Understanding Nifedipine: A Type of Antihypertensive Medication

Hypertension, a prevalent condition among middle-aged and elderly individuals, poses significant health risks and currently lacks a cure. It can only be managed through medication. Given the complexity of hypertension, a diverse range of drugs is available, necessitating individualized treatment plans based on individual health conditions. Nifedipine is a commonly prescribed medication for hypertension, and it's essential for patients to understand its characteristics. Let's explore what type of antihypertensive medication Nifedipine belongs to.

I. What Type of Antihypertensive Medication is Nifedipine?

Nifedipine belongs to the class of dihydropyridine calcium channel blockers (CCBs). Clinically, Nifedipine is available in two forms: sustained-release tablets and controlled-release tablets. It is most suitable for treating chronic angina pectoris combined with hypertension, old cerebral infarction combined with hypertension, and elderly patients with refractory hypertension. As a CCB, Nifedipine not only effectively lowers blood pressure but also dilates coronary and cerebral arteries, thereby enhancing perfusion to the heart and brain. It achieves ideal, stable, and sustained blood pressure reduction while increasing blood flow to these vital organs.

Nifedipine, being the first-generation CCB, has a decades-long history of clinical application with remarkable outcomes.

II. Medication Management for Hypertension

1. Starting with Low Doses

Most patients require long-term or even lifelong antihypertensive treatment. Starting with low doses allows for monitoring therapeutic effects and minimizing adverse reactions. If insufficient, doses can be gradually increased to achieve target blood pressure levels while maintaining relatively small but effective maintenance doses to reduce side effects. It's crucial to avoid rapid blood pressure drops or excessively low levels, as they may compromise perfusion to vital organs like the heart, brain, and kidneys, leading to ischemia.

2. Preference for Long-Acting Formulations

Long-acting formulations that provide 24-hour blood pressure control with a single daily dose are preferred to effectively manage blood pressure throughout the day, including morning peaks, and prevent cardiovascular events like sudden death, stroke, and myocardial infarction. Examples include ACE inhibitors (e.g., lisinopril, ramipril), ARBs, calcium channel blockers (e.g., amlodipine, Nifedipine controlled-release), thiazide diuretics, and beta-blockers (e.g., bisoprolol, metoprolol sustained-release).

3. Rational Combination Therapy

Only 30% to 40% of hypertensive patients can achieve target blood pressure with a single medication. About 70% require a combination of two or more antihypertensive drugs with different mechanisms of action. Small doses of combined medications can complement each other's mechanisms, enhancing therapeutic efficacy while mitigating or canceling out adverse effects. Combination therapy can involve multiple separate medications or single-pill combinations. For diabetics, ACE inhibitors and ARBs are preferred, often combined with calcium channel blockers, indapamide, low-dose thiazide diuretics, or low-dose selective beta-blockers.

4. Adhering to Individualized Treatment Plans

Physicians should devise tailored blood pressure reduction plans based on patients' specific circumstances, such as age, blood pressure patterns, and presence of comorbidities. The primary benefit of hypertension treatment stems from lowering blood pressure to internationally accepted levels (below 140/90 mmHg). Elderly patients, especially those with higher blood pressure or longer disease duration, may initially aim for <150/90 mmHg, with further reductions if tolerated. Caution is advised in elderly patients with severe coronary artery stenosis, as diastolic blood pressure should generally not fall below 60-70 mmHg.