Many friends ask Huazi, in the first-line antihypertensive drugs, there are Pry drugs and satan drugs, both related to the angiotensin system, what is the difference between the two, what should be paid attention to when choosing?
Huazi said that both pry and sartan drugs can inhibit the action of the angiotensin system, and the pharmacological mechanism is similar. The traditional usage is to choose "puly" first, and if the patient cannot tolerate the adverse reactions of the drug, then choose "sartan", but the choice has changed now.
First, the effect of both on angiotensin
In the human body, there is an important blood pressure regulation system called the Renin-Angiotensin-Aldosterol system (RAAS). Renin is produced by pararenal cells and, under the action of a series of biological enzymes, is converted into angiotensin 1, angiotensin 2, and angiotensin 3, and promotes the release of aldosterone.
In RAAS, the strongest role of vasoconstriction of blood vessels with angiotensin 2, puri drugs are angiotensin-converting enzyme inhibitors, which can inhibit the conversion of angiotensin 1 into angiotensin 2, directly reducing the level of angiotensin 2. Sartans are angiotensin-2 receptor antagonists that prevent angiotensin-2 from binding to receptors on blood vessels.
Second, "Puli" and "satan" cannot be used together
For example, if angiotensin 2 is a "rope" that can tighten blood pressure, the role of the pry drug is to cut the middle of the rope, and the effect of the satan is to cut the end of the rope. Both are actually through the same way, blood pressure is controlled.
In related studies, a combination of pry and sartan has been conducted, and the final conclusion shows that patients will not benefit from this and may increase adverse reactions. Although most patients with hypertension require the use of multiple drugs to effectively control blood pressure, "puly" and "sartan" can not be used together.
Third, from the experience of medication "puly" drugs as the first choice
"Puli" and "satan" can also play a good protective role for the heart and kidneys while lowering blood pressure. Therefore, some people with normal blood pressure, but have heart disease or kidney disease, doctors will also use both for treatment.
Pryprix appeared earlier, and in the 1990s there were sufficient clinical data to confirm a strong organ protection effect. Moreover, in addition to inhibiting RAAS, politics will also affect the bradykinin system, increase the level of bradykinin in the human body, and can exert cardiovascular protection through two ways.
However, after elevated bradykinin levels, they accumulate mainly in the lungs, so prydices may cause adverse reactions of dry cough. The vast majority of people have mild symptoms of dry cough and can be tolerated. A small number of people with severe dry cough can use sartans instead of politics.
Sartans were studied much later than plelips and acted only on RAAS and did not affect the bradykinin system. Relatively speaking, there is more evidence of organ protection for pry drugs and are often preferred, while sartans are in the role of "substitute".
Fourth, different choices for different organ damage
Hypertension, coronary heart disease, myocardial infarction and other diseases can cause ventricular hypertrophy, which in turn causes heart failure and is life-threatening. Lowering blood pressure is the main method of reversing ventricular hypertrophy, but in studies of first-line antihypertensive drugs, it was found that sartans had the strongest reversal effect on ventricular hypertrophy. So now in patients with ventricular hypertrophy, sartans can be used as the drug of choice.
Both pry and sartans can dilate the ball and enter the arteriole, which has a renal protective effect. In patients with proteinuria or microproteuria, there is more evidence of lowering proteinuria with pry. Therefore, for the treatment of renal syndrome, pry drugs are still the first choice. Those who cannot tolerate adverse reactions can be replaced with sartans.
To sum up, "Puli" and "sartan" are both first-line antihypertensive drugs with similar mechanisms of action, both of which can not only reduce blood pressure, but also have good heart and kidney protection. Because the pry drug was developed earlier, there is more clinical evidence and is more commonly used. Sartans are rising stars, although often used as a "substitute" for pry drugs, but with the increase of related research, the advantages are gradually being discovered.
Medications should be used under the guidance of a doctor, if you have any doubts about medication, please consult a doctor or pharmacist. I am a pharmacist Huazi, welcome to follow me and share more health knowledge.