What medicines can be prescribed for chronic disease and high blood pressure

Currently, the drugs that can be prescribed routinely in clinical practice for the treatment of hypertension cover the five classic categories (calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, diuretics, and beta-blockers), as well as the SGLT2 inhibitors (also commonly known as leucine drugs) and ARNI-type new antihypertensive drugs that have been approved in recent years. The specific type and dose to be prescribed depends entirely on the individual situation of the patient, and there is no unified standard plan.

Last week I saw a 62-year-old Aunt Zhang who has diabetes. She was found to have high blood pressure for more than 5 years. I had been buying nifedipine tablets at the drugstore for almost two years. Her feet were swollen and she couldn't wear shoes. She also always felt hot and dizzy. Her blood pressure was always fluctuating around 150mmHg when she came for a follow-up visit. She adjusted to valsartan combined with low-dose dapagliflozin. After taking it for three weeks, she came back for a review. Her blood pressure was stable at 130/82mmHg, the swelling in her feet had disappeared, and her fasting blood sugar had dropped from the previous 7.8mmol/L to 6.9mmol/L. She said that even her previous problem of always feeling tired was much less severe.

The first thing many people say when they come to the clinic is, "The doctor will prescribe the best antihypertensive drug for me." There is really no such thing as "the best". The choice of the right antihypertensive drug is much more important than whether it is expensive or not. For example, a young man in his 20s or 30s who has just been diagnosed with high blood pressure usually has a lot of sympathetic nervous system excitement when working overtime, and his resting heart rate can reach 90 or 100 beats/min. Then he can be prescribed a beta-blocker such as metoprolol, which can lower blood pressure and stabilize the heart rate at the same time, which is more suitable than using expensive new drugs; if an old man in his 70s has only systolic blood pressure that cannot be lowered, and his calves are always swollen, taking a small dose of hydrochlorothiazide is often more effective than hundreds of boxes of new drugs.

It’s interesting to say that patients often ask me based on popular science on the Internet whether it is true that β-blockers have been kicked out of the first-line antihypertensive drugs. In fact, there have been different voices in the industry on this issue. Some updated guidelines in Europe and the United States in recent years have indeed removed it from general use. Adjustments have been made to the first-line antihypertensive drugs, but our domestic clinical consensus is still clear. If the patient is also complicated by coronary heart disease, heart failure, or tachyarrhythmia, beta-blockers are still the preferred category, and we cannot directly say that they have been "eliminated" regardless of the situation.

Don’t blame the doctor for being verbose when prescribing medicine. He may ask you whether you have gout, whether you have an unexplained dry cough, and whether your kidney function is abnormal. They are all trying to help you avoid pitfalls. For example, if a patient with gout with high uric acid is prescribed a large dose of diuretics, Urine, if taken, can actually induce gout attacks; if people who usually have a dry cough take ACEI drugs like enalapril, the dry cough will only become more serious. At that time, they will think that there is a problem with their lungs, but it will cause unnecessary trouble.

To put it bluntly, antihypertensive drugs are never prescribed for the disease, but for specific people. Drugs that are suitable for others may not be suitable for you. Regular review and adjustment according to the doctor's instructions are the key to stabilizing blood pressure.