Which new generation antihypertensive drug is better? What effect can be expected from antihypertensive drugs? List of effective latest generation products

Arterial hypertension is one of the most common types of pathologies of the cardiovascular system, which is getting younger every year. Lack of timely treatment of the disease leads to premature wear of the heart and blood vessels, resulting in the development of complications dangerous to life and health: cardiac ischemia, strokes, heart attacks, hypertensive crises and even death.

In order not to bring your body to a “borderline” state in the bad sense of the word, you need a comprehensive, regular intake of medications. Modern drugs provide the best results in the fight against hypertension.

Modern medications for blood pressure

Treatment of hypertension is complex. To achieve the desired effect, a diverse effect on the patient’s body is required. For this purpose, the patient is prescribed new generation medications.

They are perfectly adapted to the conditions in which the modern patient is being treated, and are maximally improved, due to which they have the ability to act quickly.

The listed drugs are among the popular medications used by modern doctors in the fight against hypertension. In addition to the type of effect, all new generation drugs used to treat hypertension can also be divided into some other categories.

Centrally acting drugs

Blood pressure never rises for no reason. Elevated numbers on the tonometer scale are a consequence of disturbances in the functioning of individual organ systems.

The drug Clonidine

One of the most important regulators of blood pressure is the sympathetic nervous system. Pathologies in its functioning can lead to sudden jumps or persistently elevated blood pressure.

To eliminate this pathology, centrally acting drugs are used, which reduce sympathetic impulses to the heart and blood vessels. The active substances inhibit the vasomotor center, resulting in a decrease in blood pressure.

Centrally acting drugs include the following drugs:

• Clonidine;
• Hemiton;
• Catapresan;
• Clonidine;
• other drug options.

Most centrally acting drugs have a fairly “powerful” composition, so they can cause not only side effects, but also withdrawal symptoms.

To prevent this from happening, you must take medications from this category exclusively under the supervision and as prescribed by your doctor.

Combination drugs

These are new generation products that contain 2-3 active substances. Due to this feature, drugs in this group have a longer period of influence on the body, so they are taken once a day.

Medicines that can be classified as combination medications include:

• Lorista N or Lozap plus;
• Renipril GT;
• Tonorma;
• Noliprel;
• Exforge;
• other drugs.

The prolonged action of combined drugs requires careful monitoring of the patient's condition in the first days of use.

Overdose and independent increase in the volume of the drug used are unacceptable. Such actions can lead to a sharp drop in blood pressure and worsening of the condition.

Antihypertensive drugs

A separate group of antihypertensive drugs that give a good effect include medications that can act directly on the walls of blood vessels - myotropic and neurotropic - eliminating spasm of the smooth muscles of the body tissues and relaxing the blood vessels.

Nitroglycerin tablets

Such medications contribute to a rapid decrease in indicators. Only the attending physician should prescribe the drug, determine its dosage and duration of use, based on test results, the severity of the disease and the patient’s state of health.

Myotropic antihypertensive drugs include Nitroglycerin, Sodium Nitroprusside, Minoxidil and others. The group of neurotropic drugs includes Clonidine and many other drugs.

Supplements for high blood pressure

Dietary supplements or dietary supplements are another effective remedy that can give a good effect in the fight against hypertension.

Dietary supplement Lecithin

Such drugs contain substances of natural origin, the action of which is aimed at normalizing the functioning of the heart and blood vessels, as well as restoring normal blood pressure levels.

Dietary supplements are consumed during meals, adding them to regular food. The dietary supplement does not spoil the taste of the main products and at the same time has a positive effect on the condition of the body.

The positive properties of dietary supplements include:

• removal of salts and excess fluid;
• lowering sugar levels;
• maintaining liver and kidney function;
• burning excess fat reserves;
• normalization of metabolic processes;
• neutralization and subsequent removal of cholesterol deposits from the body.

Depending on the composition, dietary supplements may also differ in other beneficial properties.

In order for the dietary supplement to give the desired effect, it is necessary to follow the diet prescribed for hypertensive patients: eat less salty, spicy, sweet, fried and fatty foods, opting for cereals, vegetables, fruits, low-fat dairy products and lean meats and fish.

1. Cardiol. The dietary supplement is indicated for people with hypertension, as well as athletes. Helps avoid the development of atherosclerosis. It is not recommended to take during pregnancy, lactation, or in childhood;
2. Hypertol. The drug is taken for no more than 1 month. The drug has a powerful diuretic effect, due to which a rapid decrease in blood pressure is possible;
3. Batenin. This is a dietary supplement, the main ingredient of which is beets. The product is used for preventive purposes. Patients of any age can use dietary supplements;
4. Lecithin. The additive is used for preventive purposes. The product can be used even by patients who do not have pathologies in the functioning of the heart and blood vessels. The dietary supplement helps remove excess cholesterol from the blood, resulting in a decrease in blood pressure;
5. milk thistle oil. The product allows you to prevent the development of sclerotic processes inside the vessels. This effect is possible due to the presence of fat-soluble vitamins, flavonoids, silymarin, biogenic amines and other ingredients in the dietary supplement. The dietary supplement is obtained from plant raw materials that have undergone cold pressing, which allows preserving the natural beneficial properties of the plant.

Video on the topic

List of latest generation antihypertensive drugs in the video:

Treatment of hypertension is a long, complex process that must be managed by the attending physician. The success of therapeutic measures depends on the patient’s timely contact with a specialist, as well as on how seriously the patient follows the recommendations issued by the doctor.

The newest - a list of the latest generation of antihypertensive drugs - recommendations, tips, videos

The information on the website is for reference and general information, collected from publicly available sources and cannot serve as a basis for making a decision on the use of medications in the course of treatment.

Article update 01/30/2019

Arterial hypertension(AH) in the Russian Federation (RF) remains one of the most significant medical and social problems. This is due to the widespread prevalence of this disease (about 40% of the adult population of the Russian Federation has high blood pressure), as well as the fact that hypertension is the most important risk factor for major cardiovascular diseases - myocardial infarction and cerebral stroke.

Constant persistent increase in blood pressure (BP) up to 140/90 mm. rt. Art. and higher- a sign of arterial hypertension (hypertension).

Risk factors contributing to the manifestation of arterial hypertension include:

• Age (men over 55, women over 65)
• Smoking
• sedentary lifestyle,
• Obesity (waist circumference more than 94 cm for men and more than 80 cm for women)
• Familial history of early cardiovascular disease (men under 55 years of age, women under 65 years of age)
• The value of pulse blood pressure in the elderly (the difference between systolic (upper) and diastolic (lower) blood pressure). Normally it is 30-50 mmHg.
• Fasting plasma glucose 5.6-6.9 mmol/l
• Dyslipidemia: total cholesterol more than 5.0 mmol/l, low-density lipoprotein cholesterol 3.0 mmol/l or more, high-density lipoprotein cholesterol 1.0 mmol/l or less for men, and 1.2 mmol/l or less for women, triglycerides more than 1.7 mmol/l
• Stressful situations
• alcohol abuse,
• Excessive salt intake (more than 5 grams per day).

The development of hypertension is also promoted by diseases and conditions such as:

• Diabetes mellitus (fasting plasma glucose 7.0 mmol/l or more with repeated measurements, as well as postprandial plasma glucose 11.0 mmol/l or more)
• Other endocrinological diseases (pheochromocytoma, primary aldosteronism)
• Diseases of the kidneys and renal arteries
• Taking medications and substances (glucocorticosteroids, non-steroidal anti-inflammatory drugs, hormonal contraceptives, erythropoietin, cocaine, cyclosporine).

Knowing the causes of the disease, you can prevent the development of complications. Elderly people are at risk.

According to the modern classification adopted by the World Health Organization (WHO), hypertension is divided into:

• 1st degree: Increased blood pressure 140-159/90-99 mm Hg
• 2nd degree: Increased blood pressure 160-179/100-109 mm Hg
• 3rd degree: Increase in blood pressure to 180/110 mmHg and higher.

Blood pressure readings obtained at home can be a valuable addition to monitoring the effectiveness of treatment and are important in identifying hypertension. The patient’s task is to keep a diary of self-monitoring of blood pressure, where blood pressure and pulse values ​​are recorded when measured at least in the morning, at lunch, and in the evening. It is possible to make comments on lifestyle (getting up, eating, physical activity, stressful situations).

Blood pressure measurement technique:

• Quickly inflate the cuff to a pressure level 20 mmHg above systolic blood pressure (SBP) when the pulse disappears
• Blood pressure is measured with an accuracy of 2 mmHg
• Reduce cuff pressure at a rate of approximately 2 mmHg per second
• The pressure level at which the 1st sound appears corresponds to SBP
• The pressure level at which sounds disappear corresponds to diastolic blood pressure (DBP)
• If the tones are very weak, you should raise your hand and perform several squeezing movements with the hand, then repeat the measurement, but do not squeeze the artery too much with the membrane of the phonendoscope
• During the initial measurement, blood pressure is recorded in both arms. In the future, the measurement is carried out on the arm on which the blood pressure is higher
• In patients with diabetes mellitus and in those receiving antihypertensive drugs, blood pressure should also be measured after 2 minutes of standing.

Patients with hypertension experience pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, possible pain in the heart, and blurred vision.
The disease is complicated by hypertensive crises (when blood pressure rises sharply to high numbers, frequent urination, headache, dizziness, palpitations, and a feeling of heat occur); impaired renal function - nephrosclerosis; strokes, intracerebral hemorrhage; myocardial infarction.

To prevent complications, patients with hypertension need to constantly monitor their blood pressure and take special antihypertensive drugs.
If a person is bothered by the above complaints, as well as blood pressure 1-2 times a month, this is a reason to contact a therapist or cardiologist, who will prescribe the necessary examinations and subsequently determine further treatment tactics. Only after carrying out the necessary set of examinations can we talk about prescribing drug therapy.

Self-prescription of medications can lead to the development of unwanted side effects, complications and can be fatal! It is prohibited to independently use medicines on the principle of “helping friends” or resort to the recommendations of pharmacists in pharmacy chains!!! The use of antihypertensive drugs is possible only as prescribed by a doctor!

The main goal of treating patients with hypertension is to minimize the risk of developing cardiovascular complications and death from them!

1. Lifestyle change measures:

• To give up smoking
• Normalization of body weight
• Consumption of alcoholic beverages less than 30 g/day of alcohol for men and 20 g/day for women
• Increasing physical activity - regular aerobic (dynamic) exercise for 30-40 minutes at least 4 times a week
• Reducing table salt consumption to 3-5 g/day
• Changing your diet with an increase in the consumption of plant foods, an increase in the diet of potassium, calcium (found in vegetables, fruits, grains) and magnesium (found in dairy products), as well as a decrease in the consumption of animal fats.

These measures are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow you to: lower blood pressure, reduce the need for antihypertensive drugs, and have a beneficial effect on existing risk factors.

2. Drug therapy

Today we will talk about these drugs - modern drugs for the treatment of arterial hypertension.
Arterial hypertension is a chronic disease that requires not only constant monitoring of blood pressure, but also constant use of medications. There is no course of antihypertensive therapy; all drugs are taken indefinitely. If monotherapy is ineffective, drugs are selected from various groups, often combining several drugs.
As a rule, the desire of a patient with hypertension is to purchase the strongest, but not expensive, drug. However, it is necessary to understand that this does not exist.
What medications are offered for this purpose to patients suffering from high blood pressure?

Each antihypertensive drug has its own mechanism of action, i.e. influence one or another "mechanisms" of increased blood pressure :

a) Renin-angiotensin system- the kidneys produce the substance prorenin (with a decrease in pressure), which passes into the blood into renin. Renin (a proteolytic enzyme) interacts with the blood plasma protein angiotensinogen, resulting in the formation of the inactive substance angiotensin I. Angiotensin, when interacting with angiotensin-converting enzyme (ACE), is converted into the active substance angiotensin II. This substance increases blood pressure, constricts blood vessels, increases the frequency and strength of heart contractions, excites the sympathetic nervous system (which also leads to increased blood pressure), and increases the production of aldosterone. Aldosterone promotes sodium and water retention, which also increases blood pressure. Angiotensin II is one of the most powerful vasoconstrictor substances in the body.

b) Calcium channels of the cells of our body- calcium in the body is in a bound state. When calcium enters the cell through special channels, a contractile protein, actomyosin, is formed. Under its influence, the blood vessels narrow, the heart begins to contract more strongly, the pressure rises and the heart rate increases.

c) Adrenoreceptors- In our body, in some organs there are receptors, the irritation of which affects blood pressure. These receptors include alpha-adrenergic receptors (α1 and α2) and beta-adrenergic receptors (β1 and β2). Stimulation of α1-adrenergic receptors leads to an increase in blood pressure, α2-adrenergic receptors - to a decrease in blood pressure. α-adrenergic receptors are located in arterioles. β1-adrenergic receptors are localized in the heart, in the kidneys, their stimulation leads to an increase in heart rate, an increase in myocardial oxygen demand and an increase in blood pressure. Stimulation of β2-adrenergic receptors located in the bronchioles causes dilation of the bronchioles and relief of bronchospasm.

d) Urinary system- as a result of excess water in the body, blood pressure increases.

e) Central nervous system- stimulation of the central nervous system increases blood pressure. The brain contains vasomotor centers that regulate blood pressure levels.

So, we have looked at the main mechanisms of increasing blood pressure in the human body. It's time to move on to blood pressure lowering agents (antihypertensives), which affect these same mechanisms.

Classification of drugs for arterial hypertension

1. Diuretics (diuretics)
2. Calcium channel blockers
3. Beta blockers
4. Agents acting on the renin-angiotensin system
   1. Angiotensin receptor blockers (antagonists) (sartans)
5. Neurotropic agents of central action
6. Drugs acting on the central nervous system (CNS)
7. Alpha blockers

1. Diuretics (diuretics)

As a result of the removal of excess fluid from the body, blood pressure decreases. Diuretics prevent the reabsorption of sodium ions, which as a result are excreted and carry water with them. In addition to sodium ions, diuretics flush out potassium ions from the body, which are necessary for the functioning of the cardiovascular system. There are potassium-sparing diuretics.

Representatives:

• Hydrochlorothiazide (Hypothiazide) - 25 mg, 100 mg, included in combination preparations; Long-term use at a dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes!
• Indapamide (Arifonretard, Ravel SR, Indapamide MV, Indap, Ionic retard, Acripamidretard) - most often the dosage is 1.5 mg.
• Triampur (a combined diuretic containing potassium-sparing triamterene and hydrochlorothiazide);
• Spironolactone (Veroshpiron, Aldactone). It has a significant side effect (in men it causes the development of gynecomastia and mastodynia).
• Eplerenone (Inspra) - often used in patients with chronic heart failure, does not cause the development of gynecomastia and mastodynia.
• Furosemide 20 mg, 40 mg. The drug is short but fast acting. Inhibits the reabsorption of sodium ions in the ascending limb of the loop of Henle, proximal and distal tubules. Increases the excretion of bicarbonates, phosphates, calcium, magnesium.
• Torsemide (Diuver) – 5 mg, 10 mg, is a loop diuretic. The main mechanism of action of the drug is due to the reversible binding of torasemide to the sodium/chlorine/potassium ion contransporter located in the apical membrane of the thick segment of the ascending limb of the loop of Henle, as a result of which the reabsorption of sodium ions is reduced or completely inhibited and the osmotic pressure of intracellular fluid and water reabsorption are reduced. Blocks myocardial aldosterone receptors, reduces fibrosis and improves myocardial diastolic function. Torasemide causes hypokalemia to a lesser extent than furosemide, but it is more active and its action is longer lasting.

Diuretics are prescribed in combination with other antihypertensive drugs. The drug indapamide is the only diuretic used independently for hypertension.
Rapid-acting diuretics (furosemide) are not advisable to use systematically for hypertension; they are taken in emergency conditions.
When using diuretics, it is important to take potassium supplements in courses of up to 1 month.

2. Calcium channel blockers

Calcium channel blockers (calcium antagonists) are a heterogeneous group of drugs that have the same mechanism of action, but differ in a number of properties, including pharmacokinetics, tissue selectivity, and effect on heart rate.
Another name for this group is calcium ion antagonists.
There are three main subgroups of AAs: dihydropyridine (the main representative is nifedipine), phenylalkylamines (the main representative is verapamil) and benzothiazepines (the main representative is diltiazem).
Recently, they have been divided into two large groups depending on their effect on heart rate. Diltiazem and verapamil are classified as so-called “rhythm-slowing” calcium antagonists (non-dihydropyridine). The other group (dihydropyridine) includes amlodipine, nifedipine and all other dihydropyridine derivatives that increase or do not change the heart rate.
Calcium channel blockers are used for arterial hypertension, coronary heart disease (contraindicated in acute forms!) and arrhythmias. For arrhythmias, not all calcium channel blockers are used, but only pulse-lowering ones.

Representatives:

Pulse reducers (non-dihydropyridine):

• Verapamil 40 mg, 80 mg (extended: Isoptin SR, Verogalid EP) - dosage 240 mg;
• Diltiazem 90 mg (Altiazem RR) - dosage 180 mg;

The following representatives (dihydropyridine derivatives) are not used for arrhythmia: Contraindicated in acute myocardial infarction and unstable angina!!!

• Nifedipine (Adalat, Cordaflex, Cordafen, Cordipin, Corinfar, Nifecard, Phenigidine) - dosage 10 mg, 20 mg; NifecardXL 30mg, 60mg.
• Amlodipine (Norvasc, Normodipin, Tenox, Cordi Cor, Es Cordi Cor, Cardilopin, Kalchek,
• Amlotop, Omelarcardio, Amlovas) - dosage 5 mg, 10 mg;
• Felodipine (Plendil, Felodip) - 2.5 mg, 5 mg, 10 mg;
• Nimodipine (Nimotop) - 30 mg;
• Lacidipine (Latsipil, Sakur) - 2 mg, 4 mg;
• Lercanidipine (Lerkamen) - 20 mg.

Side effects of dihydropyridine derivatives include swelling, mainly lower extremities headache, redness of the face, increased heart rate, and increased urination. If swelling persists, it is necessary to replace the drug.
Lerkamen, which is a representative of the third generation of calcium antagonists, due to its higher selectivity to slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.

3. Beta blockers

There are drugs that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other drugs selectively block only the beta receptors of the heart - selective action. All beta blockers interfere with the synthesis of prorenin in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels dilate, blood pressure decreases.

Representatives:

• Metoprolol (Betalok ZOK 25 mg, 50 mg, 100 mg, Egilok retard 25 mg, 50 mg, 100 mg, 200 mg, Egilok S, Vasocardin retard 200 mg, Metocard retard 100 mg);
• Bisoprolol (Concor, Coronal, Biol, Bisogamma, Cordinorm, Niperten, Biprol, Bidop, Aritel) - most often the dosage is 5 mg, 10 mg;
• Nebivolol (Nebilet, Binelol) - 5 mg, 10 mg;
• Betaxolol (Lokren) - 20 mg;
• Carvedilol (Carvetrend, Coriol, Talliton, Dilatrend, Acridiol) - mainly dosage 6.25 mg, 12.5 mg, 25 mg.

Drugs in this group are used for hypertension combined with coronary heart disease and arrhythmias.
Short-acting drugs, the use of which is not rational for hypertension: anaprilin (obzidan), atenolol, propranolol.

Main contraindications to beta blockers:

• bronchial asthma;
• low pressure;
• sick sinus syndrome;
• pathology of peripheral arteries;
• bradycardia;
• cardiogenic shock;
• atrioventricular block of the second or third degree.

4. Drugs acting on the renin-angiotensin system

The drugs act on different stages of angiotensin II formation. Some inhibit (suppress) angiotensin-converting enzyme, others block the receptors on which angiotensin II acts. The third group inhibits renin and is represented by only one drug (aliskiren).

Angiotensin-converting enzyme (ACE) inhibitors

These drugs prevent the conversion of angiotensin I to active angiotensin II. As a result, the concentration of angiotensin II in the blood decreases, blood vessels dilate, and pressure decreases.
Representatives (synonyms are indicated in brackets - substances with the same chemical composition):

• Captopril (Capoten) - dosage 25 mg, 50 mg;
• Enalapril (Renitek, Berlipril, Renipril, Ednit, Enap, Enarenal, Enam) - dosage is most often 5 mg, 10 mg, 20 mg;
• Lisinopril (Diroton, Dapril, Lysigamma, Lisinoton) - dosage is most often 5 mg, 10 mg, 20 mg;
• Perindopril (Prestarium A, Perineva) - Perindopril - dosage 2.5 mg, 5 mg, 10 mg. Perineva – dosage 4 mg, 8 mg;
• Ramipril (Tritace, Amprilan, Hartil, Pyramil) - dosage 2.5 mg, 5 mg, 10 mg;
• Quinapril (Accupro) - 5mg, 10mg, 20mg, 40mg;
• Fosinopril (Fosicard, Monopril) - in a dosage of 10 mg, 20 mg;
• Trandolapril (Hopten) - 2 mg;
• Zofenopril (Zocardis) - dosage 7.5 mg, 30 mg.

The drugs are available in different dosages for the treatment of varying degrees of increased blood pressure.

A feature of the drug Captopril (Capoten) is that, due to its short duration of action, it is rational only for hypertensive crises.

A prominent representative of the group, Enalapril and its synonyms are used very often. This drug does not have a long duration of action, so it is taken 2 times a day. In general, the full effect of ACE inhibitors can be observed after 1-2 weeks of drug use. In pharmacies you can find a variety of generics (analogues) of enalapril, i.e. Cheaper enalapril-containing drugs produced by small manufacturers. We discussed the quality of generics in another article, but here it is worth noting that generic enalapril is suitable for some, but does not work for others.

ACE inhibitors cause a side effect - dry cough. In cases of cough development, ACE inhibitors are replaced with drugs from another group.
This group of drugs is contraindicated during pregnancy and has a teratogenic effect in the fetus!

Angiotensin receptor blockers (antagonists) (sartans)

These drugs block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels dilate, and blood pressure decreases

Representatives:

• Losartan (Cozaar 50 mg, 100 mg; Lozap 12.5 mg, 50 mg, 100 mg; Lorista 12.5 mg, 25 mg, 50 mg, 100 mg; Vasotens 50 mg, 100 mg);
• Eprosartan (Teveten) - 400 mg, 600 mg;
• Valsartan (Diovan 40mg, 80mg, 160mg, 320mg; Valsacor 80mg, 160mg, 320mg, Valz 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; Valsafors 80mg, 160mg);
• Irbesartan (Aprovel) - 150 mg, 300 mg;
  Candesartan (Atacand) - 8 mg, 16 mg, 32 mg;
  Telmisartan (Micardis) - 40 mg, 80 mg;
  Olmesartan (Cardosal) - 10 mg, 20 mg, 40 mg.

Just like its predecessors, it allows you to evaluate the full effect 1-2 weeks after the start of administration. Does not cause dry cough. Should not be used during pregnancy! If pregnancy is detected during treatment, antihypertensive therapy with drugs of this group should be discontinued!

5. Centrally acting neurotropic agents

Centrally acting neurotropic drugs affect the vasomotor center in the brain, reducing its tone.

• Moxonidine (Physiotens, Moxonitex, Moxogamma) - 0.2 mg, 0.4 mg;
• Rilmenidine (Albarel (1mg) - 1mg;
• Methyldopa (Dopegit) - 250 mg.

The first representative of this group is clonidine, which was previously widely used for hypertension. This drug is now available strictly by prescription.
Currently, moxonidine is used both for emergency treatment of hypertensive crisis and for planned therapy. Dosage 0.2 mg, 0.4 mg. The maximum daily dosage is 0.6 mg/day.

6. Drugs acting on the central nervous system

If hypertension is caused by prolonged stress, then drugs that act on the central nervous system are used (sedatives (Novopassit, Persen, Valerian, Motherwort, tranquilizers, sleeping pills).

7. Alpha blockers

These agents attach to alpha adrenergic receptors and block them from the irritating effects of norepinephrine. As a result, blood pressure decreases.
The representative used - Doxazosin (Cardura, Tonocardin) - is often available in dosages of 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many alpha blocker drugs have been discontinued.

Why do you take several medications at once for arterial hypertension?

In the initial stage of the disease, the doctor prescribes one drug, based on some research and taking into account the patient’s existing diseases. If one drug is ineffective, other drugs are often added, creating a combination of blood pressure-lowering drugs that target different mechanisms of blood pressure lowering. Combination therapy for refractory (stable) arterial hypertension can combine up to 5-6 drugs!

Drugs are selected from different groups. For example:

• ACE inhibitor/diuretic;
• angiotensin receptor blocker/diuretic;
• ACE inhibitor/calcium channel blocker;
• ACE inhibitor/calcium channel blocker/beta blocker;
• angiotensin receptor blocker/calcium channel blocker/beta blocker;
• ACE inhibitor/calcium channel blocker/diuretic and other combinations.

There are combinations of drugs that are irrational, for example: beta blockers/calcium channel blockers, pulse-lowering drugs, beta blockers/central acting drugs and other combinations. It is dangerous to self-medicate!!!

There are combination drugs that combine in 1 tablet components of substances from different groups of antihypertensive drugs.

For example:

• ACE inhibitor/diuretic
  • Enalapril/Hydrochlorothiazide (Co-Renitec, Enap NL, Enap N,
  • Enap NL 20, Renipril GT)
  • Enalapril/Indapamide (Enzix duo, Enzix duo forte)
  • Lisinopril/Hydrochlorothiazide (Iruzid, Lisinoton, Liten N)
  • Perindopril/Indapamide (NoliprelA and NoliprelAforte)
  • Quinapril/Hydrochlorothiazide (Accusid)
  • Fosinopril/Hydrochlorothiazide (Fosicard N)
• angiotensin receptor blocker/diuretic
  • Losartan/Hydrochlorothiazide (Gizaar, Lozap plus, Lorista N,
  • Lorista ND)
  • Eprosartan/Hydrochlorothiazide (Teveten plus)
  • Valsartan/Hydrochlorothiazide (Co-diovan)
  • Irbesartan/Hydrochlorothiazide (Co-aprovel)
  • Candesartan/Hydrochlorothiazide (Atacand Plus)
  • Telmisartan / HCTZ (Micardis Plus)
• ACE inhibitor/calcium channel blocker
  • Trandolapril/Verapamil (Tarka)
  • Lisinopril/Amlodipine (Equator)
• angiotensin receptor blocker/calcium channel blocker
  • Valsartan/Amlodipine (Exforge)
• calcium channel blocker dihydropyridine/beta blocker
  • Felodipine/metoprolol (Logimax)
• beta blocker/diuretic (not recommended for diabetes and obesity)
  • Bisoprolol/Hydrochlorothiazide (Lodoz, Aritel plus)

All drugs are available in different dosages of one and another component; the dose must be selected for the patient by the doctor.

Achieving and maintaining target blood pressure levels requires long-term medical supervision with regular monitoring of the patient’s compliance with recommendations for lifestyle changes and compliance with prescribed antihypertensive drugs, as well as adjustment of therapy depending on the effectiveness, safety and tolerability of treatment. During dynamic monitoring, the establishment of personal contact between the doctor and the patient and patient education in schools for patients with hypertension, which increases the patient’s adherence to treatment, are crucial.

Be healthy!

Article update 01/30/2019

CardiologistZvezdochetovaNatalya Anatolyevna

Combined antihypertensive drugs

S. Yu. Shtrygol, Doctor of Medical Sciences, Professor,
E. A. Gaidukova, pharmacist, National Pharmaceutical University, Kharkov

The unfavorable trend of decreasing life expectancy of the population in Ukraine is largely due to the high mortality rate from diseases of the cardiovascular system, among which the most important position is occupied by arterial hypertension. This is due to several reasons: insufficient detection of diseases characterized by high blood pressure (BP) hypertension, symptomatic arterial hypertension; poor awareness of patients that they have high blood pressure (approximately every third patient does not know about this); lack of practical consideration of risk factors, primary and secondary prevention on a population scale; often an inadequate choice of pharmacotherapy and therefore its insufficient effectiveness. Even in countries with a high level of healthcare organization, the rate of adequate control of arterial hypertension does not exceed 27%. In Ukraine, unfortunately, it is much lower.

According to the criteria of the World Health Organization and the International Society of Hypertension, arterial hypertension is defined as a condition in which systolic blood pressure is 140 mmHg. Art. or higher and/or diastolic blood pressure 90 mm Hg. Art. or higher in individuals not receiving antihypertensive therapy.

Large-scale studies have been conducted around the world that have made it possible to develop new classifications of arterial hypertension. Target levels of blood pressure reduction during antihypertensive therapy were determined, and stratification of risk levels for developing cardiovascular complications in patients was carried out. The principles of non-drug and drug therapy are formulated. The basis of treatment of arterial hypertension is pharmacotherapy. Until recently, a stepwise approach prevailed in the choice of treatment tactics for arterial hypertension, when, if the effect of monotherapy was insufficient, the dose of the drug was increased or moved to the next stage of treatment, adding another antihypertensive drug to the drug used. Today, based on the results of large multicenter studies, maximum individualization of antihypertensive pharmacotherapy is recommended. It has been shown that the least number of complications (acute cerebrovascular accidents, myocardial infarction, renal failure, circulatory disorders in the retina with decreased vision, etc.) occurs in patients with a diastolic pressure level not higher than 83 mm Hg. Art., achieved during treatment. After all, it is not the increased blood pressure value in itself that is dangerous (it is aimed at ensuring blood supply to various organs and tissue metabolism in changed circulatory conditions - during stressful maladaptation of the cardiovascular system, remodeling of the vascular wall, etc.). The danger comes primarily from the already mentioned progressive changes in target organs, especially hypertrophied myocardium (ischemia), brain (stroke), and kidneys (chronic renal failure).

The modern arsenal of drugs provides many opportunities for both monotherapy and combination antihypertensive treatment. An analysis of literature data shows that approximately 70% of patients require combination treatment; in a significantly smaller number of patients, monotherapy has a sufficient effect.

Effective blood pressure control, improvement of the condition of target organs, and increased quality of life are best achieved through the use of combination pharmacotherapy. The most convenient are official combination drugs. Their advantages are quite obvious:

• the combination of two or more components allows you to simultaneously influence different parts of the pathogenesis of the disease (for example, the activity of the renin-angiotensin-aldosterone and sympathoadrenal systems; calcium-dependent mechanisms of contraction of vascular and myocardial muscles, reducing vasoconstriction, and the state of the excretory function of the kidneys, which reduces sodium and water retention in the body), ultimately increasing the efficiency and reliability of blood pressure control;
• the combination of different mechanisms of action has a beneficial effect on the condition of target organs and prevents cerebrovascular and cardiac complications;
• components of combination drugs are used in moderate doses, which usually means that treatment is well tolerated, minimal side effects and their mutual leveling;
• the use of combination drugs is more convenient, since there is no need to evaluate the compatibility of components and take 23 drugs at the same time; In addition, as a rule, combination drugs, due to their long duration of action, are taken once a day, and this reduces the likelihood of skipping a medication and increases the patient’s compliance - his adherence to treatment and willingness to follow recommendations.

Fixed combinations of two or even three drugs in small doses are increasingly being used. Their use has the listed advantages and is most convenient for the patient. The following most rational combinations of antihypertensive drugs are recommended:

• β-blocker + diuretic;
• β-blocker + calcium channel blocker (dihydropyridine series only!);
• β-blocker + ACE inhibitor;
• ACE inhibitor (or angiotensin II receptor antagonist) + diuretic;
• calcium channel blocker + ACE inhibitor (or angiotensin II receptor antagonist);
• α-blocker + β-blocker;
• centrally acting drug + diuretic;
• Combinations of three or even four components, including hypotensive and hypocholesterolemic, are also possible.

Not all combination drugs with an antihypertensive profile of action available on the pharmaceutical market of Ukraine are focused on such combinations. Let's look at some of them in more detail.

Of the drugs containing three or more components (Table 1), only one, Tonorma, combines three first-line antihypertensive drugs: a cardioselective β1-blocker that penetrates poorly into the brain (atenolol), a dihydropyridine vasodilator (nifedipine), and a thiazide long-acting diuretic. (chlorthalidone). The synergistic composition in question is quite effective: an open clinical study showed that taking one tablet per day reduced blood pressure to 140/90 mmHg in 66% of patients. Art. and lower values, in another 20% of patients the use of Tonorma gave a moderate result, i.e. the efficiency was 86%. Minor side effects that did not require discontinuation of the drug were observed in only 8% of patients.

Table 1. Examples of multicomponent antihypertensive drugs on the pharmaceutical market of Ukraine

As for the remaining drugs, only their diuretic component is considered a first-line drug. Peripheral vasodilators (dihydralazine, dihydroergocristine) and sympatholytics (reserpine) second-line drugs. The sympatholytic of central and peripheral action, reserpine, has a large number of side effects: typical depression of the central nervous system up to mental depression, the development of parkinsonism due to depletion of monoamines, vagotonic disorders of the digestive tract (intense salivation, nausea, diarrhea, stomach pain). The use of a combination drug raunatin containing reserpine as part of a mixture of rauwolfia alkaloids is not a modern approach to the treatment of arterial hypertension. The drug "Andipal-B", which provides a predominantly antispasmodic and analgesic effect, is also not an effective antihypertensive drug.

The combination of a β-blocker and a diuretic is beneficial in the pharmacotherapy of arterial hypertension (Table 2). The β-adrenergic blocker, reducing the sympatho-adrenal effects on the myocardium, provides a decrease in stroke and cardiac output, and with long-term use, slightly reduces the total peripheral vascular resistance. The diuretic, by increasing the renal excretion of sodium and water, reduces the volume of circulating blood and also has a relaxing effect on the arterial vessels. Pindolol, which is part of Viskaldix, is a non-selective β-blocker, clopamide is a thiazide diuretic with an average duration of action. The composition of two other drugs (tenoret, atenol-N) includes the cardioselective β1-blocker atenolol in combination with the thiazide diuretic chlorthalidone. When discussing these combinations that are synergistic with regard to the normalization of blood pressure, it should be noted that the possibility of their use is limited by broncho-obstructive diseases, especially bronchial asthma, and diabetes mellitus, since an adverse effect on carbohydrate metabolism is possible. However, small doses of thiazide diuretics included in combination drugs have little effect on metabolic processes. In addition, a decrease in calcium excretion during treatment with these drugs is a favorable point in the treatment of women suffering from postmenopausal hypertension. As shown in the SHEP study, treatment with beta-blockers and diuretics reduces the risk of cardiovascular complications by 34%.

Table 2. Two-component antihypertensive drugs containing a beta-blocker and a diuretic

The next group of combined drugs is β-blockers and dihydropyridine calcium channel blockers (Table 3). The β-blocker reduces heart function, and amlodipine provides a long-term decrease in the tone of resistive vessels. At the same time, there is no mutual enhancement of side effects from the heart; amlodipine, like other dihydropyridines, has little effect on the myocardium, does not cause bradycardia and conduction slowdown, like a β-blocker. Amlodipine prescribed separately (at an initial dose of 2.5 mg, then 5 x 10 mg) allows you to achieve a target pressure of 140/90 mm Hg within 8 weeks. Art. in 72.4% of patients, with side effects noted in 5% of cases. A β-blocker potentiates its hypotensive effect. In addition, this combination reduces the risk of withdrawal syndrome (remember that abrupt cessation of β-blockers is unacceptable due to the risk of developing a hypertensive crisis and exacerbation of coronary heart disease).

Table 3. Combination antihypertensive drugs containing a dihydropyridine calcium channel blocker and a β-blocker

The pronounced vasodilator and moderate diuretic, antiatherogenic effect of the calcium channel blocker, the absence of disturbances in the metabolism of carbohydrates and uric acid, are also favorable.

Combinations of angiotensin-converting enzyme (ACE) inhibitors with diuretics are becoming increasingly important in antihypertensive therapy. In terms of the number of trade names, they prevail over other combined antihypertensive drugs. Examples of such drugs are given in table. 4. They are effective antihypertensive combinations that reduce blood pressure both by reducing the work of the heart and by reducing vascular tone. It is important that ACE inhibitors (especially the latest generation - enalapril, lisinopril, perindopril, fosinopril) and indapamide have a cardioprotective effect - they effectively reduce left ventricular hypertrophy (by 1325%), and also exhibit nephroprotective properties. Perindopril and indapamide are presented in the preparations Noliprel, Noliprel-Forte. The high effectiveness of combinations of ACE inhibitors and diuretics has been repeatedly confirmed in controlled studies. Thus, enalapril (starting dose 5 mg, then 10 and 20 mg per day) allowed 67% of patients to reach the target blood pressure level, while side effects were noted in 17% of cases. During 16 weeks of use in patients with moderate and severe forms of hypertension, Korenitec reduced daytime blood pressure by an average of 14.9/8.9 mmHg. Art., night by 18.8/11.4 mm Hg. Art., normalized the daily rhythm of blood pressure. Target systolic blood pressure was achieved in 77% of patients, diastolic blood pressure in 69%. In addition, Korenitek significantly reduced microalbuminuria, which confirms its nephroprotective properties. These data show that combination drugs containing an ACE inhibitor and a diuretic improve the effectiveness of the treatment of arterial hypertension.

Table 4. Medicines containing ACE inhibitor and diuretic

A less extensive range of combinations of ACE inhibitors with calcium channel blockers on the Ukrainian pharmaceutical market is presented in Table. 5. Verapamil (part of the drug Tarka) causes a rhythm-slowing effect, mainly reducing the work of the heart. Amlodipine has virtually no effect on heart rate, mainly reduces vascular resistance, potentiating the hypotensive effect of the ACE inhibitor. In these combinations, the metabolic neutrality of both components is attractive, which makes it possible to use them in patients with diabetes. The drug combinations under consideration have a beneficial effect on the hypertrophied myocardium and increase the quality of life.

Table 5. Two-component antihypertensive drugs containing an ACE inhibitor and a calcium channel blocker

One cannot help but pay attention to such combination drugs as angiotensin-II receptor blockers in combination with diuretics (Table 6). Angiotensin II receptor antagonists neutralize the effect of angiotensin on the cardiovascular system through selective blockade of AT1 type receptors. At the same time, candesartan becomes active only after a series of metabolic transformations in the liver; the rest of the drugs listed in the table themselves have pharmacological activity, and losartan also has several active metabolites with a strong and long-lasting effect. Eprosartan (teveten) has an additional mechanism of action that other representatives of this group do not have: it affects the sympathetic nervous system, inhibiting the release of norepinephrine from the endings of sympathetic nerve fibers, and thereby reduces the stimulation of adrenergic receptors in vascular smooth muscle. Treatment with hysaar, judging by the results of clinical studies, provides effective blood pressure control in 76% of patients. Similar efficacy values ​​for the combination of another angiotensin receptor antagonist, irbesartan, with hydrochlorothiazide (77% for systolic and 83% for diastolic blood pressure) were obtained in the INCLUSIVE study. Hyperuricemia is common in patients with arterial hypertension. The thiazide diuretic hydrochlorothiazide, which is part of combination drugs, can itself cause secondary hyperuricemia and gout. Angiotensin receptor blockers, especially losartan, which is part of hysaar, increase the excretion of uric acid and reduce the level of hyperuricemia.

Table 6. Antihypertensive drugs containing an angiotensin II receptor blocker and a diuretic

Diuretics, as already noted, are among the first-line antihypertensive drugs. Up to 30% of patients achieve target blood pressure using the most widely used hydrochlorothiazide. The disadvantage of this drug is the high incidence of electrolyte disturbances, primarily hypokalemia. Therefore, it is rational to combine it with potassium-sparing diuretics, such as triamterene and amiloride (Table 7). Possible hypomagnesemia, hyperuricemia, disorders of cholesterol and glucose metabolism (therefore, these drugs should not be used in patients with diabetes). Sometimes impotence occurs, which should be taken into account when choosing a drug for a particular patient.

Table 7. Combined diuretics

The development of arterial hypertension is promoted by hypercholesterolemia and atherosclerosis. Unfortunately, there are no combination antihypertensive drugs containing hypocholesterolemic agents on the Ukrainian pharmaceutical market yet.

It is extremely important to control the amount of table salt consumed by the patient and combine sodium restriction with drug treatment of arterial hypertension. Thus, according to the largest multicenter study INTERSALT, when the daily intake of sodium chloride is reduced to 100 mmol (6 g), systolic pressure in the population decreases by an average of 2.2 mm Hg, which reduces the risk of coronary death by 6%. And if, against this background, the consumption of potassium and magnesium salts increases, especially due to vegetables and fruits or table salt substitutes used to add salt to ready-made dishes, then systolic pressure decreases by 5 mm Hg. Art., the risk of death from coronary heart disease decreases by 14%, and in old age by 23%. However, combination with potassium salts is unacceptable during treatment with ACE inhibitors or angiotensin receptor blockers. Much evidence has been obtained of enhancing the hypotensive effect, the possibility of reducing doses and reducing the side effects of saluretics, labetalol, visken, nifedipine against the background of a low-salt diet and additional intake of potassium salts. We have confirmed and expanded these data, studied the mechanisms of interaction of potassium, magnesium and calcium salts with antihypertensive drugs of different groups. In addition, the effectiveness of antihypertensive therapy, including combination drugs, increases significantly when the patient limits or stops smoking.

In conclusion, it should be noted that the modern range of antihypertensive drugs, especially combined formulations, makes it possible to improve the treatment of arterial hypertension and associated diseases. From the standpoint of evidence-based medicine, this is convincingly demonstrated by the results of clinical studies.

Literature

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High blood pressure is a disease with a lot of symptoms that changes the life of everyone who encounters this pathology. Hypertension is not age-selective and can affect any member of the younger generation, however, it is more common after forty years of age in combination with atherosclerotic lesions of the body. Two combined pathologies are a real scourge of modern medicine, which directs funds and efforts to find the most effective medicine that eliminates the symptoms of both diseases quickly and relapse-free. Combination therapy requires maximum effect with minimal dosages of drugs.

Symptoms of hypertension

The search for the best remedy for high blood pressure is invariably associated with the clinical picture and symptoms of the disease. Modern research shows that in the human body there are many mechanisms for regulating vascular tone, which leads to many drugs in the fight against blood pressure when they fail. The blood pressure is regulated directly by the blood vessels themselves, as well as by the heart, kidneys, and brain.

High blood pressure primarily affects small-caliber vessels and even smaller capillaries. The small vascular network of the visual organ, kidneys, and brain is important for the body.

Therefore, the first symptoms of hypertension are disorders of these organs:

1. Clinic of decreased vision, inability to see the details of objects at dusk, difficulties in night vision and when driving.
2. Impaired renal excretory function, frequent infectious diseases of organs, intoxication syndrome.
3. Tormenting headaches without clear localization. Frequent dizziness, feelings of nausea, episodes of loss of consciousness during sudden movements, and fatigue may occur.
4. The first symptoms of hypertension are often accompanied by excessive fatigue, difficulty sleeping, absent-mindedness, and decreased concentration. Resistance to high vascular tone requires significant energy expenditure, which creates a noticeable loss of strength.

Typically, a person who is confident in his health misses such symptoms and tries not to notice them, citing stress, poor ecology, and long working hours.

Ignoring these symptoms and deliberately refusing medications that lower blood pressure become fertile ground for the formation of more serious manifestations of hypertension. New symptoms appear, renal failure increases, the normal functionality of the heart becomes difficult, and almost all organs and systems suffer from transient ischemia.

Stable, uncontrollable high blood pressure can lead to dangerous catastrophes in the form of cerebral hemorrhage or heart attack.

Drugs used for arterial hypertension are designed to combat the first and subsequent manifestations of a dangerous pathology. The success of therapy largely depends on its timeliness and the absence of irreversible complications.

Drug therapy for hypertension

The multifactorial disease hypertension requires a special approach to treatment. In this case, drugs are rarely prescribed with only one mechanism of action; an experienced doctor uses a combination of therapeutic techniques.

Tablets for high blood pressure are prescribed according to protocols that reflect current global trends in eliminating the symptoms of hypertension.

The pharmacological industry is currently developing successfully and offers a choice of drugs that vary in cost and effectiveness. The list of medications for hypertension is truly diverse and sometimes makes it difficult to choose. A qualified doctor bases his treatment on a detailed examination of the patient and accurate laboratory diagnosis. They clarify the clinical picture and indicate which drugs will be more effective.

For a long time, diuretic drugs have been claiming to be fast and safe means of lowering blood pressure. The mechanism of their action is based on the removal of the water component of the blood, which reduces its specific gravity, and, therefore, the pressure on the walls of the vascular bed. Diuretic tablets provide an extremely rapid effect, which is indispensable in the face of the threat of ischemic disasters. The action of thiazide diuretics is complemented by blocking additional absorption of water and salts when the vessels recognize a decrease in blood mass.

The following diuretic drugs are often used in medical practice:

• Hydrochlorothiazide is a tablet as a stand-alone substance, but can also be produced in combination with other drugs. Their dosage is enough for a single dose, which is preferably taken in the morning. Long-term use of the drug is accompanied by such a side effect as the excretion of potassium ions necessary for the normal functioning of the heart muscle. Combination therapy of hydrochlorothiazide and spironolactone helps prevent this.
• Furosemide replaces thiazide diuretics when the latter are ineffective. This usually happens with combined pathology with damage to the kidneys or heart.

Furosemide tablets may have another trade name - Lasix, but these drugs also remove the potassium needed by the heart muscle, and also disable carbohydrate and fat metabolism. Without this side effect, indapamide has a short-lasting effect and is used in emergency conditions. As an alternative, you can use osmotic drugs, among which beckons is more popular.

• The potassium-sparing drug spironolactone does not have the side effects of the diuretics described above, but has its own list of adverse reactions. Its long-term use provokes impotence even in young men, and women begin to suffer from hormonal fluctuations, menstrual disorders, and drug-induced infertility.

Modern approaches to the treatment of high blood pressure include the prescription of beta blockers. The first testing of the isolated active substance of the drug group showed its effect on sensitive receptors in the heart, which react by slowing down the heart. The amount of blood and the force of its release remain at the same level, but the number of contractions decreases.

Against this background, the number of pulse waves per minute decreases.

• Bisoprolol and its new generation analogues - Concor, Coronal - qualitatively reduce blood pressure due to heart contractions that occur less frequently. A side effect is observed in most patients in the form of cough, since receptors susceptible to the drug are also located in the bronchi, which react to the drug by narrowing them.

• Metoprolol, propranolol, nebivalol are not without this side effect with long-term use, but show a greater therapeutic effect in older people. They are able to fight migraine attacks, congestion in the lungs, and heart failure of somatic etiology.

Sartans are drugs, mainly in tablet forms, that affect the production of renin. The latter has a unique ability to lower blood pressure through a whole cycle of biochemical reactions.

Medicines in this group were discovered relatively recently, which is why they are called new generation drugs. Today, these products are fully justified by their effectiveness and safety for any age.

Losartan, as a new representative of antihypertensive therapy, has a lasting effect even with long-term use. With increasing symptoms, it is possible to increase the dosage, which does not cause addiction and side effects.

The tablets of this product have undergone many studies and have a huge base of evidence of its effectiveness. It is losartan that shows the most pronounced clinical effect compared to its analogues - eprosartan, valsartan.

ACE inhibitors also have a mechanism of action related to renal regulation. The above-mentioned renin triggers the conversion of the active agent angiotensinogen of the first line into the second under the action of angiotensin-converting enzyme.

Drugs in this series block this chain reaction, which occurs when vascular tone drops or the volume of circulating blood decreases. Medicines that inhibit ACE can cope even with very high blood pressure, but their effect is short-lived.

These drugs are also prescribed for hypertension due to diabetes mellitus, a history of myocardial infarction, and other cardiac pathology.

1. Enalapril - tablets for mild forms of hypertension with medium duration of action. A single dose of the drug controls high blood pressure indicators and allows you to forget about its clinic. If the disease becomes malignant, the dosage of the drug can be increased, as well as the frequency of administration, due to the absence of side effects and the occurrence of dependence.
2. Lisinopril is a longer-lasting medicine that allows you to control blood pressure for the whole day.
3. Captopril - requires administration with each new rise in blood pressure. It is also prescribed twice or thrice daily for systemic therapy.

Drugs in this series may have a dry cough as a side effect, which dictates the discontinuation of the drug.

Another new generation of drugs are calcium antagonists, the basis of which is the removal of this ion. Positively charged calcium creates additional tone of the muscle fiber, which also exists as a vascular layer. The drop in pressure occurs due to muscle relaxation, which causes some side effects.

1. Amlodipine - tablets of this drug are well tolerated in small doses. Undesirable effects may include paroxysmal headaches, facial redness and a feeling of heat, ascending cold swelling, and sensations of rapid heartbeat.
2. Nifedipine gave way to new generation analogues (Corinfar) with improved tolerability. These drugs are contraindicated in case of concomitant cardiac pathology.

Innovative medicines

The list of medications for high blood pressure is constantly growing and improving. The changes most affected combination drugs, which include two or more substances.

Such tablets have clear advantages, because previously a portable first aid kit for hypertensive patients included up to a dozen medications of various pharmacological forms. Now one medicine can replace several others, and its composition is carefully selected and meets therapeutic standards.

Drugs with a long history are somewhat relegated to another plan due to other advantages of innovative antihypertensive drugs:

• The composition of the combined medicine is carefully selected. Certain dosages of drugs do not interrupt each other’s actions and can even potentiate the effect.
• The practicality of use lies in the convenient one-time use. The latest drugs even establish control over blood pressure for up to three days from one use.

• The number of side effects is reduced to a minimum or completely absent.
• Long-term use of drugs does not cause addiction and does not require increasing the dose.
• The components of the combined products are low-allergenic and well tolerated by all categories of patients with hypertension.

It was the integrated approach to treating high blood pressure that prompted the creation and development of combination drugs. The variety of regulatory mechanisms of vascular tone and blood volume necessitate the need to influence several systems simultaneously.

In the modern world, the situation is such that despite modernized diagnostic methods, hypertension can only be recognized when it has become a chronic condition. Then drugs to relieve this condition are prescribed for life. Renin inhibitors or sartans are used in this case based on modern scientific works. New drugs in this series - Alskiren and Cardosal - are completely devoid of the painful symptom when using sartans - dry cough.

Cardosal embodies all the best achievements of medicine. A convenient tablet form allows you to control blood pressure in one morning dose. Optimization of vascular tone occurs with systemic use. The percentage of side effects is close to zero: cough, runny nose, occasional headaches, malaise, joint and bone pain are extremely rare and are mainly associated with individual intolerance to the drug.

Severe side effects are observed due to medical errors due to ignoring contraindications. Liver and kidney failure, thrombocytopenia can occur in pregnant women, children under 18 years of age, and people with somatic kidney pathology.

Lozap, as a medicine for lowering blood pressure by blocking receptors for type 2 angiotensin, copes with its task perfectly. Against the background of its intake, the vascular bed loses the signal to narrow and relaxes with the formation of additional volume to contain blood. Lozap plus additionally contains a thiazide diuretic and is also well tolerated by patients of all ages. Although the instructions warn about possible disorders of the respiratory, cardiovascular, and digestive systems, side effects occur only in case of individual intolerance.

Olmesartan is the most recent calcium antagonist. It is used in those patients whose arterial blood is controlled by taking this particular group, and switching to it allows you to reduce vascular tone faster and more effectively.

Diuretics continue to be popular drugs for lowering blood pressure quickly and safely. The newest torasemide is now used in patients with glucose tolerance and in elderly people with many concomitant pathologies.

The newest ACE inhibitor, Fosinopril, is also fighting for popularity. Its properties provide a quick and safe effect and often help with hypertensive crises.

Beta blockers have also improved. An effective decrease in heart rate and vasodilation continue to be accompanied by the formation of an addiction syndrome. But the effectiveness of modernized drugs is much higher.

Enalapril and its modern modifications have retained their ability to relieve high blood pressure during an emergency rise. Enalapril invariably comes to the rescue in situations where no other drug can cope, and the risk of a hypertensive crisis is extremely high. Its quick results last for up to a day, and the mild diuretic effect also alleviates the general condition of the patient. While taking it, mild stool upset, short-term muscle spasms, and arthalgia are observed.

Many pharmaceutical companies are looking for other means to prolong the lives of people with hypertension without reducing their social functionality.

Undoubtedly, modernized drugs do their job better and have undergone more clinical studies and trials.

However, their use is recommended for the first case of hypertension in the patient's history. The transition from an old drug to a newer one should be carried out with the notification of the attending physician or on his recommendations. Qualified specialists are aware of pharmaceutical innovations and can correlate all the indications and risks of each specific drug for a person with individual characteristics.

No matter what achievements in the effectiveness and safety of drugs for arterial hypertension the world medical community can boast of, any disease is better prevented. When it comes to high blood pressure, what is important is a person’s own attitude towards their health, which will not allow them to miss the fateful symptoms of dangerous diseases.

Hypertension in the initial stages can be stopped by simple lifestyle changes, when there is no point in using innovative drugs. Giving up bad habits, getting involved in sports and physical activity, and introducing a healthy diet can fight even the most burdened heredity and are the best preventive measures not only for arterial hypertension, but also for a host of other serious somatic diseases. Thus, the body independently forms the most powerful immune defense and regulates all elements of metabolism. No modernized drugs can restore health to the level that the human body can do on its own.

Antihypertensive drugs are designed to lower blood pressure and are used to treat hypertension.

An increase in blood pressure itself may indicate the presence of a large group of diseases, although primarily these are diseases of the kidneys and arteries of the kidneys. However, arterial hypertension is also characteristic of thyrotoxicosis and some other diseases. The reasons, knowledge of which will prompt an appropriate treatment plan, should only be determined by a doctor.
In many cases, it is impossible to determine the diseases that lead to increased blood pressure, in which case hypertension is diagnosed.

Predisposing factors for this disease are excessive consumption of salt as it contains sodium, atherosclerosis, smoking, alcoholism, obesity, and a sedentary lifestyle.

When treating hypertension, doctors first try to eliminate the risk factors a person has or reduce their effect on the body. In many cases, these actions are enough to significantly reduce pressure.

When prescribing medications, doctors are guided by blood pressure parameters – the upper one, which characterizes the strength of heart contractions, and the lower one, which maintains vascular tone. Taking these indicators into account, medications are prescribed that either “slow down” the heart a little, or

Antihypertensive drugs lower blood pressure. They are used for arterial hypertension, when blood pressure is high, they can reduce it to normal levels. In this regard, such drugs are called antihypertensive drugs.

These drugs have their own classification based on their principle of action.

There are four groups in total.

The first includes medications that reduce the tone of the sympathetic nervous system. These are neurotropic antihypertensive drugs of central and peripheral action.

The first includes Clonidine (Clonidine, Gemiton), which increases the inhibitory effect of the vagus on the heart and reduces the stimulating effect of sympathetic innervation on the blood vessels and heart. Cardiac output and vascular tone decrease, and blood pressure also drops.

Clonidine is used primarily for the rapid reduction of blood pressure during hypertensive crises. In this case, the drug is administered intravenously over about six minutes.

In addition, similar centrally acting drugs include Moxonidine, which reduces the activity of the vasomotor center, cardiac output and blood vessel tone, Guanfacine, and Methyldopa, which is prescribed orally.

Drugs that block peripheral sympathetic innervation include ganglion blockers (azamethonium (pentamine), hexamethonium benzosulfonate (benzohexonium), gimpatolytics (reserpine, guanethidine), adrenoblockers (prazosin, terazosin, doxazosin).

In addition, a number of drugs are produced that inhibit the renin-angiotensin system. These are drugs that inhibit renin secretion, disrupt the formation of angiotensin II (ACE and vasopeptidase inhibitors) and interfere with the action of angiotensin II.

These are captopril, enalapril, perindopril, ramipril, fosinopril.

Myotropic vasodilators are also produced, which act directly on the smooth muscle fibers of blood vessels, initiating their relaxation, while the vessels dilate, and the dilation of arterial vessels leads to a drop in blood pressure. Similar substances include Diazoxide, Apressin, Magnesium sulfate, Sodium nitroprusside, Dibazol.

The fourth group includes diuretic () drugs.
These include Bekvorin, Birch buds and leaves, Brinaldix, Brusniver, Brusniver-T, Lingonberry leaves, Burinex, Bufenox, Vero-Indapamide, Herbafol, Hygroton, Hydrochlorothiazide-Verte, Hydrochlorothiazide, Hydrochlorothiazide-SAR, Hypothiazide, Polygonum renal herb, Polygonum bird grass, Diacarb, Disalunil, Diusemid, Difurex.

As you can see, there are many herbal preparations in this group.