Blood pressure fluctuates, are you really taking antihypertensive drugs correctly? Here are 3 things to pay attention to!

The number of people with hypertension in China has reached 300 million, and the incidence of hypertension complications such as coronary heart disease and cerebral infarction is rising year by year. However, as long as the correct blood pressure reduction method is mastered, hypertension can be prevented and controlled. Many hypertensive patients have this situation: blood pressure fluctuates like a roller coaster, and even if the dosage of antihypertensive drugs is increased, it is still unstable . What is the reason for this? Is there any way to make blood pressure reduction "twice the result with half the effort"? The following 3 experiences are worth learning from.

01

Choice between short-acting and long-acting drugs

Let me tell you a case first: A 50-year-old male patient has been suffering from hypertension for 3 years. He does not take antihypertensive drugs regularly. He only takes nifedipine sustained-release tablets temporarily when he feels dizzy and uncomfortable. In the past year, his blood pressure has been getting higher and higher, reaching 180/110 mmHg at the highest. The dosage of antihypertensive drugs has also been increasing. He even takes two tablets three to four times a day, but his blood pressure still fluctuates. When he just finished taking the medicine, his blood pressure dropped to 140/90 mmHg, but it soared again within an hour or two! Instead, he had headaches and dizziness due to frequent fluctuations in blood pressure. This patient does not have a long history of hypertension. After taking antihypertensive drugs, his blood pressure can return to normal levels, but it cannot remain stable. This is all caused by short-acting antihypertensive drugs.

There are a wide variety of antihypertensive drugs on the market, but the antihypertensive effects are completely different. Here, it is recommended that patients with hypertension try to take long-acting antihypertensive drugs and avoid short-acting drugs. Why is this? Common short-acting antihypertensive drugs on the market include nifedipine sustained-release tablets, captopril, etc. They are released quickly after taking them and metabolized quickly. Generally, the antihypertensive effect will disappear in 4 to 6 hours, so the instructions require taking it 3 times a day. Once taken in time or even missed, blood pressure will rise suddenly. This pressure change will cause greater damage to blood vessels, and the probability of complications such as cerebral hemorrhage will increase . Many patients will also experience obvious dizziness and headaches during medication. With the improvement of pharmaceutical mechanisms, the current long-acting antihypertensive drugs release their effects quickly and evenly to achieve the purpose of stable blood pressure reduction; at the same time, the drug effect lasts for a long time, which can exceed 24 hours, so as to achieve continuous blood pressure reduction, and there will be no high and low blood pressure during the interval between medication. It can be taken once a day in the morning. If long-acting antihypertensive drugs are taken regularly and over a long period of time, blood pressure can remain stable even if a dose is missed for a short period of time. This is also the reason why some patients mistakenly believe that hypertension has been "cured".

Common long-acting antihypertensive drugs on the market include nifedipine controlled-release tablets, amlodipine, valsartan, etc. In the past, the price of long-acting antihypertensive drugs was too high, and the price of more than three or four yuan per pill was difficult for people to bear for a long time. Now that public hospitals have implemented zero markup on drugs, the price of many long-acting antihypertensive drugs has dropped to a few cents per tablet, which has brought real benefits to patients with hypertension.

02

Screening for secondary hypertension

Many patients found that after getting high blood pressure, they wanted to go to the hospital to adjust and prescribe some antihypertensive drugs, but the doctor first prescribed various CT and ultrasound examinations. In fact, this is exactly the doctor's differentiation between primary and secondary hypertension , because the treatment methods of the two types of hypertension are completely different. Primary hypertension is caused by the combined effects of multiple genetic factors, environmental factors and other mechanisms that cause high blood pressure. Blood pressure can be effectively lowered by taking medicine and improving lifestyle. Secondary hypertension , high blood pressure is secondary to other diseases, such as renal artery stenosis, pheochromocytoma, etc. At this time, the nerves and hormone levels that regulate blood pressure in the body are abnormal, and blood pressure is stubbornly elevated or even fluctuates significantly. Secondary hypertension accounts for 10% of the total number of people with hypertension, and the proportion is constantly increasing. Not only is the effect of drug treatment poor, but patients with bilateral renal artery stenosis may even develop complications such as renal failure due to taking ACEI/ARB antihypertensive drugs! At this time, surgery such as stent implantation to relieve renal artery stenosis or removal of hyperplastic adrenal glands is an effective method of lowering blood pressure. After surgery, you can even maintain normal blood pressure without taking antihypertensive drugs. Therefore, before treating hypertension, you must first screen for secondary hypertension. Common examination items include six items of hypertension , 24-hour potassium, sodium and chloride examination , adrenal CT , renal vascular ultrasound , etc.

03

Choose the right time to take medication

Choosing the right time to take medicine can often achieve twice the result with half the effort in lowering blood pressure. The blood pressure of the human body fluctuates all the time during the day, and the overall blood pressure curve is spoon-shaped. There will be a peak in blood pressure between 6 and 8 in the morning , which is the time when the blood pressure is the highest in the day, and then the blood pressure begins to drop. For patients with hypertension, the peak of blood pressure in the morning is particularly obvious. Since many patients are afraid that taking antihypertensive drugs will "hurt the stomach", they often choose to take antihypertensive drugs after breakfast or even before going to bed, which is inappropriate. First of all, antihypertensive drugs will not hurt the stomach , so they can be taken before meals or even on an empty stomach; secondly, antihypertensive drugs should be taken on an empty stomach in the morning . In this way, the efficacy of the drug can just cover the period when blood pressure is highest in the morning, and can effectively treat the peak of blood pressure in the morning. Here, I would like to remind everyone that the vast majority of hypertensive patients meet the dipper type of hypertension with the highest blood pressure in the morning, but nearly 20% of patients are reverse dipper type hypertension, that is, abnormally high blood pressure at night, which requires taking antihypertensive drugs before going to bed . Therefore, hypertensive patients must first conduct 24-hour blood pressure monitoring, and then choose the appropriate time to take medicine after clarifying the type of hypertension.

Author | Zhang Jianbo, attending physician of the Department of Cardiology, Cangzhou Central Hospital

Review | Ma Qingchun, Chief Physician and Professor of Cardiology, Peking University People's Hospital

Source: Science Refutes Rumors