This year, 62-year-old Li Bo is a hypertensive patient, with a history of hypertension for 7 years, and the first thing he does after breakfast every day is to take antihypertensive medicine, and he has been controlling his blood pressure at about 140 for so many years.
But recently, he saw an article on the Internet saying that antihypertensive drugs should be taken at night, because blood pressure fluctuations at night are more harmful to cardiovascular and cerebrovascular diseases, and at this time, drugs can better control blood pressure and reduce accidents.
This can confuse Li Bo, could it be that he has been taking the wrong blood pressure medicine for so many years?
What is the truth, today Xiao Jiu will come to tell you when to take blood pressure medicine.
1. Should blood pressure medication be taken in the morning or at night?
Many readers will have the same confusion as Li Bo, when should I take blood pressure medicine? A large forward-looking trial in Europe in 2022 may provide the answer.
The TIME study, a large European study, found that there was no clear difference between taking antihypertensive drugs earlier or later in preventing cardiovascular events in patients with arytenoid hypertension.
The study included data from more than 21,000 subjects and randomized them, including 10,503 cases of taking medication at 20~24 o'clock in the evening and 10,601 cases taking medication at 6~10 o'clock in the morning, and the subjects were followed up for a median of 5.2 years.
The results showed that the incidence of endpoint events was 3.4% in the evening and 3.7% in the morning group, and there was no significant difference between the two.
However, it should be noted that the study only focused on arytenoid hypertension, which is also the most common type of hypertension, with the characteristics of "two peaks and one valley", with two peak periods appearing at 6~8 am and 4~6 pm respectively, and the trough time period is 2~3 am. And the blood pressure is high during the day and low at night, and the blood pressure at night will drop by 10~20% compared with the day.
However, due to age, functional deterioration and other reasons, data show that 69% of the elderly over 60 years old are non-ladle type, and when they are over 80 years old, the proportion of non-dipper type is as high as 83.3%.
Therefore, for patients with high blood pressure, if they want to control and stabilize their blood pressure, the first thing to do is to figure out what type of blood pressure they have, which can be determined by going to the hospital with a ambulatory blood pressure monitor.
Liu Xin, an associate professor at the School of Pharmacy of Capital Medical University, said that patients with arytenoid hypertension can choose to take medicine in the morning or evening according to their personal habits. However, if there is no significant decrease in blood pressure at night or during the day, or there is an abnormal rise, it is recommended to take the drug at night; Conversely, if there is a significant drop in blood pressure at night, it is recommended to take the medicine in the morning.
Two or three antihypertensive drugs have been "eliminated", but many patients are still taking them
According to the data in the China Cardiovascular Disease Report 2022, there are 330 million patients with cardiovascular diseases in mainland China, of which the number of hypertension patients has reached 245 million. However, the medication rate was only 45.8%, and the blood pressure control compliance rate was even lower to 16.8%, and only about one-third of the patients achieved the blood pressure control target.
Part of the reason for this is that some elderly patients still insist on taking "obsolete" antihypertensive drugs, which are not recommended for conventional antihypertensive therapy. In particular, the following three types.
1. Nifedipine tablets
Guidelines for the prevention and treatment of hypertension in mainland China recommend the use of long-acting antihypertensive drugs to ensure that blood pressure can be controlled smoothly for a long time. Nifedipine, on the other hand, has the characteristics of short half-life, high clearance and short persistence, which is short-term for blood pressure control, and it is difficult to achieve 24-hour comprehensive coverage.
And the magnitude and speed of blood pressure reduction are difficult to grasp, which may bring some adverse consequences to health. At present, nifedipine controlled-release tablets and extended-release tablets have been used in clinical practice instead of nifedipine, and nifedipine is not the first choice for conventional hypertension treatment.
2. Compound Luobuma tablets
The drug is a compound preparation composed of a variety of traditional Chinese medicine and Western medicine, among which hydrochlorothiazide and dihydralazine have antihypertensive effects.
The former is the most commonly used antihypertensive ingredient, but the latter is a simple vasodilator that causes reflex sympathetic excitement and increased heart rate. Long-term, large-scale use may also cause lupus-like changes in the skin, and the first-line routine use of compound Luobuma tablets is no longer recommended.
3. Traditional compound antihypertensive drugs containing reserpine
Compound antihypertensive tablets such as reserpine tablets are not commonly used antihypertensive drugs recommended by hypertension guidelines.
Because the reserpine in it will promote gastric acid secretion and inhibit central nervous system function, long-term, high-dose administration will lead to a significant increase in the risk of adverse reactions. Moreover, these compound antihypertensive drugs often have many side effects and are easy to cause complications.
3. Regarding taking blood pressure medications, these 3 minefields should be avoided
Patients with hypertension have misunderstandings about antihypertensive drugs, and lack of understanding is also one of the reasons why blood pressure control is not up to standard.
Xiao Junfeng, pharmacist in charge of the clinical pharmacy department of the Southern Theater General Hospital, said that regarding taking blood pressure drugs, these three minefields must be avoided.
1. Diagnosis of hypertension can be done without medication
Many patients who have been diagnosed with high blood pressure are reluctant to take medicine as soon as possible, believing that the body has no symptoms, long-term medication will lead to drug resistance, and side effects, but this idea is very wrong.
It is true that people with high blood pressure need to take the drug for life, but the drug itself does not develop resistance. Whether there are adverse reactions has a lot to do with the way of medication, and taking the medication according to the doctor's instructions can greatly reduce the risk of occurring. If the blood pressure is not lowered in time, it will cause great damage to the blood vessels, which will bring greater threats to health.
2. If the blood pressure is normal, the drug can be stopped
After the blood pressure returns to normal, many patients feel that they are cured and will stop the drug on their own, which is also wrong!
There is no cure for high blood pressure, and the condition can only be controlled by taking medication, and blindly stopping the drug will lead to a rebound in blood pressure, which will bring serious damage to the heart, brain, kidney and other organs.
3. Health products can replace antihypertensive drugs
There are many antihypertensive drugs in life that advertise that they can cure high blood pressure, but! Hypertension is a chronic disease that cannot be cured, once diagnosed, it needs to be treated with standardized medication, the essence of health care products is food, which cannot play a role in treating diseases, we must have a correct attitude towards this, and we cannot blindly believe it.
After being diagnosed with high blood pressure, it is necessary to take antihypertensive drugs, and you cannot change or adjust the dose at will, everything must be done in consultation with a doctor and according to the doctor's instructions. As long as you take your medicine on time and maintain a healthy lifestyle, you can live a long and healthy life like ordinary people.
Resources:
[1] "Should I take blood pressure medicine in the morning or at night?" Before or after a meal? 》. Fuwai said the heart 2023-05-17
[2] "Antihypertensive drugs that have been eliminated clinically, but many patients are still taking them!" 》. Rational use of drugs in China 2021-03-16
[3] "Popular Science | What are the misconceptions of self-management of hypertensive patients? Come and get to know →. Guangdong Food and Drug Administration 2022-09-05
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