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Elderly hypertension, the blood pressure of dipine and sartan has not reached the standard, should I increase the dose or add medicine?

Time:2022-09-27 14:30:57 source:psychiatricethics.com author:Prevent anxiety Read:846次
Elderly hypertension, the blood pressure of dipine and sartan has not reached the standard, should I increase the dose or add medicine?

An elderly friend with high blood pressure and Hua Zi said that he has been using amlodipine and valsartan to control blood pressure, but the effect is always unsatisfactory. The high pressure is still around 150mmHg, but the low pressure is only 70mmHg. He asked Hua Zi, is it necessary to increase the dose of the drug? Hua Zi told the friend that the difference between high pressure and low pressure is normally between 20~60mmHg, and he reached 80mmHg, which means that the large arteries are hardened, which is a typical feature of senile hypertension, and diuretics are added. Better than increasing the dose of the drug.

1. Infer arterial conditions from blood pressure conditions

The blood pressure of the human body is divided into systolic blood pressure (high pressure) and diastolic blood pressure (low pressure). Corresponds to the systolic and diastolic blood pressure values. When the heart contracts, the pressure generated by the ejected blood on the walls of the large arteries is high pressure. At this time, the large arteries expand to accommodate blood; when the heart is diastolic, the large arteries are elastically retracted, pushing blood to flow to the peripheral arteries, and the pressure generated by the blood vessel walls on the blood is low pressure. . Arteries in the elderly are prone to hardening, which increases the resistance of the heart during systole and increases systolic blood pressure. The hardened arteries have decreased elasticity and insufficient retraction force, which in turn will lead to a decrease in low pressure. Increased high pressure, unchanged or decreased low pressure, and increased pulse pressure between high pressure and low pressure are typical features of elderly hypertension, which means that the large arterial system is hardened. The higher the pulse pressure, the higher the degree of arteriosclerosis.

Second, dipine and sartan are "good partners"

The dipine and sartan used by this elderly friend are two of the antihypertensive drugs "Good partner". Dipine reduces blood pressure by inhibiting calcium ion channels on arterial smooth muscle, dilating blood vessels and reducing blood pressure; sartan can block the "renin-angiotensin-aldosterone" system (RAAS) and reduce blood pressure. The two drugs synergistically reduce blood pressure through different pharmacological mechanisms, and sartan can also reduce the adverse reaction of dipine-induced lower extremity edema. Therefore, the combination of dipine and sartan can produce a "1+1>2" effect. The combination of dipine and sartan is a common drug regimen for patients with hypertension whose initial blood pressure exceeds 160/100 mmHg.

Third, the "iron triangle" in antihypertensive therapy

However, many elderly people still cannot control blood pressure well with the combination of dipine and sartan , even if the dosage of the drug is increased, the improvement of the antihypertensive effect is limited, and the high-dose drug will face a greater risk of drug use. The reason is that the sensitivity of the elderly to antihypertensive drugs decreases. It has been found in studies that elderly hypertension is sensitive to sodium salt and belongs to volume-type hypertension. Therefore, on the basis of the combination of dipine and sartan, adding diuretics (such as hydrochlorothiazide, indapamide, etc.) can promote the excretion of water and sodium, reduce blood volume, and reduce the level of sodium ions in the human body, which can better control blood pressure. Dipine, sartan and diuretics form an "iron triangle" of blood pressure lowering, which is especially suitable for elderly hypertension with high hypertension and increased pulse pressure.

Fourth, the combination of multiple drugs in antihypertensive treatment is better

Many people told Hua Zi that they were worried that too much medication would harm the body. Huazi told them that in antihypertensive treatment, the effect and safety of multi-drug combination are usually better than single-drug therapy. The benefit of antihypertensive therapy comes from the reduction in blood pressure itself. Hypertension monotherapy has been found to have limited efficacy in studies, with a single drug only reducing blood pressure by around 10mmHg on average. Blood pressure over 160/100mmHg basically requires a combination of two or more antihypertensive drugs to be effectively controlled. The combination of multiple lower-dose antihypertensive drugs has fewer adverse reactions than high-dose monotherapy, and the antihypertensive effect is synergistic, the adverse reactions are complementary, and the safety is higher. To sum up, for elderly hypertension with increased high pressure, decreased low pressure, and increased pulse pressure, when the treatment effect of dipine and sartan is unsatisfactory, adding diuretics to form an "iron triangle" of blood pressure is better than increasing the dose of drugs. . The medicine should be used under the guidance of a doctor. If you have any doubts about the medicine, please consult your doctor or pharmacist. I am Huazi, a pharmacist. Welcome to follow me and share more health knowledge.

(责任编辑:Anxiety disorder)

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