Blood pressure is high, do you have a tablet of antihypertensive medicine under the tongue?

This problem is not a vacuum, and it is often used in the clinic, especially if nifedipine or cartopipine is used to quickly lower blood pressure.

Why do I take medication sublingually? For the sake of a quick buck, of course. Some patients have high blood pressure, and the patient himself or the doctor wants to lower the blood pressure as soon as possible, so he takes the drug under the tongue. So, for severe hypertension, should there be a drug under the tongue?

Author: Guo Yifang, People's Hospital of Hebei Province

Source: Guo Yifang Heart Frontier

Sublingual taking nifedipine (commonly known as "heartache") is a method of medication often used by many doctors and even patients: the drug has a rapid onset of action, and can exert a hypotensive effect after several minutes after taking sublingual, but this medication method may adversely affect patients or even lead to serious consequences, the mechanism includes: (1) severe hypertension patients in a short period of time Blood pressure rapidly and significantly reduced, can lead to a significant decrease in blood perfusion pressure of important living organs, blood flow significantly reduced ;(2) Taking nifedipine can lead to a redistribution of blood flow throughout the body, an increase in peripheral vascular blood flow and a relative decrease in cardiac and cerebrovascular blood flow.

For more than 30 years, there have been many reports at home and abroad suggesting that taking nifedipine under the tongue can lead to acute stroke, acute myocardial infarction and even sudden death, so in 1985, the US Food and Drug Administration believed that patients with hypertension should not take nifedipine under the tongue. The 6th report of the U.S. Joint National Commission for the Prevention, Detection, Evaluation, and Treatment of Hypertension also clearly states that sublingual use of nifedipine is "unacceptable." The Guidelines for the Prevention and Treatment of Hypertension in China (2009 Grassroots Edition) also point out that patients with hypertensive emergencies should use or not take nifedipine under the tongue with caution.

If I can't take nifedipine sublingually, can I take captopril? This is also a rapid antihypertensive method often used by many doctors or patients.

At present, the guidelines for hypertension at home and abroad do not recommend sublingual antihypertensive drugs. However, some patients with severe hypertension are inconvenient to go to the hospital for infusion, and taking captopril under the tongue seems to be a means of emergency blood pressure reduction. However, after taking the drug, it is necessary to lie in bed or sit still, and closely monitor blood pressure, if there is excessive reduction of blood pressure or dizziness, visual impairment, and even syncope and other adverse reactions, you should seek medical attention in time.

Kazerani et al. studied the efficacy and safety of sublingual captopril 25 mg in 101 patients with hypertensive subacute (blood pressure ≥ 180/110 mmHg but no significant target organ damage), and the results showed that this method was effective for most patients and no serious adverse reactions were seen (Singapore Med J 2009, 50: 400). Kaya et al. compared the antihypertensive effects of oral or sublingual captopril in 212 patients. The results showed that the decrease in blood pressure with captopril under the tongue after 30 minutes of administration was greater than that in the oral captopril group, but there was no significant difference in the decrease in blood pressure between the two groups after 1 hour (Eur Rev Med Pharmacol Sci. 2012，16: 1642）。

Sublingual administration of nifedipine can lead to a rapid decrease in blood pressure and reflexive excitation of the activity of the sympathetic and renin angiotensin systems, adversely affecting the cardiovascular system. Because captopril exerts a hypotensive effect by inhibiting the activity of the renin angiotensin system, it is safer than nifedipine when used sublingually. However, no matter which drug is used, the rapid and substantial reduction of blood pressure in a short period of time may lead to a significant decrease in the blood perfusion pressure of important living organs and a significant decrease in blood flow, so it is not used as the preferred antihypertensive treatment measure.

In summary, the simplest answer to this question is: if the blood pressure is seriously elevated but it is inconvenient to go to the hospital, you should not take nifedipine under the tongue, you can try to take captopril sublingually, but in the process of medication, you need to closely observe the patient's blood pressure changes and whether there are any discomfort symptoms, and seek medical treatment immediately if necessary.