There are many pril-type antihypertensive drugs. What are the differences between them and which one is better to choose?

A friend left a message to Huazi, saying that he needed to take pril drugs to treat high blood pressure, but he found that there were many drugs with "pril" in their names, so he asked Huazi, what are the differences between so many "prils" and which one is better to choose?

Huazi said that all pril drugs are angiotensin-converting enzyme inhibitors (ACEI) with the same mechanism of action. The difference lies in the changes in blood drug concentrations and the effects on the liver and kidneys during metabolism.

1. What can prils do? Prils, as we usually call them, are called angiotensin converting enzyme inhibitors in pharmacology. Their main function is to inhibit angiotensin converting enzyme, preventing angiotensin I from converting to angiotensin II, thereby blocking the effects of angiotensin II-mediated vasoconstriction, water and sodium retention, and increased blood pressure. They have an inhibitory effect on the renin-angiotensin-aldosterone system (RAAS).

Prils can cause blood sugar to decrease and can be used in hypertensive patients with diabetes. They also inhibit bradykinin hydrolase, increase bradykinin levels, increase nitric oxide (NO) and prostacyclin (PGI2) levels, and can also dilate blood vessels and lower blood pressure. Prils are the only antihypertensive drugs that act on both the RAAS and bradykinin systems, producing a dual protective effect.

Moreover, the continuous inhibition of RAAS by pril drugs can improve left heart function, reduce left ventricular filling, increase ejection fraction and cardiac index, and delay the thickening of vascular and ventricular walls. For patients with myocardial infarction and heart failure, it can inhibit ventricular remodeling.

Pril drugs have a dilating effect on both arterioles and venules, which can reduce peripheral vascular resistance and the resistance of coronary arteries and renal arteries, increase venous bed capacity, increase coronary and renal artery blood flow, increase glomerular filtration rate, and have a protective effect on renal function.

2. What are the differences between different "prils"? There are many pril drugs, including captopril, enalapril, benazepril, lisinopril, ramipril, perindopril, fosinopril, imidapril, cilazapril, etc. Among them, the first pril drug is captopril, which has the shortest half-life of blood drug concentration, only about 2 hours, and needs to be taken 2 to 3 times a day, which is not convenient. Therefore, it is usually only used for acute hypertension and rarely used for routine antihypertensive treatment.

The half-life of other pril drugs can reach more than 10 hours, and it is more convenient to take the medicine once a day. However, to control blood pressure, it is important to stabilize the blood drug concentration. Among all pril drugs, lisinopril and enalapril have the most stable blood drug concentration changes and are more commonly used. Enalapril is low in price, has good protective effects on the heart and kidneys, and has the highest "cost-effectiveness". Lisinopril has a strong antihypertensive effect and fewer side effects, but it is expensive.

That is to say, when using pril drugs, patients usually only choose between enalapril and lisinopril according to their different needs. For example, elderly patients with hypertension need better protection for the heart and kidneys, and long-term medication is cheaper, so they can choose enalapril. If you want a better blood pressure-lowering effect and fewer side effects, you can use lisinopril.

Most prils are excreted through the kidneys, but fosinopril is metabolized through both the liver and kidneys, which puts less burden on the kidneys. Therefore, people with poor kidney function can choose fosinopril. For the prils not mentioned above, their effects are similar and they do not have particularly outstanding characteristics. The choice is mainly based on the doctor's preference for medication.

To sum up, all pril drugs have similar effects, and there are 4 commonly used ones. Among them, captopril has a short duration of action and is suitable for hypertensive emergencies. The blood concentrations of enalapril and lisinopril are relatively stable and are commonly used choices. People with poor kidney function can choose fosinopril. Drugs must be used under the guidance of a doctor. If you have any questions about the use of drugs, please consult a doctor or pharmacist in time. I am pharmacist Huazi, welcome to follow me and share more health knowledge.