Trigeminal disorders are hypertension, hyperglycemia and hyperlipidemia, which can exist alone or in association with each other. They have become the “number one killer” of humans. Among the Chinese population, deaths related to THP account for 27% of all deaths. The correct timing of medication is particularly important for patients with THP.
I. Blood pressure lowering drugs
1, the human blood pressure rhythm of sunrise and sunset.
In order to work and rest needs, under normal physiological conditions, human blood pressure within 24 hours is a certain rhythm fluctuations. Early in the morning, blood pressure begins to rise at 4 to 5, 6 to 8 all-day peak after a steady decline; 16 to 18 again a small peak, followed by a slow and continuous decline, 0 to 2 reached a trough and maintained until 4 to 5. The whole day shows the characteristics of “high day and low night, double peak and valley”.
2.Arytenoid and non-Arytenoid blood pressure
The blood pressure rhythm can be divided into four types according to the blood pressure drop at night: ① aryepiglottic blood pressure: blood pressure at night is 10%-20% lower than daytime; ② non aryepiglottic blood pressure: blood pressure at night is 0-10% lower than daytime; ③ super aryepiglottic blood pressure: blood pressure at night is >20% lower than daytime; ④ anti aryepiglottic blood pressure: blood pressure at night is not lower or even higher than daytime level.
Except for arytenoid blood pressure, the other three patterns are abnormal blood pressure rhythms. The arytenoid rhythm of blood pressure is beneficial in adapting to the body’s activity pattern and protecting the structure and function of the heart. Patients with non-arytenoidal blood pressure rhythms are considered to be at high risk for complications of cardiovascular and cerebrovascular diseases.
3.Time to take medication for arytenoid hypertension
Generally speaking, oral antihypertensive drugs mostly appear 30 minutes after taking the medication, and the effect is strongest after 2 to 3h. In order to effectively and smoothly control blood pressure, the best antihypertensive effect is given before the peak.
For patients with arytenoid hypertension, if they take long-acting antihypertensive drugs once a day, it is best to take them at 7 a.m.; if they take antihypertensive drugs twice a day, it is best to take them at 7 a.m. and 3-6 p.m.
In arytenoid hypertension, antihypertensive drugs should not be taken at bedtime or at night to avoid low blood pressure (diastolic blood pressure) during sleep at night, which may lead to ischemic stroke, especially in the elderly.
4.Timing of medication for non-arrythmia hypertension
For patients with non-ascending hypertension, if they are taking long-acting antihypertensive drugs once a day, they should take them at 8:00 p.m. This can significantly improve the non-ascending blood pressure rhythm; on the contrary, taking them at 7:00 a.m. has a tendency to aggravate the non-ascending blood pressure rhythm.
Patients with hypertension must go to the hospital for blood pressure monitoring to find out whether they have arytenoid blood pressure or non-arytenoid blood pressure, and then personalize their medication. In addition, hypertensive patients should pay attention to monitoring the changes in blood pressure at various time points after medication to prevent cardiovascular and cerebrovascular events.
Second, statin lipid-lowering drugs
1.Cholesterol sources and hazards
Cholesterol comes from two sources in vitro or in vivo, the former by dietary intake and the latter mainly synthesized in the liver. If there is excess cholesterol in the body, it will be deposited in the walls of arteries and produce atherosclerotic plaques, which will gradually narrow or block the lumen of blood vessels and cause ischemia or infarction in the tissues and organs supplied with blood.
2.Timing of statin lipid-lowering drugs
The most widely used clinical “star” class of lipid-lowering drugs are statin lipid-lowering drugs. Such as pravastatin, simvastatin, resulvastatin, etc..
Statin lipid-lowering drugs can competitively inhibit HMG-CoA reductase, a key enzyme in hepatic cholesterol synthesis. Because the liver synthesizes cholesterol most actively at 2 to 3 at night, statin lipid-lowering drugs should be taken before bedtime.
Atorvastatin and Rosuvastatin have a long half-life and can be taken at any time of the day when given once a day.
3, statins and beta-lipid-lowering drugs together
If statins are combined with fibrates (mainly gemfibrozil) in the treatment of mixed hyperlipidemia, in order to avoid competitive interactions between liver enzymes and adverse effects such as hepatic enzyme metabolism, rhabdomyolysis and myalgia. It should be taken alternately in the morning, evening or between days.
Third, oral hypoglycemic drugs
The time of taking hypoglycemic drugs is mainly related to the type of hypoglycemic drugs and meal time, and must not be generalized. Wrong time of taking medication will not only fail to achieve the ideal effect of lowering blood sugar, but also cause hypoglycemia and other adverse reactions.
1.Pro-insulin secretagogues
The main function of these drugs is to stimulate insulin secretion by pancreatic β-cells, but the prerequisite is that pancreatic β-cells have certain functions of synthesizing and secreting insulin.
◆The commonly used sulfonylurea hypoglycemic agents are: glipizide, gliclazide, glipizide, glimepiride, etc. These drugs can cause serious hypoglycemic reactions and need to be taken within 20~30 minutes before meals.
◆The commonly used non-sulfonylurea insulin-producing drugs are: Repaglinide and nateglinide. The pro-insulin secretion reaction occurs within 30 minutes after oral administration, so they are usually taken within 0~15 minutes before meals.
2.Insulin sensitizers
These drugs can increase the sensitivity of tissues to insulin, reduce insulin resistance and protect pancreatic function. However, there is a risk of causing or aggravating congestive heart failure in some patients.
Commonly used insulin sensitizers are: pioglitazone and pergolide. This class of drugs alone does not occur when applied to hypoglycemic reactions, taking medication and eating independent.
3.Metformin
Metformin can not only lower blood sugar, but also improve insulin resistance and lipid metabolism, make weight loss, prolong life and reduce the rate of disability and morbidity and mortality.
◆Metformin enteric soluble tablets: 0.25g~0.5g/time, 2~3 times/day, daily dose: 1~1.5g, max 2g; take it when eating or after meal.
◆Metformin extended-release tablets : The starting dosage is usually 0.5g once a day, taken with dinner; the maximum daily dose should not exceed 2g. If 2g once a day cannot achieve satisfactory efficacy, it can be changed to 1g twice a day, taken with or after meals.
4.α-Glucosidase inhibitors
The commonly used α-glycosidase inhibitors are: acarbose and voglibose.
These drugs compete with carbohydrates in food for carbohydrate hydrolase and inhibit the conversion of disaccharides into monosaccharides, thus slowing down the production of glucose and slowing down the absorption of glucose, and should be taken immediately before meals or chewed with the first bite of main food.