Modern blood pressure drugs are divided into 10 different groups according to their mechanism of action. The doctor, having studied the patient's complaints and test results, prescribes one or more drugs, which in no case should be changed independently. Medicines for the heart and blood vessels are not what you can "recommend to a friend". A wrong choice can lead to dire consequences. Antihypertensive drugs are all available with a prescription. In this article we will consider their modern classification based on active substances and the nature of the effect on the body.
People often ask pharmacies for new generation blood pressure drugs without side effects. But this does not happen in practice. All effective drugs have their side effects. You should spend a lot of time choosing your high blood pressure medication group with your doctor. Try it, adjust the dose or replace it entirely if the drug is not suitable.
Classification of drugs for high blood pressure (BP)
Diuretics or diuretics
Drugs that enhance kidney function remove salts and excess water. This leads to a decrease in the volume of circulating blood and a decrease in vascular resistance - a drop in pressure. Not all diuretics are suitable for this purpose. The main requirement for such drugs is the mildness and duration of the diuretic action and the ability to conserve potassium. Many drugs of this group are included in combination drugs for hypertension.
The most common are thiazides. The drug based on the substance indapamide is available in pure and compound form. Hydrochlorothiazide and chlorthalidone are commonly found in blood pressure medications. Examples: substances chlorthalidone + atenolol, chlorthalidone + azilsartan. The numerous options include a complex of hydrochlorothiazide with different substances for hypertension: with quinapril, ramipril, candesartan, bisoprolol, losartan, valsartan. Indapamide is more common with lisinopril, amlodipine and perindopril.
When diuretics are properly prescribed by a doctor, side effects are practically non-existent. Potassium losses are not significant. Sometimes a patient needs to change medications because of an allergic reaction. In some cases, your doctor may prescribe potassium supplements.
It happens that one type of diuretic is not enough. There is a drug that includes two diuretics: hydrochlorothiazide and triamterene (a potassium-sparing agent). The indications for this drug are as follows: edema syndrome, cirrhosis of the liver and hypertension.
Drugs that affect angiotensin-converting enzyme (ACE) activity
Many systems work simultaneously in our body to maintain normal blood pressure. One of them is the renin-angiotensin system. We will not describe the features of its work, but will only say that the main active substance that increases blood pressure is the oligopeptide angiotensin II. When a person has a vascular imbalance, angiotensin should be inhibited. A large group of drugs has been developed for this purpose.
Generations of blood pressure drugs that affect angiotensin II are constantly being updated. Many well-known and popular treatments are already outdated and are being replaced by more modern and effective ones.
It starts working in about 1 hour and is active all day. It is considered a powerful medicine. For this reason, many find it difficult to adjust the dosage; it is impossible to do this without a doctor. A particular side effect is excessive lowering of blood pressure, which is dangerous. Sometimes the cardiologist is forced to completely stop a drug from this group. But for severe headache symptoms, perindopril is an ideal choice, especially in combination with indapamide. Coughing and shortness of breath when taking perindopril are much less frequent and less severe than when taking enalapril.
ACE inhibitors
Newer blood pressure drugs without side effects like cough are ACE inhibitors, they work in a similar way but have a higher safety profile. These are candesartan, eprosartan, irbesartan, losartan, telmisartan. Valsartans are no longer considered new.
Sartans reduce blood pressure after 3 hours, but the maximum effect occurs after 4-8 weeks of continuous use. The correct use of this drug reduces the risk of mortality in patients with a high risk of cardiovascular diseases. ACE inhibitors from the sartan group are more expensive than ACE inhibitors because they act more selectively and are better tolerated.
Beta and alpha adrenergic blockers
This group of drugs works by reducing the activity of adrenaline, which increases blood pressure, the frequency and force of heart contractions. Adrenergic blockers are prescribed to people who do not respond to ACE inhibitors, as well as to patients with heart disease. Several generations of drugs are distinguished here. The oldest of these were drugs based on the substances atenolol and metoprolol. Doctors now prescribe drugs with the active substance bisoprolol fumarate, alone or in combination with a diuretic component.
This medicine works mainly through the heart, reducing the minimum blood volume. It additionally affects blood vessels and renin activity. As a result, blood pressure and heart rate decrease. It is prescribed for chronic heart failure, to prevent angina attacks and to fight hypertension. Side effects can be dangerous: low pulse, dizziness, cardiac conduction disorders.
Carvedilol has a combined adrenergic exclusive effect. It is an alpha and beta adrenergic blocker. It belongs to a new generation and is considered a powerful medicine. It reduces the pressure through the heart and peripheral vessels by dilating them. It is prescribed for the treatment of stable angina pectoris, chronic heart failure and hypertension.
Nebivolol is a third-generation β-blocker. It has a better vasodilator effect and a higher safety profile.
Calcium channel blockers
Calcium normally maintains myocardial contractility and vascular tone. A group of drugs has been developed that limit its effect in order to lower blood pressure in hypertension.
Calcium channel blockers are considered powerful and are sometimes prescribed as an emergency treatment for very high blood pressure.
Preparations based on the substance amlodipine besylateprescribed for hypertension and angina pectoris. Adverse effects often include hypotension, palpitations, edema, and worsening cardiac function. Medicines containing the substance lercanidipine hydrochloride lower blood pressure mainly through the vascular layer and therefore have no side effects on the heart or are significantly less severe. Among the indications there is only hypertension.
Imidazoline receptor agonists
This group of new blood pressure medications are called alpha 2 central adrenergic agonists.
As we mentioned above, the vital support of pressure in the vascular bed is under the control of many systems in our body. One of them is the vasomotor center in the brain. The representative of the group, the substance moxonidine, reduces the activity of this center and the pressure decreases, the process happens gradually.
Moxonidine-based drugs qualitatively lower blood pressure. But unlike others, this substance is contraindicated in acute and chronic heart failure, and these pathologies often accompany hypertension.
Side effects include dry mouth, diarrhea, drowsiness, headache, insomnia, and nervousness.
As we can see, there are no new blood pressure drugs without side effects. The choice of medication will be made by the doctor based on the study of blood tests, ECG and tonometer readings. Before visiting a doctor, you need to keep a diary with blood pressure values, where the pressure will be recorded in the morning, afternoon and evening.
Adherence to a diet low in salt, animal fat and light carbohydrates, as well as regular sports activities, has a positive effect.
To improve the functioning of the cardiovascular system, we can recommend food supplements with important elements. For example, selenium, magnesium, potassium. They are contained in many popular nutritional supplements and vitamin complexes.
Dietary supplement with omega 3 supports vascular health and regulates blood pressure. There is a wide variety of medicines available in pharmacies.