myocardial contractility, reducing palpitation symptoms.
4. Constipation: Dihydropyridine drugs can also cause constipation due to their effects on calcium ion transport in the smooth muscles of the intestines. Generally, constipation is not severe. If constipation is more pronounced, consider switching to other antihypertensive drugs.
In addition, some other less common side effects include gingival hyperplasia, hypotension, dizziness, nausea, fatigue, facial flushing, etc. These reactions can usually be relieved through control and do not pose significant harm to patients. It is important to note that the appearance of side effects may vary due to individual differences. Therefore, when taking antihypertensive drugs, it is best to follow the advice of a physician and closely monitor one’s own reactions.
How to reduce side effects? Recommended combination therapy
Combination therapy is a common strategy used to more effectively manage hypertension, reduce the side effects of single drugs, and improve treatment outcomes. Here are some common combination therapy regimens, some of which are considered highly effective combinations:
1. ARBs/ACE inhibitors + long-acting dihydropyridine: This is a complementary combination therapy regimen. Long-acting dihydropyridine antihypertensive drugs can dilate arterial blood vessels, have diuretic and sodium-depleting effects, enhancing the antihypertensive effects of ARBs or ACE inhibitors. Moreover, ARBs reduce the ankle edema issue caused by long-acting dihydropyridines by dilating veins. This combination therapy regimen is suitable for hypertensive patients, especially those with a history of myocardial infarction, coronary artery surgery, or unstable angina symptoms.
2. Long-acting dihydropyridine + beta-blockers: Dihydropyridine antihypertensive drugs can offset the increase in peripheral vascular resistance caused by beta-blockers by dilating blood vessels, reducing vascular resistance, and promoting sodium excretion. Beta-blockers can offset the sympathetic nervous system excitation caused by dihydropyridine antihypertensive drugs by reducing the heart’s contractility and heart rate. This combination therapy regimen is suitable for hypertensive patients, especially those with angina symptoms.
Dihydropyridine antihypertensive drugs are among the most commonly used drugs in hypertension treatment. However, their use requires caution, as misuse can lead to various adverse reactions. Therefore, to ensure safety, it is recommended to consult a healthcare professional and follow medical advice when taking medication to better control high blood pressure.
