How to rationalize the use of anti-hypertensive drugs

  Rational use of anti-hypertensive drugs 1. For patients with first-episode and class I hypertension, seasonal reduction or discontinuation of drugs is possible with better lifestyle interventions.  2.For young patients, treatment should be based on total cardiovascular risk.  3.Patients with high-risk hypertension and patients with high nocturnal blood pressure load often require a combination of two or three long-acting antihypertensive drugs.  4, Different blood pressure, disease status and different age of elderly patients, antihypertensive goals are different.  5, reasonable combination therapy is more important than increasing the number of drugs.  6.Rational use of domestic fixed compounding is still an important choice for anti-hypertensive treatment at the primary level in China.  7, hypertension with complex disease, it is recommended to use the prescription free combination program, stable lesions can be used fixed compound preparations.  Myths of antihypertensive treatment Myth 1: “Hypertension is a disease that requires lifelong drug treatment and cannot be stopped once medication is taken” Currently, it is believed that hypertension is a progressive disease, and the delay in progression is related to lifestyle intervention and reasonable treatment. The progression is delayed by lifestyle interventions and reasonable treatment. Therefore, patients with first-episode and class I hypertension can reduce or discontinue medication seasonally (mostly in summer) if lifestyle interventions are good.  If a patient has diabetes or coronary artery disease in addition to increased blood pressure, two or three medications should be combined, even if the blood pressure is at a class I level. The treatment of young hypertensive patients is not based on age, nor is it based on whether or not they have “first-episode hypertension”, but on the patient’s total cardiovascular risk.  Myth 3: “Long-acting and high trough/peak ratios (> 60%) are sufficient once daily, and single drugs can control blood pressure throughout the day without combining drugs” There are many types of long-acting antihypertensive drugs that can control blood pressure throughout the day, and the trough/peak (T/P) ratios of different drugs vary greatly. The FDA has determined that all drugs with T/P > 50% are long-acting drugs and can be used once a day. However, there are significant differences in the efficacy of drugs with T/P > 50%, 60%, 70%, or 80%, and these drugs have limited ability to control blood pressure throughout the day in patients with “non-ryphoid” blood pressure (high nighttime blood pressure load) or early morning hypertension. Therefore, some patients using a long-acting drugs still can not control blood pressure throughout the day, the need for a combination of drugs, especially in patients with high risk of cardiovascular disease hypertension and high blood pressure load at night, often need to use a combination of two or three long-acting antihypertensive drugs.  Myth 4: “Elderly patients with hypertension are at high risk and should have a lower target blood pressure, so combination therapy is often recommended.” Elderly patients have different blood pressure and disease conditions, and the blood pressure needs of elderly patients vary by age. In patients with intracranial and extracranial vascular stenosis, blood pressure cannot be controlled too low, even in the elderly. In these patients, it is possible to control blood pressure to a level that is tolerated by the patient with monotherapy.  Myth 5: “High-risk hypertensive patients (diabetes, kidney disease, coronary artery disease, stroke patients) target blood pressure.