Summary of five types of commonly used antihypertensive drugs usage and dosage contraindications! (Collection)

Author: Lu Xiong

Source: Medical Community Cardiovascular Channel

Although there are hundreds of antihypertensive drugs on the market, they are always the same, and when choosing the class of antihypertensive drugs, commonly used calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor antagonists (ARBs), diuretics, and β receptor antagonists can all be used as initial treatments.

The rationality of antihypertensive drugs should be evaluated according to whether the patient has comorbidities and whether it is a special population, and individualized treatment should be carried out.

Calcium channel blockers

CCBs can relax vascular smooth muscle by reducing intracellular calcium content, leading to arterial dilation and a decrease in total peripheral vascular resistance, which in turn lowers blood pressure. Due to the dilation of peripheral blood vessels, it can cause increased sympathetic reflexivity and cause an increase in heart rate.

CCB has a relatively strong antihypertensive effect and amplitude, and is suitable for hypertension, coronary heart disease, peripheral vascular disease, arrhythmia, primary pulmonary hypertension, nervous system diseases, etc. Compared with other classes of antihypertensive drugs, there are no absolute contraindications to CCB, and the relative contraindications are tachyarrhythmia, congestive heart failure, severe heart failure, cardiogenic shock, and aortic stenosis.

Table 1 Summary of commonly used calcium channel blockers (CCBs).

Amlodipine besylate	Indications: For the treatment of hypertension and chronic stable angina and variant angina.
Usage: For the treatment of hypertension, the initial dose is 5 mg once a day, and the maximum dose is 10 mg once a day. For the treatment of angina, the initial dose is 5-10 mg 1 time a day.
Taboo: 1. Patients who are allergic to dihydropyridine drugs or any of the ingredients in this product are prohibited. 2. Patients with severe hypotension are prohibited. 3. Patients with severe aortic stenosis are prohibited.
Nifedipine controlled-release tablets	Indications: This product is used for hypertension, coronary heart disease, chronic stable angina pectoris (exertional angina).
Usage: For high blood pressure, 30mg or 60mg once, once a day. Coronary heart disease: chronic stable angina pectoris (exertional angina), 30 mg or 60 mg once, once a day.
Taboo: 1. This product is forbidden to be used in patients who are known to be allergic to nifedipine or any of the ingredients in this product. 2. It is contraindicated in patients with KOCK sacs (ileostomy after rectocolectomy). 3. Due to the enzyme induction, when combined with rifampicin, nifedipine cannot reach the effective plasma concentration. Therefore, it should not be used in combination with rifampicin. 4. Nifedipine is contraindicated for use in 20 weeks of pregnancy and lactating women.
Lassidipine tablets	Indications: For the treatment of hypertension.
Directions: Adults start with 4 mg once a day, preferably in the morning. It can be used before or after meals. If needed, it can be increased to 6 mg and 8 mg once a day for 3 to 4 weeks.
Contraindications: Those who are allergic to any of the ingredients of this product. As with other dihydropyridines, lasidipine is contraindicated in patients with severe aortic stenosis.
Felodipine tablets	Indications: For the treatment of mild and moderate essential hypertension.
Usage: Oral. Start with 2.5 mg twice daily or as directed by a healthcare practitioner. The usual maintenance dose is 5 mg or 10 mg daily.
Contraindications: decompensated heart failure, acute myocardial infarction, pregnant women, patients with unstable angina, allergic to felodipine and any of the ingredients in this product.

Angiotensin-converting enzyme inhibitors

ACE inhibitors are a class of drugs that have antihypertensive effects, can delay and reverse ventricular remodeling, prevent the further development of myocardial hypertrophy, improve vascular endothelial function and cardiac function, and reduce the occurrence of arrhythmia.

It is mainly suitable for hypertension, congestive heart failure, myocardial infarction and other diseases, and its common adverse reactions include angioedema, hypotension, renal damage, etc.

Table 2 Summary of commonly used angiotensin-converting enzyme inhibitors (ACE inhibitors).

Captopril	Indications: hypertension, can be used alone or in combination with other antihypertensive drugs. Heart failure, either alone or in combination with cardiac diuretics.
Directions: For hypertension, 12.5 mg 2-3 times a day, increase to 50 mg 2-3 times a day within 1-2 weeks as needed. For heart failure, start with 12.5 mg 2-3 times a day, gradually increase to 50 mg 2-3 times a day if necessary.
Taboo: 1. Those who are allergic to this product or other angiotensin-converting enzyme inhibitors are prohibited. 2. It is forbidden for pregnant women.
Benazepril hydrochloride	Indications: 1. Hypertension at all stages. 2. Congestive heart failure. 3. As an adjuvant treatment for patients with congestive heart failure (NYHA class II.-IV.) who do not respond well to digitalis and/or diuretics.
Usage: For hypertension, the recommended daily dose for patients who are not treated with diuretics is 10 mg once a day, and if the effect is not good, it can be increased to 20 mg a day. Adjuvant therapy for patients with congestive heart failure is recommended at an initial dose of 2.5 mg once a day.
Taboo: 1. Those who are allergic to benazepril hydrochloride. 2. Those with a history of angioneurotic edema.
Enalapril maleate	Indications: Enalapril maleate tablets are suitable for hypertension, renovascular hypertension, and heart failure at all levels, and can also prevent symptomatic heart failure and delay the course of the disease.
Directions: Take before, during, or after meals. For essential hypertension, the starting dose is 10 mg to 20 mg once a day, and the usual maintenance dose is 20 mg daily. Renovascular hypertension is treated with a smaller dose (such as 5 mg or less), and for most patients, taking 20 mg of this product once daily can receive the expected effect.
Contraindications: Patients who are allergic to any of the ingredients of this product, or patients who have been previously treated with an angiotensin-converting enzyme inhibitor and have a history of angioedema, as well as patients with hereditary or spontaneous angioedema, this product is contraindicated.
Perindopril tert-butylmine tablets	Indications: hypertension and congestive heart failure.
Directions: Must be taken before meals, once daily. In anhydrous sodium loss or kidney failure, the effective dose is 4 mg/day, once in the morning. Depending on the efficacy, the dose can be gradually increased to a maximum dose of 8 mg/day over three to four weeks.
Taboo: 1. Allergy to perindopril. 2. History of angioneurotic edema related to the use of ACE inhibitors. 3. 4 to 9 months of pregnancy. 4. Feeding. Perindopril is not recommended in the following situations: 1. Combined with potassium-preserving diuretics, potassium salt, lithium salt, estradiol nitrogen mustard. 2. Bilateral renal artery stenosis or single renal renal artery stenosis. 3. High blood potassium. 4. In the first trimester of pregnancy and lactation.

Angiotensin II receptor antagonists

ARBs are one of the most commonly used first-line treatments for hypertension. By selectively blocking angiotensin II receptor (AT1 type), ARB blocks angiotensin II (AngII.) to constrict blood vessels, increase blood pressure, promote aldosterone secretion, water and sodium retention, and excite sympathetic nerves. These drugs are indicated for patients with high blood pressure who have diabetes, coronary heart disease, and chronic kidney disease.

Table 3 Summary of commonly used angiotensin II receptor antagonists

Irbesartan tablets	Indications: For the treatment of essential hypertension and type II diabetic nephropathy with hypertension.
Usage: The recommended starting dose is 0.15g, 1 time a day. Depending on the condition, it can be increased to 0.3g, once a day.
Taboo: 1. Known allergy to the ingredients of this product. 2. The 4th to 9th month of pregnancy. 3. Feeding period.
Losartan potassium	Indications: For the treatment of essential hypertension.
Usage: The usual starting and maintenance dose is 50 mg once a day. Maximal antihypertensive effect can be achieved after 3 to 6 weeks of treatment. In some patients, increasing the dose to 100 mg once daily may have a further antihypertensive effect.
Contraindications: Those who are allergic to any of the ingredients of this product are prohibited.
Valsartan	Indications: It is used for all kinds of mild to moderate hypertension, especially for patients who are intolerant to ACE inhibitors.
Usage: The recommended dose is 80 mg once daily, regardless of gender, age or ethnicity. Can be taken with a meal or on an empty stomach. It is recommended to take the medication at the same time every day (e.g., in the morning). The antihypertensive effect appears within 2 weeks, and the effect reaches its maximum after 4 weeks. In patients who do not control their blood pressure adequately, the daily dose can be increased to 160 mg.
Taboo: 1. Those who are known to be allergic to this product are prohibited. 2. Pregnant and lactating women are prohibited. 3. There is no experience in the application of this product in patients with severe renal failure (creatinine clearance rate <10ml/min).
Alisartan cil	Indications: For the treatment of mild and moderate essential hypertension.
Usage: The usual starting and maintenance dose is 240 mg once a day, and continuing to increase the dose will not further improve the efficacy. Maximal antihypertensive effect can be achieved after 4 weeks of treatment. Food will reduce the absorption of this product, it is recommended not to take it with food.
Taboo: 1. Those who are allergic to any of the ingredients of this product are prohibited. 2. It is forbidden in the middle and third stages of pregnancy and lactation.

diuretic

Diuretics mainly include loop diuretics such as furosemide, thiazide diuretics such as hydrochlorothiazide and indapamide, potassium-sparing diuretics such as spironolactone, etc., and thiazide diuretics are the most widely used in clinical practice. Diuretics are especially suitable for elderly patients with hypertension, refractory hypertension, heart failure complicated with hypertension, and salt-sensitive hypertension.

Summary of commonly used diuretics Table 4

Furosemide	Indications: Generally not used as the first choice for the treatment of essential hypertension, but when thiazides are not effective, especially when accompanied by renal insufficiency or hypertensive crisis, this class of drugs is particularly suitable.
Directions: Start with 40-80mg daily in 2 divided doses, and adjust dose as appropriate.
Taboo: 1. It is forbidden for those who are allergic to this product, sulfonamides and thiazide diuretics. 2. Pregnant women within three months of pregnancy are prohibited.
Hydrochlorothiazide	Indications: It can be used alone or in combination with other antihypertensive drugs, mainly for the treatment of essential hypertension.
Directions: 25-100mg daily, divided into 1-2 doses, and adjust the dose according to the antihypertensive effect.
Contraindications: unclear.
Indapamide	Indications: For the treatment of essential hypertension in adults.
Usage: Oral, common dose for adults, 2.5mg once, once a day. Initial administration is 1.25 mg once daily. Indapamide extended-release tablets: 1.5 mg once a day.
Taboo: 1. Patients who are allergic to sulfonamides, severe renal insufficiency, hepatic encephalopathy, and hypokalemia are prohibited. 2. In general, this drug should not be used in combination with lithium and non-antiarrhythmic drugs that can induce torsional ventricular tachycardia.
Spironolactone	Indications: For the prevention of edematous diseases, hypertension, primary aldosteronism, and hypokalemia.
Usage: For the treatment of hypertension, start with 40-80mg a day, divided doses, at least 2 weeks, and then adjust the dose as appropriate, and should not be combined with angiotensin-converting enzyme inhibitors, so as not to increase the chance of hyperkalemia.
Contraindications: contraindicated in patients with hyperkalemia.

β receptor antagonists

β receptor antagonists have the effects of antihypertensive, reduce myocardial oxygen consumption, increase coronary blood flow, improve ventricular remodeling, improve cardiac function and increase left ventricular ejection fraction, anti-arrhythmia, prevent recurrence of ventricular fibrillation and sudden cardiac death, reduce plasma renin and sympathetic nerve activity, and are suitable for different degrees of hypertension, coronary heart disease, heart failure, arrhythmia, hypertrophic cardiomyopathy, aortic dissection, mitral valve prolapse syndrome, primary long Q-T syndrome, etc.

Table 5 Summary of commonly used β receptor antagonists

Metoprolol tartrate tablets	Indications: It is used for the treatment of hypertension, angina, myocardial infarction, hypertrophic cardiomyopathy, aortic dissection, arrhythmia, hyperthyroidism, cardiac neurosis, etc.
Usage: Oral. The dose should be individualized to avoid bradycardia. The drug should be taken on an empty stomach and with meals can increase the bioavailability of metoprolol by 40%. For the treatment of high blood pressure, take 100-200 mg daily in 1 to 2 divided doses.
Taboo: 1. Cardiogenic shock. 2. Sick sinus syndrome. 3. Second-degree, third-degree atrioventricular block. 4. Patients with unstable, decompensated heart failure (pulmonary edema, hypoperfusion or hypotension), receiving continuous or intermittent positive force therapy with β receptor agonists. 5. Symptomatic bradycardia or hypotension. 6. Metoprolol should not be used for those patients with suspected acute myocardial infarction, manifested by a heart rate of 0.24 seconds or a systolic blood pressure of < 100mmHg. 7. Patients with severe peripheral vascular disease with the risk of gangrene. 8. Those who are allergic to any of the ingredients in this product or other β receptor blockers.
Bisoprolol fumarate tablets	Indications: This product is used for the treatment of hypertension, coronary heart disease (angina), moderate to severe chronic stable heart failure with ventricular systolic function, and requires ACE inhibitors, diuretics and selective cardiac glycosides to be treated as prescribed.
Directions: This product should be taken in the morning and can be taken with meals. Take the tablets whole with water and should not be chewed. Treatment of high blood pressure or angina pectoris, usually 5 mg once a day. Patients with mild hypertension can be treated with 2.5 mg. If none of the effects are significant, the dose can be increased to 10 mg once daily.
Taboo: 1. Patients with acute heart failure or in the decompensated stage of heart failure who need to be treated with intravenous inotropes. 2. Patients with cardiogenic shock. 3. Patients with second- or third-degree atrioventricular block (without pacemaker). 4. Patients with sick sinus syndrome. 5. Sinus block. 6. Patients with bradycardia causing symptoms (symptomatic bradycardia). 7. Symptomatic hypotension. 8. Patients with severe bronchial asthma or severe chronic obstructive pulmonary disease. 9. Patients with severe peripheral arterial occlusion disease and Raynaud's syndrome. 10. Patients with untreated pheochromocytoma. 11. Patients with metabolic acidosis. 12. Patients who are known to be allergic to this product and its derivatives or any component of this product.
Propranolol hydrochloride tablets	Indications: Hypertension (alone or in combination with other antihypertensive drugs).
Usage: hypertension, oral, initial dose 10 mg, 3-4 times a day, can be used alone or in combination with diuretics. The dose should be increased gradually, with a maximum daily dose of 200 mg.
Taboo: 1. It is forbidden for patients with bronchial asthma. 2. Patients with cardiogenic shock are prohibited. 3. Patients with heart block (II.-III. atrioventricular block) are prohibited. 4. Patients with severe or acute heart failure are prohibited. 5. It is forbidden for patients with sinus bradycardia. 6. Those who are allergic to this product are prohibited.

Bibliography:

{1}. Jun Huang, Zuhu Huang, Handbook of Clinical Drugs (Shanghai Science and Technology Press), Fifth Edition

{2}. Su Guanhua and Wang Zhaohui, New Quick Reference Manual of Clinical Medication (3rd Edition)