home Consultations New generation drugs for pressure. Other drugs with antihypertensive action. Neurotropic agents of central action

New generation drugs for pressure. Other drugs with antihypertensive action. Neurotropic agents of central action

For treatment hypertension using antihypertensive drugs. They are the only means that lower the pressure and prevent the consequences. Preparations latest generation have minimal side effects and, when properly dosed, do not pose a health risk for long-term use.

Classification of antihypertensive drugs

First line drugs:
- ACE inhibitors;
- diuretics;
- angiotensin receptor blockers;
- beta-blockers;
- calcium antagonists.
Second line drugs:
- alpha-blockers;
- rauwolfia alkaloids;
- antagonists of the central action;
- vasodilators direct action.

Types of drugs

ACE inhibitors

Such drugs are especially useful for people with a history of heart failure.

The most effective antihypertensive drugs. The property of the group is the effect on the adrenal hormone, which retains fluid in the body, as a result of which pressure rises. They have vasodilating activity, while not affecting the heart rate and the amount of blood ejection by the heart. They are recommended for patients with chronic heart failure. With long-term use of new generation ACE inhibitors, blood pressure stabilization can be achieved. Contraindications for use are pregnancy, lactation, high level potassium in the blood.

ACE inhibitors with prolonged use cause a dry cough.

Diuretics

The hypotensive effect of this group of drugs has their diuretic effect. They are able to bring out excess liquid from the human body, as a result of which the load on the heart is reduced. People suffering from gout should not use. Very often, diuretics are prescribed in combination with other antihypertensive drugs. Classification of diuretic drugs:

Furosemide is suitable for emergency therapy, but not for systemic.

Thiazide. The combination of these diuretics with and angiotensin receptor antagonists is often used to treat high pressure in the elderly and diabetics. Contraindicated for use with kidney failure.
Potassium-sparing antihypertensive drugs. The hypotensive effect is achieved due to the withdrawal of sodium ions, while potassium is preserved. List of these drugs ( medicines) is recommended for people with chronic heart failure and heart edema. It is forbidden to take them with CRF (chronic renal failure).
Loopback. The main difference from other diuretics is the ability of drugs to achieve a faster hypotensive effect. With the wrong dose of the drug, the pressure can drop sharply, then hypertensive drugs are used. They are considered the best means for relieving a hypertensive crisis, but they are not suitable for long-term use, as they wash out electrolytes with liquid. And this means that loop diuretic tablets can disrupt all metabolic processes in the body. List of major loop diuretics:
- "Torasemide";
- "Ethacrynic acid".

Adrenoblockers-beta

This group of drugs is suitable for people suffering from angina pectoris.

Modern antihypertensive drugs. Reduce cardiac output and the production of renin in the kidneys, which causes vasospasm, resulting in lower blood pressure. Beta-blockers treat the combination of hypertension with angina pectoris, arrhythmia and chronic heart failure. Contraindicated in breastfeeding, pregnancy, diabetes, bronchial asthma. After discontinuation, a withdrawal syndrome may develop.

calcium antagonists

Drugs that have the ability to block the flow of calcium ions into smooth muscle cells blood vessels, due to which their spasm decreases and pressure decreases. Antihypertensive treatment This type of drug reduces the risk of heart attack and stroke. Do not use for children, patients with cardiovascular insufficiency, pregnant women and during lactation. Depending on the chemical structure Calcium antagonists are divided into the following types:

dihydropyridines: "Felodipine", "Amlodipine";
benzothiazepines: "Diltiazem";
phenylalkylamines: "Verapamil".

Neurotropic

Raunatin is popular among neuroleptics.

Central action drugs:
- Sedatives. The composition includes motherwort herb, valerian and magnesium sulfate.
- Sleeping pills. With hypertension, the optimal drugs are Phenobarbital, Etaminal-sodium.
- Antipsychotics. IN complex therapy use a list of funds: "Aminazin", "Reserpine", "Raunatin". Many antipsychotics are long-acting.
- Tranquilizers. Apply at the initial degree of arterial hypertension: "Sibazon", "Chlozepin", "Oxylidine".
Neurotropic agents peripheral action:
- Ganglioblockers: "Benzohexonium", "Pentamine". This type is used very rarely, due to the large list of side effects.
- Alpha-blockers: "Fentolamine", "Tropafen", "Pyrroxan". Used in hypertensive crisis.
- Beta-blockers: Anaprilin, Trazikor. They relieve vasospasm and have a sedative effect.
- Sympatholytics: "Reserpine", "Guanetedine". Most often used combined preparations, which include sympatholytics.

Angiotensin receptor blockers

It is better for pregnant women to avoid taking drugs from this group.

These are new generation drugs that are effective in the treatment of hypertension. They are recommended for long-term use, as they are well tolerated and do not have many side effects and contraindications. It can be prescribed to patients with pathologies of the heart and kidneys. Angiotensin receptor blockers should not be used during pregnancy, hyperkalemia and allergic reactions.

Antihypertensive drugs have been used effectively for several years as a means to lower blood pressure. They help not only to cope with arterial hypertension, but also reduce the risk of complications such as heart attack and stroke. Classification antihypertensive drugs selects drugs depending on the area of their action and the expected effects.

List of remedies for high blood pressure

Among the variety of drugs prescribed to lower blood pressure, the following main groups are distinguished:

ACE inhibitors.
Beta blockers.
calcium antagonists.
Diuretics.
Angiotensin II antagonists (sartans).

These vasodilators can be used alone or in combination. The choice depends on the condition of the patient, the presence of contraindications, possible risk development of complications and severity of symptoms of the disease. These antihypertensive drugs are first-line drugs. In case of intolerance to these drugs or the presence of contraindications to their use, drugs of the second group are prescribed. They will be listed in the table.

There are also a number of funds, the purpose of which is also shown when arterial hypertension. Their classification is shown in the table below.

Mechanism of action	Fund group	Examples of drugs
Influence on the renin-angiotensin system	Angiotensin receptor blockers ACE inhibitors Vasopeptidase inhibitors	Valsartan, losartan Lisinopril, enalapril Omapatrilat
Vasodilators	Calcium channel blockers Venous and arteriolar vasodilators Activators potassium channels Arteriolar vasodilators	diltiazem, amlodipine Sodium nitroprusside Nicorandil, minoxidil Hydralazine
Neurotropic drugs (reduce adrenergic effects on the cardiovascular system)	?- adrenoblockers Imidazoline I1 receptor agonists ? – adrenoblockers ?, ? - blockers Central?2-agonists Ganglioblockers	Metoprolol, bisoprolol Moxonidine Prazosin, phentolamine Carvedilol Clonidine, dopehyd Pentamine
Drugs that affect water-salt metabolism	Diuretics (diuretics)	Indapamide, furosemide, torasemide

The following combinations of antihypertensive drugs are the most correct: diuretic + ?-blocker + calcium antagonist or diuretic + ?-blocker + ACE inhibitor, diuretic + ?-blocker + ?-blocker. Most often, a double combination is used. These funds include: Equator, Enziks, Hartil-d, etc.

The classification given in the table shows how wide the range of medicines for the treatment of arterial hypertension, however, each of them has not only beneficial effects but also a number of contraindications.

Positive properties and unwanted effects

Angiotensin-converting enzyme inhibitors are among the most commonly prescribed antihypertensive drugs. They are well tolerated, low cost and high efficiency.

ACE inhibitors, some of which are presented in the table, cause vasodilation and reduce pressure. The hypotensive effect of the application occurs after taking one tablet. In the future, it grows and after three weeks reaches the desired level. If it is not possible to reduce the pressure to the desired numbers, it is possible to add a drug from another group, but within the framework of a rational combination.

ACE inhibitors are used to reduce pressure and dilate blood vessels.

In addition to the vasodilating action indicated in the table, ACE inhibitors have the following positive effects:

Reduce the risk of damage to atherosclerotic plaque and the development of thrombosis.
Improve blood circulation in the brain and kidneys.
Reduce insulin resistance, which improves glucose uptake.
Increase the synthesis of lipoproteins high density that prevent the formation cholesterol plaques.
They cause a decrease in hypertrophy (wall thickening) of the left ventricle of the heart.

Side effects include: increased levels of potassium in the blood, paroxysmal dry cough, impaired kidney function, bile stasis, excretion of protein in the urine. The use of this group of drugs during childbearing, with bilateral stenosis is contraindicated renal arteries and with an increase in potassium concentration.

? - adrenoblockers.

The drugs of this group, as can be seen from the table, by reducing renin in the kidneys, reduce vascular spasm and reduce cardiac output. They are selective and non-selective. Selective drugs act only on the heart, and non-selective - on respiratory system and carbohydrate-fat metabolism, causing obesity. The latter drugs are undesirable to take with bronchial asthma, chronic obstructive pulmonary disease and AV blockade II-III degree.

Adrenoblockers due to an increase in cardiac output are often used in the treatment of angina pectoris and chronic heart failure. From unwanted effects emit: a decrease in the pulse rate, bronchospasm, cold extremities, attacks of hypoglycemia in patients with diabetes mellitus.

calcium antagonists.

These antihypertensive drugs have their effect not only due to the effect on the flow of calcium into smooth muscle cells and, as a result, their relaxation, but also by reducing the sensitivity of blood vessels to the vasopressor action of adrenaline and similar substances. The most commonly used, as shown in the table, drugs such as amlodipine, verapamil, diltiazem.

The drug acts on the heart, making it easier for him to work.

Two latest drug affect not only the state of the vessels, but also slow down the heart rate, which facilitates the work of the heart, especially with arrhythmia. Amlodipine causes only a decrease in vascular tone. Verapamil reduces myocardial oxygen demand, therefore, it is successfully used to treat angina pectoris.

TO positive effects calcium antagonists also include a decrease in myocardial hypertrophy and no effect on metabolic processes. When prescribing these drugs, you should carefully monitor the pulse rate, as they can cause bradycardia (decreased heart rate). In addition, there may be complaints of headaches, swelling of the legs, palpitations, interruptions in the work of the heart.

A contraindication to the appointment of calcium antagonists is congestive heart failure.

Diuretics.

These antihypertensive drugs are most often used in the form combination therapy. They increase the excretion of fluid from the body, reduce the level of extracellular fluid and circulating blood volume, as well as reduce cardiac output and dilate blood vessels. Thanks to complex action diuretics effectively reduce arterial pressure.

The following groups of diuretics are distinguished:

Thiazide. These include hypothiazide. They are not recommended for use in severe renal failure.
Thiazide-like. They include indapamide.
Loop diuretics: furosemide, torasemide. These drugs have proven themselves in the treatment of arterial hypertension, which is combined with heart and kidney failure. Perhaps their use in acute conditions.
Potassium-sparing: veroshpiron, triamteren. These drugs are not used as monotherapy. They slightly excrete sodium and retain calcium. The use of these diuretics is strictly contraindicated in the presence of severe renal insufficiency.

Diuretics presented in the table and list can provoke such adverse reactions as: headache, dyspeptic disorders, decreased levels of potassium and sodium in the blood, paresthesia, increased cholesterol, decreased platelet count. The appointment of diuretics is contraindicated in gout.

The drug is contraindicated in renal failure.

Angiotensin II antagonists.

Sartans have high efficiency and duration of exposure. After taking one tablet, the result is stored for 24 hours. In addition, unlike ACE inhibitors, these drugs do not cause attacks of dry cough, therefore, if this symptom appears while taking ACE inhibitors, they are replaced with angiotensin II antagonists.

These medicines are different a wide range impact. They not only cause a vasodilating effect, as shown in the table, but also increase the excretion of excess fluid and salt. The most commonly prescribed antihypertensive drugs in this group, in addition to those indicated in the table, are: candesartan, telmisartan.

These drugs are contraindicated during pregnancy, elevated level potassium, bilateral stenosis of the renal arteries. Side effects are similar to those of ACE inhibitors.

Other drugs

?-blockers presented in the table are considered second-line drugs, since they long-term use can cause the development of chronic heart failure, strokes, increases the risk sudden death. TO positive properties These antihypertensive drugs should include an increase in the metabolism of fats and carbohydrates, which is especially important in obesity and diabetes.

Direct-acting vasodilators, such as dibazol, apressin, are most often used in injectable form and cause a mild decrease in blood pressure. They are not indicated for patients suffering from atherosclerosis, as they cause a deterioration in cerebral circulation.

Antihypertensive agents of central action, which include dopegyt and clonidine (only in extreme cases), are used in the treatment of arterial hypertension in pregnant women. They act on the central nervous system, reducing sympathetic influence. TO side effects These drugs include: drowsiness, decreased reaction acuity, lethargy, headache, weakness.

Thus, each group of antihypertensive drugs differs in the mechanism of action and points of application, however, their common property is to reduce vascular tone and pressure reduction. The choice of the drug is determined by a number of factors, so you should not make a decision about taking it yourself, and if side effects occur, you should not only stop taking it, but also replace it with a medicine from another group.

High blood pressure can lead to more dangerous consequences- the development of myocardial infarction or ischemic disease. Those who suffer from hypertension (hypertension) should be constantly monitored by a doctor and undergo preventive treatment. Antihypertensive drugs are used to stabilize the pressure. They are selected according to the severity of the disease and the presence of related problems with health.

What is hypertension

Arterial hypertension (AH, hypertension) is one of the most common pathologies of cardio-vascular system, characterized by a stable increase in blood pressure to 140/90 mm Hg or higher. The main symptoms of the disease are:

Headache that does not have a clear relationship with the time of day. Patients describe it as heaviness in the back of the head, a feeling of fullness cranium.
Heart pain that occurs equally at rest and under stress.
Violation of peripheral vision. It is characterized by the appearance of a veil, eye fogging, "flies" before the eyes.
Tinnitus, swelling of the eyelids or face - additional symptoms hypertension.

An increase in blood pressure develops under the influence of external or internal environmental factors that provoke disruption of the vasomotor, cardiovascular systems and hormonal mechanisms responsible for BP control. Physicians consider the primary factors hereditary predisposition: if someone in the family suffered from hypertension, the risk of its development in relatives increases significantly.

Another reason for the development of the disease is frequent stress, nervous work, sedentary image life. Of the many provoking factors, WHO experts have identified those that often contribute to the development of hypertension:

metabolic disorders in the body and, as a result, the appearance overweight body;
prolonged depression, stress, nerve strain experienced tragedies;
craniocerebral injuries - abrasions, bruises, accidents, hypothermia;
chronic diseases in the acute stage - atherosclerosis, diabetes mellitus, rheumatoid arthritis, gout;
consequences of the virus and infectious diseases- meningitis, sinusitis, pharyngitis;
age-related changes in the structure of blood vessels;
the formation of cholesterol plaques on the walls of blood vessels;
climacteric state in women after 40 years;
bad habits - smoking, drinking alcohol, proper nutrition.

Treatment

For successful therapy It is important to diagnose the disease in time and identify the cause of its occurrence. With a properly organized treatment regimen, it is possible to avoid dangerous complications- thrombosis, aneurysm, deterioration or loss of vision, myocardial infarction, stroke, development of heart or kidney failure. If a slight increase in blood pressure is detected, the doctor will recommend to establish proper nutrition, exercise more, refuse bad habits. Arterial hypertension of the second and third degree is treated with the addition drug therapy.

The choice of drug is carried out in accordance with the patient's history. If he has inflammation of the prostate gland, alpha-blockers are preferred. For people with heart failure or left ventricular dysfunction, ACE inhibitors (angiotensin-converting enzyme inhibitors) and diuretics are often prescribed. In the presence of pain in the region of the heart, Nitroglycerin or Papazol may be prescribed. Only the attending physician is engaged in the choice of medicine.

Medicines for high blood pressure

Several mechanisms are responsible for the increase in blood pressure, so some patients require two or more medications at the same time to achieve stable control of blood pressure. In order to reduce the number of pills taken and reduce the risk of side effects, the latest generation of hypertension drugs has been created. There are only five groups of antihypertensive drugs. Classification is carried out according to the composition and principle of action of tablets on the body:

angiotensin II receptor antagonists;
diuretics (diuretic) drugs;
calcium antagonists;
beta - blockers;
angiotensin-converting enzyme inhibitors.

Beta blockers

This is a popular group of new generation hypertension drugs with high efficacy and versatility. Hypertension can occur from the effects of catecholamines (norepinephrine and adrenaline) on special receptors located in the heart - beta-adrenergic receptors. This effect causes the heart muscle to contract faster and the heart to beat faster, increasing blood pressure. Beta-blockers stop this mechanism, providing a persistent hypertensive effect.

The first beta-blocker was introduced to the world in 1964, and many doctors called the development one of the important events in medicine. Over time, other products with a similar principle of action began to be produced. Some of them affect the work of all types of beta-adrenergic receptors, others - on one of them. Depending on this, beta-blockers are usually divided into three groups:

First generation or non-selective drugs - block the beta-1 and beta-2 receptors. These include: Propranolol, Sotalol, Timolol, Anaprilin.

Second generation or selective agents - block the work of only the beta-1 receptor. This group is represented by: Oxprenolol, Metoprolol, Bisoprolol, Esmolol, Atenolol, Betaxolol, Doxazosin, Candesartan, Concor.

Medicines of the third generation with a neurogenic effect - affect the regulation of vascular tone. These include: Clonidine, Carvedilol, Labetalol, Nebivolol,

Diuretics

Diuretic drugs are one of the oldest groups of antihypertensive drugs. It was first used in the early 50s of the last century, but diuretics have not lost their popularity today. Today, diuretic drugs to lower blood pressure are prescribed in combination with other drugs (ACE inhibitors or sartans).

Diuretics help lower blood pressure by increasing the excretion of salt and fluids by the kidneys. This effect on the body leads to a decrease in the load on the vessels, contributes to their relaxation. Modern diuretics are used in very low dosages, which does not cause a significant diuretic effect, washing out a large number useful substances from the body. The hypotensive effect occurs 4-6 weeks after the start of treatment.

In pharmacology, there are up to four types of diuretic drugs, but only three of them are used to treat hypertension:

Thiazide and thiazide-like - refer to the means of prolonged action. They possess mild action have almost no contraindications. The disadvantage of thiazides is that they can reduce the level of potassium in the blood, which is why it is necessary to evaluate the patient's condition every month after starting to take the pills. Thiazide diuretics: Hypothiazide, Apo-Hydro, Dichlothiazide, Arifon, Indapamide,

Loop - are prescribed only when diagnosing highly resistant hypertension. They quickly lower blood pressure, but at the same time contribute to the loss of a significant amount of magnesium and sodium ions, increase the concentration uric acid in blood. Loop diuretics - Diuver, Torasemide, Furosemide.

Potassium-sparing - are used very rarely, because they increase the risk of developing hyperkalemia. These include: Veroshpiron, Spironolactone, Aldactone.

Sartans

Angiotensin II receptor blockers are one of the newest groups of antihypertensive drugs. According to the mechanism of action, they are similar to ACE inhibitors. The active components of sartans block the last level of the renin-angiotensin system, preventing the interaction of its receptors with cells. human body. As a result of this work, angiotensin does not constrict blood vessels, while the secretion of vasopressin and aldosterone (hormones that contribute to the accumulation of fluid in tissues) is reduced.

All sartans act for a long time, the hypotensive effect lasts for 24 hours. With regular use of angiotensin 2 blockers, the level of blood pressure does not decrease below acceptable values. It is worth knowing that these are not high blood pressure pills. fast action. A steady decrease in blood pressure begins to appear 2-4 weeks after the start of treatment and intensifies by the 8th week of therapy. Sartans include:

ACE inhibitors

This pharmaceuticals, which are prescribed for high blood pressure against the background of heart failure, diabetes, kidney disease. Angiotensin-converting enzyme (ACE) inhibitors change the balance of biologically active blood components in favor of vasodilators, thereby reducing blood pressure.

The hypotensive effect of ACE inhibitors may decrease with the simultaneous use of non-steroidal anti-inflammatory drugs. According to the chemical structure, ACE inhibitors are divided into three groups:

Sulfhydryl - act for a short period of time. These are ACE: Zofenopril, Captopril, Lotensin, Kapoten.

Carboxyl - different average duration actions. This group includes: Lisinopril, Enalapril, Khortil, Quinapril, Perindopril.

Phosphinyl - have a prolonged effect. This group includes: Fosinopril, Ramipril, Perindopril.

calcium inhibitors

Another name for these drugs is calcium channel blockers. This group is mainly used in complex treatment hypertension. They are suitable for those patients who have many contraindications to the use of other new generation hypertension drugs. Calcium inhibitors may be given to pregnant women, the elderly, and patients with heart failure.

The main principle of action of calcium channel blockers is vasodilation by creating obstacles for the penetration of calcium ions into muscle cells. Inhibitors are conditionally divided into three groups: nifedipine (dihydropyridines), diltiazem (benzothiazepines), verapamil (phenylalkylamines). To reduce blood pressure, the nifedipine group is more often prescribed. The medicines included in it are divided into subspecies:

First generation - Calcigard retard, Cordaflex retard, Nifecard, Nifedipine.

Means of the second generation - Felodipine, Nicardipine, Plendil.

Medicines of the third class - Amlodipine, Amlovas, Kalchek, Norvask.

Fourth generation - Cilnidipine, Duocard (for hypertension, they are prescribed very rarely).

The latest generation of pressure medications

Most of the representatives of the above list are available in the form of tablets for oral use. The only exception is one beta-blocker - Labetalol, which comes on the shelves in the form of a powder or solution for intravenous administration. There are other medicines produced in the form of injections (for example, sodium nitroprusside, nitrates), but they do not belong to the category of modern medicines and are used exclusively to eliminate a hypertensive crisis.

Modern drugs for pressure in tablets will help get rid of not only changes in blood pressure, but also improve the functioning of the cardiovascular system, central nervous system and kidneys. Other benefits of the new drugs include:

Unlike systemic agents, modern pills from hypertension can reduce left ventricular hypertrophy.
They have a selective effect on the body, due to which they are well tolerated by the elderly.
Do not reduce the efficiency and sexual activity of patients.
Gentle on the nervous system. Many products contain benzodiazepine, which helps fight depression, stress, and nervous disorders.

Calcium channel blockers

Calcigard retard is a new slow-release drug for hypertension. The drug has a high lipophilicity, due to which it has a long-term effect. active ingredient tablet is nifedipine. Auxiliary components - starch, magnesium stearate, sodium lauryl sulfate, polyethylene glycol, stearic acid.

Calciguard retard is very gentle and can be used for permanent treatment hypertension, stable angina pectoris, Raynaud's disease. Pharmacological properties tablets consist in slow vasodilation, due to which Calcigard has fewer side effects than pure Nifedipine. Negative reactions may include:

Calcigard retard is taken orally during or after a meal, average dose is 1 tablet 2 times a day. With caution, this medicine is prescribed during pregnancy. Treatment with tablets is strictly prohibited for:

Angiotensin-converting enzyme inhibitors

A bright representative of this group is the drug Diroton. The new generation hypertension drug is suitable even for the treatment of patients in whom high blood pressure is combined with liver diseases, the remedy has a minimum of contraindications and side effects. The active substance of Diroton is lisinopril. Auxiliary components - magnesium stearate, talc, corn starch, calcium hydrogen phosphate dihydrate, mannitol.

The tool has a prolonged action, so it must be taken once a day in the morning before or after meals. The main indications for use are:

arterial hypertension(for monotherapy or combined treatment);
chronic heart failure;
acute infarction myocardium;
nephropathy due to diabetes.

With caution, Diroton is combined with potassium-containing diuretics and salt substitutes. Categorical contraindications: history of angioedema, age under 18 years, hypersensitivity to tablet components, hereditary edema Quincke. Side effects may include:

Beta blockers

One of the members of this group is modern medicine from the pressure of a new generation of Labetalol. The drug belongs to hybrid blockers, it simultaneously acts on beta and alpha receptors. Apply Labetalol for the permanent treatment of hypertension, pheochromocytoma, preeclampsia and for the relief of hypertensive crisis. Unlike selective drugs of the new generation, it gives an instant antihypertensive effect. The method of dosing and duration of treatment is selected individually. Average dosage is 100 mg 2-3 times a day with meals.

Of the drugs for hypertension of the new generation of selective action, Nebivolol can be distinguished separately. Produced in the form of tablets, coated with a soluble shell. In addition to the antihypertensive effect, the drug has vasodilating properties by increasing the production of nitric oxide in the walls of blood vessels. Nebivolol is taken orally at a dose of 5 mg once daily with or without food. The drug does not increase the level of glucose and lipids, practically does not affect the heart rate.

All beta-blockers are prescribed with caution to patients with diabetes mellitus, myasthenia gravis, bradycardia, and low blood pressure. Categorical contraindications - bronchial asthma, obstructive pulmonary diseases, severe obliterating diseases blood arteries, unstable heart failure, atrioventricular block 2 and 3 degrees. Of the side effects can be observed:

headache;
insomnia (as a result of insufficient production of melatonin);
erectile disfunction;
bronchospasm;
dyspeptic phenomena;
fatigue;
swelling.

Angiotensin 2 receptor blockers

Edarbi is a characteristic representative of the sartans group. The drug is produced in the form of round tablets of white or almost white color. The active ingredient is azilsartan medoxomil potassium. As auxiliary components in the composition of the drug are present: mannitol, sodium hydroxide, hyprolose, microcrystalline cellulose, fumaric acid, magnesium stearate.

The antihypertensive effect of azilsartan develops during the first days, reaching the highest degree therapeutic action 30 days after the start of treatment. The decrease in blood pressure occurs within a few hours after ingestion of a single dose and persists throughout the day. Tablets can be taken at any time of the day, even on an empty stomach. The recommended starting dosage is 40 mg.

With caution, the drug is prescribed for arrhythmia, severe chronic cardiac, hepatic or renal failure, with bilateral renal artery stenosis, patients over 75 years of age. TO absolute contraindications relate:

pregnancy;
individual intolerance to the components;
age up to 18 years;
diabetes;
severe liver dysfunction.

Edarbi is indicated for the treatment of essential hypertension. The drug is well tolerated by patients, but rare cases side effects may occur:

Direct renin inhibitors

Aliskiren is a new generation of little-known hypertension drug. The drug belongs to selective inhibitors renin, which has a pronounced activity. Aliskiren inhibits the interaction of renin with angiotensinogen of the first and second groups, due to which a decrease in blood pressure is observed. The drug is never used for monotherapy, but only as a maintenance agent in the treatment of severe hypertension.

Aliskiren is prescribed with caution in renal artery stenosis, diabetes mellitus, after kidney transplantation. It is strictly forbidden to use this medicine a new generation of people with hypersensitivity to the composition, with severe liver failure, with nephrotic syndrome, pregnancy or lactation, children under 18 years of age. The list of side effects includes:

dry cough;
skin rash;
diarrhea;
increased potassium levels;
headache.

Price

All drugs can be bought at a pharmacy, online store or ordered through a catalog from an official manufacturer. The cost of heart drugs for blood pressure will depend on your region of residence, the country of manufacture of the drug, and pharmacy pricing. Approximate prices for antihypertensive drugs in Moscow:

The name of the next generation drug	Estimated cost, rubles
ACE inhibitors:
Parnavel
Monopril

Renipril
Amprilan
Zocardis


Calcium channel blockers:

Kordafen


Angiotensin II receptor blockers:


Valsacor
Aprovel

How to choose new generation hypertension drugs

The active participation of the patient in the treatment process significantly increases the chances of recovery, especially if a person understands: what drugs are prescribed for him, how they work, why it is necessary to take pills. Competent treatment must necessarily take place under the supervision of a doctor, he must also be engaged in the selection the best medicine from the pressure of the new generation. You should not listen to what your neighbors say or rely entirely on user reviews on the global network. Self-medication can not only aggravate the situation, but also lead to the development severe complications.

No Side Effects

There are no new generation drugs for hypertension that do not have a list of side effects in the annotation. It should be understood that not all patients may experience any negative reactions even after taking potent drugs. If you still decide to protect the body as much as possible from the appearance of side effects, you should pay attention to medicines for plant-based but don't expect immediate results.

IN medical practice homeopathic medicines are prescribed only for complex treatment as biologically active additives to food. Some of them, in addition to the ability to lower blood pressure, have a number of other useful properties: stimulate the immune system, cleanse the body of toxins and toxins, are able to thin blood clots. To popular homeopathic remedies relate:

Hyper stable;
Golubitoks;
Cardimap;
Normolife (Normalif).

Fast acting tablets

At jumps Blood pressure increases several times the load on the heart and blood vessels, there is an insufficient flow of oxygen and blood to the tissues internal organs which worsens the patient's condition. Help to calm down simple medicines- Valerian tincture, Motherwort. To normalize pressure, the following new-generation fast-acting drugs are used:

Captropil;

Weak pills

This group of drugs includes drugs that have the ability to gradually accumulate in the body and begin to act actively some time after the start of treatment. Veroshpiron is isolated from diuretics of weak action. It helps lower blood pressure, but it does not remove potassium from the body. Weak hypotensive properties have:

Lacidipine;
Lercanidipine;

Strong pills

The most potent drug for hypertension is Clonidine, but it is released only by prescription. Simple but effective drugs should not only normalize blood pressure, but prevent the emergence of new jumps in blood pressure and prevent the development of complications. There are several such drugs that have proven themselves well, according to patient reviews:

Noliprel;
Methyldopa;

Video

Lecture No. 18

antihypertensive (antihypertensive) drugs

Used to treat hypertension.

Principles of treatment of hypertension

decrease in OPPS - vasodilators (vasodilators).

decrease in cardiac work and decrease in cardiac output. Beta blockers.

decrease in BCC - diuretics (diuretics).

decrease in renin production, activation of the RAAS and the formation of angiotensin II.

decrease in blood clotting.

6) normalization of the lipid spectrum.

7) reduction of neuropsychic stress.

classification of antihypertensive

funds according to the mechanism of action

Neurotropic drugs: means of suppressing SDC , ganglioblockers, sympatholytics, α-, β-AB, α- and β-AB, sedatives.

Myotropic drugs: PDE inhibitors, NO donators, calcium blockers and potassium channel activators, various agents.

Means affecting the RAAS.

Diuretics.

Combined drugs.

antihypertensive agents

central action

Clonidine (clonidine)

Stimulates postsynaptic α 2 -AR and imidazoline I 1 -receptors of neurons of the nuclei of the solitary tract in the medulla oblongata. This leads to suppression of the SDC, a decrease in the tone of the sympathetic innervation and vasodilation.

Increases tone vagus nerves causes bradycardia and decreased cardiac output.

Stimulates peripheral presynaptic α 2 -AR and reduces the release of norepinephrine from nerve endings.

Depresses the central nervous system, has a sedative and hypnotic action, potentiates the action of sleeping pills, psychotropic drugs, alcohol; It is a non-opioid centrally acting analgesic.

Reduces the production of intraocular fluid and reduces intraocular pressure.

The duration of action is 5-12 hours, it is used orally, parenterally, as part of eye drops.

Applies with hypertension stage 1-2, for the relief of hypertensive crisis, with glaucoma.

Side effects: with rapid intravenous administration, hypertension, drowsiness, lethargy, dry mouth, constipation, respiratory depression in children, retains sodium and water in the body, causes withdrawal syndrome (for its prevention, the drug is canceled gradually, within 10-40 days).

Guanfacine - similar to clonidine, acts longer, is prescribed once a day.

Methyldopa (dopegyt) - turns into alpha-methylnorepinephrine, which stimulates the central α 2 -AR and inhibits the SDC. IN high doses reduces the content of norepinephrine, dopamine and serotonin in brain tissues and most peripheral tissues. Depresses the central nervous system.

Moxonidine (Physiotens, Cint) - selective agonist I 1-imidazoline receptors. It inhibits SDC and dilates blood vessels, reduces the production of renin, ATII, aldosterone, reduces heart function, reduces left ventricular hypertrophy, and has a sedative effect. It has a pronounced hypotensive effect, is prescribed once a day.

Beta blockers

They reduce the work of the heart, reduce cardiac output, depress the central nervous system, reduce renin secretion and RAAS activity, restore the baroreceptor depressor reflex, dilate blood vessels with prolonged use (reduce central sympathetic effects on the heart and blood vessels, reduce the release of norepinephrine from presynaptic endings).

SUBSTANCES AFFECTING THE RAAS

Decreasing renin secretion

- adrenoblockers

Violating the formation of antibodiesII.

A) ACE inhibitors (angiotensin-converting enzyme) - ACE inhibitors captopril (Capoten), enalapril (Enap), etc.

B) vasopeptidase inhibitors - omapatrilat

II(AT 1 )

losartan (cozaar), valsartan (diovan)

Aldosterone antagonists

spironolactone (veroshpiron)

The cardiovascular effects of AT II, mediated by AT 2 - receptors, are opposite to the effects of excitation of AT 1 - receptors. Stimulation of AT 2 - receptors is accompanied by vasodilation, inhibition of cell growth, suppression of the proliferation of endothelial and smooth muscle cells and fibroblasts, inhibition of cardiomyocyte hypertrophy.

ACE inhibitors (angiotensin converting enzyme)

1st generation - captopril, 2nd generation - enalapril, lisinopril, perindopril, etc.

Mechanism of action:

They disrupt the transition of AT I to AT II and, in this regard, reduce the tone of arterial and venous vessels, reduce systolic and diastolic blood pressure, the load on the heart, increase blood flow in the organs.

Inhibition of ACE leads to the accumulation of bradykinin, prostacyclin, PG E 2 and other vasodilators.

The hypertrophy of the myocardium and blood vessels decreases, the contractility of the heart increases, and the signs of heart failure decrease.

Increased diuresis.

Application: essential and symptomatic renal hypertension, chronic heart failure, diabetic nephropathy.

Side effects: hypotension, allergic reactions, dry, persistent cough associated with the accumulation of bradykinin (not stopped by codeine), dyspeptic disorders, hyperkalemia.

It is important to consider that ACE inhibitors do not completely block the synthesis of AT II. RAAS is found in many tissues. Particularly in the heart, where the formation of ATII from AT1 is catalyzed by the enzyme chymase. Therefore, the RAAS blockers of AT 1 receptors are most completely turned off.

Omapatrilat blocks ACE and neutral endopeptidase, which inactivates endogenous peptides that dilate blood vessels. Therefore, it eliminates the imbalance between pressor and depressor influences.

Applies with GB, chronic heart failure.

Side effects: headache, cough, diarrhea.

Angiotensin receptor blockersII(AT 1 )

Losartan, valsartan, telmisartan, etc. The mechanism of the hypotensive action of these drugs is associated with the development of the following effects:

1. Blockade of AT 1 - receptors prevents the adverse effect of AT II on vascular tone and is accompanied by a decrease in blood pressure.

2. Long-term use these drugs leads to a weakening of the proliferation of vascular smooth muscle cells, a decrease and even reverse development of left ventricular hypertrophy.

3. Against the background of the blockade of AT 1 - receptors AT II stimulates AT 2 - receptors and dilates blood vessels, reduces the load on the heart.

4. In addition, angiotensins 1-7 are formed from AT I and II, which stimulate AT x receptors, increase the release of NO, PG E and PC and have a vasodilatory, natriuretic and antiplatelet effect.

All AT 1 receptor blockers act gradually, the antihypertensive effect develops smoothly and lasts up to 24 hours. To increase the effectiveness of therapy, it is recommended to combine these drugs with diuretics: Gizaar (losartan + hydrochlorothiazide), Co-diovan (valsartan + hydrochlorothiazide) and others.

Inhibitors of AT 1 - receptors are contraindicated in individual hypersensitivity, pregnancy and lactation, since experimental data on animals indicate that drugs that affect the RAAS can cause damage to the fetus, death of the fetus and newborn.

myotropic vasodilators

Blockers of slow calcium channels.

They inhibit the entry of calcium into the cell, dilate arterioles and veins, and reduce systemic arterial pressure. Improve blood supply to vital organs (heart, brain, kidneys). Dihydropyridines (nifedipine, nitrendipine and felodipine) are most effective in arterial hypertension.

Anticalcium drugs apply with moderately severe hypertension, hypertensive crises (nifedipine under the tongue), supraventricular tachyarrhythmias and angina pectoris. For systemic use, it is better to use drugs long-acting.

Potassium channel activators.

Minoxidil, diazoxide.

Minoxidil. Expands arterioles, reduces systolic and diastolic blood pressure, reduces the load on the myocardium, causes reflex tachycardia and an increase in cardiac output. Increases renin activity and retains sodium and water in the body.

Stimulates hair growth in androgen-dependent alopecia, as it dilates blood vessels and improves microcirculation in the skin and trophism of hair follicles.

Application. Particularly severe forms of arterial hypertension, resistant to combination therapy with other antihypertensive drugs; in the form of a solution for external use regine for the treatment of alopecia.

DonorsNO.

Sodium nitroprusside. Mechanism of action. Expands arterioles and veins, which leads to a decrease in blood pressure. With a single-stage intravenous administration, it lasts 1-2 minutes. Therefore, it is administered intravenously in case of hypertensive crises, heart failure, for controlled hypotension.

Side effects: tachycardia, headache, dyspeptic disorders.

Phosphodiesterase inhibitors.

Papaverine is an opium alkaloid of the isoquinoline series. Mechanism of action. It has not only a hypotensive, but also an antispasmodic effect: it reduces the tone of the smooth muscles of the bronchi, gastrointestinal tract, and the genitourinary system. It is used as part of combined preparations for the treatment of hypertension, with spasms of cerebral vessels, with colic, with a hypertensive crisis.

Various myotropic agents.

Bendazole - It has antispasmodic, antihypertensive and immunostimulating effects. Blood pressure decreases as peripheral vessels dilate and cardiac output decreases. The hypotensive activity of dibazol is very moderate, and its effect is short-lived. In hypertension, it is usually prescribed in combination with other antihypertensive drugs. It is used in / in for the relief of a hypertensive crisis.

The immunostimulatory effect is associated with an increase in the synthesis of nucleic acids, proteins and interferon, the formation of antibodies, and an increase in phagocytosis.

Magnesium sulfate- inhibits SDC, inhibits the transmission of excitation in the autonomic ganglia, has a direct myotropic effect, inhibiting the entry of calcium into the cell. It is used to stop a hypertensive crisis.