What are the 6 major classes of antihypertensive drugs and how should I choose them? The incidence of hypertension is high, and the rate of awareness and treatment is low. Many patients follow the advice of their doctors and take antihypertensive drugs, but why did your doctor choose this class of drugs for you, and what are the effects and side effects of this drug? But why did your doctor choose this drug for you, what are the effects and side effects of this drug, and whether it is appropriate to choose other types of drugs instead? Today, we will briefly explain to you the characteristics of each of the six major types of antihypertensive drugs. The first class of drugs has “diphenhydramine” in its name, which is a calcium channel blocker (CCB). It is mainly by blocking the calcium channels on the smooth muscle cells of blood vessels, and play the role of vasodilation to lower blood pressure. For example, nifedipine, amlodipine, felodipine, benidipine and others are commonly used in clinical practice. These drugs are mostly used in elderly patients with hypertension, peripheral vascular disease, and simple systolic hypertension. Calcium antagonists may have side effects such as facial flushing, ankle edema, gum growth, etc., and require close attention when administered. The second class of drugs has “Pulley” in its name, which is an angiotensin-converting enzyme inhibitor (ACEI). It inhibits angiotensin-converting enzyme, blocks the production of renin angiotensin II, and inhibits the degradation of kinase to play a role in lowering blood pressure. For example, captopril, enalapril, lenopril, ramipril, fosinopril, etc. are used in clinical practice. These drugs are mostly used in patients with hypertension combined with heart failure, coronary artery disease, left ventricular hypertrophy, left ventricular insufficiency, carotid atherosclerosis, non-diabetic nephropathy, diabetic nephropathy, proteinuria/microalbuminuria or metabolic syndrome. Drugs are more effective in lowering diastolic blood pressure than the first category. Angiotensin-converting enzyme inhibitors side effects can cause a dry cough, which can be relieved for a period of time in some patients, but is not tolerated by many patients and needs to be discontinued. Patients must monitor renal function and urinary routine after taking the drug for a period of time. Patients with moderate to severe renal insufficiency should not use these drugs. The third class of drugs has “sartan” in its name, which is an angiotensin II receptor antagonist (ARB). It exerts its antihypertensive effect by blocking the angiotensin II type 1 receptor (AT1). For example, the drugs with the word “sartan” are commonly used in clinical practice, such as Crosartan, Valsartan, Irbesartan, and Temisartan. These drugs are used in patients with combined heart failure, coronary artery disease, left ventricular hypertrophy, diabetic nephropathy, proteinuria/microalbuminuria or metabolic syndrome, and in patients who cannot tolerate ACEI. However, the combination of ARB drugs and ACEI drugs is not recommended, as this increases the risk of ionic disturbances. The incidence of angiotensin II receptor antagonists causing cough is much lower than that of ACEIs, but cough still occurs in a very small number of patients, and blood potassium and creatinine levels should also be closely monitored after drug administration. These drugs should not be used in patients with moderate to severe renal insufficiency. The fourth class of drugs has “Lol” in its name, which is a betablocker. Mainly by blocking adrenergic beta-receptors, inhibit the over-activated sympathetic nerve activity, inhibit myocardial contractility, slow down the heart rate to play a role in lowering blood pressure. For example, bisoprolol, metoprolol tartrate (betaxolol), aurolol, propranolol, etc. are commonly used in clinical practice. These drugs are used in patients with hypertension combined with coronary artery disease, hypertension combined with heart failure, hypertension combined with myocardial infarction, and hypertension combined with tachyarrhythmia. However, it should be noted that we do not recommend beta-blockers as the first choice for elderly patients with hypertension and stroke unless there is a strong indication for beta-blocker use. In other words, the preferred antihypertensive drug for the above patients should not be a betablocker. Also diabetic patients should be used with caution. These drugs should be monitored closely after administration to avoid bradycardia, and once the resting heart rhythm is less than 50 beats, the drug may need to be adjusted or discontinued. In addition, the application of betablockers should not be stopped suddenly, otherwise rebound phenomenon can occur, which may lead to the rebound of blood pressure and heart rate. The fourth class of drugs is diuretics, which have little commonality in name. These drugs mainly exert their antihypertensive effect by diuretic excretion of sodium and reduction of volume load. Common clinical drugs include: hydrochlorothiazide, indapamide, spironolactone, etc. These drugs are used in patients with hypertension combined with heart failure, geriatric hypertension, and simple systolic hypertension. It is important to note that thiazide diuretics are contraindicated in patients with gout and high uric acid. The combination of diuretics with beta-blockers may increase the risk of new-onset diabetes in diabetes-prone people, so the combination needs to be avoided. Because these drugs increase urination, which in turn removes electrolytes from the blood, blood electrolytes (blood potassium, blood sodium, etc.) should be tested 2-4 weeks after starting the medication, and should also be reviewed every 6 months if the patient does not show hypokalemia. If the patient is not suffering from hypokalemia, he/she should be rechecked every six months. The sixth class of drugs has “zolpidem” in its name, which is a selective alpha1-blocker. This type of drugs by blocking the adrenergic alpha 1 receptors, directly dilate blood vessels to play a hypotensive effect. This includes the clinical use of: terazosin, doxazosin prazosin and so on. This type of drug is suitable for patients with hypertension with prostate enlargement. However, it is important to note that these drugs can cause water and sodium retention and have the risk of causing congestive heart failure. Short-term use can reflexively cause an increase in heart rate, and individual patients can induce angina pectoris. Therefore, it is generally not used as the first-line antihypertensive drug for hypertension, which is why it is ranked last. And this drug should not be taken indiscriminately. It should be taken before going to sleep to prevent the occurrence of postural hypotension when the initial dose is given or the dose is increased. Above we have talked about the antihypertensive mechanism, antihypertensive characteristics, suitable for the population, medication characteristics, precautions, etc. of the six types of antihypertensive drugs, hoping that you can have an initial intuitive understanding of your drugs. We need to repeatedly emphasize that your doctor will choose the right drug according to your age, gender, hypertension characteristics, and co-morbidities. Therefore, if you have abnormal blood pressure, make sure to ask your doctor to adjust your medication. Do not listen to the advice of “a neighbor”, “a colleague” or “a friend” and use the medication casually. If you don’t use your blood pressure medication properly, it can do a lot of harm to your body.