Guidelines for Long-Term Use of Hypertension Medication: In-Depth Analysis of the Pharmacological Characteristics and Clinical Selection of Six Major Antihypertensive Drugs

31. Does Hypertension Require Long-Term Medication? Some hypertensive patients experience excellent blood pressure control after taking antihypertensive medication, but over time, they may become bored and wonder if they can avoid long-term medication. Hypertension can be classified into primary hypertension (i.e., hypertension) and secondary hypertension based on its cause. Hypertension can only be diagnosed after ruling out secondary causes and is more common clinically. Because the cause of hypertension is unclear, it may be related to genetics, gene expression, vasoactive factors, etc., so it cannot be cured but can be effectively controlled, requiring lifelong antihypertensive medication. Secondary hypertension, on the other hand, can be cured by removing the underlying cause. Currently, there is no drug that can cure hypertension. Blood pressure levels do not always correlate with subjective symptoms. Hypertensive patients should never take medication based on their feelings, regardless of whether they have symptoms or not. As long as 24-hour blood pressure remains stable below 140/90 mmHg, it can protect target organs such as the heart, brain, and kidneys from damage, thus achieving the goal of health and longevity. It's difficult to stick to anything, but since you now understand the necessity of long-term blood pressure control, I believe you will take your medication more seriously. Make taking your medication a habit, and you'll naturally stick to it.

32. What are the commonly used antihypertensive drugs and what are their characteristics? Currently, there are many types of antihypertensive drugs and various advertisements are everywhere, making it difficult for patients to know where to go. The following is an introduction to the classification of antihypertensive drugs, their characteristics, contraindications and common adverse reactions. Currently, commonly used antihypertensive drugs are divided into six categories: diuretics, β-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and α-blockers. The blood pressure reduction of various antihypertensive drugs is generally similar for most mild hypertension when used alone. Usually, monotherapy at the generally recommended dose can reduce systolic blood pressure by 7-13 mmHg and diastolic blood pressure by 4-8 mmHg. (1) Diuretics. Diuretics have a clear therapeutic effect whether used alone or in combination with other antihypertensive drugs. They are inexpensive and have few adverse reactions when used in small doses. They are especially suitable for patients with isolated systolic hypertension. Commonly used preparations include: hydrochlorothiazide (hydrochlorothiazide), chlorthalidone, indapamide (Suppisan, Natrixol), etc. Patients with gout and renal insufficiency (serum creatinine > 265.2 μmol/L) should not use this medication. High doses can cause hypokalemia and affect glucose, lipid, and uric acid metabolism, so high doses are not recommended. (2) β-blockers. Mainly used for mild to moderate hypertension, especially for young and middle-aged patients with a fast resting heart rate (> 80 beats/min) or those with angina. Common medications of this type include: metoprolol (Betaloc), bisoprolol (Concor, Bosu), atenolol (Aminoxinan), etc. Patients with asthma, obstructive pulmonary disease, second or third-degree atrioventricular block, peripheral vascular disease, or diabetes should not use this medication. (3) Calcium channel blockers. Widely used in the treatment of hypertension, coronary heart disease, arrhythmia, and cerebrovascular disease. Long-acting calcium channel blockers are preferred for antihypertensive treatment, such as amlodipine (Amlodipine, Amlodipine, Landi, etc.), felodipine (Plendil), nifedipine controlled-release tablets (Baixintong), verapamil sustained-release tablets (Sustained-release isopaque), diltiazem sustained-release tablets (Hebeishuang), etc. Short-acting calcium channel blockers should be avoided. Verapamil or diltiazem should not be used in patients with cardiac conduction block. (4) Angiotensin-converting enzyme inhibitors. ACEIs have significant antihypertensive effects, few adverse reactions, stable dose-response curves, are easy to use, and have few contraindications. In particular, dual-channel metabolized angiotensin-converting enzyme inhibitors such as benazepril (Lodinxin) and fosinopril (Mono) have good protective effects on the liver and kidneys. They are not suitable for pregnant women, those with hyperkalemia, bilateral renal artery stenosis, or serum creatinine >265.2 μmol/L. A few people experience dry cough. (5) Angiotensin II receptor antagonists. Indications and contraindications are the same as for angiotensin-converting enzyme inhibitors, used for patients with cough caused by angiotensin-converting enzyme inhibitors. Valsartan (Diovan) and losartan (Cozaar) are commonly used representative drugs in this class. (6) Alpha-receptor blockers. They have a clear antihypertensive effect and have little effect on metabolism. They are beneficial for male patients with benign prostatic hyperplasia and patients with high vascular resistance due to arterial spasm. They are not suitable for patients with aortic stenosis. Attention should be paid to orthostatic hypotension. Commonly used drugs include terazosin (Mashani).