With the increasing emphasis on chronic disease management, many patients are becoming more aware of lifelong management and lifelong treatment of chronic diseases, but sometimes after taking a single antihypertensive drug, some patients are in deep distress in the face of “high” blood pressure. This is when the combination of drugs is the best choice.
But clinically many patients believe that “medicine is three parts poisonous”, always feel that the more drugs eat the more side effects on the body and the greater the harm, but do not know that if the use of a single drug is not good for disease control, do not combine drugs, for the body is actually more harmful, which has to mention the significance of the combination of drugs for hypertensive patients.
1, the significance of the combination of drugs
Improve the efficiency of antihypertensive
Primary hypertension patients with increased blood pressure involves numerous mechanisms, and the role of each type of existing antihypertensive drugs can not cover more than one mechanism, the combination of drugs to intervene in several mechanisms at the same time, can play a role in enhancing the antihypertensive effect.
Stable blood pressure lowering
Different antihypertensive drugs have different peaks and durations, and the combination of drugs can have a smooth lowering effect for 24 hours, including suppressing morning peaks and reducing nocturnal hypertension.
Reduce or not increase side effects
The combination of different antihypertensive drugs can reduce or not increase drug-related adverse effects, such as the combination of angiotensin receptor antagonists (ARB) and thiazide diuretics, which can reduce the probability of hypokalemia.
Although there are many benefits of combining medications for hypertensive patients, not all hypertensive patients need to combine medications or have to do so, and there are certain clinical indications for combining medications.
2, the combination of drug indications
Clinical hypertension patients with blood ≥ 160/100mmHg, or higher than the target blood pressure 20/10mmHg of high-risk groups, often the initial treatment that requires the application of two antihypertensive drugs.
If the blood pressure exceeds 140/90mmHg, the initial low-dose combination antihypertensive drug therapy can also be considered. If the target blood pressure still cannot be achieved, the dose can be increased on top of the original drug, or 3 or even 4 or more antihypertensive drugs may be required in combination.
Clearly the benefits of the combination of drugs and the indications, the next can be with the combination of drugs for a deeper understanding, which is also a lot of hypertension patients interested in the question, is the combination of drugs in the end how should be combined?
3, the method of combined medication and the specific program
When hypertensive patients are combined, the mechanism of antihypertensive action of the two drugs should be complementary, while having an additive antihypertensive effect, and can offset each other or reduce adverse reactions. The principle of treatment for hypertensive patients is usually based on symptoms, first choose a single drug for the initial treatment, the effect is not satisfactory then can consider the combination of two drugs, if the combination of two drug treatment effect is still not satisfactory, then consider three drugs for treatment, and so on.
The main recommended optimal combination therapy in China includes: dihydropyridine CCB + angiotensin receptor antagonist (ARB); dihydropyridine CCB + angiotensin converting enzyme inhibitor (ACEI); angiotensin receptor antagonist (ARB) + thiazide diuretic; angiotensin converting enzyme inhibitor (ACEI) + thiazide diuretic; dihydropyridine CCB + thiazide diuretics; dihydropyridine CCB + beta-blockers.
The three-drug combination scheme is to add another antihypertensive drug to the above-mentioned two-drug combination, which constitutes a three-drug combination scheme, such as the combination of dihydropyridine CCB + angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) + thiazide diuretic, which is also a more commonly used clinical drug scheme.
The four-drug combination regimen is mainly suitable for patients with refractory hypertension, and a fourth drug can be added to the above three-drug combination, such as beta-blockers, aldosterone receptor antagonists, aminopterin, colistin or alpha-blockers.
There are many combination drug regimens, which require comprehensive consideration according to the patient’s age, pathogenesis, and other concomitant symptoms or diseases in order to choose the appropriate combination drug regimen, and there are various “doors” that not most patients can “penetrate”. The various “rules” involved cannot be “understood” by most patients. Therefore, once a patient’s blood pressure is not satisfactorily controlled, it is recommended to consult a professional physician to develop an appropriate combination antihypertensive regimen.
References
[1] None, Liu L. S., et al. Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition) [J]. Chinese Journal of Cardiovascular,2019,024(001):33.
[2]Sun NL,Huo Y,et al. Guide to the rational use of drugs for hypertension (2nd ed.)[J]. Chinese Journal of Frontiers in Medicine (Electronic Edition),2017(7).