Priligy and sartan, two antihypertensive drugs, both act on the angiotensin system. What are the differences between them?

Many friends asked Huazi, among the first-line antihypertensive drugs, there are pril drugs and sartans drugs, both of which are related to the angiotensin system. What is the difference between the two and what should we pay attention to when choosing?

Hua Zi said that both pril drugs and sartan drugs can inhibit the action of the angiotensin system, and their pharmacological mechanisms are similar. The traditional usage is to choose "pril" first, and then choose "sartan" if the patient cannot tolerate the adverse reactions of the drug, but now the choice has changed.

1. The influence of both on angiotensin In the human body, there is an important blood pressure regulation system called the "renin-angiotensin-aldosterone" system (RAAS). Renin is produced by the juxtacellular cells of the kidneys and is converted into angiotensin 1, angiotensin 2, and angiotensin 3 under the action of a series of biological enzymes, and promotes the release of aldosterone.

Among RAAS, angiotensin 2 has the strongest effect in constricting blood vessels. Prils are angiotensin converting enzyme inhibitors that can inhibit the conversion of angiotensin 1 to angiotensin 2, directly reducing the level of angiotensin 2. Sartans are angiotensin 2 receptor antagonists that can prevent angiotensin 2 from binding to receptors on blood vessels.

Second, "prils" and "sartans" cannot be used together. For example, if angiotensin 2 is a "rope" that can tighten blood pressure, the role of prils is to cut the middle of the rope, and the role of sartans is to cut the end of the rope. Both actually control blood pressure through the same pathway.

In related studies, a trial of combining pril and sartan was conducted, and the final conclusion showed that patients would not benefit from it and it might increase adverse reactions. Although most patients with hypertension need to use multiple drugs in combination to effectively control blood pressure, "pril" and "sartan" cannot be used together.

3. From the experience of using medicines, "pril" drugs are the first choice. "Pril" and "sartan" can not only lower blood pressure, but also play a good role in protecting the heart and kidneys. Therefore, some people with normal blood pressure but heart disease or kidney disease will be treated by doctors with these two drugs.

Prils appeared earlier, and in the 1990s, there was sufficient clinical data to prove that they have a strong organ protective effect. In addition to inhibiting RAAS, prils also affect the bradykinin system and increase the body's bradykinin level, which can play a cardiovascular protective role through two pathways.

However, after bradykinin levels rise, they mainly accumulate in the lungs, so prils may cause adverse reactions such as dry cough. The dry cough symptoms of most people are mild and can be tolerated. For a few people with severe dry cough, sartan drugs can be used instead of prils.

Sartans were studied much later than prils, and they only act on RAAS and cannot affect the bradykinin system. Relatively speaking, prils have more evidence of organ protection and are often the first choice, while sartans are in a "substitute" role.

4. Different choices for different organ damage Hypertension, coronary heart disease, myocardial infarction and other diseases can cause ventricular hypertrophy, which in turn causes heart failure and threatens life. Lowering blood pressure is the main method to reverse ventricular hypertrophy, but in the study of first-line antihypertensive drugs, it was found that sartan drugs have the strongest reversal effect on ventricular hypertrophy. Therefore, sartan drugs can be used as the first choice for patients with ventricular hypertrophy.

Both prils and sartans can dilate the afferent and efferent arterioles and protect the kidneys. There is more evidence that prils can reduce proteinuria in patients with proteinuria or microalbuminuria. Therefore, prils are still the first choice for the treatment of nephrotic syndrome. Those who cannot tolerate adverse reactions can use sartans instead.

In summary, "pril" and "sartan" are both first-line antihypertensive drugs with similar mechanisms of action. Both can not only lower blood pressure, but also have good heart and kidney protection effects. Because pril drugs were developed earlier and have more clinical evidence, they are more commonly used. Sartan drugs are rising stars. Although they are often used as "substitutes" for pril drugs, their advantages are gradually being discovered as more related research increases.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.