The treatment of hypertension

The treatment of hypertension
At present the majority of people believe that hypertension can produce calendar critical target organ damage and should be emphasis on the critical patients with hypertension, should track follow-up six months to observe changes in blood pressure, blood pressure if the normal, not treatment. If the blood pressure changes for the diagnosis of hypertension, should be treated. For those who are still in critical fluctuations in the level of hypertension, may be to use non-drug. If treatment fails, then choose drug treatment.

First, the general treatment
The incidence of hypertension and related central nervous system disorder, attention should be paid Laoyijiehe to ensure adequate sleep, avoid excessive stress, prevent physical fatigue. Appropriate physical activity, such as walking, gymnastics, tai chi, qi gong, and so on. Significantly increased blood pressure, or more symptoms of patients with complications, should be based on condition and the nature of the work, reducing work to strengthen the appropriate rest. Catering to light and less into the salt and cholesterol and more food, eat more potassium Hanmei food. Food intake to prevent weight as overweight, should quit smoking and avoid excessive drinking. Nervous Shuiyan poor can choose tranquilizers, such as stability, Li Mianning, Mian-Seoul, phenobarbital, and so on.

Second, antihypertensive drug treatment

(A) of angiotensin-converting enzyme inhibitors are currently more applications for captopril acid. Can be used for the period of high blood pressure, 6.25 mg ~ 25mg dose of oral day three. The goods can reduce blood pressure by limiting sodium intake and enhanced. If a combination of diuretics, antihypertensive effect can be enhanced significantly. Side effects: fever, rash, itching, dizziness, neutropenia, the existing renal insufficiency may increase renal insufficiency. Enalapril use 5 mg, oral, the second day, the dose can be increased once a week, until the maximum dose of 40 mg / day or effective. Oral 1 to 2 hours after the beginning of a buck, four to six hours of the peak. Gradually after the effective reduction, once a day to maintain efficacy. Muscle booster-C anti-angiotensin Ⅱ antagonist is the angiotensin Ⅱ competitive antagonism. The angiotensin-induced hypertension increased Ⅱ a relief role, can also be used for malignant hypertension. The renin-and low-normal renin hypertension, not only did not buck, it can or hypertension, this is because the goods are angiotensin Ⅱ analogues, the angiotensin receptor Ⅱ have a certain inherent excitement role.

(B) calcium antagonist is a group of different chemical structure, mechanism of the drugs vary. As inhibition of calcium ions through the cell membrane on the calcium channel in the flow, thus known as calcium channel blocker. Calcium antagonist reduce vascular smooth muscle cells within the free calcium concentration, the blood vessels expand, blood pressure dropped, but also inhibits platelet aggregation, enhance red blood cell in the case of hypoxia the deformation capacity, the adverse impact on lipid metabolism without the advantages of commonly used drugs Verapamil, diltiazem Zhuo-and nifedipine. Nifedipine (nifedipine), with strong vasodilative role in the treatment of hypertension play an important role.

Nifedipine buck has the following characteristics: ① role in the rapid, sublingual 1 to 5 minutes a role to play, oral 10 to 20 minutes after the onset. ② significant effect, the buck and the original rate of high blood pressure related to higher blood pressure, the greater the rate of hypotension, low blood pressure rarely a serious response. ③ convenient, oral, including, in a coma patients with sublingual. ④ more than a drug effect, that is, expansion of peripheral vascular and hypotension, expansion of coronary artery and rule angina. Because of increased cardiac output, the expansion of renal vascular diuretic, it can be the treatment of heart failure. Dose: 10 ~ 20 mg, daily three to four times. Side effects of smaller, sometimes a slight expansion of headache, Touzhang, face red. Reduce blood pressure often associated with significantly speed up the heart rate, this may be due to peripheral expansion of reflex sympathetic nerve function caused by hyperthyroidism. The goods and captopril acid when combined, can enhance the antihypertensive effect. Verapamil treatment of hypertension, fewer side effects, verapamil buck the merits ① expansion peripheral arterial blood pressure lowering effect strong, rapid effect, the rate relief and related high blood pressure, high blood pressure, pressure-relief rate, blood pressure normal, No significant relief role, hypertensive crisis can be intravenous injection, the effect quickly. ② expansion of the treatment of coronary artery angina, myocardial ischemic protection, especially for those hypertensive patients with coronary heart disease. ③ atrioventricular conduction velocity has slowed down, should not extend the effective period of self-discipline to reduce the role of electrophysiology, applicable to the rapid arrhythmia, hypertension merger. ④ due to expansion of peripheral artery, can be used for hypertension associated with peripheral arterial obstructive disease, side effects are: sinus bradycardia, atrioventricular block, the negative effect of muscle strength and thus in sick sinus syndrome, heart block , Heart failure caught disabled, dose 40 ~ 80 mg, three times a day, if necessary, 0.075 mg / kg, intravenous injection. Diltiazem Zhuo-the buck to a certain extent, but not as nifedipine, but also inhibited atrioventricular node conduction velocity, the atrioventricular node should not extend the period of the role, but weaker than verapamil, old and young with moderate hypertension Room on the rapid arrhythmia than those applicable. Dose of 30 ~ 60 mg, orally, three times a day. Side effects with verapamil, nitrendipine reduced peripheral vascular resistance and relief, has little effect on normal blood pressure, medication one hour after the start buck, efficacy can be maintained 24 hours, no adverse effects on blood lipid blood sugar, dose 10 mg, oral 1 to 2 times a day, nimodipine goods easily through the blood-brain barrier, is a potent cerebral vascular expansion of both buck. Has the role of prevention of stroke onset. Dose of 10 ~ 30 mg, daily 2 to 3 times. Nicardipine expansion of the role of cerebral vascular stronger, apply to hypertensive patients with cerebrovascular disease, the dose of 10 ~ 20 mg, orally, three times a day.

(C) expansion of direct vascular relaxation of vascular smooth muscle, the expansion of blood vessels, lowering blood pressure. Commonly used drugs are:

1. SNP direct expansion of small arteries and veins, while reducing the heart before the load, can also reduce the heart after the load. Hui Xin not only reduce output but also to the increased risk to the former amount of time is short, the need for intravenous infusion. Mainly for high blood pressure and hypertension associated with acute heart failure who. Usage: Start with 10 ~ 20 ug / min, blood pressure levels can be adjusted according to dose infusion, the biggest of not more than 300 ug / min. Side effects: position of low blood pressure, sleepiness, fatigue, nausea, vomiting, sweating, headache, and so on. Continuous intravenous infusion, is generally not more than 48 hours, the SNP in the body into thiocyanate, continuous use over 72 hours, should be the next day of thiocyanate concentrations in blood, if more than 10% for the concentration of poisoning. Should be stopping.

2. Pressure for long direct role in the smooth muscle of small arteries, reduce blood pressure strong and lasting effects of time. Apply severe or intractable hypertension, resistance to other drugs or effect of poor persons. The drug did not reduce kidney blood vessel traffic, high blood pressure is applied to those with kidney dysfunction. Usage: 25 mg, oral, two to four times a day, gradually increasing doses a day maximum dose not exceed 40 mg, common side effects, swelling, and more hair, echocardiography excessive, nausea, stomach discomfort.

3. Hydrazine triazine of benzene in some of the blood vessels shrink as necessary to trace metals such as copper have sequestration by the histamine-and dual-hydroxybutyrate Effects of hydroxyl to also inhibit the enzyme, and the latter in norepinephrine Synthesis of closely related. In addition peptide can inhibit the two substances, that is, blood pressure and angiotensin-supported activity, through a variety of ways to pressure-relief purposes. The drug enhanced myocardial contraction and speed up heart rate, increased cardiac output, increased renal blood flow and myocardial oxygen consumption increase, which will be anti-coronary heart disease. Hypertensive patients with renal insufficiency, Ben Pinke to share with diuretics, commonly used dose of 10 ~ 25 mg, orally, four times a day, gradually increase, on the 1st of not more than 250 mg suitable. The current use of double-triazine hydrazine of benzene, used in 25 ~ 50 mg, orally, three times a day, side effects: tachycardia, headache, nausea, vomiting, fatigue reduce blood cells, multiple neuritis and lupus erythematosus - Like symptoms, and so on.

(D) the role of the sympathetic nervous system antihypertensive drugs

1. Central sympathetic inhibitors

(1) Clonidine can inhibit the extension of cerebral vascular sports hub, so that sympathetic nerve activity decreased peripheral, peripheral resistance to drop relief purposes, but also the vagus nerve activity increased, decreased heart rate, lower blood pressure, can also direct expansion of peripheral vascular and Hypotension, a有镇静作用, easily excited and nervous more appropriate for the patients, can also be used in high renin-who. Starting amount of 75 ug, oral, 2 to 3 times daily, such as invalid, the dose can be increased gradually to 300 ug, three times a day. The drug markedly effective rapid, oral relief after half an hour to 2 to 3 hours of greatest effect. Side effects of dry mouth, nausea, fatigue, sleepiness, flustered, headache, dizziness. Sudden withdrawal could rebound to higher blood pressure, headache, palpitations, sweating, should be gradually reducing and then stopping. In order to reduce Shuinazhuliu, preferably with the use of diuretics.

(2)-Pakistan can be more competitive block of norepinephrine in the course of more dopamine into Pakistan to the decarboxylation role to prevent the synthesis of norepinephrine and hypotension. On heart rate, cardiac output impact is very small, and to maintain renal blood flow and glomerular filtration rate unchanged, but also expansion of the renal artery, renal vascular resistance decreased, applicable to patients with hypertension, renal failure . Liver dysfunction who is disabled. Usage: 250 mg, oral, 2 to 3 times daily, can be gradually increased to 1000 mg, three times a day. Side effects: drowsiness, dry mouth, fatigue, fever, and so on.

2. Ganglion blockers block the transmission sympathetic excitement, expansion of small arteries, reducing blood vessel resistance, and expansion of small vein, Yizhi postural hypotension, have used the Argentine side that special 500 mg, glucose dissolved in 50% 500 ml of fluid infusion for the treatment of hypertensive encephalopathy.

3. Sympathetic to the post-blockers in the peripheral sympathetic norepinephrine storage depletion, and the purpose of relief.

(1) Effect B啶sympathetic peripheral to stop the release of norepinephrine and noradrenaline depletion of the storage, thus jamming the post-adrenergic nerve peripheral nerve transmission, so that peripheral resistance decreased blood pressure dropped, The heart rate, cardiac output decreased dose 10 mg, oral, 2 to 3 times daily, increasing to 75 mg / day. Antihypertensive effect stronger, more adverse effects, a position hypotension, dry mouth, diarrhea, stuffy nose, impotence, and so on. Currently used only for severe hypertension and other antihypertensive drugs to poor effect.

(2) Reserpine is a Luo Fumu category will enable the brain and internal organs of the lower level of catecholamine, depletion and thus inhibit the sympathetic peripheral nerve transmission material so that the peripheral resistance decreased blood pressure dropped, but also enables Brain serotonin levels have decreased and the central role of sedation. The easing of goods, a role to play slow, usually in the first medication after one to two hours before gradually play a role, the role of sustained 24 to 48 hours, the drug effects of medication after the peak in one to two weeks. Dose: 0.25 mg, oral, three times a day, with the central inhibition, depression who is disabled, can promote the secretion of gastric juice, can lead to gastrointestinal bleeding, the original anti-ulcer should be, there are side effects of nasal obstruction, the echocardiography Ease, fatigue, long-term use can lead to elevated blood lipids, more because of side effects, has not the first choice for antihypertensive drug treatment.

4. Adrenergic receptor blocker

(1) β-blocker drug and catecholamine competition and β-receptor combination, reduce the sympathetic nervous tension, improve vascular smooth muscle of the vasodilative drug sensitivity. A negative strength and frequency of negative effects, heart rate, cardiac output reduction. Β-block within the kidneys can inhibit the renin secretion. Β-block central nervous system, produce bradycardia and hypotension, indications: ① young patients with hypertension; ② high renin hypertension (malignant hypertension, renal hypertension, high renin essential hypertension); ③ High cardiac output of hypertension; ④ tachycardia with hypertension; ⑤ merger labor angina, arrhythmia hypertension, often have experience of 10 ~ 80 mg, orally, three times a day, the dose should be individualized Steeled effective. Encore experience increased serum triglycerides, very low density lipoprotein, high density lipoprotein lower. Since the adverse effects on serum lipids, has not the first choice for antihypertensive drugs, bronchial asthma are banned, labetalol recommended by the WHO is scheduled antihypertensive drug, propranolol of analogue, with α and β - Joint block role. Norepinephrine may antagonize the vasoconstrictor, α receptor antagonist exciting step-up role, the vasodilative antagonistic isoproterenol, β receptor antagonist excited about the role of heart rate to accelerate. The role of β-block> block α receptor role. Dose of 100 ~ 200 mg, orally, three times a day, if necessary, 1.5 ~ 2 mg / kg intravenous infusion, combined with diuretics, can enhance the effect. Side effects: bradycardia, postural hypotension, dry mouth, drowsiness, nausea, vomiting, diarrhea, etc.. Vinegar Dibutyryl metoprolol mild to moderate hypertension a good buck, heart rate slowed down the role of light, no adverse effects on blood lipids. Dose of 400 ~ 800 mg / day, 2 hours of oral. In addition, the United States metoprolol, Effects of metoprolol also good relief role.

(2) α-blockers block epinephrine, norepinephrine and sympathetic to the role of blood vessels, reducing peripheral resistance and hypotension, often have prazosin, α1 block receptors, the cardiac blood Volume, heart rate and plasma renin activity less affected, first to 0.5 ~ 1 mg trial service, if no response, while 1 mg, three times a day, increasing to 5 mg, three times a day. The stronger role for the vessel, the first of 30 to 60 minutes after the possible position of low blood pressure, even syncope, to start small doses. Doxazosin, reduce blood pressure more than prazosin, easy to use. 2.4mg, a day, phentolamine block α1 and α2 receptor, reducing post-load, cardiac output increased, the release of renin increase in heart rate accelerated dose 25 ~ 50 mg, orally, three times a day, or 10mg diluted to five percent of 250 ml of glucose infusion, benzene benzylamine block α1 and α2 receptors, dose 10 ~ 20 mg, orally, three times a day, side effects are dizziness, fatigue, swelling.

(5) diuretic antihypertensive drugs

1. Thiazin-type is the most extensive application of the oral diuretic antihypertensive drugs, dihydrochloride grams of urine thiadiazole 25 mg, daily 2 to 3 times, the mild to moderate hypertension role of a good buck. Because lowering blood volume and lower blood pressure, blood viscosity increase, cerebrovascular disease, have evoked the risk of cerebral ischemia, the elderly have the history of transient ischemic disease among the anti. The drug suppression of renal excretion of uric acid, increased serum uric acid concentrations, can be induced gout. As inhibit the release of insulin and glucose utilization barriers surrounding tissue, can be induced by hyperglycemia. People should be anti-diabetic. May also increased serum cholesterol and triglycerides, have an adverse impact on coronary heart disease, can cause low potassium low magnesium. As more side effects, it is not appropriate as the preferred treatment.

2. Chloro-thiadiazole role a long time and dose of 50 mg, a day, the goods also increased serum cholesterol and triglycerides, the adverse coronary heart disease.

3. Furosemide role of strong and effective short. Dose of 40 mg, twice daily, severe hypertension, intravenous injection.

4. Anben Die buck role of the weak, Pai potassium sodium retention, the dose of 50 mg, daily 1.