Aunt Chen, 67 years old, was diagnosed with essential hypertension a few months ago, but fortunately, the discovery was timely, and the doctor prescribed telmisartan tablets for treatment. However, after taking it for a period of time, Aunt Chen felt that the effect was not obvious, and she often experienced headaches and dizziness.
In desperation, Aunt Chen found another hospital for help. Different from the initial diagnosis, this time the doctor prescribed triamterene tablets to her and told her not to change the medication or change the dosage at will.
However, in order to quickly relieve the symptoms, Aunt Chen, who was eager to treat the disease, chose to take the two medicines together.
Sure enough, the antihypertensive effect after the combination was immediate, but soon after Aunt Chen was admitted to the hospital due to arrhythmia and metabolic acidosis caused by high blood potassium, and almost lost her life.
Obviously, they are all antihypertensive drugs, why do they have such serious consequences when used in combination? How to combine antihypertensive drugs to be safe and effective? To understand these problems, we must first understand the current situation of hypertension and the existing drugs.
1. Doctor's warning: High blood pressure is riddled with high blood pressure, do not take medicine in a hurry
When it comes to the chronic disease of "high blood pressure", many middle-aged and elderly people will have chills down their backs.
This "silent killer" not only has a hidden onset, but may also be the initiator of a series of dangerous diseases such as coronary heart disease, heart failure, cerebral hemorrhage, stroke, and chronic renal failure.
The "2023 Global Hypertension Report" released by the World Health Organization clearly points out that the prevalence of hypertension has reached 33% among people aged 30~79 years old in the world, and the compliance rate after treatment is only 16%.
In mainland China, the prevalence of hypertension is about 27%, which is lower than the world average, but the total number of patients has exceeded 257 million, which is also the "hardest hit area" of hypertension.
In addition to genetic factors, poor lifestyle habits are also one of the culprits behind the high incidence of hypertension.
For example, problems such as tension, anxiety, and insomnia caused by work stress, as well as behaviors such as staying up late, eating a high-salt diet, drinking too much, and not exercising, can cause a persistent increase in blood pressure.
Fortunately, unlike other chronic diseases, a wide range of drugs have been developed for hypertension, and most of them have achieved good results.
At present, there are five types of commonly used antihypertensive drugs: diuretics (hydrochlorothiazide, indapamide), β receptor blockers (lol), calcium-channel blockers (dipine), angiotensin-converting enzyme inhibitors (pulli), and angiotensin II receptor blockers (sartans).
In addition, some natural alkaloids, such as reserpine, also have a certain antihypertensive effect.
The antihypertensive principles and pharmacokinetics of these drugs differ from each other, and doctors can decide to use a single drug regimen or a combination of drugs based on the patient's severity, underlying medical conditions, and drug tolerance.
It is important to note that the combination of drugs must be carried out under the guidance of a doctor, and the medication cycle and dosage are strictly controlled. If patients use these drugs in a random combination, it is not only difficult to improve the antihypertensive effect, but may also face serious risks.
On the one hand, drugs with similar antihypertensive principles should not be used together.
For example, the purpose of lowering blood pressure by interfering with calcium channel blockers to relax vascular smooth muscle is reduced, and sartans that act on angiotensin and its receptors to achieve the purpose of lowering blood pressure, the two antihypertensive principles are not similar and can be used in combination;
However, the antihypertensive drugs of the pril class also act on angiotensin and its receptors to exert a hypotensive effect, and the two antihypertensive drugs of sartan and pull are not recommended to be used together. Because, because the blood pressure drops too quickly, it may cause kidney damage, which can be life-threatening in severe cases.
On the other hand, drugs with overlapping adverse reactions should not be used in combination.
For example, potassium-sparing diuretics (spironolactone) and sartan drugs have the effect of raising blood potassium, and the combination of the two will exacerbate the effect of potassium elevation, make patients develop hyperkalemia, increase the burden on the heart, and long-term use can even induce cardiac arrest.
Therefore, for the sake of your own health, you must not "rush to the doctor" after having high blood pressure, let alone blindly take medicine in order to lower blood pressure quickly. But the question is, if a single drug cannot effectively control blood pressure, how can the medication regimen be adjusted?
2. Combined strikes: These four "buck down packages" are safe and effective
The doctor reminds that don't panic when your blood pressure can't be controlled, the following four blood pressure reduction combinations are not only safe, but also can have the effect of "1+1>2", you may wish to ask the doctor to evaluate and use it as appropriate.
1. Nifedipine + telmisartan
Nifedipine ranging from 2~30 yuan is a commonly used antihypertensive drug in patients with hypertension and is a commonly used calcium channel blocker.
Not only is the price affordable for most Chinese, but also the safety window is larger and there are fewer adverse reactions. Nifedipine also has the advantages of stable antihypertensive and long-lasting effect, and there are no absolute contraindications and age restrictions, so it is one of the most widely used antihypertensive drugs.
In addition, sugar friends should be more interested in this kind of antihypertensive drugs, why do you say that?Sugar friends are most concerned about blood sugar levels, if blood sugar is really not well controlled, kidneys, vision and other functional organs may be damaged, so if blood sugar and blood pressure are high, the level drugs that will not affect glucose metabolism are more prominent.
Telmisartan, which is often "partnered" with nifedipine, also has a good safety profile, rapid oral onset, and can significantly improve the antihypertensive effect when combined with nifedipine, and effectively reduce the adverse reactions caused by taking nifedipine.
A domestic study found that compared with nifedipine alone, the effective rate of nifedipine combined with telmisartan in the treatment of resistant hypertension increased from 74% to 95%, and the adverse reaction rate was only 4%, which further demonstrated the safety of this regimen.
2. Captopril + Bisoprolol
Captopril is a relatively common ACE inhibitor, which can effectively dilate peripheral blood vessels, increase urine output, reduce fluid load, and has a reliable antihypertensive effect, and can take effect within 30 minutes after oral administration, which is widely loved by middle-aged and elderly patients.
Bisoprolol is a third-generation β receptor blocker, which has the effect of controlling heart rate and relieving angina pectoris while lowering blood pressure, and can alleviate the side effects of tachycardia when combined with captopril, protect myocardial cells while lowering blood pressure, and is the preferred match for patients with hypertension and heart disease.
This is also the reason why middle-aged and elderly patients prefer this combination, we know that organs will also age with age, like the heart, after the age of 40, it will enter the process of aging, at this time, coupled with the impact of blood pressure, cardiovascular disease is more likely to occur, so it is not surprising that the combination of "captopril + bisoprolol" that is beneficial to both is liked by the majority of middle-aged and elderly patients.
3. Bisoprolol + amlodipine
Amlodipine is similar to nifedipine in that it lowers blood pressure by dilating arterial blood vessels, while bisoprolol lowers blood pressure by lowering heart rate.
In addition, like captopril, amlodipine also has the problem of increased heart rate, so the combination with bisoprolol can effectively reduce the damage to the cardiovascular system. For hypertensive patients with heart failure and coronary heart disease, this combination can be considered.
4. Hydrochlorothiazide + telmisartan + potassium citrate
Hydrochlorothiazide is the most commonly used diuretic antihypertensive drug, which can effectively promote the excretion of sodium and water, reduce the constriction of blood vessels, and achieve the purpose of lowering blood pressure. However, hydrochlorothiazide monotherapy promotes urination and affects the sodium-potassium balance in the body, thereby decreasing serum potassium and increasing the risk of hypokalemia.
In contrast, telmisartan lowers blood pressure and has a potassium-raising effect, which can counteract the adverse effects of diuretics, so the two are often used in combination preparations. In addition, similar combinations include hydrochlorothiazide + irbesartan, hydrochlorothiazide + valsartan, perindopril + indapamide, etc.
If the blood potassium is still low after taking it for a period of time, potassium citrate can be taken appropriately to supplement potassium, but the drug is generally not added at the beginning of treatment. This regimen may be considered in hypertensive patients with a sound urinary system and no other chronic medical conditions.
Write at the end
In fact, although the "arsenal" of combating high blood pressure is sufficient, hitting the wrong direction will also be self-inflicted.
Before combining drugs, it is necessary to fully evaluate your own situation with your doctor and tailor a personalized treatment plan to avoid "everyone is the same", and eventually delay the treatment time.
Bibliography:
[1] Jia Zhantao, Cheng Shuaishi et al. Effect of nifedipine controlled-release tablets combined with telmisartan tablets in the treatment of elderly patients with coronary heart disease complicated with refractory hypertension[J]. Chinese Journal of Practical Medicine, 2022, 49(12): 98-101.
[2] Gao Zaiqiang, Hu Yuping. Characteristics and rationality of clinical combination of antihypertensive drugs[J]. Clinical Medical Research and Practice, 2018, 3(19): 102-103.
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