Antihypertensive therapy for a comorbid patient: what to look for when choosing a drug?

Hypotensive effect - what is it? This question is asked by women and men who are faced with the problem of high blood pressure or hypertension for the first time and who have no idea what the hypotensive effect of the drugs prescribed to them by their attending physician means. An antihypertensive effect is a decrease in blood pressure under the influence of a particular drug.

Experienced professional therapists of the highest category at the Yusupov Hospital Therapy Clinic, who are proficient in advanced treatment and diagnostic methods, will provide qualified assistance to patients with arterial hypertension and select an effective treatment regimen that eliminates the development of negative consequences.

Hypotensive syndrome

Hypotensive syndrome is a whole complex of symptoms that reflects a persistent decrease in intracranial pressure in women. It occurs only in pregnant women aged 25 to 29 years. This syndrome significantly reduces the quality of life of the expectant mother and requires qualified medical care.

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Causes

The causes of this pathology are the following factors:

• severe dehydration after undergoing drug therapy;
• head injuries;
• leakage of cerebrospinal fluid due to a violation of the integrity of the skull bones or brain tissue;
• a decrease in blood pressure, leading to a decrease in intracranial pressure.

Every pregnant woman should be doubly attentive to her health, since she is also responsible for the life of the child. Any changes in health should be a reason to consult a doctor. Doctors at the Yusupov Hospital are ready to answer all their patients’ questions at any time, either in person or by phone.

Symptoms of hypotensive syndrome in pregnant women are:

• severe constricting sudden headaches;
• increased headaches when raising the head or in a sitting position;
• reduction in the intensity of headaches when lowering the head;
• prostration;
• feeling drowsy;
• irritability;
• attacks of nausea and vomiting.

Of course, many of the above symptoms occur in pregnant women and are a consequence of changes in the functioning of all organs and systems during the period of bearing a baby. They may have nothing to do with hypotensive syndrome.

But in any case, if the expectant mother’s health worsens, she must inform the doctor about it. Caution and attentiveness to your health will help you avoid the development of complications, identify hypotensive syndrome and undergo an effective course of therapy.

Diagnostics

If symptoms of the disease appear during pregnancy, it is necessary to undergo examinations by a gynecologist, neurologist and neurosurgeon. Doctors conduct examinations, analyze all the patient’s complaints and make a preliminary diagnosis. To confirm or refute it, the pregnant woman is prescribed a number of diagnostic measures, namely:

• general and biochemical blood test;
• general urine analysis;
• X-ray of the skull;
• spinal tap;
• MRI of the brain.

At the Yusupov Hospital, all diagnostic procedures are carried out using modern medical equipment, which allows you to obtain accurate data and promptly begin treatment.

Antihypertensive therapy for diabetes mellitus

Diabetes mellitus is a chronic disease, the development of which is associated with an absolute or relative deficiency of the hormone insulin. Lack of insulin or lack of sensitivity to it leads to an increase in blood glucose levels. This condition has a negative impact on all systems and organs of the human body, including the cardiovascular system.

Almost all patients suffering from diabetes complain of high blood pressure, which can be reduced with great difficulty without the help of a doctor.

Hypertension and diabetes mellitus

Hypertension in patients with diabetes is an integral and very dangerous component, which can several times increase the risk of developing the following diseases:

• 3-5 times - heart attack;
• 3-4 times - stroke:
• 10-20 times - blindness;
• 20-25 times – renal failure;
• 20 times - gangrene, requiring limb amputation.

If blood pressure readings exceed 140/90, there is no need to hesitate to contact a specialist, since hypertension that occurs against the background of diabetes mellitus can lead to the development of irreversible consequences, often incompatible with life.

Hypertension in type 1 diabetes mellitus

The main and most dangerous cause of arterial hypertension in type 1 diabetes mellitus is the presence of diabetic nephropathy in patients with this disease. The development of this complication is observed in almost 40% of people suffering from type 1 diabetes. Increased blood pressure is directly related to the amount of protein excreted in the urine.

Hypertension due to renal failure also develops due to poor excretion of sodium in the urine. As sodium increases in the blood, fluid accumulates to dilute it. Due to the increase in circulating blood volume, blood pressure increases. This process may also be associated with an increase in glucose concentration, which occurs in diabetes mellitus. As a result, to reduce blood density, the body produces even more fluid and the volume of circulating blood further increases for this reason.

Hypertension in type 2 diabetes mellitus

One of the factors that provokes the development of type 2 diabetes mellitus is insulin resistance, i.e. decreased sensitivity of tissues to the action of insulin.

To compensate for insulin resistance, excessive amounts of insulin circulate in the blood, which itself causes an increase in blood pressure. Over time, a narrowing of the lumen of blood vessels occurs, caused by atherosclerosis, which also contributes to the occurrence of hypertension. In parallel, patients experience the development of abdominal obesity, and, as is known, it is from adipose tissue that substances that increase blood pressure are released into the blood.

Hypertension in diabetes: features

In patients with diabetes mellitus, there is a disturbance in the natural daily rhythm of blood pressure fluctuations. In a healthy person, blood pressure levels in the morning and at night are usually 10-20% lower than in the daytime. In patients with diabetes, there is no decrease in blood pressure at night. Moreover, their nighttime pressure readings may be even higher than their daytime ones. According to experts, this phenomenon is caused by diabetic neuropathy. An increased concentration of sugar in the blood leads to damage to the autonomic nervous system, which is responsible for regulating the body's vital functions. There is a deterioration in the ability of blood vessels to regulate their tone - narrowing and relaxing depending on the load.

Antihypertensive drugs for diabetes mellitus

To date, eight groups of antihypertensive drugs are known, of which five are considered primary, and three are considered additional. Antihypertensive therapy for diabetes mellitus involves taking the following medications:

• diuretics;
• calcium channel blockers;
• beta blockers;
• centrally acting drugs;
• ACE inhibitors;
• angiotensin II receptor blockers;
• alpha-blockers;
• renin inhibitor (racillosis).

Medicines that make up additional groups are prescribed, most often, as components of combination treatment.

Features of the body of older people

Treatment of hypertension in middle-aged and elderly people has its own characteristics. This is due to the appearance of age-related changes, the number of which increases with each passing year of a person.

Most often, many other diseases are diagnosed in older people against the background of hypertension. Therefore, the goal of treatment is not only to reduce blood pressure, but also to maintain general health, without harm to internal organs and systems. Most often, damage is caused to the brain, kidneys, liver, visual organs, blood vessels and cardiovascular system. Unfortunately, medications almost always have side effects. However, doctors are trying to select antihypertensive drugs for older people with the least side effects.

The body of older people has its own characteristics:

• Vessels in older people are more fragile and brittle. Due to the fact that blood vessels are more difficult to adapt to pressure changes, the risk of hemorrhage increases significantly;
• The presence of atherosclerotic changes in the endothelium is often observed, as a result of which vascular tone increases.

Jumps in blood pressure in older people are not always associated with hypertension. Thus, dysfunction of the kidneys and adrenal glands may occur.

Antihypertensive therapy: general rules

Both symptomatic hypertension and hypertension require correction with drugs that have a hypotensive effect. Antihypertensive therapy can be carried out with drugs that differ in their mechanism of action: antiadrenergic agents, vasodilators, calcium antagonists, angiotensin antagonists, and diuretics.

You can obtain information about the hypotensive effect of the drug and what medications to take for high blood pressure not only from your doctor, but also from your pharmacist.

Arterial hypertension is a chronic disease that requires constant drug support, daily monitoring and regular use of prescribed medications. Not only the state of health, but also the life of a person depends on compliance with these rules.

Despite the general availability of treatment rules for reducing blood pressure, many patients have to be reminded what a treatment regimen for hypertension should look like:

• Antihypertensive medications should be taken regularly, regardless of the patient’s well-being and blood pressure level. This allows you to increase the effectiveness of blood pressure control, as well as prevent cardiovascular complications and target organ damage;
• It is necessary to strictly adhere to the dosage and use the form of the drug prescribed by the attending physician. Independently changing the recommended dose or replacing the drug may distort the hypotensive effect;
• even if you are constantly taking antihypertensive drugs, it is necessary to systematically measure blood pressure, which will allow you to evaluate the effectiveness of therapy, timely identify certain changes and adjust treatment;
• in the case of an increase in blood pressure against the background of constant antihypertensive treatment - the development of an uncomplicated hypertensive crisis, an additional dose of a previously taken long-acting drug is not recommended. Blood pressure can be quickly reduced using short-acting antihypertensive drugs.

List of fast and long-acting drugs

The increase in pressure can be spontaneous, sudden or gradual, but steady. This requires the use of rapid or long-acting antihypertensive drugs.

Fast acting drugs:

• Lasix (Furosemide) is a loop diuretic, the drug of choice for emergency care, corrects electrolyte metabolism, causes frequent urination, tablets are effective within an hour, injectable within the first 20 minutes;
• Atenolol (Anaprilin, Sotagestal) - slows down the heart rate while leveling blood pressure, acts after 15 minutes;
• Adelfan - antihypertensive tablets under the tongue, effective in 10 minutes;
• Clonidine – the effect is observed after half an hour, minus – dryness of the mucous membranes;
• Nifedipine – begins to work 5 minutes after sublingual administration;
• Captopril - under the tongue, works in 20 minutes, minus - three times a day.
• Nitroglycerin has a hypotensive effect after 5 minutes, prevents vasospasm, leading to heart attacks.

These antihypertensive drugs are indicated for the relief of hypertensive crises. Complicated crises require injection therapy.

The prolonged group was developed for the convenience of treating hypertension; lifelong use of drugs once or twice a day does not interfere with leading a normal lifestyle:

• Sotalol, Propranol, Carvedilol - non-selective beta receptor blockers;
• Atenolol, Bisoprolol, Betaxol - selective beta blockers;
• Amlodipine, Verapamil, Diltiazem – calcium antagonists;
• Enalapril, Lisinopril, Perindopril – ACE inhibitors;
• Indapamide, Hydrochlorothiazide, Hypothiazide are diuretics.

These drugs are used in the combination treatment of second or third degree hypertension.

Antihypertensive therapy: drugs to lower blood pressure

During antihypertensive therapy, several main groups of drugs that help lower blood pressure are currently used:

• beta blockers;
• ACE inhibitors;
• calcium antagonists;
• diuretics;
• angiotensin II receptor blockers.

All of the above groups have comparable effectiveness and their own characteristics that determine their use in a given situation.

Beta blockers

Drugs in this group reduce the likelihood of developing coronary complications in patients suffering from angina pectoris, prevent cardiovascular accidents in patients with myocardial infarction, tachyarrhythmia, and are used in patients with chronic heart failure. Beta-blockers are not recommended for patients with diabetes mellitus, lipid metabolism disorders and metabolic syndrome.

ACE inhibitors

Angiotensin-converting enzyme inhibitors have pronounced hypotensive properties, they have organoprotective effects: their use reduces the risk of complications of atherosclerosis, reduces left ventricular hypertrophy, and slows the decline in renal function. ACE inhibitors are well tolerated and have no negative effects on lipid metabolism and glucose levels.

Calcium antagonists

In addition to antihypertensive properties, drugs in this group have antianginal and organoprotective effects, help reduce the risk of strokes, atherosclerotic lesions of the carotid arteries and left ventricular hypertrophy. Calcium antagonists may be used alone or in combination with other drugs that have antihypertensive properties.

Diuretics

Diuretic drugs are usually used in combination with other antihypertensive drugs in order to enhance the therapeutic effect.

Diuretics are also prescribed to persons suffering from pathologies such as refractory hypertension and chronic heart failure. To avoid the development of side effects, when taking these drugs continuously, minimal dosages are prescribed.

Angiotensin II receptor blockers

Drugs in this group, which have neuro- and cardioprotective effects, are used to improve control of blood glucose levels. They can increase the life expectancy of patients suffering from chronic heart failure. Antihypertensive therapy using angiotensin II receptor blockers can be prescribed to patients who have had a myocardial infarction, suffer from renal failure, gout, metabolic syndrome and diabetes mellitus.