Personalized medication strategy for hypertension: In-depth analysis of the six principles of antihypertensive drug use and the clinical effects of diuretics.

What are the principles of antihypertensive drug treatment?

Primary hypertension is mostly a lifelong disease. In the early stages (blood pressure 140-150/90-94 mmHg), non-pharmacological measures (restricting salt, weight loss, quitting smoking, limiting alcohol, adjusting dietary structure, appropriate exercise, and regulating mental, psychological, and emotional state) should be implemented first, with close monitoring of blood pressure for 3-6 months. If blood pressure still cannot be reduced to normal (<140/90 mmHg), drug treatment should be started. The principles of drug treatment are as follows:

① First, the principles of evidence-based medicine should be followed, selecting drugs that have been proven to be highly effective, low in toxicity, inexpensive, and convenient to take through prospective, multicenter, large-scale, randomized, controlled, double-blind, and long-term follow-up observations.

② When selecting drug treatment, the principle of individualization must be followed. Drugs should be rationally and cautiously selected based on the patient's age, the physiological functions of major organs (liver and kidney function), and coexisting diseases. ③ For patients with significant blood pressure fluctuations or persistently high blood pressure, and for elderly patients, long-acting, sustained-release, or controlled-release formulations should be used whenever possible, with a trough-to-peak ratio controlled above 60%. These drugs have a long-lasting effect and provide stable blood pressure reduction.

④ When the efficacy of a single antihypertensive drug is unsatisfactory (generally with an effectiveness rate of around 60%), two or more drugs should be used in combination therapy, depending on the patient's condition. When using combination therapy, it is crucial to control the dosage, starting with the lowest dose and gradually increasing until satisfactory efficacy is achieved without significant adverse reactions.

⑤ For the treatment of grade 2 and 3 hypertension, fixed-dose combination preparations can also be used. Combination preparations have advantages such as convenient administration, good efficacy, and fewer side effects.

⑥ Comprehensive intervention. While treating hypertension, other risk factors, such as dyslipidemia and hyperglycemia, should not be ignored, and comprehensive intervention should be implemented.

What issues should be noted when taking antihypertensive drugs?

① Antihypertensive drugs must be taken under the guidance and monitoring of a cardiologist. Do not make decisions on your own. Adjustments, additions, or discontinuations of medication should be made under the guidance of a doctor. ② Patients must strictly adhere to the medication treatment plan prescribed by their doctor, taking their medication daily without fail. Even after blood pressure has returned to normal and symptoms have completely disappeared, daily medication should continue.

③ Pay attention to the timing of medication administration. If taking medication only once a day, the optimal time is between 6 and 7 AM. If taking medication twice a day, 7 AM and 3 PM are preferable. Generally, antihypertensive medications should not be taken at night, especially before bedtime.

④ The ideal blood pressure for elderly patients with hypertension after taking medication is the same as for younger people: a gradual reduction in systolic blood pressure below 140 mmHg and diastolic blood pressure below 90 mmHg.

⑤ Elderly patients taking antihypertensive medication should inform their doctor of the type of medication they are taking when seeking medical attention for other illnesses. This information will help the doctor when prescribing medication and avoid adverse drug reactions.

⑥ Blood pressure should not be lowered too quickly. Some patients, upon discovering high blood pressure, desperately want to lower it immediately and arbitrarily increase the dosage. However, this can potentially lead to serious cardiovascular and cerebrovascular diseases. ⑦ Dosage must be accurate and appropriate, starting with a small dose and gradually increasing to the optimal dose for the individual, gradually reaching the target blood pressure value.

⑧ Medication should not be taken intermittently. Some patients take a few antihypertensive pills when their blood pressure is high, and then immediately stop taking the medication once their blood pressure drops. This is incorrect. Abruptly stopping medication can easily cause a rebound in blood pressure, which is detrimental to blood pressure stability.

⑨ Do not be swayed by false advertising in the market. Do not seek new, expensive, or trendy medications. Prioritize safety, effectiveness, and rationality.

⑩ Understand the principle of individualized treatment. Different hypertensive patients may have multiple different symptoms simultaneously. A medication suitable for one patient may not be suitable for another. For example, a patient with a fast heart rate may use a beta-blocker, but this is not suitable for someone with a naturally slow heart rate. Therefore, the use of antihypertensive drugs must be tailored to the individual, adhering to the principle of individualized treatment and prescribing medication according to the specific symptoms. What are the different modes of action of antihypertensive drugs? The six commonly used classes of antihypertensive drugs primarily target the pathogenesis of hypertension to lower blood pressure, and their modes of action are as follows:

① Reduce circulating blood volume and sodium ion concentration in the blood, thus decreasing blood volume and lowering blood pressure, such as diuretics.

② Reduce adrenergic activity, such as alpha-blockers and beta-blockers.

③ Dilate peripheral blood vessels and reduce peripheral resistance, such as calcium channel blockers (CCBs).

④ Inhibit renin release and reduce cardiac output, such as beta-blockers.

⑤ Act on the renin-angiotensin-aldosterone system (RAAS) to inhibit the activity of angiotensin-converting enzyme, such as angiotensin-converting enzyme inhibitors (ACEIs).

⑥ Antagonize angiotensin II receptors, such as angiotensin II receptor antagonists (ARBs). Diuretics

What role do diuretics play in antihypertensive treatment?
Clinical practice has shown that low-dose diuretics have fewer adverse reactions and are relatively safe. They can be used alone as the first-line drug for treating stage 1 hypertension, or in combination with other antihypertensive drugs for treating stage 2 and 3 hypertension. Therefore, scholars at home and abroad have listed them as first-line antihypertensive drugs. The important roles of diuretics are as follows:

① Significant antihypertensive effect: Diuretics can effectively lower and control blood pressure, especially suitable and effective for the elderly, obese patients, and patients with hypertension and heart failure.
② Reduce the incidence of cardiovascular and cerebrovascular diseases: The use of diuretics plays an indispensable role in reducing the disability and mortality rates of hypertension and preventing cerebrovascular diseases and heart failure.

③ Enhance the effect of combination therapy: Diuretics can enhance the antihypertensive effect of combination therapy. In antihypertensive treatment, approximately 82% of patients need to take two or more drugs, and 51% of patients need to take three or more drugs to lower their blood pressure to the target level. In the earliest recommended combination therapy regimens (stepwise therapy), diuretics were the first-line drugs. Currently, regulations stipulate that when using three antihypertensive drugs in combination, a diuretic must be included unless there are contraindications.

④ Optimal Combination Components: Most commonly used fixed-dose combination antihypertensive preparations both domestically and internationally currently use small doses of diuretics as a component.