How to use blood pressure lowering drugs, principles, and timing?

How to reasonably combine blood pressure lowering drugs?

To achieve the maximum efficacy in treating hypertension, it requires a greater degree of blood pressure reduction, which can sometimes be difficult to achieve with just one drug. Increasing the dose can easily lead to adverse reactions. Using two or more blood pressure lowering drugs together can achieve effects that are difficult to achieve with one drug. In combination, the dose of each drug is not large, but the therapeutic effect is much greater, and adverse reactions are mutually offset, at least fewer than when added together.

How to use blood pressure lowering drugs, principles, and timing?
How to use blood pressure lowering drugs, principles, and timing?

The number of drug combinations should not be too many to avoid complex drug interactions. Currently, considered reasonable combinations include ACEI with diuretics; ACE II receptor antagonists with diuretics; ACEI with calcium channel blockers, β-blockers with calcium channel blockers, β-blockers with diuretics; β-blockers with α-blockers; also, in the elderly, calcium channel blockers and diuretics can be combined.

Principles of long-term use of blood pressure lowering drugs.

After reaching the target blood pressure in treatment, long-term medication is required, along with regular blood pressure measurements and monitoring changes in cardiovascular diseases associated with other risk factors. Adjustments to medication should be made appropriately based on the situation, following a regular medication schedule, and avoiding frequent changes in the type of anti-hypertensive drugs used. Patients with hypertension usually need lifelong treatment. If the diagnosis of hypertension is accurate, stopping treatment will eventually cause blood pressure to return to the pre-treatment level.

However, if the patient’s blood pressure has been long-term controlled, medication frequency, dosage, and types can be cautiously reduced gradually, especially for those who can implement strict non-drug treatments. Careful monitoring of blood pressure is necessary during the “gradual reduction” period.

How to adjust the dosage of medication for hypertension patients.

For most non-severe or emergency hypertension, find the minimum effective dose that can be tolerated, and do not lower blood pressure too quickly. Start with a small dose of medication, and after one month, if the efficacy is insufficient and the adverse reactions are minimal or tolerable, the dose can be increased. If intolerable adverse reactions occur, switch to another class of medication. If there is no response after three months of treatment, change to another class of medication or add a small dose of another class of medication.

If there is partial response, increase the dose or add one of the medications in another class, while also paying attention to actively and seriously improving lifestyle. After treatment, if blood pressure remains stable for more than one year, consider reducing the dose to minimize potential side effects, but ensure it does not affect the efficacy.

How to choose a reasonable medication time.

Choose long-acting anti-hypertensive drugs, which are suitable for morning administration, and generally not recommended for nighttime use. Beta-blockers are an exception, often taken before bedtime.

The goal of treating hypertension is to reduce the risk of cardiovascular diseases. Treating other risk factors and existing clinical conditions in hypertensive patients is equally important. Therefore, if diabetes, hyperlipidemia, coronary heart disease, cerebrovascular disease, or kidney disease coexists, visit a related specialist or develop appropriate lifestyle and medication management for these conditions.

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