The “main battlefield” of hypertension management in China has shifted to the community and primary health care institutions, whose management level will directly affect the occurrence and development of our future cardiovascular diseases. How much do you know about nifedipine? In order to better regulate the management of hypertension in community and primary health care institutions, the recently updated 2017 edition of the National Guidelines for the Management of Primary Hypertension Prevention and Control was released. The article clearly mentions that sublingual administration of nifedipine and other short-acting drugs to rapidly lower blood pressure is strictly prohibited, which deserves the attention of our medical workers and hypertensive patients. Nifedipine is a first-generation dihydropyridine calcium antagonist, and common nifedipine is a short-acting agent. According to the results of the Shanghai Trial of Nifedipine in Elderly Hypertension (STONE), it was confirmed that it can reduce the incidence of stroke and cardiovascular events, as well as reduce the disability and mortality rates of hypertension. Therefore, although all guidelines mostly recommend the use of once-a-day long-acting antihypertensive drugs to manage blood pressure, there is still a large market for generic nifedipine, which is cheap and effective, in the vast grassroots. Attention! For patients with blood pressure ≥ 180/110 mmHg without clinical symptoms of acute cardiac, cerebral or renal complications, we often give generic nifedipine sublingually for management. This brings a lot of significant pitfalls to our clinical practice. Foreign studies have reported 2 cases of unstable angina pectoris patients who died after containing nifedipine, and the autopsy confirmed the cause of death as myocardial infarction. It is hypothesized that this may be due to a rapid and significant drop in blood pressure leading to inadequate coronary perfusion and consequent fatal myocardial infarction. Our study also reported 7 cases of hypertensive patients with severe adverse effects due to sublingual nifedipine, whose main manifestations included hallucinations, dizziness, nausea, chest pain, chest tightness, profuse sweating, near-death feeling, impaired consciousness, stroke with hemiparesis, and blindness. Nifedipine has the effect of inhibiting Ca2+ inward flow, relaxing vascular smooth muscle, dilating coronary arteries and increasing their blood flow, while dilating small peripheral arteries and decreasing peripheral vascular resistance, thus causing blood pressure to drop. Why is nifedipine harmful when taken orally? Generally speaking, after the drug is taken orally, it is first inactivated by various enzymes in the gastrointestinal tract or liver before entering the body circulation, so that the actual amount of drug entering the body circulation is reduced, which is known as the first-pass effect in medicine. The human sublingual mucosa is rich in venous plexus, so the sublingual drug takes effect faster. Therefore, oral nifedipine 15min onset of action, 1 ~ 2h peak effect, the effect lasts 4 ~ 8h; while sublingual administration 2 ~ 3min onset of action, 20min can reach the peak. Sublingual nifedipine, because of its rapid onset of action, may lead to a dramatic drop in blood pressure within a short period of time, which can cause redistribution of blood flow and lead to ischemia of important organs, especially poor circulation in the coronary arteries and brain, leading to ischemia of the heart, brain and other organs, which may induce serious ischemic cardiovascular and cerebrovascular events, such as angina pectoris, heart attack, stroke and so on. It also reflexively excites sympathetic nerves, increases the secretion of catecholamines, increases tachycardia, strengthens myocardial contraction, and increases oxygen consumption in the heart, making the already ischemic myocardium even more ischemic and causing palpitations and suffocating symptoms. Therefore, as early as 1985, the US FDA considered that patients with hypertension should not take sublingual nifedipine. The US JNC-6 clearly states that sublingual nifedipine is “unacceptable”. The Chinese Guidelines for the Prevention and Treatment of Hypertension (2009 Primary Edition) also states that sublingual nifedipine should be used with caution or not in patients with acute hypertension. The latest 2017 edition of the National Guidelines for the Management of Primary Hypertension Prevention and Control explicitly mentions that sublingual nifedipine and other short-acting drugs are strictly prohibited for rapid hypotension. How to use medication for hypertension? Patients with blood pressure ≥ 180/110 mmHg, without acute complications of heart, brain and kidney how to use medication: 1, oral short-acting antihypertensive drugs, such as captopril 12.5-25 mg, or nifedipine 10 mg or metoprolol 25 mg orally, 1 hour later can be repeated, outpatient observation until reduced to 180/110 mmHg below; 2, still ≥ 180/110 mmHg 2, still ≥ 180/110 mmHg, or obvious symptoms, recommend referral; 3, 24-48 h to 160/100 mmHg or less, then adjust the long-term treatment plan.