For the treatment of hypertensive disease, hypotensive drugs are used. They are the only means that reduce the pressure and prevent the emergence of consequences. Preparations of the last generation have a minimal side effect and with a properly selected dose are not risks for health with their long-term use.

Classification of hypotensive tools

• First line drugs:
  • aCE inhibitors;
  • diuretics;
  • angiotensin receptor blockers;
  • beta adrenoblocators;
  • calcium antagonists.
• Types of second line:
  • alpha adrenoblocators;
  • alkaloids Rauolfia;
  • central action antagonists;
  • vasodilators of direct action.

Types of drugs

ACE inhibitors

Especially useful such medicines for people with heart failure in history.

Most effective hypotensive means. The property of the group is the impact on the hormone of adrenal glands, which delays the fluid in the body, as a result of which the pressure increases. Possess vasodilatory activity, while they do not affect the heart rate and the amount of blood emissions with heart. They are recommended to take patients with chronic heart failure. With long-term reception of the new generation ACE inhibitors, hell can be achieved. Contraindication for use is pregnancy, lactation, high blood potassium level.

ACE inhibitors with long-term use cause a dry cough.

Diuretics

The hypotensive effect of this group of drugs has their diuretic effect. They are able to remove an excess fluid from the human body, as a result of which the load on the heart is reduced. It is impossible to use people suffering from gout. Very often, diuretics are prescribed in combination with other hypotensive means. Classification of diuretic drugs:

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

• Tiazid. The combination of these diuretics with and angiotensin receptor antagonists is often used to treat high pressure in older and diabetes mellitus. Contraindicated use with renal failure.
• Potassybean hypotensive drugs. The hypotensive effect is achieved by the output of sodium ions, and potassium is preserved. The list of these drugs (drugs) recommend applying people with chronic heart failure and cardiac outcurses. Their reception is prohibited at CPN (chronic renal failure).
• Loop. The main difference from other diuretics is the ability of drugs to most quickly hypotensive effect. With incorrectly selected dose, the drug may dramatically decrease the pressure, then hypertensive means are used. They are considered optimal means for removing a hypertensive crisis, but for long-term use, they are not suitable, since they are washed with electrolyte fluid. And this means that looped diuretic pills can violate all metabolic processes in the body. List of main loop diuretics:
  • "ToramSemid";
  • "Stacrinic acid".

Adrenoblators-beta

Such a group of drugs suits people suffering from angina.

Modern hypotensive drugs. Reduce the heart rate and the production of renin in the kidneys, which causes spasm of vessels, as a result of which the pressure is lowered. Beta adrenoblockers are treated with a combination of hypertension with angina, arrhythmia and chronic heart failure. Contraindicated with breastfeeding, pregnancy, diabetes, bronchial asthma. After stopping the reception, the abolition syndrome may develop.

Calcium antagonists

Medicinal preparations that have the ability to overlap the flow of calcium ions into the cells of the smooth muscles of blood vessels, which is why their spasm decreases and the pressure is reduced. Hypotensive treatment with this type of means reduces the risk of infarction and stroke. It is impossible to use for children patients with cardiovascular insufficiency, pregnant women and during lactation. Depending on the chemical structure, calcium antagonists are divided into such types:

• dihydropyridines: "Felodipine", "Amlodipine";
• benzothiazepines: "Diltiaze";
• phenylaclamins: "Verapamil".

Neurotropic

Raunatine uses popular among neuroleptics.

• Central Action Preparations:
  • Sedative. The composition includes grass of mother-in-law, valerian and magnesium sulfate.
  • Sleeping. In hypertension, optimal preparations: "Phenobarbital", "etame-sodium".
  • Neuroleptics. In comprehensive therapy, a list of funds is used: "Aminazin", "Reports", "Raunatin". Many neuroleptics prolonged action.
  • Tranquilizers. Apply to the initial degree of arterial hypertension: "Sibazon", "Hlozepin", "oxilidine".
• Neurotropic means of peripheral action:
  • Gangliplockers: "Benzohexonius", "Pentamin". This species is used very rarely, due to the large list of side effects.
  • Alpha-adrenobloclars: "fantolamine", "TropaPhen", "Pirroxan". Used in hypertensive crisis.
  • Beta-adrenoblays: "Anaprilin", "Trashcor". Remove the spasm of vessels and have a sedative effect.
  • Sympatholites: "Replanted", "Guanotein". Most often used combined drugs, which include sympatholites.

Blockers receptor angiotensin

Pregnant women are better to avoid reception of drugs from this group.

These are the preparations of a new generation, which are characterized by efficiency 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. You can assign patients with heart and kidney pathologies. Angiotensin receptor blockers cannot be used during pregnancy, hypercalemia and allergic reactions.

Due to the fact that hypertension does not sleep and more often appears in young people, the development of a new generation of hypotensive drugs becomes paramount importance. These funds cover a wide range of drugs and are designed to adjust blood pressure. Despite the choice, scientists continue to work on hypotensive means, therefore it is worth considering the features of the new generation of drugs.

Features of new generation hypotensive drugs

To help the body in the struggle for normal pressure and well-being annually scientists produce increasingly new, improved drugs. The reasons for pressure surges are varied: nervous overvoltage or kidney disease. What would not lead to hypertension, the doctor writes out. Receiving tablets pursues the following objectives:

Specify your pressure

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• expand the vessels to stabilize the pressure;
• to provide therapeutic effect on the heart, eyes and kidneys;
• do not cause adverse reactions (or reduce their manifestation to a minimum).

Do not self-medicate, drugs from high pressure include a list of contraindications and side effects that can only harm health. Always consult your doctor.

Great popularity among use. It is these drugs that effectively reduce blood pressure, and, in addition, restore the work of the heart, kidneys and prevent the development of complications. The mechanism of action of such drugs is reduced to the exposure to the central nervous system or to limit the development of enzymes, which are responsible for the increase in pressure.

Names of new hypotensive

The modern drug market offers a wide selection of medicines for treating blood pressure.

At the moment, a huge amount of preparations have been developed, each of which is suitable for any situation. Selection factors depend on individual tolerability, background diseases and side effects. Modern doctors got the opportunity to combine the names of different groups:

• diuretic;
• calcium channel blockers;
• beta-adrenoreceptor blockers;
• angeiothesin antagonists-2.

APF inhibitors

The IAPP is considered large-scale tools that are suitable for different patients. This group includes "Captive", "Lisinopil". Modern ACE inhibitors are distinguished by a high probability of reducing exacerbations, among which are myocardial infarction, heart failure, as well as a positive impact on affected bodies. In chronic insufficiency of the heart, the preparations of the IAPF are prescribed, they are well tolerated by the elderly people, with arrhythmias, diabetes, after a heart attack.

Cough is considered a cough as a consequence caused by a change in peptide metabolism. But if you have the following contraindications, it is better to refuse to receive:

• increased potassium rate in blood plasma;
• stenosis of the renal arteries;
• quincke swelling caused by the use of inhibitors earlier;
• pregnancy.

Diuretic products

Diuretics will be able to facilitate the load on the heart.

New generation diuretics are no less common than IAPF. The purpose of such tools is reduced to the help of the body in the removal of extra liquid, salts, which leads to a relief of the load on the heart, and a decrease in the volume of circulating blood. Diuretics have such a diverse group that the classification includes several types of diuretics:

Diuretikov varieties	List of drugs	Description	Contraindications
Tiazide	"Hypothiazide", "Indapamide"	it is allowed to prescribe to people of old age and diabetics, with any metabolic disorders; the mechanism of action is based on changing the exchange of electrolytes, carbohydrate and lipid metabolism.	gout
Potassiezer	"Amyloride", "Eplerenon"	allowed to people with heart failure at the chronic stage, in the presence of heart swelling; reducing the blood pressure is carried out by synthesizing excess fluids, salts.	kidney dysfunction
Loopers	"Laziks", "Edided"	able to reduce the pressure rate faster than the remaining drugs of this group; actively used to treat hypertensive crises.

Calcium channel blockers

BKK contributes to a decrease in calcium infiltration into muscle fibers, in which the sensitivity of the vessels to substances is reduced, in particular, to the fact that they cause spasms (adrenaline). Medicines differ in nature effect on the vessels, myocardium. Antagonists do not violate metabolic processes and successfully oppose hypertrophy in the presence of hypertension, reduce the risk of stroke. Calcium blockers include preparations of 3 groups:

• benzothiazepine antagonists ("Diltiaze");
• dihydropyridines ("Amlodipine", "Felodipin");
• phenylaclamines ("Verapamil").

Beta-adrenoreceptor blockers

Atenolol has many side effects, you need to use with caution.

With the choice of this group, it should be attentive because they are able to cause many side effects, although unconditional dignity is a large duration of action, which is why the tablets should be taken once a day. Scientists still lead to active development and improvement of beta blockers. In the meantime, this group is actively used in the treatment of persons suffering from ischemia and chronic heart failure. Widely used preparations of central action - "Atenolol", "Bisoprolol".

Hypertension, or a persistent increase in blood pressure, is now found not only in the elderly. Even young men and women often suffer from such disorders, and they have to regularly take anti-hypotensive drugs.

Medicines for hypertension and their types

Before the introduction into the treatment of hypotensive drugs, the main methods of treatment were a diet, receiving sedatives. Later in the arsenal of doctors there were special drugs that reduce the pressure, in recent years their list expanded.

A whole list of antihypertensive drugs of the last generation appeared, in which the best properties are less "sobs", contraindications, higher efficiency.

The doctor should be selected by the doctor according to the testimony, and at first the dose of the drug is minimal.

The classification of antihypertensive drugs includes different groups. There are five basic groups, the remaining more often apply as independent means of therapy, but in the complex with the following.

At the initial stages of hypertension, a person can help with one tool from the list of the list, whereas as the disease progressing, it is necessary to select a combination of short and prolonged drugs. It is important to take into account specific pressure numbers and the defeat of target organs, as well as contraindications - only the therapist or cardiologist can do it.

ACE inhibitors - Best Representatives

These tablets belong to the most popular, they are usually recommended for rapidly removing the attack of hypertension. The action is based on blocking the activity of a special enzyme that carries a vasoconstrictor action, causes vessels and increase pressure. The hypotensive effect of such drugs does not depend on the production of hormones. Also, ACE inhibitors give effects:

Modern means of this type - Lysinopril (170 rubles), Preshaum (420 rubles), previously used captive (20 rubles), Enalapril (35 rubles), but they did not lose relevance.

Usually medications are recommended for reception with already available renal, heart failure, with diabetes, after a heart attack. In some cases, they can be drunk even during pregnancy. The disadvantage can be called a number of side effects - often there is a dry cough, less often there is a swelling of a face, body, so patients have to change the medicine to another. With overdose there is a risk of poisoning. If you apply combined schemes from ACE and diuretics inhibitors, the probability of "sides" is lower.

Diuretic and calcium antagonists

Diuretics are one of the oldest groups of drugs that began to be used against high pressure. They eliminate excess liquid from the body, also remove a number of salts, so the amount of blood in the bloodstream decreases, the vessels relax.

There are several types of diuretics depending on the action:

Diuretics have a lot of contraindications, but sometimes they are indispensable. If the patient's condition is severe, without diuretic, it is difficult to bring down the pressure (at 3 degrees of hypertension).

Calcium antagonists - often a prescribed group of drugs of central action in arterial hypertension.

The effect of receiving calcium antagonists is based on a decrease in the penetration of the ions of this element in the vessels. As a result, the sensitivity of the walls of the vessels to the action of adrenaline and other vasopressors is reduced, they relax. The most famous means - Verapamil, Felodipine.

Beta adrenoblocators

Usually beta-blockers as hypotensive preparations of the last generation are prescribed with concomitant diseases of the heart - IBS, angina, heart failure.

Their cost varies depending on the manufacturer and the form: for example, bisoprolol costs about 50 rubles, and betalok is already 400 rubles.

Medicines of this type reduce heart emissions, as well as depress the production of a special enzyme (renin), which provokes contractions of the arteries.

With diabetes mellitus, beta blockers are not prescribed - they can cause metabolism failures.

With bronchial asthma, medications are not shown due to the risk of bronchial spasmodes. Due to changes in the rhythm of the heart with a number of arrhythmias, they can also be drunk. Representatives of the Group are also Concorp, Metaprolol, Nebivallol.

Other drugs

Fixed drug circuits can be accessed over the years, but the lists of drugs from hypertension are replenished, so doctors are often advised to include "new items" into therapy. For example, there is a substance with a central action - moxonidine, on the basis of which physiothenz drugs are created, strain (300-600 rubles).

Moxonidine stimulates the receptors sensitive to imidazoline, which are responsible for the regulation of sympathetic nerve trunks. As a result, blood pressure is reduced. New generation medicines are different:

• prolonged action;
• lack of cough, swelling, dry mouth;
• low probability of drowsiness, sedative action.

Especially showing such means in obesity, atherosclerosis and diabetes - they improve metabolism, reduce the amount of cholesterol and triglycerides in the blood. It is impossible to be treated with drugs only to children and with arrhythmias, heart blocks.

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Hypotensive drugs are a pharmacological group of medical facilities that are accepted for the treatment of hypertension. The All-Russian Scientific Society of Cardiologists classifies these funds into several groups (taking into account the mechanism of action).

Principles of classification

Before taking the hypotensive means of central action, the classification table is studied. Specialists of INCS share hypotensive medicines into the following classes:

1. 1. Diuretics.
2. 2. Beta adrenoblocators.
3. 3. Calcium antagonists.
4. 4. ACE inhibitors.
5. 5. Angiotensin receptor blockers.

Treatment should be under the control of the doctor.Sedative preparations reduce the functional disorders of the CNS, which are observed in hypertension. Treatment of AG tranquilizers and sleeping pills at an early stage has a long hypotensive effect (decrease in blood pressure). What is a hypotensive action should know every patient suffering from hypertension.

List of sedative preparations (some with a recipe update):

• Bromide;
• Adalin;
• Bromoral.

It is possible to replace the above-mentioned medicines with such tranquilizers as Meprotan, trioxesin, diazepam. The dosage is selected taking into account the sensitivity of the patient to such medicines. During the course of treatment, it is necessary to abandon the work that require a rapid response from the motor system.

Aminezine is more often taken from tranquilizers. Indications for receiving:

• excitation of an emotional nature;
• hypertensive crisis, which is accompanied by psychomotor excitation.

The aminazine has a central hypotensive effect, quickly reducing hell. But the hypotensive effect of this drug is expressed in varying degrees in all patients. What is a hypotensive effect, as he manifests itself, should know every patient. Under the hypotensive effect it is understood as a decrease in the frequency and strength of heart rate, which helps to reduce the minute and shock emission.

Second group of medicines

If the doctor has diagnosed with climate arterial hypertension, the patient is prescribed Frenolon. If necessary, combined therapy (tranquilizers and hormonal agents) are carried out. To improve sleep, the reception of sedatives is shown. If for 3 weeks the sleep does not improve, tranquilizers with a sleeping pills (non-oxiron, sadocent). With prolonged sleep disorders, it is recommended to drink neuroleptics (levomepromazine).

Preparations of sympatholic and anti-adverergic action include central action medicines (Domekarbin, undeveloped, Aprescin). You can treat the AG drugs obtained from the root or Rowolphia leaves. They contribute to the decrease in the reserves of catecholamines and serotonin in the central nervous system, heart, pancreas.

This inhibits the activity of the motor and vascular centers, providing a sympatholic effect. At the same time, the CNS calms down, the sleep is deepened, the interoreceptive reflexes are inhibited. In the process of receiving drugs of this group, a gradual, but strong hypotensive effect is observed.

Parasympathetic effects, specialists include slow motion of the heart, reinforced peristaltics of the intestine. Previously need consultation attending physician. Radolphia medicines prohibit central adrenergic mechanisms, reducing the intracellular sodium concentration. At the initial stage of hypertension, Aymalin, Rezynovin takes. Using the reserp, you can reduce peripheral resistance.

Anti-adverergic substances

Simpatolytic and anti-adverergic substances include drugs such as Vixen, Anaprilin. They have a strong, but short hypotensive effect. Therefore, the tropuffs are prescribed to relieve a hypertensive crisis. At the same time there is a threat of excessive decline in blood pressure.

With the help of gangli-blocking drugs, it is possible to prevent the transfer of pulses between the various fibers of parasympathetic and sympathetic departments. Medicines provoke vegetative denervation.

To have a hypotensive effect, reduce the tone of arterioles, take gangliplockers.

In this case, in various organs there is a decrease in venous pressure and a decrease in the motor activity of the intestine.

Reception of such drugs is carried out taking into account the following conditions:

• stationary reception;
• individual dosage installation;
• reception of the drug / injection at the same time interval;
• after entering the drug, the patient must lie (2 hours), lifting his head;
• a gradual increase in dose, while the doctor must follow the reaction of the body;
• long therapy;
• the drug is canceled by a gradual dose reduction.

Ganglioblocators are contraindicated:

• with a hypertensive crisis;
• if the patient's age exceeds 60 years;
• with congenital cerebral atherosclerosis;
• at feochromocytoma;
• during pregnancy.

But they are taken in the ineffectiveness of combined therapy, a resistant hypertension with complications, hypertension, left-deuded deficiency, encephalitis. Also drugs of this pharmacological group are prescribed in the case of intolerance to modern hypotensive drugs.

Drugs of other groups

To enhance diuresis at AG, the reception of aldosterone inhibitors is shown. This hormone is involved in the formation of pronounced and stable hypertension. Other diuretic medicines with saluretic effect can be prescribed to the patient (contribute to the outstanding of sodium). With elevated blood pressure, they have a clear and constant hypotensive effect. Diolets reinforce the effect of other hypotensive medical facilities. Therefore, they are accepted in the complex. Tiazide diuretic drugs include furosemide, clopamide, etcrinic acid.

Other contemporary hypotensive preparations are presented in the form of methyloft and clofelin. List of hypotensive preparations of the last generation:

1. 1. Rasilez.
2. 2. Cardosal.
3. 3. Trifas.

Rasilez is an Renin inhibitor that helps to keep the pressure in the norm during the day. The drug is well tolerated by patients, without causing a dry cough, characteristic of the ACE inhibitors. Contemporary antagonists include a cardosal. It has the following advantages:

• systematic reception means provides persistent decrease in blood pressure;
• no cancellation syndrome;
• minor side effects.

Cardosal, in contrast to racilee, provides normal hell for 8 weeks. From the diuretics of the new generation, trifas is isolated. It is prescribed to patients with diabetes. Trifas, unlike classic analogues, is accepted daily.

In the treatment of AG shows the reception of calcium channel blockers. Amlodipine can be allocated from the last generation. Such blockers are accepted independently or in a complex with other means. Any hypotensive medicines are applied after consulting a doctor.

Permissible combinations of treatment

According to the recommendations of the All-Russian Scientific Society of Cardiologists, the treatment of arterial hypertension begins with combination therapy. Pre-patient prescribed low dose medicines. If the patient hell exceeds 160/100 mm Hg.st. And there is a high risk of heart and vascular complications, the full-term combination therapy is shown.

Previously, the doctor assesses the interaction of drugs from safety and efficiency. Applied hypotensive medicines must comply with the following requirements:

• complement;
• achieving an improved result with joint admission;
• the presence of pharmacokinetic and pharmacodynamic parameters.

According to the recommendations of the VNC, the low dose of the thiazide diuretics is allowed in combination with a beta-adrenoblocator of a highly selective or vasodilant action. Men suffering from aging, prescribe the following therapy scheme: alpha and beta blockers.

A large doubt causes such a combination as calcium antagonist and a diuretic. It can lead to myocardial infarction. Specialists of the Voints are recommended to combine ACE inhibitors with calcium antagonists. Using data, you can quickly reduce blood pressure.

The amlodipine + leasing scheme reduces the diastolic and systolic levels of blood pressure, while there is a minimum risk of adverse reactions. To ensure comfortable treatment, the doctor combines drugs. Such a diagram of the treatment of AG, in contrast to combined therapy, has the following advantages:

• ensuring social and psychological comfort;
• low price of drugs.

Features of the reception of combined antihypertensive medicines:

• showing patients in need of combination treatment;
• typical strength hypertension;
• used as supportive therapy;
• require a lifetime reception.

From new combined drugs, experts identify the equator submitted as a combination of lysinopril and amlodipine. He controls hell throughout the day. At the same time, the risk of leg edema, the development of tachycardia decreases. If the first choice medication is ineffective, then:

• the doctor adds a drug of another class (taking into account the recommendations of the INC);
• replaces this agent to another drug of this class.

The interval between the stages of therapy is more than 4 weeks, if there is no need for a faster normalization of blood pressure.

Update Article 30.01.2019

Arterial hypertension (AG) In the Russian Federation (RF) remains one of the most significant medical and social problems. This is due to the widespread dissemination of this disease (about 40% of the adult population of the Russian Federation has an increased level of blood pressure), as well as the fact that the AH is the most important risk factor of the main cardiovascular diseases - myocardial infarction and brain stroke.

Permanent persistent increase in blood pressure (blood pressure) up to 140/90 mm. RT. Art. and higher - Sign of arterial hypertension (hypertension).

The risk factors contributing to the manifestation of arterial hypertension include:

• Age (men older than 55 years old, women over 65)
• Smoking
• sedentary lifestyle,
• Obesity (waist amount of more than 94 cm for men and more than 80 cm for women)
• Family cases of early cardiovascular diseases (men under 55 years old, women under the age of 65)
• The magnitude of the pulse arterial pressure in the elderly (the difference between systolic (upper) and diastolic (lower) arterial pressure). Normally, it is 30-50 mm RT Art.
• Plasma glucose an empty stomach 5.6-6.9 mmol / l
• Dyslipidemia: total cholesterol more than 5.0 mmol / l, low-density lipoprotein cholesterol 3.0 mmol / l and more, high density lipoprotein cholesterol 1.0 mmol / l and less for men, and 1.2 mmol / l and less for Women, triglycerides more than 1.7 mmol / l
• Stressful situations
• alcohol abuse
• Excessive salt use (more than 5 grams per day).

Also, the development of AG contributes to diseases and conditions as:

• Sugar diabetes (glucose in plasma on an empty stomach 7.0 mmol / l and more during repeated measurements, as well as glucose in blood plasma after eating 11.0 mmol / l and more)
• Other Endocrinological Diseases (Feochromocytoma, Primary Aldosteronism)
• Diseases of the kidneys and renal arteries
• Reception of drugs 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. In the risk group are the elderly.

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

• 1 degree: Increased blood pressure 140-159 / 90-99 mm RTCT
• 2 degree: Increased blood pressure 160-179 / 100-109 mm RTC
• 3 degree: Increased blood pressure up to 180/110 mm RTTC and higher.

The blood pressure indicators obtained at home can become a valuable addition when monitoring the effectiveness of treatment and are important when the AG is detected. The task of the patient is to conduct the blood pressure self-control diary, where the indicators of the blood pressure and pulse are recorded when measuring, at least in the morning, at lunch, in the evening. It is possible to comment on the lifestyle (lifting, eating, physical activity, stressful situations).

Technique measuring hell:

• Quickly pump air into the cuff to the pressure level, by 20 mm RTTC, exceeding systolic blood pressure (garden), on the disappearance of the pulse
• Hell is measured with an accuracy of up to 2 mm RTCT
• Reduce the pressure in the cuff at a speed of about 2 mm RTTC in 1 second
• The pressure level in which the 1st tone appears, the garden corresponds to
• The pressure level at which the disappearance of the tones corresponds to the diastolic arterial pressure (DDA)
• If the tones are very weak, you should raise your hand and perform several compressive movements with a brush, then the measurement is repeated, and it should not be very comprehended by the artery of the membrane of the Phondoscope
• In the primary measurement, the hell is fixed on both hands. In the future, the measurement is carried out on the hand on which hell is higher
• In patients with diabetes and in persons receiving antihypertensive agents, the hell should also be measured after 2 minutes of stay in the standing position.

Patients with ag are pain in the head (often in the temporal, occipital region), episodes of dizziness, rapid fatigue, poor sleep, may occur pain in the heart, violation of vision.
The disease is complicated by hypertensive crises (when the hell is sharply increased to high digits, rapid urination, headache, dizziness, heartbeat, feeling of heat); impaired kidney function - nephrosclerosis; strokes, intracerebral hemorrhage; Myocardial infarction.

For the prevention of complications of patients with AG, it is necessary to constantly monitor its blood pressure and take special antihypertensive drugs.
If a person is worried about the above complaints, as well as pressure 1-2 times a month - this is a reason to refer to the therapist or cardiologist, which will appoint the necessary surveys, and subsequently determine the further tactics of treatment. Only after the necessary survey complex it is possible to talk about the appointment of drug therapy.

An independent purpose of drugs may threaten the development of undesirable side effects, complications and may have a fatal outcome! It is prohibited to the independent use of medicines according to the principle "helped familiar" or resort to the recommendations of pharmacists in pharmacy chains !!! The use of antihypertensive drugs is possible only by appointment of a doctor!

The main purpose of the treatment of patients with AG consists in maximizing the risk of developing cardiovascular complications and death from them!

1. Activities for lifestyle change:

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

These activities are prescribed to all patients with arterial hypertension, including those receiving antihypertensive drugs. They allow: reduce blood pressure, reduce the need for antihypertensive preparations, favorably affects the available risk factors.

2. Medical therapy

Today we will talk exactly about these drugs - modern means for the treatment of arterial hypertension.
Arterial hypertension is a chronic disease that requires not only constant control of blood pressure, but also a permanent reception of drugs. There is no course of antihypertensive therapy, all drugs are accepted indefinitely. With the inefficiency of monotherapy, the selection of drugs from various groups is carried out, often combining several drugs.
As a rule, the patient's desire with AG is the strongest, but not expensive drug. However, it is necessary to understand that this does not exist.
What drugs for this offer patients suffering from high pressure?

Each antihypertensive drug has its own mechanism of action, i.e. affect those or other "Mechanisms" raising blood pressure :

a) renin angiotensin system - A substance is produced in the kidneys (with a decrease in pressure), which goes into the blood in Renin. The renin (proteolytic enzyme) interacts with the blood plasma protein - angiotensinogen, as a result, an inactive substance of angiotensin I is formed. Angiotensin when interacting with an angiothesin-plating enzyme (ACE) enters the active substance angiotensin II. This substance contributes to an increase in blood pressure, narrowing the vessels, an increase in the frequency and force of heart rate, the excitation of the sympathetic nervous system (which also leads to an increase in blood pressure), strengthening the production of aldosterone. Aldosterone promotes sodium and water delay, which also enhances hell. Angiotenzine II is one of the strongest vessels in the body.

b) Calcium Channels of our organism - Calcium in the body is in the associated state. When calciding is admitted through special channels into the cell, the formation of a contractile protein - actomyosis. Under his action, the vessels are narrowed, the heart begins to shrink more, 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. Such receptors include alpha-adrenoreceptors (α1 and α2) and beta-adrenoreceptors (β1 and β2). The focusing of α1-adrenoreceptors leads to an increase in blood pressure, α2-adrenoreceptors to decrease the blood pressure .α-adrenoreceptors are arranged in the arteries. β1 adrenoreceptors are localized in the heart, in the kidneys, their stimulation leads to an increase in the heart rate, increasing the need of myocardium in oxygen and increase blood pressure. Stimulation of β2-adrenoreceptors located in bronchioles causes the expansion of bronchiol and removal of bronchospasm.

d) urinary system- As a result of an excessive amount of water in the body, hell rises.

e) central nervous system- The excitation of the central nervous system increases blood pressure. In the brain there are vascular centers governing the level of blood pressure.

So, we considered the basic mechanisms of improving blood pressure in the human body. It's time to move to the means to reduce pressure (antihypertensive) that affect these very mechanisms.

Classification of funds for arterial hypertension

1. Diuretics (diuretic)
2. Calcium channel blockers
3. Beta adrenoblocators
4. Means acting on a renin angiotensive system
   1. Blockers (antagonists) angiotensive receptors (sartans)
5. Neurotropic means of central action
6. Tools acting on the central nervous system (CNS)
7. Alpha adrenoblocators

1. Diolets (Diuretics)

As a result of the elimination of excessive fluid from the body, blood pressure is reduced. A diuretic tools prevent the reverse absorption of sodium ions, which are derived from the outside and carries out water. In addition to sodium ions, diuretics are flushed out of the body of potassium ions, which are necessary for the work of the cardiovascular system. There are diuretic products saving potassium.

Representatives:

• Hydrochlorothiazide (hypothiazide) - 25mg, 100mg, is part of the combined drugs; Long-term use in the dosage above 12.5 mg is not recommended, due to the possible development of type 2 diabetes mellitus!
• Indapamide (Arifonredard, Rowed Wed, Indapamide MV, Indap, Ionik Retard, Acrypamidredard) - more often Dosage 1,5mg.
• Triampur (combination diuretik, containing potassium-saving triamtener and hydrochlorostiazide);
• Spironolactone (Veroshpiron, Aldakton). It has a significant side effect (men causes the development of gynecomastia, median).
• Eplerenone (Inspra) - is often used in patients with chronic heart failure, it does not cause the development of gynecomastia and medodinia.
• Furosemide 20mg, 40mg. Preparation of short but quick action. It slows down the reabsorption of sodium ions in the rising knee of the loop of Genlen, proximal and distal tubules. Increases bicarbonate, phosphates, calcium, magnesium.
• Toramsemid (Diiouver) - 5mg, 10mg, is a loop diuretic. The main mechanism of the drug is due to the reversible binding of the thoracemide with the cable carrier of sodium / chlorine / chlorine ions / potassium, located in the apical membrane of the thick segment of the rising part of the loop of the loop of Genla, as a result of which the reabsorption of sodium ions is reduced or fully inhibited and the osmotic pressure of the intracellular fluid and the reabsorption of water decreases. Blocks aldosterone myocardial receptors, reduces fibrosis and improves myocardial diastolic function. Thoraraside to a lesser extent than furosemide causes hypocalemia, while it exhibits greater activity, and its action is longer.

Diuretics are prescribed in a complex with other antihypertensive drugs. The drug Indapamide is the only diuretic applied at AG on their own.
A diuretic rapid action (furosemide) is undesirable to apply systematically with hypertension, they are taken in case of emergency states.
When applying diuretics, it is important to take potassium preparations by courses up to 1 month.

2. Calcium channel blockers

Calcium channel blockers (calcium antagonists) is a heterogeneous group of drugs having the same mechanism of action, but differing in a number of properties, including according to pharmacokinetics, tissue selectivity, effect on the frequency of heart abbreviations.
Another name of this group is calcium ion antagonists.
There are three main subgroups of AK: dihydropyridine (the main representative - nifedipine), phenylalkylamin (the main representative - verapamil) and benzothiazepines (the main representative - Diltiazem).
Recently, they began to divide into two large groups, depending on the impact on the frequency of heart abbreviations. Diltiazene and Verapamil refer to the so-called "rejuvenating rhythm" calcium antagonists (NEDIGIDROPIRODINOVY). The other group (dihydropyridine) includes amlodipine, nifedipine and all other Dihydropyrididin derivatives, increasing or non-changing heart rate.
Calcium channel blockers are used in arterial hypertension, coronary heart disease (contraindicated with sharp forms!) And arrhythmias. At arrhythmias, not all calcium channel blockers are used, but only pulserizing.

Representatives:

Pulsusuring (NEDIGIDROPIRODINOVY):

• Verapamil 40mg, 80mg (prolonged: Isopin CP, Veroralide EP) - dosage 240mg;
• Diltiakeeze 90mg (altiazem pp) - dosage 180mg;

The following representatives (dihydropyridine derivatives) do not apply during arrhythmias: Contraindicated in acute myocardial infarction and unstable angina !!!

• Nifedipine (Adalat, Cordaflex, Cordafen, Cordypin, Corinthar, Nyfekard, Penigidine) - Dosage 10 mg, 20 mg; Nyfekardxl 30mg, 60mg.
• Amlodipine (Norvask, Normodipin, Tenox, Cordin Cord, Es Cordic, Cardopin, Kalkhek,
• Amlotop, Omeloarkardio, Amlovas) - Dosage 5mg, 10mg;
• Felodipine (Captionil, Felodip) - 2,5mg, 5mg, 10mg;
• Nimodipine (Nimotop) - 30mg;
• Lazidipin (Lazipil, Sakur) - 2mg, 4mg;
• Lercanidipine (Lercomen) - 20mg.

From side effects of dihydropyridine derivatives, you can specify swelling, mainly lower extremities. Headache, redness of the face, the increase in the pulse, the increase in urination. If the edema is saved, it is necessary to replace the drug.
Lercamen, which is a representative of the third generation of calcium antagonists, due to higher selectivity for slow calcium channels, causes edema to a lesser extent compared to other representatives of this group.

3. beta adrenoblocators

There are funds that do not selectively block receptors - non-selective action, they are contraindicated in bronchial asthma, chronic obstructive pulmonary disease (COPD). Other funds selectively block only the beta-receptors of the heart - selective action. All beta blockers prevent the synthesis of prophene in the kidneys, thereby blocking the renin-angiotensin system. In this regard, the vessels expand, hell decreases.

Representatives:

• Metoprolol (Betalk Zok 25mg, 50mg, 100mg, Egyot Retard 25mg, 50mg, 100mg, 200mg, Egyptions C, VaseCardinerell 200 mg, metabardard 100 mg) ;;
• Bisoprolol (Concorp, Coronal, Biol, Bisogamma, Cordinorm, Niperthen, Biprol, Bidop, Aritel) - Most often Dosage 5mg, 10mg;
• Nebivolol (non-binelol) - 5 mg, 10 mg;
• Betaxolol (Locase) - 20 mg;
• Carvedilol (Karvendrend, Coriol, Talliton, Dilatrend, Acrediol) - mostly dosage 6.25mg, 12,5mg, 25mg.

Preparations of this group are used in hypertension combined with ischemic heart disease and arrhythmias.
Short-breathing drugs whose use is not rational with hypertension: anaprilin (indisimated), atenolol, propranolol.

Basic contraindications to beta blockers:

• bronchial asthma;
• low pressure;
• sinus node weakness syndrome;
• pathologies of peripheral arteries;
• bradycardia;
• cardiogenic shock;
• atrioventricular blockade of the second or third degree.

4. Means acting on a renin angiotensin system

Preparations operate at different stages of the formation of angiotensin II. Some inhibit (suppress) an angiotensification enzyme, others block the receptors to which angiotensin II act. The third group inhibits renin, is represented by only one drug (alianis).

Angiotenzine Enzyme Enzyme Inhibitors (ACE)

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

• Captive (Kopoten) - Dosage 25mg, 50mg;
• Enalapril (ReniPril, Berlipril, Renipril, Ednit, Anap, Enaren, Enam) - Dosage most often 5mg, 10mg, 20mg;
• Lysinopril (Dotroton, Dapril, Lizigamma, Leisioton) - Dosage most often 5mg, 10mg, 20mg;
• Perindopril (Preshaum A, Perines) - Perindopril - 2,5mg dosage, 5mg, 10mg. Perines - dosage 4mg, 8mg.;
• Ramipril (Tritacea, Amprilan, Kartil, Pyramil) - 2,5mg dosage, 5mg, 10mg;
• Hinapril (Akkiro) - 5mg, 10mg, 20mg, 40mg;
• Fozinopril (Fozicard, Monophil) - Dosage 10mg, 20mg;
• Transdolapril (gopten) - 2mg;
• Zofensoid (Zocardis) - Dosage 7,5mg, 30mg.

Preparations are available in different dosages for therapy with varying degrees of enhancement of blood pressure.

The peculiarity of the preparation of Captopril (Kopoten) is that he is due to its short-term action is rational only with hypertensive crises.

The bright representative of the Enalapril group and its synonyms are used very often. This drug does not differ in the duration of action, so take 2 times a day. In general, the full effect of APF Igraphs can be observed after 1-2 weeks of use of drugs. In pharmacies you can meet a variety of generics (analogs) of Enalapril, i.e. Cheaper, containing enalapril preparations that produce small manufacturers. We reasoned about the quality of generics in another article, it is worth noting that someone enalapril is suitable for someone, they do not work for someone.

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

Blockers (antagonists) angiotensin receptors (sartans)

These funds block angiotensin receptors. As a result, angiotensin II does not interact with them, the vessels are expanding, hell decreases

Representatives:

• Lozartan (Kozar 50mg, 100mg; Lozec 12.5mg, 50mg, 100mg; Lorist 12,5mg, 25mg, 50mg, 100mg; vasotenz 50mg, 100mg);
• Eprosartan (Teveten) - 400mg, 600mg;
• Walssartan (40mg, 80mg, 160mg, 320mg; Waltacor 80mg, 160mg, 320mg, Vals 40mg, 80mg, 160mg; Nortivan 40mg, 80mg, 160mg; valsafors 80mg, 160mg);
• Irbesartan (Approvnel) - 150mg, 300mg;
  Kandesartan (atacand) - 8mg, 16mg, 32mg;
  Telmisartan (Macardis) - 40mg, 80 mg;
  Olmertan (Cardosal) - 10mg, 20mg, 40mg.

Just as predecessors, allow us to estimate the full action after 1-2 weeks after the start of reception. Do not cause dry cough. Do not apply during pregnancy! When pregnaning pregnancy during the treatment period, hypotensive therapy with drugs of this group should be discontinued!

5. Neurotropic means of central action

Neurotropic drugs of central action affect the vessels center in the brain, reducing its tone.

• Moxonidine (Physiotense, Moksonitex, Moksogamma) - 0.2 mg, 0.4 mg;
• Rilmenidin (Albarel (1MG) - 1MG;
• Metyldop (operated) - 250 mg.

The first representative of this group is clofelin, which has been widely used earlier with AG. Now this drug is released strictly by recipe.
Currently, Moxonidine is used both for emergency assistance in hypertensive crisis, as well as for planned therapy. Dosage 0.2 mg, 0.4 mg. Maximum daily dosage 0,6mg / day.

6. Means operating on the central nervous

If the AG is caused by prolonged stress, then drugs acting on the central nervous system are used (sedatives (novative, perrsen, valerian, dyeing, tranquilizers, sleeping pills).

7. Alpha Adrenoblocators

These funds are attached to alpha-adrenoreceptors and block them for irritant effects of norepinephrine. As a result, hell is reduced.
The used representative - doxazosin (Cardura, Tonokardin) - more often produced in dosages 1 mg, 2 mg. It is used to relieve attacks and long-term therapy. Many drugs of alpha blockers are removed from production.

Why are few drugs at once with arterial hypertension

In the initial stage of the disease, the doctor prescribes one drug, on the basis of some studies and, taking into account the diseases of the patient. If one drug is ineffective, other drugs are often added, creating a combination of drugs to reduce blood pressure, affecting various mechanisms to reduce blood pressure. Combined therapy for refractory (sustainable) arterial hypertension can combine up to 5-6 drugs!

Preparations are selected from different groups. For example:

• aPF / diuretic inhibitor;
• angiotensin / diuretic receptor blocker;
• aFF inhibitor / calcium channel blocker;
• aCF / Calcium Channels / Beta-Adrenoblocator;
• an angiotensin receptor block / calcium channel blocker / beta-adrenoblocator;
• aFF inhibitor / calcium channel blocker / diuretic and other combinations.

There are combinations of drugs that are irrational, for example: beta blockers / calcium channel blockers pulserizing, beta blockers / central action preparations and other combinations. It is dangerous to engage in self-medication !!!

There are combined drugs combining in 1 tablet components of substances from different groups of antihypertensive drugs.

For example:

• aCF / diuretic inhibitor
  • Enalapril / Hydrochlorothiazide (Ko-Renatez, ENAP NL, ENAP N,
  • ENAP NL 20, Renipril GT)
  • Enalapril / Indapamide (Enzyx Duo, Enzyme Duo Forte)
  • Lysinopril / Hydrochlorothiazide (Iruzide, Leisioton, Lithan H)
  • Perindopril / Indapamide (Noliprelai Nolipreforte)
  • Hinapril / hydrochlorothiazide (accumulated)
  • Fozinopil / Hydrochlorothiazide (Fozicard H)
• angiotensin receptor blocker / diuretic
  • Lozartan / Hydrochlorothiazide (Gizar, Lozap Plus, Lorista N,
  • Lorist ND)
  • Eprosartan / Hydrochlorothiazide (Teveten Plus)
  • Valsartan / Hydrochlorothiazide (co-doda)
  • Irbesartan / Hydrochlorothiazide (Co-Approvnel)
  • Candesartan / Hydrochlorothiazide (Ataanda Plus)
  • Telmisartan / HCHT (McCardis Plus)
• aCF / Calcium Channel Ingiber
  • Transdolapril / Verapamil (Tarka)
  • Lysinopril / Amlodipine (Equator)
• angiotensin receptor blocker / calcium channel blocker
  • Valsartan / Amlodipine (Exeffer)
• dihydropyridine calcium channel blocker / beta blocker
  • Felodipine / metoprolol (logism)
• beta blocker / diuretic (it is impossible in diabetes and obesity)
  • Bisoprolol / hydrochlorothiazide (Lodoz, Aritel Plus)

All drugs are produced in different dosages of one and another component, the dose must be selected for the patient.

The achievement and maintenance of target levels of blood pressure require long-term medical observation with regular control of the patient's implementation of recommendations on how to modify the lifestyle and compliance with the admission mode of appointed antihypertensive agents, as well as correction of therapy, depending on the effectiveness, safety and tolerance of treatment. With a dynamic observation, the establishment of personal contact between the doctor and the patient, training of patients in schools for patients with hypertension, which increases the commitment of the patient to treatment is crucial.