A drug used for hypertension. Pressure pills: a list of the best drugs, no side effects

High blood pressure does not always have clear-cut symptoms. A sick person can walk without noticing his symptoms, continues to live, getting used to this condition. Increased pressure on the walls of blood vessels causes dangerous complications - heart attack and stroke. It is necessary to carefully consider the first signs of the disease, visit a doctor who will prescribe pills for hypertension. Their task is not to relieve the attack, they do not affect the cause of the disease. Their main goal is to reduce and stabilize pressure. That's what

The main groups of drugs for hypertension

The attending physician selects tablets to lower the pressure for the patient, taking into account his condition. There are several groups of drugs that can regulate blood pressure. All of them operate according to different schemes, have their own characteristics, contraindications, side effects. The tablets should be drunk constantly, regardless of the tonometer readings. They have a peculiarity - they accumulate in the body, have a long-term effect. Many drugs are addictive, so your doctor changes them periodically. If you have hypertension, prepare to drink them for the rest of your life.

Drugs that can regulate pressure solve the main tasks:

• reduce headache;
• prevent nosebleeds;
• remove flies before the eyes;
• prevent kidney failure;
• reduce pain in the heart;
• prevent the risk of stroke, heart attack.

Let's take a closer look at these drugs. The main groups of drugs that solve high blood pressure problems:

• beta blockers;
• alpha blockers;
• calcium antagonists;
• angiotensin 2 antagonists;
• diuretics
• aCE inhibitors.

Beta blockers

Tablets of this group are able to affect the heart rate, reducing it. At the same time, the walls of the vessels relax, the volume of blood entering them in a certain period of time decreases. This leads to a decrease in blood pressure. Prescribe drugs in the presence of concomitant heart diseases: tachycardia, coronary artery disease, rhythm disturbances. Tablets in this group have side effects. It is not advisable to take them in case of complaints of heart pain and seizures. The group includes: "Concor", "Nebivalol", "Metaprolol".

Alpha blockers

Tablets of this group have an antispasmodic effect, dilate blood vessels, relaxing the muscles along them. This helps to reduce pressure. If the drugs are taken separately from diuretics, beta-blockers, swelling and headaches are possible. Alpha blockers are used in severe cases when other drugs are ineffective. The tablets are addictive, capable of provoking an increase in heart rate, hyper hairiness. These drugs include: "Hydralazine", "Minoxidil".

Calcium antagonists

This group of drugs has another name - calcium channel blockers. The tablets interfere with the flow of calcium into the vascular cells, which at the same time expand, and the pressure decreases. Tops the rating of drugs "Nifedipine", which can quickly relieve a hypertensive crisis. With increased pressure, which is accompanied by diseases - arrhythmia, diabetes mellitus, kidney disease, appoint "Verapamil", "Amlodipine". These drugs do not cause lethargy, help to transfer physical activity. Often prescribed to the elderly.

Angiotensin 2 antagonists

For modern drugs of the group, which have minimal side effects, they use another name - sartans. The effect of their use is enhanced when combined with diuretics. Consistent results are visible after just a few weeks. Popular tablets in this group: Lozap, Valz, Losartan. They are not addictive, have a long-term effect - you need to take them once a day. Thanks to their use:

• reduced risk of stroke, heart attack;
• the likelihood of renal failure decreases.

Diuretics (diuretics)

Among pills for hypertension, diuretics are prescribed among the first drugs. They help to remove excess water and salt from the body and reduce swelling. This reduces the volume of blood, less stress on the heart. All this helps to normalize blood pressure. Diuretics are prescribed only by a doctor - this is due to the fact that they remove calcium, potassium and magnesium from the body. They have contraindications for use. Together with diuretics, drugs are prescribed that restore the balance of potassium, calcium and magnesium.

Effective high pressure diuretics:

• "Furosemide", "Diuver" - potent drugs, actively remove calcium and magnesium, are not recommended during pregnancy.
• "Hypotheazid", "Indapamide" - act slowly, have few side effects.
• "Veroshpiron" - has a weak diuretic effect, but is a potassium-sparing drug, helps with the highest, third degree of arterial hypertension.

It is worthwhile to be wary of diuretic pills for hypertension. They are sold without prescriptions, the drugs are cheap, but you need to drink them only as directed and under the supervision of a doctor. This is due to side effects:

• the risk of diabetes increases;
• cholesterol level rises;
• there are problems with potency;
• fatigue becomes higher;
• hormonal disruptions occur;
• loss of consciousness is possible.

Angiotensin Converting Enzyme Inhibitors (ACE)

Such drugs are prescribed to patients with hypertension, who have heart failure and diabetes mellitus, and have coronary heart disease. ACE inhibitors dilate blood vessels, contribute to reduced results of tonometer readings. They reduce the risks of stroke, heart attack, protect the kidneys, and reduce the likelihood of developing diabetes. The drugs have a short duration of action, so they are taken according to the scheme prescribed by the doctor.

These medicines have few side effects. Sometimes there is a dry cough, slight swelling of the face. They should be taken at the dose indicated in the instructions, due to the possibility of a sharp decrease in pressure. Prescribe drugs together with diuretics, calcium antagonists - with this option, a strong therapeutic effect is obtained. ACE inhibitors are often used:

• Enalapril;
• Captopril;
• "Lisinopril";
• Ramipril.

How to choose the right therapy for high blood pressure

Do not self-medicate if you have high blood pressure. In order to choose the right pills for hypertension, it is important to see a doctor. He will find out what your blood pressure is now, what indicators you need to achieve after treatment. This is especially important for the elderly - correctly selected antihypertensive drugs prolong life and improve its quality.

Modern methods of treating hypertension are aimed at reducing and normalizing blood pressure. Only a qualified doctor is able to correctly select, from all the variety, the necessary drugs, taking into account the analyzes, the age of the patient. During the appointment, he:

• learns about concomitant diseases;
• defines contraindications;
• empirically select medicines for pressure;
• prescribe a dosage starting with small values;
• determine the dosage regimen, depending on the duration of the drugs;
• monitor the effectiveness of treatment.

List of the best new generation hypertension drugs

Modern drugs for lowering blood pressure differ in that they have few side effects. The pharmaceutical industry offers the latest developments that have received excellent reviews from doctors. In the list of the new generation of pills for hypertension there are combined drugs that simultaneously have a vasodilator, diuretic and antispasmodic effect: Andipal, Twinsta.

Modern pills for hypertension - new items on the market of pharmacological medications - require mandatory medical supervision. Each group of drugs has innovations:

• calcium antagonists - "Amlodipine", "Riodipin";
• sartans - Valsartan, Cardosal;
• diuretics - "Torasimide", "Rolofilin";
• alpha and beta blockers - Nebivolol, Carvedilol;
• aCE inhibitors - "Enalapril", "Lizinopril" and its analogue - "Dapril".

Fast acting high pressure tablets

How to bring down the pressure if it suddenly rises sharply? For urgent relief of a hypertensive crisis, it is necessary to dissolve the "Nifedipine" tablet under the tongue. The intake of "Kapoten" quickly normalizes blood pressure. It is also placed under the tongue - until it dissolves - the action begins after 10 minutes. It is very important that the pressure drop does not occur very abruptly - otherwise there may be a stroke. If the attack is accompanied by pain in the heart, an ambulance is provided with a "Nitroglycerin" tablet under the tongue. Esmolol helps well with increased heart rate. The newest remedy is also widely recommended

In the medulla oblongata (this is the lowest part of the brain) is vasomotor (vasomotor) center... It has two departments - pressor and depressor, which increase and decrease blood pressure, respectively, acting through the nerve centers of the sympathetic nervous system in the spinal cord. The physiology of the vasomotor center and the regulation of vascular tone is described in more detail here: http://www.bibliotekar.ru/447/117.htm (text from a textbook on normal physiology for medical schools).

The vasomotor center is important for us because there is a group of drugs that act on its receptors and thus lower blood pressure.

Departments of the brain.

Classification of centrally acting drugs

To drugs that primarily affect on sympathetic activity in the brain, relate:

• clonidine (clonidine),
• moxonidine (physiotens),
• methyldopa (can be used in pregnant women),
• guanfacine,
• guanabenz.

In the search for pharmacies in Moscow and Belarus, no methyldopa, guanfacine and guanabenzabut sold clonidine (strictly according to the recipe) and moxonidine.

There is also a central component of action, about them - in the next section.

Clonidine (clonidine)

Clonidine (clonidine) inhibits the secretion of catecholamines by the adrenal glands and stimulates alpha 2 -adrenergic receptors and I 1 -imidazoline receptors of the vasomotor center. It reduces blood pressure (by relaxing blood vessels) and heart rate (heart rate). Clonidine also has hypnotic and analgesic effect.

The scheme of regulation of cardiac activity and blood pressure.

In cardiology, clonidine is used mainly for treatment of hypertensive crises... This drug is adored by criminals and ... retired grandmothers. Attackers like to mix clonidine into alcohol, and when the victim is “cut out” and falls asleep, they rob fellow travelers ( never drink alcohol on the road with unfamiliar people!) This is one of the reasons why clonidine (clonidine) has long been available in pharmacies. exclusively by prescription.

The popularity of clonidine as a remedy for arterial hypertension in grandmothers "clonidine" (who cannot live without taking clonidine, like smokers without a cigarette) is due to several reasons:

1. high efficiency drug. Local doctors prescribe it for the treatment of hypertensive crises, as well as from despair when other drugs are not effective enough or the patient cannot afford it, but something needs to be treated. Clonidine lowers blood pressure even when other drugs are ineffective. Gradually, the elderly develop mental and even physical dependence on this drug.
2. hypnotic (sedative) Effect. Cannot sleep without their favorite medicine. Sedatives are generally popular with people, I previously wrote in detail about.
3. anesthetic the effect also matters, especially in old age, when “ everything hurts».
4. wide therapeutic interval (i.e. a wide range of safe doses). For example, the maximum daily dose is 1.2-2.4 mg, which is as much as 8-16 0.15 mg tablets. Few pills for pressure can be taken with impunity in such quantities.
5. cheapness drug. Clonidine is one of the cheapest drugs, which is of paramount importance for a poor pensioner.

Clonidine is recommended for use only for the treatment of hypertensive crises, for regular intake 2-3 times a day, it is undesirable, since rapid significant fluctuations in blood pressure levels are possible during the day, which can be dangerous for blood vessels. The main side effects: dry mouth, dizziness, and lethargy (not allowed to drivers), development is possible depression (then clonidine should be canceled).

Orthostatic hypotension (lowering blood pressure in an upright position) clonidine does not cause.

Most dangerous side effect of clonidine - withdrawal syndrome... Grandmothers - "klofelinschitsy" take many pills per day, bringing the average daily intake to high daily doses. But since the drug is purely prescription, it will not be possible to create a six-month supply of clonidine at home. If local pharmacies, for some reason, have interruptions in supply of clonidine, these patients develop severe withdrawal symptoms. As with. Absent in the blood, clonidine no longer inhibits the release of catecholamines into the blood and does not lower blood pressure. Patients are worried agitation, insomnia, headache, palpitations, and very high blood pressure... Treatment consists in the introduction of clonidine, and.

Remember! Regular taking clonidine should not stop abruptly... You need to cancel the drug gradually, replacing? - and? -adrenergic blockers.

Moxonidine (Physiotens)

Moxonidine is a modern promising drug that can be briefly called “ improved clonidine". Moxonidine belongs to the second generation of drugs acting on the central nervous system. The drug acts on the same receptors as clonidine (clonidine), but the effect on I 1 - imidazoline receptors it is much more pronounced than the effect on alpha2-adrenergic receptors. Due to the stimulation of I 1 receptors, the release of catecholamines (adrenaline, norepinephrine, dopamine) is inhibited, which lowers blood pressure (blood pressure). Moxonidine long-term maintains a reduced level of adrenaline in the blood. In some cases, like clonidine, in the first hour after ingestion before a decrease in blood pressure, it may increase by 10%, due to stimulation.

In clinical trials Moxonidine reduced the systolic (upper) blood pressure by 25-30 mm Hg. Art. and diastolic (lower) pressure of 15–20 mm without developing drug resistance over 2 years of treatment. The effectiveness of the treatment was comparable to that of a beta blocker atenolol and ACE inhibitors captopril and enalapril.

Antihypertensive effect Moxonidine lasts 24 hours, the drug is taken Once a day... Moxonidine does not increase blood sugar and lipids, and its effect is independent of body weight, gender and age. Moxonidine reduced LVH ( left ventricular hypertrophy), which allows the heart to live longer.

The high antihypertensive activity of moxonidine made it possible to use it for the complex treatment of patients with CHF (chronic heart failure) with II-IV functional class, but the results in the study MOXCON (1999) were depressing. After 4 months of treatment, the clinical study had to be terminated early due to the high mortality rate in the experimental group compared to the control group (5.3% versus 3.1%). Overall mortality increased due to increased rates of sudden death, heart failure, and acute myocardial infarction.

Moxonidine causes fewer side effects compared to clonidinealthough they are very similar. In comparative cross 6-week study of moxonidine with clonidine ( each patient received both compared drugs in a random sequence) side effects led to discontinuation of treatment in 10% of patients receiving clonidine, and only in 1.6% of patientstaking moxonidine. More often disturbed dry mouth, headache, dizziness, tiredness or drowsiness.

Withdrawal syndrome was observed on the first day after discontinuation of the drug in 14% of those who received clonidine, and only in 6% of patients receiving moxonidine.

Thus, it turns out:

• clonidine is cheap but has many side effects
• moxonidine costs much more, but is taken once a day and is better tolerated. It can be prescribed if drugs from other groups are not effective enough or are contraindicated.

Output: if financial situation allows, between clonidine and moxonidine for permanent reception, it is better to choose the latter (1 time per day). Clonidine is taken only in case of hypertensive crises, it is not a drug for every day.

(otherwise called hypertension) is a stable increase in blood pressure figures above 140/90, for no apparent reason. It is one of the most common diseases in the world, especially among our compatriots. We can safely say that after fifty years, almost every citizen of the post-Soviet space suffers from increased pressure. This is explained by overweight, smoking, alcohol abuse, constant stress and other adverse factors. What is most unpleasant in this situation is that hypertension begins to "get younger" - every year more and more cases of high blood pressure are recorded in people of working age, and the number of cardiovascular accidents (myocardial infarctions, strokes) is also increasing, which leads to chronic disability with subsequent disability ... Thus, arterial hypertension is becoming a problem not only medical, but also social.

No, there are, of course, cases when a stable increase in blood pressure numbers becomes a consequence of some primary disease (for example, caused by pheochromocytoma - a neoplasm that affects the adrenal glands and is accompanied by a high release of hormones into the blood that activate the sympathoadrenal system). However, there are very few such cases (no more than 5% of the registered clinical conditions characterized by a stable increase in blood pressure) and it should be noted that the approaches to the treatment of hypertension, both primary and approximately the same. The only difference is that in the second case, it is necessary to eliminate the root cause of this disease. But the normalization of blood pressure figures is just the same carried out according to the same principles, with the same drugs.

Today, the treatment of hypertension with drugs of different groups is practiced.

Medicines

Which are used in the treatment of arterial hypertension, as well as their classification.

Of greater importance for practitioners is the conditional division of antihypertensive drugs into drugs for routine administration and drugs, the action of which allows them to be used as an emergency aid in hypertensive crises.

Angiotensin-converting enzyme (ACE) inhibitors

Medicines belonging to this group are the number one drugs of choice in the treatment of both primary and secondary arterial hypertension. This is mainly due to their protective effect on the vessels of the kidneys. This phenomenon is explained by the mechanism of their biochemical action - under the action of ACE inhibitors, the action of the enzyme that converts angiotensin 1 into its active form angiotensin 2 (a substance that leads to a narrowing of the vascular lumen, thus increasing blood pressure) is slowed down. Naturally, if this metabolic process is medically inhibited, then an increase in blood pressure also does not occur.

Representatives of drugs in this group are:

Ramizes

1. Enalapril (trade name - Berlipril);
2. Lisinopril (trade name - Linotor, Diroton);
3. Ramipril (trade name - Ramizes, Cardipril);
4. Fozinopril;

These drugs are representatives of this pharmacological group, which have found the most widespread use in practical medicine.

In addition to them, there are still a lot of medicines of similar action that have not found such widespread use due to various reasons.

It is important to note one more point - all drugs from the ACE inhibitor group are prodrugs (with the exception of Captopril and Lisinopril). That is, this means that a person uses an inactive form of a pharmacological agent (the so-called prodrug), and already under the influence of metabolites, the drug goes into an active form (becomes a drug), which realizes its therapeutic effect. Captopril and Lisinopril, on the contrary, falling into the body immediately exert their therapeutic effect, in view of the fact that they are already metabolically active forms. Naturally, prodrugs start to act more slowly, but their clinical effects last longer. While Captopril has a faster and at the same time short-term effect.

Thus, it becomes clear that prodrugs (for example, Enalapril or Cardipril) are prescribed for the planned treatment of arterial hypertension, while Captopril is recommended for the relief of hypertensive crises.

The use of ACE inhibitors is contraindicated in pregnant women and during breastfeeding.

Beta-adrenergic blockers

Propranolol

The second most frequently used group of pharmacological preparations. Their principle of action is that they block adrenergic receptors, which are responsible for the realization of the effect of the sympathoadrenal system. Thus, under the influence of drugs of this pharmacological group, there is not only a decrease in blood pressure numbers, but also a decrease in heart rate. It is customary to divide beta-adrenergic receptor blockers into selective and non-selective. The difference between the two groups is that the former only act on beta 1 adrenergic receptors, while the latter block both beta 1 and beta 2 adrenergic receptors. This explains the phenomenon that when using highly selective beta-blockers, asthma attacks do not occur (this is especially important to take into account when treating hypertension in patients with bronchial asthma). It is important to note that when selective beta-blockers are used in high doses, their selectivity is partially lost.

Non-selective beta blockers include Propranolol

To selective - Metoprolol, Nebivolol, Carvedilol.

By the way, these drugs are best used in the event that the patient has a combination of hypertension along with coronary heart disease - both effects of beta-blockers will be in demand.

Slow calcium channel blockers

Another pharmacological group of drugs used to treat hypertension (which is most interesting - in Western countries, these drugs are used only to treat angina pectoris). Similar to beta-blockers, they reduce the pulse and blood pressure numbers, however, the mechanism for implementing the therapeutic effect is somewhat different - it is realized by preventing the penetration of Calcium ions to the smooth myocytes of the vascular wall. Typical representatives of this pharmacological group are amlodipine (used for planned treatment) and (emergency drug).

Diuretics

Diuretics There are several groups:

Indapamide

1. Loop diuretics - Furosemide, Torasemide (Trifas - trade name);
2. Thiazide diuretics - hydrochlorothiazide;
3. Thiazide-like diuretics - Indapamide;
4. Potassium-sparing diuretics - (Spironolactone).

To date, with hypertension, Trifas (from diuretics) is most often used - in view of the fact that it is highly effective and after its use there are not as many side effects as when using Furosemide.

The remaining groups of diuretic drugs are used, as a rule, as auxiliary because of their unexpressed effect, or in general, so that potassium is not washed out of the body (in this case Veroshpiron is ideal).

Sartans

Valsartan

Preparations, in their effect, are similar to angiotensin-converting enzyme inhibitors, with the only difference being that they do not affect the enzyme itself, but its receptors. Used in the event that after using an ACE inhibitor, a cough is observed in the patient.

Examples of drugs for treating hypertension from this group are Losartan, Valsartan.

We should not forget about the old proven tool - magnesium sulfate 25% solution (Magnesia) - an emergency drug for hypertensive crisis, is administered intramuscularly. They should not be constantly treated with GB, but for a one-time reduction in blood pressure - an ideal tool.

conclusions

There are many remedies for the treatment of hypertension and, as a rule, they are used in combination (in the event that resistant hypertension occurs, they often use a combination with second-line drugs).

Suitable groups of drugs are selected by the attending physician based on the patient’s condition, medical history, the presence of combined pathology and many other factors.

Video

Hypertension is one of the most common problems among the elderly. High blood pressure is a violation of the cardiovascular system, which can lead to serious complications and cause premature death. Against the background of hypertension, heart failure, stroke, heart attack and other pathological serious conditions can develop. Pressure in the vessels often provokes the formation of aneurysms and other abnormal phenomena that pose a threat not only to people's health, but also to their lives. Frequent attacks of hypertension force patients to systematically take hypertensive drugs in order to maintain working capacity and their condition is normal.

In the treatment of pathology, various drugs are used that differ in their effect, composition and basic properties. An important place in the complex treatment of high blood pressure is occupied by diuretics.. Let's try to understand what these pharmacological agents are and what is their role in the treatment of hypertension.

Diuretics for hypertension

Preparations of this group are diuretic and are widely used for diseases of the heart and blood vessels, which are accompanied by an increase in blood pressure. These medications are one of the main remedies for treating the disease. Diuretics for hypertension help cleanse the body of excess salt and water, which are excreted from the body with urine.

After a certain time after the start of taking the drugs, the body is mastered, and the process of removing excess fluid occurs naturally. The effect of pressure reduction is also preserved, which in the future is normalized no longer under the influence of diuretics, but against the background of a weakening of blood flow resistance.

There are different types of diuretics and each of them has a different effect on the body and causes certain side effects. However, their inclusion in therapy is more appropriate than treatment with modern drugs that reduce blood pressure, such as ACE inhibitors and calcium antagonists. The use of the latter is accompanied by numerous side effects.

A great advantage of diuretics is their relatively low cost combined with high efficiency.

Diuretics significantly reduce the risk of complications that often occur with hypertension. The risk of myocardial infarction is reduced by 15%, and stroke - by 40%.

Types of Diuretics

1. Thiazide - weakly remove salt and liquid from the body, but are highly effective in reducing blood pressure. This species includes: Hydrochlorothiazide, Chlortiazide, Benzthiazide.
2. Thiazide-like - are analogues of the previous type. Trade names of the drugs: Indapamide, Chlortalidone, Clopamide.
3. Loop - affect the filtration functions of the kidneys. They successfully cope with the task of activating the processes of removing moisture and salt, but at the same time they cause numerous adverse reactions from the body systems. Loop diuretics are represented by such drugs: Torasemide, Furasemide, Ethacrine acid.
4. Preserving potassium - affect renal nephrons, contributing to the release of sodium and chloride from the body. At the same time, such drugs interfere with the active elimination of potassium, due to which the drugs got their name. This type of diuretics includes: Triamteren, Amiloride, Spironolactone.
5. Aldosterone antagonists are drugs for hypertension, which differ in their action from the rest, since pressure reduction does not occur by removing fluid, but by blocking the release of aldosterone, a hormone that helps retain moisture and salt in the body.

In the treatment of hypertension are mainly used thiazide and thiazide-like types of diuretics that combine with the use of other drugs for high blood pressure. In those cases when therapy is ineffective and a hypertensive crisis develops with all the ensuing complications, loop diuretics are prescribed for patients.

Treatment features

Diuretics for hypertension are used in small doses, but in long courses. If patients do not experience improvement, and jumps in blood pressure continue as before, then correction of therapy is carried out. It is not recommended to increase the daily rate of diuretic drugs, since such a measure will not help to cope with hypertension, but can lead to serious consequences.

Taking diuretics in high doses leads to the development of diabetes mellitus, as well as to an increase in blood cholesterol. Therefore, it is advisable not to increase the dosage of drugs, but to replace them with more powerful diuretics, and supplement with other agents for the treatment of hypertension.

Diuretics, as a rule, are not prescribed for young people who have high blood pressure. Also, drugs of this group are contraindicated for hypertensive patients suffering from diabetes and obesity. At the discretion of the doctor, patients may be prescribed diuretics Indapamide and Torasemide. These two types of drugs have a minimum of contraindications and side effects, therefore they do not cause undesirable metabolic phenomena in the body.

What medications are used for hypertension?

Health Pharmacology

The development of drugs for hypertension has been going on for several decades. But even today, medicine and pharmacology are still faced with the acute problem of developing new, more effective and safe means of reducing and controlling pressure.

Today there is a wide range of such drugs, but they all differ in the type of exposure, effectiveness, indications and contraindications. An important role is played by their cost.

Therefore, for each patient, the doctor selects an individual regimen for the medical treatment of hypertension, based primarily on the reasons that caused it.

People have been struggling with high blood pressure for many years.

The main groups of drugs for hypertension

Hypertension is an extremely complex and multifaceted disease, the cause of which can be a variety of factors. Therefore, in each individual case, the doctor selects drugs from the corresponding group. The most commonly used categories are:

Diuretics

An extensive group of diuretics that allow you to remove excess fluid from the body, reducing the load on the heart and blood vessels. But they can be used only if there are no diseases of the kidneys, diabetes, obesity. They are often prescribed for older people suffering from hypertension. This group includes Arifon, Triamtaren, Indap, Indapamide.

Calcium antagonists

These drugs partially block calcium channels, providing a vasodilating effect. They are recommended if, at the same time as hypertension, there are vascular diseases, but are contraindicated for people who have had myocardial infarction. They are quite safe, and can be used during pregnancy and lactation. This group is extremely extensive, in the first place it includes Kalchek, Blockalcin, Cordipine, Cordaflex, Lomir, Lacipin, Felodip and so on.

ACE inhibitors

These drugs reduce the production of angiotensin-converting enzyme, which stimulates vasoconstriction. They are very effective, well tolerated by patients with hypertension, have a beneficial effect on the cardiovascular system. They are often recommended after a myocardial infarction, as well as with high blood pressure against diabetes mellitus. The most popular drugs of the group: Acetene, Kapoten, Monopril, Enap, Ednit, Dapril, Accupro, Gopten.

A medicine that relieves pressure should be selected by a doctor

Beta adrenergic blockers

They reduce heart rate and decrease their strength. They have a wide range of uses and can be recommended for angina pectoris, tachycardia, after a heart attack, against a background of heart failure. Nevertheless, they should not be prescribed to patients with diseases of the respiratory system and blood vessels. The most common representatives of the group: Metacard, Nebilet, Atenolol, Betak, Serdol, Metocard, Egilok.

Selective Imidazoline Receptor Agonists

The group of these drugs not only reduces pressure, but also reduces appetite, which makes them especially effective in the treatment of hypertension against the background of obesity. The group includes Zint, Albarel, Physiotens.

Angiotensin II Receptor Antagonists

In their effect, they are similar to ACE inhibitors and are able to replace it in case of intolerance or in case of other contraindications. But they are used infrequently due to the high cost. Representatives of this group: Diovan, Cozaar, Atakand, Teveten, Aprovel.

These are far from all groups of drugs used to treat hypertension, but they are most often recommended. Of course, they are presented for information only. Buying and starting to take something on your own is strictly prohibited, since only a doctor, and only after consultation and examination, will be able to choose the most effective and safe tool and draw up a scheme for taking it.

It must be understood that most drugs have an effect only during administration, without affecting the causes of hypertension. Therefore, it is necessary to treat this disease in a comprehensive manner, using both medication and non-medication.

Emergency Pressure Relief Medicines

All of the above medicines are taken in long courses as part of the comprehensive treatment of hypertension. At the same time, sometimes a situation arises when the pressure needs to be reduced urgently. Most often this occurs during a hypertensive crisis, when blood pressure for a short period of time becomes much higher than the working area. In such cases, the following tactics are recommended:

1. Drink a sedative: motherwort, valerian, peony root extract.

2. Put 1-2 tablets of nitroglycerin under the tongue.

3. Take a tablet of the drug for emergency pressure reduction: Captopril, Nifedepine, Clonidine.

In people prone to increased pressure, these drugs should always be on hand in case of a hypertensive crisis. But after the first emergency actions it is necessary to call an ambulance and continue treatment already under the supervision of a doctor.

The use of the drug Valsacor for arterial hypertension: the results of a Slovenian multicenter study

Ostroumova O.D. Guseva T.F. Shorikova E.G.

Currently for treatment arterial hypertension (AH) recommended five major classes of antihypertensive preparations. angiotensin converting enzyme inhibitors, angiotensin 1 receptor blockers (ARBs), calcium antagonists, b-blockers, diuretics.

To choose the drug many factors influence, the most important of which are: the presence of risk factors in the patient, target organ damage, associated diseases, kidney damage, diabetes mellitus, metabolic syndrome, concomitant diseases in which the appointment or limitation is necessary application antihypertensive preparations various classes, previous individual patient reactions to preparations various classes (pharmacological history), the likelihood of interaction with drugs that are prescribed to the patient for other reasons, as well as socio-economic factors, including the cost of treatment.

When choosing an antihypertensive the drug first of all, it is necessary to evaluate its effectiveness, the likelihood of side effects and the benefits of the drug in a particular clinical situation. The Russian recommendations for the diagnosis and treatment of hypertension specifically emphasizes that the cost of the drug should not be the main deciding factor.

Based on the results multicenter randomized research. it can be assumed that none of the main classes of antihypertensive drugs has a significant advantage in terms of reducing arterial pressure (BP). At the same time, in each specific clinical situation, it is necessary to take into account the peculiarities of the action of various antihypertensive drugs found during randomized research .

ARBs have proven themselves to slow the rate of progression of lesions of target organs and the possibility of regressing their pathological changes. They proved to be effective in reducing the severity of left ventricular myocardial hypertrophy, including its fibrous component, as well as significantly reducing the severity of microalbuminuria, proteinuria and preventing a decrease in renal function.

In recent years, indications for application ARBs have expanded significantly. Previous ones (nephropathy in type 2 diabetes mellitus, diabetic microalbuminuria, proteinuria, left ventricular myocardial hypertrophy, cough when taking ACE inhibitors) were supplemented with such items as chronic heart failure, myocardial infarction, atrial fibrillation, metabolic syndrome and diabetes mellitus.

Currently, several ARBs are used or undergoing clinical trials in world medical practice - valsartan, irbesartan, candesartan, losartan, telmisartan, eprosartan, zolarsartan, tazosartan, olmesartan (olmesartan, zolarsartan and tazosartan have not yet been registered in Russia). Different sartans differ in the set of indications for their application (Fig. 1), which is due to the degree of knowledge of the clinical efficacy of drugs in the corresponding large research.

Valsartan is one of the most studied ARBs. More than 150 clinical trials research with the study of more than 45 points of performance evaluation. The total number of patients included in the clinical research. reaches 100 thousand of which more than 40 thousand are included in research studies of morbidity and mortality. The effect of valsartan on patient survival and survival without cardiovascular complications was studied in a number of large randomized multicenter Research: VALUE, Val-HeFT, VALIANT, JIKEI Heart.

The antihypertensive effect of valsartan and other angiotensin II antagonists is due to a decrease in total peripheral vascular resistance due to the elimination of the pressor (vasoconstrictive) effect of angiotensin II, a decrease in sodium reabsorption in the renal tubules, and a decrease in the activity of the renin-angiotensin-aldosterone system and the mediator nervous system. Antihypertensive effect with prolonged application stable, as it is also due to the regression of pathological remodeling of the vascular wall. The effectiveness of the original valsartan in hypertension, its good tolerance and safety during prolonged application fully confirmed in a large number of clinical studies.

All of the above effects of angiotensin II are somehow involved in the regulation of blood pressure in the norm, as well as in maintaining it at a pathologically high level in hypertension. Selective blockade of AT1 receptors allows to reduce the pathologically increased tone of the vascular wall, promotes regression of myocardial hypertrophy and improves diastolic function of the heart, reducing the rigidity of the myocardial wall in patients with hypertension.

There is a strict correlation between the level of blood pressure and the likelihood of a stroke or coronary events. Although the activity of RAAS can be more or less successfully controlled with ACE inhibitors, the blockade of the action of angiotensin II at the receptor level, as suggested, can have several advantages compared with ACE inhibitors - this is a blockade of the effect of angiotensin II regardless of its origin, the absence of "slipping effect" , as well as the absence of influence on the degradation of bradykinin and prostaglandins.

In hypertension, valsartan is prescribed once at a dose of 80-320 mg per day; hypotensive effect is dose-dependent. The drug is rapidly absorbed from the gastrointestinal tract, the peak concentration in plasma is reached approximately 2-4 hours after ingestion. The antihypertensive effect is manifested within 2 hours in most patients after a single dose of the drug. The maximum decrease in blood pressure develops after 4-6 hours. After taking the drug, the duration of the hypotensive effect lasts more than 24 hours. With repeated use, the maximum decrease in blood pressure, regardless of the dose taken, is usually achieved within 2-4 weeks and is maintained at the achieved level during prolonged therapy. The stability of the effect is due to the strength of the connection between valsartan and AT1 receptors, as well as a long half-life (about 9 hours). At the same time, the normal circadian rhythm of blood pressure is maintained. In randomized trials, it was shown that the hypotensive effect of valsartan persists with prolonged use - for 1 year, 2 or more years.

In 2008, Russia registered one of the first generic valsartan preparations - Valsacor manufactured by KRKA (Slovenia). First of all, it was proved that Valsacor bioequivalent to the original valsartan (Fig. 2).

However, any generic must have research that examined the clinical effects of this particular drug, and not just the concentration in the blood of healthy volunteers. For antihypertensive drugs, this is at least an effect on blood pressure. Unfortunately, only a few generic medicines can boast of this.

Therefore, deserve special attention results recently ended multicenter research conducted by our slovenian colleagues. The aim of this study was to evaluate the efficacy and safety of valsartan (Valsacor) in patients with mild to moderate hypertension. The total number of patients was 1119 people (53% of men, 44% of women, average age 63.5 ± 11.7 years). Of these, 174 patients (15.5%) had not previously received antihypertensive therapy, and 944 patients (84.4%) had already received antihypertensive drugs. Patients who received therapy before inclusion in the study most often received enalapril (20.4%), ramipril (13.5%), valsartan (11.3%), indapamide (7.9%) and perindopril (7.5 %). Since the 24-hour effect of valsartan was proven, patients received 40, 80, 160 or 320 mg of valsartan (Valsacor®, Krka) once a day and were examined 3 times over 3 months. At the first visit and two visits, blood pressure was measured in dynamics, information on tolerability was collected, and the effectiveness of therapy was evaluated at the end of the observation period.

Initially, before appointment Valsacore. Blood pressure averaged 155.4 mmHg. for systolic blood pressure (SBP) and 90.9 mmHg for diastolic blood pressure (DBP) (Fig. 3). Within a month, the GARDEN reached 142.6 mm Hg. and DBP also decreased to 84.9 mmHg. At the third visit, a further decrease in blood pressure was noted, and the average SBP was 136.4 mm Hg. Art. and DBP 81.6 mmHg In general, the average decrease in SBP was 19 mm RT. Art. (12.2%), DBP - 9.3 mmHg (-10.2%). All these changes were statistically significant.

Over the entire observation period, 52 adverse reactions were observed in 42 patients (3.8%) out of a total of 1119 patients. The following side effects were most commonly observed: headache (15 patients, 1.3%), dizziness (8 patients, 0.7%) and fatigue (4 patients, 0.4%). Cough was registered in 3 patients (0.3%). 13 patients (1.2%) discontinued therapy due to adverse reactions.

By the end of the study, 64% of patients had blood pressure lower than 140/90 mm Hg. and had no adverse reactions (clinical evaluation of the treatment is “excellent”) (Fig. 4); 20% of patients reached blood pressure levels of less than 140/90 mm Hg. and had unexpressed adverse reactions (clinical evaluation of the treatment is “very good”); in 8% of patients, SBP decreased by at least 10 mmHg. and DBP, at least 5 mm RT. Art. without manifestation of unwanted adverse reactions (clinical evaluation of the treatment is “good”) (Fig. 4). The remaining patients reached the target blood pressure levels and had moderate or serious adverse reactions (evaluated as “satisfactory” or “unsatisfactory”).

Received in the result of this study, the data allowed the authors to conclude that Valsacor & reg ; It is an effective and safe antihypertensive drug for the treatment of patients with mild to moderate hypertension.

Appearance Valsacore in Russia, ARB treatment will be made more accessible to a wide range of patients, which will increase the effectiveness of treatment of hypertension and reduce cardiovascular and cerebrovascular morbidity and mortality.

Literature

1. Diagnosis and treatment arterial hypertension Russian recommendations (third revision). Cardiovascular Therapy and Prevention - 2008 - No. 6 (Appendix 2) - Page 3-32.

2. A study of the effectiveness and safety of valsartan (Valsacor) in the treatment of patients with mild to moderate hypertension. Own data of Krka, New Location, 2009.