Detailed Explanation of Five Major Categories of Antihypertensive Drugs: How to Choose Scientifically and Precautions
How to Choose Antihypertensive Drugs
Clinically, treating hypertension is not simple. Each antihypertensive drug has its indications and contraindications. Several are listed here for informational purposes only; patients should not self-medicate.
Currently, commonly used long-acting antihypertensive drugs can be roughly divided into five categories:
1. Calcium channel blockers, such as felodipine, nifedipine sustained-release tablets and controlled-release tablets, amlodipine besylate, and other dihydropyridine drugs. Because of their anti-atherosclerotic effects, they are generally the first choice for the elderly. Adverse reactions often include facial flushing, headache, ankle edema, and gingival hyperplasia within one week. Use with caution in cases of acute heart failure.
2. Angiotensin-converting enzyme inhibitors, such as perindopril, enalapril, and other ACE inhibitors. These drugs can inhibit cardiac remodeling (cardiac damage, cardiac hypertrophy), reduce proteinuria and microalbuminuria in patients with diabetes or kidney disease, and have a protective effect on the heart and kidneys. Therefore, they can be used by patients with heart disease or mild renal impairment. Common adverse reactions include dry cough. Contraindicated in patients with bilateral renal artery stenosis, pregnancy, hyperkalemia, or severe renal insufficiency.
3. Angiotensin II receptor blockers, such as valsartan, telmisartan, irbesartan, and other angiotensin II receptor blockers. Their mechanism of action is similar to that of ACE inhibitors, with fewer adverse reactions. Contraindicated in patients with bilateral renal artery stenosis, pregnancy, hyperkalemia, or severe renal insufficiency.
4. Beta-blockers, such as metoprolol, bisoprolol, alprenolol, and other beta-blockers. Commonly used in young hypertensive patients with strong sympathetic nerve excitability and a fast heart rate, or in patients with coronary heart disease or chronic heart failure. Use with caution in athletes and those engaged in heavy physical activity, patients with chronic obstructive pulmonary disease, peripheral vascular disease, or impaired glucose tolerance. Contraindicated in patients with slow heart rate or asthma.
5. Diuretics, such as hydrochlorothiazide and indapamide. These medications are particularly suitable for elderly patients with hypertension, isolated systolic hypertension, or those with heart failure, as well as hypertensive patients with high salt intake. Common adverse reactions include electrolyte imbalances, such as hypokalemia, and elevated uric acid levels. Therefore, long-term users should have their blood potassium levels monitored regularly, and these medications are contraindicated in patients with gout.
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