Content Sources:
[1] Wei Xiaoming.How much do you know about hypertensive intracerebral hemorrhage[N].Gansu Science and Technology News,2024-03-27(007).
Controversy over the inability to take fast-acting nifedipine and nifedipine controlled-release tablets[J].Chinese Journal of Hypertension,2024,32(03):217-220.DOI:10.16439/j.issn.1673-7245.2024.03.004.
Exploration of rational drug use in China,2024,21(01):113-114.
Uncle He, a 52-year-old man who lives in Hunan, works as a security guard in a community, and sits in the security room every day to watch people come and go. But Uncle He felt that there was something more difficult than the night shift, that is, not to drink. Uncle He started drinking when he was a soldier. At first, I just accompanied my comrades-in-arms to have a few drinks, but then I gradually became addicted to alcohol, and I couldn't sleep at night without three or two glasses of liquor a day.
On June 7, 2018, Uncle He got off the day shift and pulled the security guard at the other door of the community to drink, and between the cups and lamps, Uncle He felt that his temples suddenly jumped to the ground, and his head was dizzy.
The next day, it was Uncle Li's turn to work the night shift, but when he was about to take over the shift at eight o'clock in the evening, Uncle He still felt dizzy, and it stands to reason that he would have woken up early at this point. In the dead of night, Uncle He sat in the security booth and played an audio book to kill time. Suddenly, there was a buzzing in his ears, and the sound of AI reading suddenly became blurred, and Uncle He shook his head vigorously, but it didn't have half an effect. After finishing his shift in the morning, Uncle He ran to the community hospital, and the nurse from the community hospital measured Uncle He's blood pressure, which reached 179/85mmol/L. It turned out that Uncle He's dizziness and tinnitus were all due to high blood pressure.
The blood pressure of patients with hypertension is at a high level for a long time, and the lining of the blood vessel wall will gradually change, making the elasticity of the blood vessel wall weakened and hardened, and hypertension will also stimulate the secretion of vasoactive substances, resulting in vasospasm. When these changes occur in the cerebral blood vessels, patients will experience dizziness, headache, high blood pressure, and the small arteries in the brain will not be able to withstand the pressure and rupture and hemorrhage, causing cerebral hemorrhage, which is called stroke. Uncle He was shocked when he heard the cerebral hemorrhage, but he didn't expect that he had lived so many years in good health and that he would have the risk of cerebral hemorrhage.
Why did the doctor prescribe nifedipine controlled-release tablets to control blood pressure. Nifedipine is a calcium ion antagonist, calcium ion influx will cause vasoconstriction and increase blood pressure, calcium ion antagonist can reduce calcium ions into cells, relax vascular smooth muscle, vascular lumen becomes larger, blood resistance is small, so as to achieve obvious antihypertensive effect, is currently one of the most commonly used antihypertensive drugs in clinical practice.
However, nifedipine is metabolized very quickly in the body, the antihypertensive effect is fast but the play time is limited, it is completely metabolized after 6-7 hours, if you use nifedipine tablets to lower blood pressure, you need to take it at least 3 times a day, and the blood pressure fluctuation will be relatively large, and you need to measure your blood pressure frequently during the medication. As a result, nifedipine extended-release tablets and nifedipine controlled-release tablets appeared.
Nifedipine sustained-release tablets are added with a special envelope on the surface of the drug, which can make the drug release relatively slowly, just like a hole in a balloon filled with water. The effect of nifedipine controlled-release tablets is reflected in the name, which is to wrap the drug with microparticles through a special drug preparation method, so that the drug can be released slowly and evenly in the body, so that the drug concentration in the blood is at a relatively stable level, and has a better effect of controlling blood pressure.
Because he has to take medicine every day, Uncle He doesn't dare to drink, but when he is addicted to alcohol, he always feels that there is no taste in his mouth. On this day, a small truck selling fruit was parked at the entrance of the community, and the loudspeaker played a deafening sound of selling, Uncle He walked out of the security room and stepped forward to persuade the boss to lower his voice, the boss nodded sorry, and then sold his fruit to Uncle He after reducing the volume.
"The fruit I sell is not only rich in vitamin C, but also boosts immunity, lowers cholesterol, and even beautifies the skin. Saying that, he handed a piece to Uncle He to try, Uncle He took a bite, the juice burst in his mouth, and his mouth was full of sweet and sour taste, so Uncle He bought two boxes, one box in the security room, and one box at home.
On July 3, 2018, Uncle He always felt that his head was swollen recently, thinking that he was guilty of high blood pressure, but he had been taking medicine, could it be that he had developed drug resistance? I ate like this for two days, and when I got off the night shift, Uncle He suddenly felt a splitting headache, his hands and feet were not controlled, and he couldn't stand steadily, so he sat back on the chair as soon as he fell, and the security guard who took over was startled when he saw Uncle He like this, and immediately dialed 120.
The doctor gave Uncle He a CT scan of the brain, but the result was unexpected. The CT report showed a hyperdense shadow in the basal ganglia area on the left side of Uncle He, and the diagnosis was cerebral hemorrhage. After the family arrived, they heard what the doctor said and asked suspiciously: Why did he have a cerebral hemorrhage even though he was taking nifedipine every day to control his blood pressure?
The doctor couldn't think of a reason, and after carefully asking Uncle He about his living habits, he suddenly realized: "This fruit must not be eaten with nifedipine! He made these two mistakes when he took the medicine to cause a cerebral hemorrhage!"
It turned out that the fruit that Uncle He ate every day was grapefruit, and the doctor explained to Uncle He's family: before the oral drug enters the blood circulation, it will be metabolized in the intestinal mucosa and liver, and grapefruit can reduce the metabolism of nifedipine in the intestinal mucosa and liver, so that the amount of nifedipine entering the blood increases and prolongs the action time of nifedipine, thereby enhancing the effect of lowering blood pressure, and excessive blood pressure lowering will lead to the occurrence of hypotension. Moreover, Uncle He also increased the dosage of medicine on his own, which increased the risk of hypotension.
High blood pressure can lead to cerebral hemorrhage, but why does low blood pressure also lead to cerebral hemorrhage? This is because the blood pressure is lowered too low when taking medicine, and the blood pressure of hypertensive patients is usually very high, and Uncle He does not sleep well on the night shift can also easily lead to an increase in blood pressure, and violent fluctuations in blood pressure will lead to rupture and bleeding of cerebral blood vessels.
In fact, cases of cerebral hemorrhage after taking nifedipine according to the doctor's instructions are relatively rare. So how should we take nifedipine correctly? In fact, we can do the following 3 points.
1. Follow the doctor's instructions to take medication regularly
No matter what kind of tablet nifedipine is prescribed by the doctor, you should follow the doctor's instructions to take the medicine, antihypertensive drugs are not a fast-acting drug to get rid of the disease, hypertension is not a disease that can be cured in a short time, and antihypertensive drugs need to be taken for a long time to have a good effect on blood pressure control. Patients with hypertension should not only reduce their blood pressure, but also control their blood pressure within an appropriate range to avoid violent fluctuations.
2. Pay attention to the mixing with other drugs
Some patients blindly pursue blood pressure lowering and take two or more antihypertensive drugs at the same time, which may cause hypotension and harm human health. If the patient has other medical conditions and is taking multiple drugs at the same time, the dosage of the drugs should be increased or decreased under the guidance of the doctor. For example, rifampicin used in the treatment of tuberculosis has the opposite mechanism of action to grapefruit, which can reduce the blood concentration of nifedipine and affect the antihypertensive effect. At the time of consultation, you should explain your medical history and medication history to the attending doctor in advance.
3. Pay attention to adverse reactions
Patients taking nifedipine for a long time may experience some adverse reactions such as headache, redness and fever of the skin, edema of the limbs, and occasionally rapid heartbeat, palpitations, chest tightness and other symptoms. When the above symptoms occur, it is necessary to consider whether it is an adverse reaction of long-term use of nifedipine, seek medical attention in time, and change the antihypertensive regimen under the guidance of a doctor.