The main principles treatment of hypertension are as follows:
-strict compliance with the doctor's recommendations: continuous, regular intake of antihypertensive drugs;
-Development of RF, provoking an increase in blood pressure and complicating treatment;
- independent measurement of blood pressure at home;
-interpretation of self-administration of medications for hypertensive crisis in the framework of pre-hospital care;
- compliance with warnings when taking antihypertensive medications, for example, limiting alcoholic beverages;
-combination of non-pharmacological and medicinal methods of treatment - allows to reduce the side effects of medicines;
- medicinal effect on other RF - the appointment of drugs that normalize the level of cholesterol, affecting blood coagulability, sedatives, etc.
To what level and how quickly to reduce high blood pressure?
Optimum levels of blood pressure lowering. By "optimal" is meant a decrease in blood pressure to such levels,at which the risk of complications is reduced and the blood supply to the brain, heart, kidneys is not deteriorated with good tolerability of treatment to patients. It is optimal to achieve target blood pressure levels.
Drug treatment improves the prognosis of hypertension only in those cases when the drug is taken regularly and ensures a uniform decrease in blood pressure throughout the day.
Each of the antihypertensive drugs (AGP) may have a side effect, which should take into account the doctor when choosing a drug.
Thiazide diuretics can lower the level of potassium in the blood, have some negative effect on carbohydrate and fat metabolism, but the use of small doses practically does not have these side effects.
Beta-blockers reduce heart rate, can worsen the course of chronic bronchitis and bronchial asthma, as well as vascular foot disease (intermittent claudication).
When appointing calcium antagonists, headache, shin edema, and reddening of the skin may appear.
Angiotensin converting enzyme inhibitors can cause a cough.
Alpha-blockers in the first days of treatment can dramatically reduce pressure, especially in an upright position, which can lead to weakness and dizziness.
There are several main classes of modern antihypertensive drugs, which significantly expands the range of indications and allows you to choose the drug shown in each case: diuretics (indapamide); beta-blockers; calcium antagonists (amlodipine); inhibitors of the angiotensin-converting enzyme - ACE - (enalapril); angiotensin II receptor blockers; preparations of central action, including selective imidazoline receptor agonists, alpha1-adrenergic receptor blockers. The last two groups in the world are treated as second-line drugs.
It should be noted that central action drugs are different chemical compounds, including some drugs used to treat hypertension for many years (reserpine, methyldopa and etc.). In connection with the lack of evidence of their influence on the prognosis of patients' life and the presence of a number of side effects, these drugs can not currently be recommended as the main ones for long-term treatment of hypertension.
Monotherapy and combined antihypertensive therapy
Unfortunately, treatment with a single antihypertensive drug is rarely effective.Normalization of blood pressure in one pill is possible mainly in young people at the onset of the disease. If the blood pressure initially exceeds 160/100 mm Hg, treatment is almost always started with two or three drugs.
Combination therapy avoids the side effects that occur as a result of taking a single drug in a high dose; drugs in small doses complement each other's action and less often cause undesirable phenomena.
The hypertensive crisis always requires urgent intervention!
When developing symptoms of hypertensive crisis, you need:
-measure blood pressure;
-If possible before the doctor's arrival quickly try to reduce the increased blood pressure yourself:
Quick-acting drugs (tablet under the tongue) can be used: captopril 25-50 mg or nifedipine 10 mg. It is better to discuss the choice of a specific preparation with a doctor in advance;
-in case of chest pain (manifestation of angina pectoris) should be taken nitroglycerine in tablets or in the form of a spray under the tongue;
-we do not need to use ineffective agents: papasole *, dibazol *, drotaverine and other "improvised means" - this will only tighten the hypertensive crisis and aggravate the severity of the condition, - it is impossible to sharply reduce blood pressure for a short period of time, especially in old age.In elderly patients with a decrease in blood pressure (against a background of relatively low BP figures), symptoms such as weakness, drowsiness, may indicate a disturbance in brain nutrition (ischemia), - with prolonged hypertonic crisis, ineffectiveness of self-therapy or the appearance of anxiety symptoms (severe pain in the sternum, pronounced dyspnea, violation of limb movements) it is necessary to call an "ambulance".