The antihypertensive effect of hydrochlorothiazide is mild, long-lasting and slow, and it has a lowering effect on my blood pressure. It can reduce systolic blood pressure and diastolic blood pressure in proportion, and the blood pressure lowering process is smooth. Long-term medication has no obvious tolerance and generally does not cause orthostatic hypotension. The antihypertensive effect is weak when used alone, and may be used in combination with vasodilators and some sympathetic nerve inhibitors. Can produce synergistic or additive effects.

Captopril has a mild-to-moderate antihypertensive effect and has a rapid onset of action. 15 to 30 minutes after oral administration, blood pressure begins to drop, and it also has a hypotensive effect on normal blood pressure. Long-term use of the drug reduces or reverses cardiovascular wall thickening and myocardial hypertrophy caused by hypertension and protects target organs. Captopril is not likely to cause orthostatic hypotension and water and sodium retention, and it is not tolerated after long-term use.

As a dihydropyridine calcium antagonist, nifedipine has high selectivity for blood vessels and can inhibit the influx of extracellular calcium ions. The calcium particles in the vascular smooth muscle cells are deficient, causing the arteriolar smooth muscles to relax and the arteries to dilate. Lowering peripheral resistance lowers blood pressure, but has no significant effect on people with normal blood pressure.

Propranolol has a moderate degree of antihypertensive effect, and the onset of effect is slow after oral administration. The antihypertensive effect usually occurs after two to three weeks of administration. The antihypertensive effect is long-lasting, and long-term use does not cause orthostatic hypotension. Difficult to develop tolerance, anhydrous sodium retention.

It can selectively block alpha-receptors, dilate arterioles and venules, thereby reducing peripheral resistance and lowering blood pressure. Its antihypertensive effect is moderately strong. It has almost no blocking effect on anterior membrane alpha receptors, so there is no reflex increase in heart rate and renin secretion during blood pressure reduction. It also has no significant effect on renal blood flow and glomerular filtration rate, and long-term use has a blood-lipid-lowering effect. It can block α₁ receptors in the smooth muscles of the bladder and urethra, relax the smooth muscles, and reduce the symptoms of dysuria in patients with prostatic hyperplasia.

It is easy to have a hypotensive effect on normal blood pressure. Clonidine can also inhibit the secretion and movement of the gastrointestinal tract. Clonidine has a certain sedative and analgesic effect, which is related to its promotion of the release of endogenous opioid peptides. This effect can be controlled by opioid receptors. Antagonized by the blocking drug naloxone.

It can directly relax the small arteries and small veins throughout the body, significantly reducing blood pressure. Sodium nitroprusside is a nitro vasodilator.

First, early medication reduces effective blood volume through natriuresis and diuresis. Cardiac output decreases and blood pressure decreases. 2. Mild sodium deficiency in the body during long-term medication. The concentration of sodium ions in vascular smooth muscle decreases, which reduces intracellular calcium ions by affecting the sodium-calcium exchange mechanism, reducing the response of vascular smooth muscle cells to norepinephrine and other vasoconstrictor substances, decreasing vascular tone and lowering blood pressure. Hydrochlorothiazide can also induce the arterial wall to produce carnosine, prostaglandins and other vasodilator substances, which can dilate blood vessels and lower blood pressure.

Captopril antagonizes the conversion of AngⅠ to AngⅡ by inhibiting ACE, thereby producing the following effects 1. Dilate blood vessels and lower blood pressure. 2. Inhibit the production of aldosterone in kidney tissue, reduce water and sodium retention and lower blood pressure. 3. Inhibiting the hydrolysis of bradykinin and slowing fetal growth can exert a powerful vasodilatory effect. It can also stimulate prostaglandin synthesis and increase the vasodilatory effect. 4. Inhibiting the promoting effect of Ang II on myocardial cell growth factors reduces or reverses myocardial hypertrophy and blood vessel wall thickening, and inhibits myocardial and vascular remodeling.

Propranolol is a non-selective beta-receptor blocker, and its antihypertensive mechanism is related to blocking beta-receptors. 1. Block cardiac β₁ receptors, weaken myocardial contractility and reduce cardiac output. 2. Block the β₁ receptors on the glomerular cells, reducing renin secretion and Ang II production. 3. Block the β₂ receptors on the anterior membrane of the noradrenergic nerve of blood vessels, inhibit its positive feedback effect, and reduce the release of NA. 4. Inhibit beta receptors in the hypothalamus, medulla oblongata and other parts of the body, inhibit excitatory neurons, and reduce the tension of the sympathetic nerve center. 5. Reduce the sensitivity of baroreceptors on blood vessel walls. 6. Increase the synthesis of prostacyclin and dilate blood vessels.

Selectively excites the secondary neurons of the nucleus of the solitary tract of the medulla oblongata, the α₂ receptors of the protruding posterior membrane (inhibitory neurons), and the imidazoline I₁ receptors in the rostral end of the ventrolateral nucleus of the medulla, reducing peripheral sympathetic nerve tone. Excites the α₂ receptors on the anterior membrane of peripheral sympathetic nerves and their adjacent imidazoline receptors, causing negative feedback and reducing NA release from peripheral sympathetic nerve terminals.

Hydrochlorothiazide is suitable for use in combination with other antihypertensive drugs in mild to moderate hypertension. It can be used to treat moderate to severe hypertension, while also preventing water and sodium retention caused by other antihypertensive drugs. It is especially suitable for hypertensive patients with heart failure.

hypertension

chronic cardiac insufficiency

myocardial infarction

Used to treat individual hypertension and chronic cardiac insufficiency.

It is used for all kinds of mild to moderate hypertension, and has good effects on complications such as hypertension accompanied by angina pectoris, diabetes, cerebrovascular disease, and renal dysfunction. It can be used alone because it can reflexively increase sympathetic nerve activity when lowering blood pressure, causing an increase in heart rate and cardiac output. Plasma renin activity increases, so it is often combined with diuretics, beta-blockers, and ACEI. At present, gas control and sustained-release preparations are mostly used.

It is used alone for mild to moderate hypertension. It has a better effect on patients with hypertension accompanied by high cardiac output or high plasma renin levels. The antihypertensive effect is enhanced when combined with diuretics. It also has significant effects on hypertensive patients with tachyarrhythmia, coronary heart disease, and cerebrovascular disease.

Various types of hypertension

chronic cardiac insufficiency

other

Currently it is rarely used alone and can be used to treat moderate hypertension. It is suitable for patients with hypertension and renal hypertension who also have ulcer disease. It can also be used as a detoxification drug for morphine addictive drugs. The eye drops can be used to treat open-angle glaucoma.

hypertensive emergency

chronic cardiac insufficiency

Low-dose application has no obvious adverse reactions, but long-term high-dose application can lead to electrolyte disorders, such as hyponatremia, hypokalemia, and hypercalcemia. When taking medication, you should absorb it appropriately and pay attention to potassium supplementation or combination with potassium-sparing diuretics. Adverse effects on glucose metabolism and lipid metabolism, such as hyperglycemia and hyperlipidemia. Therefore, patients with hypertension and diabetes or hyperlipidemia should use it with caution. It can also increase plasma renin activity and activate the rapid angiotensin system, which is not conducive to lowering blood pressure. It can be combined with drugs that reduce renin activity such as β-receptor blockers. It can also treat hyperuricemia and stop bleeding at a high level, so patients with gout and those with reduced renal function should use it with caution.

Captopril has low toxicity, is well tolerated, and generally has hypotensive reactions, so it is advisable to start taking the drug at a low dose. Long-term medication can reduce hemorrhagic activity, cause anosmia, hair loss, eosinophilia, etc. It is advisable to supplement zinc to overcome Captopril is contraindicated in early pregnancy and should be used with caution in patients with renal impairment.

The incidence of adverse reactions is higher than that of captopril, including dizziness, hyperkalemia and orthostatic hypotension. Not suitable for pregnant and lactating women.

Common adverse reactions include facial flushing, headache, dizziness, palpitations, hypotension, ankle edema, etc. A small number of patients reflexively increase their heart rate due to lowered blood pressure, aggravate myocardial ischemia, induce angina pectoris and myocardial infarction, etc. It is contraindicated in patients with hypotension and those with poor liver and kidney function should reduce the dose.

Long -term application can affect lipid metabolism and increase blood lipids, so it is prohibited for patients with hyperlipidemia. It can delay the recovery of blood sugar, so it is accompanied by diabetes. Patients with bronchials with bronchial smooth muscles and blood vessel smooth muscles are accompanied by bronchial asthma, and patients with peripheral vascular spasm disease are used with caution. Because of the inhibitory heart, it is accompanied by heart failure, conducting block, and sinus heart. Due to the reduction of renal blood flow and glomerular filtration rate, those with poor renal function will be used with caution. The long -term use of the drug cannot be stopped suddenly, and the drug discontinuation syndrome can be discontinued. It should be gradually reduced to discontinuation, so as not to induce or aggravate hypertension, angina pectoris, etc.

The main adverse reaction is the mobile phone phenomenon. Some patients develop orthostatic hypotension within 90 minutes of taking the drug for the first time, manifesting as palpitations, fainting and loss of consciousness. Halve the first dose and take it before going to bed to avoid the first dose phenomenon. Stopping the use of diuretics one day before taking prazosin can also reduce the first dose phenomenon, as well as other adverse reactions such as dizziness, fatigue, nasal congestion, dry mouth, frequent urination, headache, drowsiness and gastrointestinal reactions. Patients with severe heart disease and mental illness should use it with caution, and those with allergies should not use it.

Common adverse reactions include dry mouth, constipation, sedation, drowsiness, headache, erectile dysfunction, etc. (all disappear on their own after stopping the drug) Prolonged use can cause water and sodium retention, which can be overcome by combined use of diuretics. A small number of patients experience drug withdrawal reactions after sudden drug discontinuation, and may experience short-term sympathetic hyperactivity, such as palpitations, sweating, and sudden increase in blood pressure. Treatment can be with clonidine or phentolamine.

Too fast intravenous infusion can cause excessive lowering of blood pressure, manifested as headache, palpitations, nausea, vomiting, etc., which may disappear after stopping the drug. Long-term or large-dose medication, its metabolite thiocyanate accumulates in the body and causes poisoning reactions. Sodium thiosulfate can be used to rescue thiocyanate and also inhibit the uptake of iodine by thyroid hormone. It is contraindicated for treating hypothyroidism, liver and kidney insufficiency. This medicine is sensitive to light and is easily destroyed. When instilling, wrap it in black paper to protect it from light.