Reminder of high blood pressure: If you take antihypertensive drugs for a long time, if you have these 4 abnormalities in your body, don't take it seriously

Mr. Zhang is 35 years old this year. He was found to have essential hypertension in a physical examination 7 years ago. The doctor suggested that he should take antihypertensive drugs for a long time. But he was worried about the side effects of the drug, so he was reluctant to take it, and he still did not control his diet. Not only did he smoke, but he often stayed up late .

As a result, last month, Mr. Zhang was sent to the hospital because he fainted. The test results showed that his primary hypertension had reached the extremely high-risk level 3 , and he was also accompanied by cerebral infarction, hyperlipidemia, ventilation, and fatty liver. and eye bleeding.

Do I have to take medicine if I have high blood pressure? What are the precautions for taking antihypertensive drugs?

1. The Lancet: Taking antihypertensive drugs at night has the same effect as taking it in the morning

There has been a lot of controversy in recent years about when to take antihypertensive drugs for the best effect. Previous studies have found that taking the drug at night reduces cardiovascular risk.

In 2019, a study of the Hygia chronotherapy trial published in the European Heart Journal found that taking antihypertensive drugs in the evening was effective in improving blood pressure control and reducing the overall risk of major cardiovascular events by 42%.

However, there are still doubts in the academic community about the results of this study.

Recently, a new study published in the internationally renowned journal "The Lancet" found that taking antihypertensive drugs at night has the same effect as taking it in the morning .

Researchers from Thomas M MacDonald's team at the University of Dundee, UK, included 21,104 participants who were 65.1 years older than the mean age, 13% of whom had a history of cardiovascular disease. During a median follow-up of 5.2 years, 10,503 people were assigned to take their medication in the evening (20:00 pm-0:00 a.m.); 10,601 were assigned to take their medication in the morning (6-10:00 a.m.).

Mean systolic blood pressure in these individuals was roughly similar, 135 mmHg in the evening group and 134.8 mmHg in the morning group; diastolic blood pressure was also roughly similar, 79.1 mmHg in the evening group and 78.8 mmHg in the morning group.

The study results found that the incidence of the main focus event (vascular death, non-fatal myocardial infarction, or non-fatal stroke hospitalization) was 3.4% in the evening group and 3.7% in the morning group, and the difference between the two groups was not significant .

Likewise, both groups were assessed on secondary endpoints (hospitalization for non-fatal myocardial infarction, hospitalization for non-fatal stroke, all-cause mortality, hospitalization or death for congestive heart failure, etc.), and adverse events (falls, fractures, and other symptoms) There was also no significant difference.

Overall, this large study concluded that there was little difference in the incidence of cardiovascular events and mortality when blood pressure medication was taken in the evening or in the morning .

Therefore, hypertensive patients can choose the appropriate medication time according to their own habits, the key is to stick to the medication.

For the medical community, the study's findings provide a powerful answer to the much-debated question of whether taking blood pressure medication in the evening is more effective than taking it in the morning.

In addition, this study also brings some new reminders to doctors. For example, hypertensive patients who take medicines at night, especially diuretics, may need to consider related adverse events such as excessive nighttime . People who take the morning medication may be more likely to experience dizziness, muscle pain, and gastrointestinal symptoms.

Is it good to eat in the morning or in the evening? Some time ago, the International Society of Hypertension (ISH), together with the World Hypertension League (WHL) and the European Society of Hypertension (ESH), issued a position paper, which put forward the following three views:

• Using long-acting antihypertensive drugs, blood pressure can be completely controlled throughout the day, which is the key goal of antihypertensive treatment;
• In clinical practice, evening dosing should not be routinely recommended. Because its benefits have not yet been proven, and there may be potential disadvantages, such as poor control of blood pressure during the day, or excessive blood pressure drop during sleep at night;
• Until high-quality scientific evidence emerges, physicians should follow a well-tested regimen in the treatment of high blood pressure, with long-acting drugs, alone or in combination, taken once in the morning.

2. Long-term use of antihypertensive drugs should pay attention to 4 abnormalities

Perhaps for most hypertensive patients, the most worrying thing about taking antihypertensive drugs for a long time is the side effects, or the antihypertensive drugs will damage the liver and kidneys.

First of all, antihypertensive drugs will not damage the liver and kidneys. The antihypertensive drugs currently used in clinical practice are relatively safe , and when doctors prescribe antihypertensive drugs to patients, they will fully consider factors such as the patient's condition, drug indications and contraindications, and usually do not appear Antihypertensive drugs "eat bad" the liver and kidney.

Secondly, the prilins or sartans in the antihypertensive drugs can not only help control blood pressure, but also have an additional protective effect on the liver and kidneys.

In fact, if hypertensive patients do not regulate medication, stop or reduce medication without authorization, resulting in fluctuation or increase in blood pressure, which will damage the liver and kidney, and even the health of other organs such as the heart, brain, blood vessels, and eyes.

However, it should be noted that when taking the same antihypertensive drug for a long time, some side effects may occur, especially the following four:

1. Edema

Taking dihydropyridine calcium channel blockers, including amlodipine, nifedipine controlled-release tablets, felodipine sustained-release tablets, etc.

When taking these drugs for a long time, patients may experience ankle edema, which is usually related to the dose . If edema persists, it is recommended that antihypertensive drugs should be replaced in time. In addition, the combined use of sartan or puli antihypertensive drugs can also effectively reduce the symptoms of edema.

2. Back pain

Long-term use of angiotensin Ⅱ receptor inhibitors, including valsartan, losartan, irbesartan, etc., is suitable for hypertensive patients who are intolerant to prilin-type antihypertensive drugs.

With long-term use, patients may experience back pain problems. Different sartan antihypertensive drugs may cause different adverse reactions in the musculoskeletal system such as back pain . If you have back pain while taking a certain sartan antihypertensive drug, you can change the drug under the advice of your doctor. .

3. Nausea, anorexia

Thiazide diuretics, including hydrochlorothiazide, indapamide, etc., can help lower blood pressure by excreting natriuresis and reducing blood volume.

When these drugs are taken for a long period of time, patients are prone to hypokalemia, with symptoms such as nausea, anorexia, listlessness, confusion and physical weakness . It is recommended that patients should reduce their sodium intake during medication, which will help relieve hypokalemia.

4. Dry cough

Angiotensin-converting enzyme inhibitors, including perindopril, enalapril, benazepril, etc.

When taking these drugs for a long time, about 30% of patients may develop persistent dry cough, especially when lying down, the symptoms will be aggravated , and the incidence is higher in female patients.

Since all antihypertensive drugs of the Puli class may cause dry cough, it is recommended that the antihypertensive drugs be replaced with antihypertensive drugs of the sartan class under the guidance of a doctor for patients who cannot tolerate it.

3. Can I stop taking antihypertensive drugs if there are side effects?

For antihypertensive drugs, many people may wonder, "Do you really have to take antihypertensive drugs for a lifetime if you have high blood pressure?" If the blood pressure is stable, can I stop taking the medicine?

First of all, antihypertensive drugs cannot be stopped at will.

Because essential hypertension is a chronic disease that will accompany lifelong, although there is no cure at present, through reasonable and standardized drug treatment and maintaining a healthy lifestyle, blood pressure can be controlled within a relatively safe range, thereby reducing Damage to organs such as the heart, brain, and kidneys and other complications from high blood pressure.

Secondly, the result of antihypertensive drug treatment is to control blood pressure at a normal level. Once antihypertensive drugs are stopped, blood pressure will rise again. This blood pressure fluctuation will also cause serious damage to organs such as the heart, brain, and kidneys. damage.

Xu Dingli, chief physician of the Department of Cardiovascular Medicine, Nanfang Hospital of Southern Medical University, reminded that if the patient's blood pressure has been maintained at a normal level for a long time, the drug can be reduced by consulting a doctor .

However, in some special cases, the patient can stop the drug under the guidance of the doctor.

Patients with mild hypertension : blood pressure can be reduced to a certain extent by improving lifestyle, and blood pressure can be maintained at normal levels without taking antihypertensive drugs;

Hypertension caused by environmental changes : If the patient's blood pressure can return to normal when the environment changes, then the drug can be reduced or stopped in an appropriate amount under the guidance of a doctor;

Serious adverse drug reactions : If the patient has serious adverse drug reactions while taking antihypertensive drugs, the original drug needs to be discontinued in time and replaced with another antihypertensive drug;

Under special conditions : During pregnancy, or under special circumstances such as general anesthesia surgery, the patient needs to temporarily stop the drug to avoid adverse reactions.

Taking antihypertensive drugs is the main means of treating high blood pressure, but lowering blood pressure cannot blindly rely on antihypertensive drugs. If patients do not change their lifestyles and rely solely on drugs to lower blood pressure, it is very undesirable.

References:

[1]Mackenzie， I.S. et al. (2022) “Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (Time Study)： A prospective， randomised， open-label， blinded-endpoint clinical trial，” The Lancet， 400(10361)， pp. 1417–1425. Available at： https：//doi.org/10.1016/s0140-6736(22)01786-x.

[2] " When is the best time to take antihypertensive drugs? The three major hypertension organizations say this ". Medical Cardiovascular Channel. 2022-09-05

[3] "Can you reduce your medication if your blood pressure drops? How to take medicine for high blood pressure is the most scientific". Nanfang Hospital of Southern Medical University. 2018-10-19

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