What blood pressure medication works best? Combining 4 drugs into one may work

Huazi encounters many consultations about hypertension every day. The most concerned issue is what kind of antihypertensive drugs are the most effective? In the past, Huazi would answer that the commonly used first-line antihypertensive drugs include diazepam, pril, sartan, lol, diuretics and other five categories. Each category of drugs is targeted at different types of hypertension and there is no comparability between them.

But after Huazi saw a plan for antihypertensive drugs at the 2021 European Society of Cardiology (ESC) Annual Meeting, he seemed to have found the answer to this question.

1. Combining 4 antihypertensive drugs into one drug The solution proposed at the ESC annual meeting is to combine 4 antihypertensive drugs at a quarter of the dose to form a compound drug. The 4 drugs selected are diazepam, sartan, lol and diuretics. In the experiment, if only one drug is used, the average reduction in high blood pressure (systolic blood pressure) is 4.7 mmHg, while if the "four-in-one" drug is used, the high blood pressure reduction can reach 22.4 mmHg.

Let's do a simple calculation. If we add 4 4.7 together, we should get 18.8, but in fact we get 22.4. That is to say, after the four antihypertensive drugs are used together, the result of "1+1+1+1>4" is produced, which is more effective than using one antihypertensive drug alone.

2. Most hypertension patients need combined medication. In fact, this method of combined medication is not uncommon in antihypertensive treatment. Because most hypertensive patients find it difficult to control their blood pressure within the standard range with one antihypertensive drug. About 60% of hypertensive patients need two or more antihypertensive drugs in combination to reduce their blood pressure to below 140/90 mmHg.

Traditional antihypertensive treatment plans usually start with one antihypertensive drug. When the maximum therapeutic dose is still not effective in lowering blood pressure, consider adding a second antihypertensive drug. If it still doesn't work, consider adding a third antihypertensive drug.

A "quadruple" medication regimen also exists, but it is usually only used for refractory and stubborn hypertension, and is basically not used for the initial treatment of hypertension.

3. Is the "four-in-one" drug reasonable? Among antihypertensive drugs, prils and sartans can reduce the effect of angiotensin 2 and inhibit the renin-angiotensin-aldosterone system (RAAS) to produce antihypertensive effects. Prils and sartans have similar pharmacological mechanisms and can replace each other, but cannot be used in combination. From this perspective, the "four-in-one" drug actually includes all first-line antihypertensive drugs.

The reason why sartan was used instead of pril is probably because pril drugs are prone to cause the side effect of dry cough, while sartan drugs have fewer side effects and are more easily accepted by people.

Among the "four-in-one" drugs, dihydrotestosterone drugs can cause a reflex increase in heart rate, which can be counteracted by the heart rate lowering effect of lolamine drugs; dihydrotestosterone drugs are prone to the side effect of lower limb edema, which can be counteracted by the effects of sartans and diuretics; sartans are prone to cause the side effect of increased blood potassium, which can be counteracted by the loss of potassium ions caused by diuretics.

That is to say, the four ingredients in the "four-in-one" drug can work together in reducing blood pressure, and antagonize each other in terms of side effects, reducing the overall adverse reactions of the drug. In the experiment, the incidence of side effects and serious adverse events in the two groups of hypertensive patients who used the "four-in-one" drug and the traditional treatment plan was similar, and there was no increase in adverse reactions due to the increase in the number of drugs used.

4. There is still a certain distance between theory and practice. Although the "four-in-one" antihypertensive drug looks good, there is no finished drug at present. Currently, there are only "two-in-one" drugs in the form of compound single-tablet preparations of antihypertensive drugs. Such as compound drugs such as "dipine + sartan", "dipine + diuretics", "diuretics + sartan", and "diuretics + pril". The hypertension treatment guidelines recommend that compound drugs can be selected when the antihypertensive effect of a single drug is not good.

The benefits of antihypertensive treatment come from the lowering of blood pressure itself. Whether using a single drug or a combination of drugs, as long as blood pressure can be controlled, the purpose of preventing complications can be achieved. It is recommended that people who have no drug contraindications choose to use a combination of drugs, which is better than doubling the effect of a single drug.

In summary, it is impossible to compare which type of antihypertensive drug is more effective. However, in the future, there may be a "four-in-one" compound antihypertensive drug, which can meet the treatment needs of most hypertensive patients with one antihypertensive drug, making antihypertensive treatment simpler. Drugs must be selected and 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.