Weight Loss and Blood Pressure Stabilization: Guidelines for Hypertension Medication and Combined Antihypertensive Regimens

My blood pressure is high, what should I do?

Blood pressure is the pressure exerted on the walls of blood vessels as blood flows from the heart through the body to all parts of the body. When blood cannot easily flow through the body, and disease narrows the blood vessels, the pressure of blood flow increases to ensure blood flow. This results in arterial blood pressure exceeding normal levels, leading to hypertension.

Currently, the diagnostic criteria for hypertension in China are: normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic; systolic blood pressure between 120 and 139 mmHg, and diastolic blood pressure between 80 and 89 mmHg, is called high-normal, a buffer zone between hypertension and normal blood pressure; any systolic blood pressure exceeding 140 mmHg or diastolic blood pressure exceeding 90 mmHg can be diagnosed as hypertension.

Hypertension is divided into primary hypertension and secondary hypertension. Primary hypertension is an independent disease characterized primarily by elevated blood pressure, with an unclear cause; secondary hypertension, also known as symptomatic hypertension, has a clear cause, and hypertension is only one of the clinical manifestations of this disease, with blood pressure rising temporarily or persistently. Therefore, if it is secondary hypertension, the underlying disease causing the high blood pressure must be treated first. Understanding the cause of high blood pressure is crucial for effective and targeted blood pressure control.

Stable blood pressure is the guarantee of life – the five pillars of antihypertensive drugs

The main treatment goal for hypertensive patients is to achieve target blood pressure, thereby minimizing the overall risk of cardiovascular complications and death.

(1) Diuretics: Commonly used drugs include hydrochlorothiazide, furosemide, and indapamide. Their mechanism of action is sodium excretion and diuresis, reducing blood volume, cardiac output, and blood pressure. The long-term antihypertensive mechanism of diuretics is due to the reduction of sodium ion concentration through diuresis, which, through a series of complex regulatory processes, lowers blood pressure while maintaining cardiac output. Suitable for various types of hypertensive patients, the effects are generally mild, with long-term sustained antihypertensive effects, and the price is low. Indapamide is a new generation of diuretic antihypertensive drugs that also has calcium antagonistic effects, providing stable and reliable blood pressure reduction. (2) Calcium Channel Blockers: Commonly used drugs include nifedipine, nifedipine, loperamide, and amlodipine. Their mechanism of action is to inhibit the transport of calcium ions into cells, reducing smooth muscle tone, thereby dilating blood vessels and lowering blood pressure. They are indicated for hypertension caused by decreased vascular elasticity and narrowing of arteries, and can be used in combination with calcium supplements to enhance the antihypertensive effect.

(3) Adrenergic Blockers: Commonly used drugs include: ① β-blockers, such as propranolol and metoprolol; ② α-blockers, such as prazosin and terazosin; ③ peripheral adrenergic blockers, such as reserpine. Their mechanism of action is to block adrenergic receptors, reduce cardiac output, and dilate blood vessels to lower blood pressure, resulting in a strong antihypertensive effect. They are suitable for various types of hypertension patients, with a strong antihypertensive effect and mostly mild side effects.

(4) Vasodilators: Commonly used drugs include hydralazine and diazepam. The mechanism of action is to lower blood pressure by dilating small arteries and reducing peripheral resistance. Due to significant side effects, these drugs are rarely used alone now.

(5) Angiotensin-converting enzyme inhibitors Commonly used drugs include Captopril, Estazone, and Lodin. Their mechanism of action is to dilate blood vessels, lower blood pressure, and prevent and reverse left ventricular hypertrophy and thickening of the vascular wall caused by hypertension. In recent years, angiotensin II receptor antagonists such as losartan and valsartan have been used clinically; these are novel antihypertensive drugs.

In addition, there are compound preparations such as compound antihypertensive tablets, compound Apocynum venetum tablets, Beijing Antihypertensive No. 0, and common antihypertensive tablets, but their specific antihypertensive mechanisms are still unclear.

A hero needs three helpers—Combined antihypertensive regimens

(1) The necessity of helpers Combined medication is an important means to improve the rate of blood pressure target achievement. For patients with moderate to severe hypertension whose blood pressure exceeds the target value by 20/10 mmHg, combined medication can be used at the beginning of treatment. To achieve target blood pressure as early as possible, patients with mild hypertension (stage 1 hypertension) can also directly use a combination of two antihypertensive drugs.

Antihypertensive drugs can be combined in various ways, but the antihypertensive effect, target organ protection, and tolerability of different combination regimens may vary significantly, thus their clinical status differs. Preferred and second-line options: Four recommended combination drug combinations can significantly enhance the antihypertensive effect and reduce adverse reactions. Multiple studies have confirmed that the above combinations have ideal antihypertensive effects and target organ protection, and can be used as the first-line option for hypertensive patients requiring combination therapy. Second-line combination regimens have some shortcomings in terms of blood pressure reduction, target organ protection, or tolerability.

(2) Guidelines (Principles of Combination Therapy) Complementary mechanisms of action, additive antihypertensive effects, and offsetting adverse reactions. Preferred combination regimens: Angiotensin-converting enzyme inhibitor + diuretic, angiotensin receptor blocker + diuretic, angiotensin-converting enzyme inhibitor + calcium channel blocker, angiotensin receptor blocker + calcium channel blocker. Second-line combination regimens include: beta-blockers + diuretics, calcium channel blockers (dihydropyridines) + beta-blockers, calcium channel blockers + diuretics, renin inhibitors + diuretics, renin inhibitors + ARBs, and thiazide diuretics + potassium-sparing diuretics. Combination regimens not routinely recommended include: angiotensin-converting enzyme inhibitors + angiotensin receptor blockers, angiotensin-converting enzyme inhibitors + beta-blockers, angiotensin receptor blockers + beta-blockers, calcium channel blockers (non-dihydropyridines) + beta-blockers, and centrally acting antihypertensive drugs + beta-blockers.