Modern blood pressure drugs are divided into 10 different groups according to their mechanism of action. The doctor, after reviewing the patient's complaints and test results, prescribes one or more drugs, which cannot be changed independently. Heart and vascular drugs are not drugs you can "recommend to a friend". The wrong choice can lead to dire consequences. Antihypertensive drugs are all available by prescription. In this article we will consider their modern classification based on active ingredients and properties of the effect on the body.
People often ask pharmacies for new generation blood pressure drugs without side effects. But this does not happen in practice. All effective drugs have side effects. You should spend a lot of time choosing a group of drugs for your hypertension with your doctor. Test, adjust the dose, or replace it altogether if the drug is not suitable.
Classification of drugs for high blood pressure (BP)
Diuretics or diuretics
Drugs that increase kidney function remove excess salt and water. This leads to a decrease in the amount of circulating blood and a decrease in vascular resistance - a decrease in pressure. Not all diuretics are suitable for this purpose. The main requirements for the drug are the mildness and duration of the diuretic effect, and the ability to conserve potassium. Many drugs from this group are included in combination drugs for hypertension.
The most common are thiazides. Medicines based on the substance indapamide are available in pure form and in complex form. Hydrochlorothiazide and chlorthalidone are commonly found in blood pressure medications. Examples: ingredients chlorthalidone + atenolol, chlorthalidone + azilsartan. Many options include hydrochlorothiazide complex with different ingredients for hypertension: with quinapril, ramipril, candesartan, bisoprolol, losartan, valsartan. Indapamide is more common with lisinopril, amlodipine and perindopril.
When diuretics are prescribed correctly by a doctor, side effects are practically non-existent. Loss of potassium is not significant. Sometimes patients have to change medications because of allergic reactions. In some cases, your doctor may prescribe potassium supplements.
It happens that one type of diuretic is not enough. There are drugs that include two diuretics: hydrochlorothiazide and triamterene (potassium sparing). Indications for this drug are as follows: edema syndrome, cirrhosis of the liver and hypertension.
Drugs that affect the activity of angiotensin-converting enzyme (ACE)
Several systems work simultaneously in our body to maintain normal blood pressure. One of them is the renin-angiotensin system. We will not describe its working characteristics, but we will only say that the main active substance that increases blood pressure is angiotensin II oligopeptide. When a person has a disturbance in the vascular balance, angiotensin should be inhibited. A large group of drugs has been developed for this purpose.
The generation of blood pressure drugs that affect angiotensin II is constantly updated. Many well-known and popular drugs have become outdated and replaced by more modern and effective ones.
It begins to act in about 1 hour and is active throughout the day. It is considered a powerful medicine. For this reason, many find it difficult to adjust the dose; it is impossible to do this without a doctor. A particular side effect is an excessive drop in blood pressure, which is dangerous. Sometimes cardiologists have to completely stop drugs from this group. But for severe headache symptoms, perindopril is an ideal choice, especially in combination with indapamide. Coughing and shortness of breath when taking perindopril are less common and less noticeable than when taking enalapril.
ACE inhibitors
The latest medicine for blood pressure without side effects such as cough are ACE inhibitors, they act in the same way, but they have a higher safety profile. These are candesartan, eprosartan, irbesartan, losartan, telmisartan. Valsartans are no longer considered new.
Sartans reduce blood pressure after 3 hours, but the maximum effect occurs after 4-8 weeks of continuous use. The correct use of this drug reduces the risk of death in patients at high risk of cardiovascular pathology. ACE inhibitors from the sartan group are more expensive than ACE inhibitors because they act more selectively and are better tolerated.
Beta and alpha adrenergic blockers
This group of drugs works by reducing the activity of adrenaline, which increases blood pressure, the frequency and strength of heart contractions. Adrenergic blockers are prescribed to people who do not respond to ACE inhibitors, as well as to patients with heart disease. Several generations of drugs are distinguished here. The earliest of them are drugs based on the substances atenolol and metoprolol. Now doctors prescribe drugs with the active ingredient bisoprolol fumarate, alone or in combination with a diuretic component.
This drug acts mainly through the heart, reducing the volume of small blood. In addition to affecting blood vessels and renin activity. As a result, blood pressure and heart rate decrease. Prescribed for chronic heart failure, to prevent angina attacks and to combat hypertension. Side effects can be dangerous: low pulse, dizziness, heart conduction disturbances.
Carvedilol has a combined adrenergic blocking effect. It is an alpha and beta adrenergic blocker. Belongs to the new generation and is considered a powerful medicine. Reduces pressure through the heart and peripheral vessels, widening them. Prescribed for the treatment of stable angina, chronic heart failure and hypertension.
Nebivolol is a third generation beta blocker. It has a better vasodilator effect and a higher safety profile.
Calcium channel blockers
Calcium normally maintains myocardial contraction and vascular tone. A group of drugs have been developed that limit their effect on lowering blood pressure in hypertension.
Calcium channel blockers are considered potent and are sometimes prescribed as an emergency treatment for very high blood pressure.
A preparation based on the substance amlodipine besylateprescribed for hypertension and angina pectoris. Side effects often include hypotension, palpitations, swelling, and deterioration of cardiac function. Medicines containing the substance lercanidipine hydrochloride reduce blood pressure mainly through the vascular bed and therefore have no or less significant side effects on the heart. Among the signs there is only hypertension.
Imidazoline receptor agonists
This new group of blood pressure medications are called central alpha 2 adrenergic agonists.
As we mentioned above, the important support of pressure in the vascular bed is under the control of many systems in our body. One of them is the vasomotor center in the brain. The representative of the group, the substance moxonidine, reduces the activity of this center and the pressure decreases, the process occurs gradually.
Drugs based on moxonidine qualitatively reduce blood pressure. But unlike others, this substance is contraindicated in acute and chronic heart failure, and this pathology often accompanies hypertension.
Unwanted effects include dry mouth, diarrhea, drowsiness, headache, insomnia, and nervousness.
As we have seen, no new blood pressure medication is without side effects. The choice of medication will be made by the doctor based on the study of blood tests, ECG and tonometer readings. Before visiting the doctor, you need to keep a diary of blood pressure values, where the pressure will be recorded in the morning, afternoon and evening.
Adherence to a diet low in salt, animal fat and light carbohydrates, as well as regular sports activity, has a positive effect.
To improve the function of the cardiovascular system, we can recommend nutritional supplements with essential elements. For example, selenium, magnesium, potassium. It is contained in many popular food supplements and vitamin complexes.
Supplements with omega 3 support vascular health and control blood pressure. There are different types of drugs available in pharmacies.