Drug treatment of hypertension: the best drugs

What is hypertension?

To understand what arterial hypertension (HTN) is and how to treat it, you need to understand how the blood vessel system works. In a healthy body, blood vessels are strong and elastic and have the ability to contract and expand as needed. This feature is called vascular tone.

When the vessels are unable to dilate, increased tension is created in the circulatory system and the walls of the vessels are subjected to pressure from the blood. The vessels themselves, which are in a state of increased tone, suffer most from this.

Regularly observed high numbers (140/90 mmHg and above) indicate that arterial hypertension has developed.

Principle and treatment regimens

Several systems regulate blood pressure (BP) in the body, and blood pressure-lowering medications exert their therapeutic effects by influencing the functions of these systems.

1. If the cause of hypertension is water and salt retention in the body, it is advisable to use blood pressure pills with a diuretic effect - diuretics.
2. For disorders in the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure using a hormone called angiotensin II, blockers of this hormone receptors - sartans - are used.
3. To reduce the load on the heart muscle and peripheral vascular resistance, normalize blood circulation and metabolism, blockers of the enzyme that converts angiotensin I into angiotensin II or ACE inhibitors are used.
4. To reduce the oxygen demand of the heart muscle, calcium channel blockers are relevant, preventing the leakage of Ca ions into its cells - CCBs, also called calcium antagonists.
5. If a direct effect on the central nervous system is necessary, centrally acting drugs are used that affect the receptors responsible for maintaining normal blood pressure.
6. For concomitant hypertension pathologies such as atrial fibrillation or coronary artery disease, the use of beta-blockers is recommended.

In treatment regimens for hypertension, combinations of antihypertensive drugs with different pharmacodynamics are often practiced.

The main principle and goal of antihypertensive therapy is to correct blood pressure to values ​​that do not pose a threat to the patient’s health, as well as to prevent severe complications in the form of cardiovascular or cerebral accidents.

Diagnostics

Then a comprehensive examination is prescribed. It begins with a doctor’s examination and blood pressure measurement, followed by several instrumental methods - an ECG (electroencephalogram), an ultrasound examination of the heart muscle and heart chambers for hypertrophy, a portable tonometer is installed to measure blood pressure throughout the day - this provides comprehensive information on which can accurately determine the presence of hypertension and its type (daytime or nighttime). The fundus of the eye is examined for the presence of modified vessels, which are often found during prolonged exposure to high pressure.

Laboratory diagnostic methods include general blood and urine tests, biochemical blood tests.

How to treat?

Let's consider which medications should be taken in the treatment of hypertension, which of them can be combined, and how to treat elderly patients. Below are lists of the most modern and best drugs used in the treatment of hypertension.

List of all tablets

Since it is impossible to provide a complete list of blood pressure tablets that are available (there are several thousand of them), we will focus on the list of active ingredients used as the basis for antihypertensive drugs and the most common trade names.

For convenience, the list of tablets for hypertension will be presented alphabetically by pharmacotherapeutic class.

The variety of blood pressure medications in the list of all drugs used in treatment regimens for hypertension indicates the ongoing study of hypertension in medicine and the desire to create new drugs for hypertension. The main requirement for new generation medications for hypertension is a minimum number of side effects while maintaining their high effectiveness.

Drug therapy for hypertension should be selected by a doctor

Combination drugs

Anti-hypertension medications come with lengthy lists of side effects, which in many cases becomes a barrier to their use in some patients. However, side effects are usually dose-dependent, which makes it possible to use minimally effective doses for the treatment of hypertension. If it is necessary to increase the effectiveness of the drug, it is recommended to use combination drugs, where the active ingredients are present in safe doses, but have complementary properties.

Due to the fact that not all tablets for hypertension can be used simultaneously, you should carefully read the list of which of the combined drugs are the best for the treatment of hypertension:

• Amprilan NL – active ingredients ramipril (ACEI) and hydrochlorothiazide (diuretic);
• Aprovask based on the CCB amlodipine and the angiotensin II receptor blocker irbesartan;
• Aritel Plus, Lodoz with the active ingredients bisoprolol and hydrochlorothiazide (beta-blocker and diuretic);
• Vasotens N, Gizaar - combinations of losartan and hydrochlorothiazide;
• Valz N, Duopress - combinations of valsartan and hydrochlorothiazide;
• Vamloset, Exforge - a combination of amlodipine and valsartan;
• Dilaprel Plus - capsules with ramipril and indapamide;
• Diroton Plus - capsules with lisinopril and indapamide;
• Capozide – tablets based on captopril and hydrochlorothiazide;
• Co-Perineva, Co-Parnavel, Noliprel, Perindopril-Indapamide Richter - a combination of the active ingredients perindopril and indapamide;
• Co-Renitek, Renipril GT, Enap N based on enalapril and hydrochlorothiazide;
• Co-Vamloset is a combination of amlodipine, valsartan and hydrochlorothiazide;
• Concor AM - a combination of amlodipine and bisoprolol;
• Lisinoton N based on lisinopril and hydrochlorothiazide;
• Logimax – tablets with metoprolol and felodipine;
• Lozap Plus, Lorista N – losartan with hydrochlorothiazide;
• Nebilong AM – amlodipine with nebivolol;
• Parnavel Amlo, Prestance – amlodipine with perindopril;
• Roxera Combi – amlodipine with rosuvastatin calcium (statin);
• Tenochek – amlodipine with atenolol;
• Tritace Plus - ramipril with hydrochlorothiazide;
• Fosicard N – fosinopril with hydrochlorothiazide;
• Egipres - ramipril capsules with amlodipine;
• Equamer is a combination of lisinopril, amlodipine and rosuvastatin;
• Equator – amlodipine with lisinopril;
• Enzix, Enzix duo forte – ACE inhibitor enalapril in combination with the diuretic indapamide.

Combined antihypertensive therapy is one of the most effective methods of treating hypertension. But its effectiveness is manifested only if the drug is selected by a qualified specialist, taking into account the characteristics of the course of hypertension in a particular patient.

Which medicine to choose for hypertension

It is worth noting that the therapeutic effects of drugs do not always lead to a sharp decrease in blood pressure. In patients who suffer from cerebral atherosclerosis, there is often a deterioration in the blood supply to brain tissue due to a sharp decrease in blood pressure (by more than 25% of the initial level). This affects the overall well-being of a person. It is important to constantly monitor blood pressure readings, especially if the patient has already suffered a myocardial infarction or stroke.

When a doctor prescribes a new blood pressure medication to a patient, he tries to recommend the dose of the drug as low as possible.

This is done to ensure that the drug does not cause side effects. If normalization of blood pressure occurs in positive dynamics, the doctor increases the dose of the antihypertensive drug.

When choosing a treatment for hypertension, many factors are taken into account:

1. previously observed patient reactions to the use of a particular medication;
2. predicting interactions with drugs taken to treat other diseases;
3. target organ damage;
4. the patient's predisposition to complications;
5. the presence of chronic diseases (diseases of the urinary system, diabetes, metabolic syndrome);
6. identification of diseases occurring in the patient’s body at the moment (to exclude the possibility of prescribing incompatible medications);
7. cost of the drug.

No side effects

The list of the best tablets for hypertension without side effects includes drugs from almost all pharmacotherapeutic groups with an antihypertensive focus:

• Amlodipine and Lercanidipine (calcium channel blockers);
• Irbesartan and Valsartan (angiotensin receptor blockers);
• Lisinopril, Perindopril, Fosinopril (ACEI);
• Indapamide, Hydrochlorothiazide (from the group of diuretics);
• Aliskiren is a renin inhibitor;
• Moxonidine, Rilmenidine are agonists of I1-imidazoline receptors.

The above list of medications does not mean that the listed tablets are completely free of side effects. Such drugs simply do not exist. But these are the best pills, the instructions for use of which indicate that their side effects are infrequent or rare.

New generation medicines

Developers of modern drugs for hypertension are striving to improve existing drugs and even create new pharmacological groups. This desire is dictated by consumer demand for the best pills for hypertension, because a considerable part of patients refuse antihypertensive therapy for fear of adverse reactions. This is how new generation drugs appear, some of which have already been found in the above lists.

Among the first on the list of drugs of the latest generation is a new pharmacotherapeutic group of drugs - renin inhibitors. The active substance aliskiren, known to Russian consumers, is a representative of this group. The trade name of the new generation drug based on aliskiren is Rasilez.

Representatives of another pharmaceutical group - angiotensin receptor blockers, or sartans - are not lagging behind in terms of effectiveness and safety. The most modern drugs are those based on olmesartan (Cardosartan) and valsartan (Valsakor, etc.).

In Germany, a centrally acting drug is produced that belongs to a new pharmaceutical group of I1-imidazoline receptor agonists, Physiotens. Its Russian analogue, Moxonidine, has also received well-deserved recognition from patients and cardiologists.

From the group of alpha- and beta-blockers, Carvedilol stands out, which relatively recently found use as a vasodilator.

Not long ago, drugs used in the treatment of hypertension such as Amlodipine and Lercanidipine, which are third-generation calcium channel blockers, were also certified.

It would be fair to complete the list of new generation blood pressure pills with the most modern ACE inhibitor - fosinopril. This active substance is included in the best medications for hypertension, both as an independent component and in combination with other antihypertensive drugs.

Features of therapy for older people

Treatment of hypertension in older people in most cases is complicated by the presence of several concomitant pathologies in the patient.

In addition, hypertension in the elderly is often unstable and prone to changes in blood pressure. The pulse of the majority of representatives of this group of patients also does not differ in physiological adequacy, often increasing or decreasing not according to the circumstances, but in spite of them. For this reason, choosing a medicine without side effects for the elderly is quite difficult.

Practical experience shows that elderly patients respond well to the treatment of hypertension with diuretics; in this class, the best for them are thiazide-like and thiazide diuretics - Indapamide, Hydrochlorothiazide.

Many cardiologists note that it is better to combat hypertension in older people using small doses of combined drugs with a gradual release of active substances. The doctor must select the best medicine to lower blood pressure individually.

Treatment of hypertension in young men. Main symptoms

In men, the symptoms of hypertension can be different, and their difference lies in the severity of the disease and its stage. In total, there are 3 degrees of the disease. At the first stage, only periodic pressure surges are observed, after which there is a decline and independent normalization of indicators. In the third stage, the pressure will be constantly high and may be at critical points. It does not normalize on its own.

To identify high blood pressure, it is important to understand the main symptoms and signs of hypertension:

Headache. With high blood pressure, headaches may appear in the occipital or temporal region of the head. The pain will be more intense during exercise, and if this symptom is very strong, then a hypertensive crisis may occur.

1. Pain in the heart area. As a rule, this sign is not very obvious, the pain is aching in nature and compression in the chest may be felt. If the pressure changes sharply, the pain becomes stabbing.
2. The heart begins to beat faster, heaviness appears, and a rapid change in pulse is possible.
3. My head is spinning, my ears are ringing, and I’m starting to feel nauseous.
4. Blurred vision.
5. Hot flashes, in other words, redness of the face, are possible.
6. The face swells, especially in the morning; swelling is often noticed on the eyelids.
7. Limbs swell.
8. Vision is impaired.

In later stages of the disease, symptoms may change, this affects the functioning of the heart. It gets tired of the constant load, leads to failures, and the following symptoms appear:

1. Tachycardia.


Pain in the heart area.

2. Blood from the nasal cavity.
3. With any kind of tension, the face begins to turn red.
4. Brain functions are impaired.
5. Sleep is disturbed, difficulty falling asleep or lack of sleep is possible.
6. Feeling of pressure in the eyes, pain.
7. Vomiting for no apparent reason.

As a result of hypertension, constant weakness and irritability begin, activity decreases, and anxiety appears inside. Sick people may have problems with coordination and their gait may change. With the onset of a hypertensive crisis, the following symptoms are possible:

1. Unbearable pain in the head.
2. Increased heart rate.
3. Rapid deterioration of vision.
4. Nausea and vomiting after a while.
5. Sensation in the limbs disappears.
6. The face turns red.
7. Shortness of breath begins not only during exercise, but also at rest.
8. Heartache.

The symptoms of hypertension in young and elderly men are no different; in addition, the presented list of signs may indicate not only high blood pressure, but also heart disease. A doctor can make an accurate diagnosis. During a hypertensive crisis, a person may lose consciousness, pain occurs in the chest area, radiating to the shoulder blade and arm. If any of the described discomfort occurs, it is better to consult a doctor as soon as possible, as this may be a serious pathology.

Can it be cured forever?

Arterial hypertension is a chronic pathology, and chronic diseases, as is known, are completely cured only in exceptional cases. Therefore, there is no such thing as a course of treatment for hypertension, and the question of whether hypertension is curable disappears by itself. But it is quite possible to significantly improve the well-being of patients with hypertension with the help of antihypertensive drugs and improved lifestyle.

Properly selected antihypertensive therapy has long successfully maintained the quality of life of patients in European countries at the level of healthy people, but even there they do not ask the question whether hypertension can be cured completely and how to do this forever. Understanding that there are chronic diseases, you just need to be disciplined and strictly follow the doctor’s recommendations.

Prevention

Timely precautions taken will help prevent the development of hypertension, as well as support the body after drug treatment.

For prevention purposes it is necessary:

1. Limit business trips and night shifts. Go to bed on time and rest during the day.
2. Eat nutritiously, include fish, cereals, vegetables, lean meat and fruits in your diet, and also reduce salt intake.
3. Lead an active lifestyle, do yoga and breathing exercises, and walk more in the fresh air.
4. Give up bad habits, especially smoking, as it increases the risk of developing coronary artery disease.
5. Try to avoid unnecessary stress and anxiety.

Hypertension is not a death sentence.
You can get rid of this disease in non-drug ways without the help of pills, if you follow the doctor’s recommendations and monitor your blood pressure. It is important to measure your blood pressure daily so that even the slightest deviation from the norm can prescribe effective treatment. Author of the article Svetlana Anatolyevna Ivanova, general practitioner

Non-drug measures

Investigating the etiological prerequisites for the development of arterial hypertension, experts have established a close connection between this pathological condition and the patient’s lifestyle. Therefore, the very first steps in treating hypertension should be taken by the patient himself, following the rules on how to treat hypertension at home.

Diet

It has been noticed and proven that excess salt in the diet in almost 100% of cases leads to the development of hypertension.

Excess fat in the food consumed has no less impact on the condition of blood vessels - they create an excessive load on the metabolic system, which causes dyslipidemia (a disorder of fat metabolism) and the deposition of cholesterol in the walls of blood vessels. In most cases, this leads to a narrowing of the lumen and a deterioration in the elasticity of blood vessels. In this regard, the main requirements in the antihypertensive diet concern strict restrictions regarding salt, fats and sugars.

Folk remedies

Junk food should be replaced in the diet of a person who wants to start treating hypertension without medications with foods that improve digestion and metabolism and help normalize blood circulation. And during periods of increased blood pressure, you can use the hypotensive properties of some berries, fruits and vegetables to treat hypertension, consuming them in the form of juices or whole. As a pleasant addition to the non-drug treatment of hypertension, teas with the addition of medicinal herbs are used - cudweed, motherwort, St. John's wort, mint and others.

Symptoms

Having become familiar with the methods of treating hypertension, let us remember the symptoms that manifest this pathological condition. The main one is high blood pressure readings recorded by a tonometer. These are values ​​from 140/90 mmHg and above. Different people's bodies react differently to hypertension:

• Some people have pain or burning in the back of their heads;
• others feel dizzy and “heavy”;
• still others complain of lack of air and increased heart rate;
• A dangerous symptom is severe pain in the center of the chest.

The presence of pronounced symptoms with high blood pressure indicates the need for urgent measures to treat hypertension.

Signs of hypertension

Stress Reduction

Stress is another important factor that can contribute to high blood pressure. A person's response to stress can also affect heart health. Stress reduction techniques include:

• breathing exercises
• meditation
• practices such as tai chi and qigong
• yoga and stretching
• acupuncture or massage
• personal stress removal

Reducing stress is part of an overall change for heart health.

The most effective methods

In the variety of methods for treating hypertension, it is difficult to independently select the most effective drug for hypertension, which would fully meet the requirements of safety and therapeutic effectiveness. Only a doctor, based on the collected medical history and diagnostic studies of the patient, is able to determine which anti-hypertension pills will be the most effective in this case. Therefore, it is not possible to name a universal “best remedy for the treatment of hypertension.”

Lists of the safest and most modern tablets, including the new generation, have already been presented above. Today's doctors will certainly offer their patients to use one of the most modern and best medications to treat hypertension.

Features of arterial hypertension (AH)

This is the medical name for a disease that is considered a chronic disorder. It rises significantly above normal and remains at this level. At the same time, it is not possible to reduce it to the required units even with the help of medications. The main danger for patients is that the process of destruction of blood vessels is accelerated, so all ailments associated with the vascular system can be activated. Hypertension may not appear for a long time (asymptomatic), and then lead to an attack with a possible fatal outcome.

To understand whether you or a relative has high blood pressure, check the normal table:

Arterial hypertension is diagnosed in 70% of people among the age segment of the population around the world. It is necessary to promptly treat the disease and maintain normal condition to avoid an increased risk of pathologies such as:

• stroke;
• myocardial infarction;
• chronic heart and kidney failure.

Let us explain why hypertension occurs more often in elderly patients than in young patients, although the same reasons apply to them. This happens due to factors:

• The SAS and RAAS systems, which are responsible for regulating blood pressure, are being rebuilt.
• The elasticity of the vascular walls decreases, so they themselves become more susceptible to any external and internal (physical and chemical) influences.
• Aortas and veins, under the influence of atherosclerosis (almost every second elderly person has an initial degree of the disease), grow with fibrous tissue and suffer the accumulation of lipids.
• The layer lining the inner surface of blood and lymph vessels loses its functions, including secreting a vasodilator.
• Local decrease in blood supply to the kidneys and parts of the heart - ischemic changes.
• Poor circulation in some other parts of the body and limbs.
• Weight changes – weight gain often increases with age, which has a negative impact on the cardiovascular system.
• Reducing physical activity. We strongly encourage grandparents to take frequent walks, sign up for swimming or exercise in the pool, and exercise at home.
• An increase in the overall negative impact of bad habits on the body - the harm adds up and has a big impact.

If you feel that your blood pressure is higher than normal and constantly remains at these levels, this can lead to complications:

• the risk of cardiovascular diseases increases;
• any medications that enter the body are absorbed into the blood much worse, and, by the way, are also excreted;
• drugs that previously helped lower blood pressure now have no effect;
• Possible side effects.

Each doctor takes into account these features, the presence of secondary and primary diseases.

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Review Reviews

You can make your own rating of pills for hypertension based on reviews from patients communicating on numerous medical forums. Patients' opinions quite often coincide with doctors' reviews about the treatment of hypertension. Of course, reviews should not be used as a guide when choosing which blood pressure pills are good, since what is good for one person may not be suitable for another body at all. Therefore, the review of opinions about medicines is for informational purposes and not a recommendation.

Based on the reviews, the drug rating is as follows:

• Physiotens (Moxonidine) is called the best, but also the most expensive drug for blood pressure;
• those suffering from bronchial asthma call sartan Valsacor the drug of choice for the treatment of hypertension;
• elderly patients give good ratings to the drug Prestarium (ACEI);
• women suffering from dizziness praise Betalok ZOK;
• patients who have survived a pre-infarction state say that they are supported by the tablets Vamloset (a combination drug) and Veroshpiron (the active ingredient is the diuretic Spironolactone);
• people who have been taking antihypertensive drugs for years (more than 10 years) believe that Lisinopril is the best for them;
• those suffering from atrial fibrillation and pressure surges are successfully treated with Bisoprolol.

As you can see, there are many variations in the course of hypertension described even in reviews, so you should choose your best medicine strictly individually.