What is the First-Choice Basic Antihypertensive Drug?

Hypertension is a common issue among middle-aged and elderly individuals, and even those without hypertension should promptly control high blood pressure. Currently, there is no cure for hypertension, and it can only be controlled through medication. Antihypertensive drugs need to be used long-term, but the choice of basic antihypertensive drugs should be guided by doctors based on the patient's condition, and medication should not be taken blindly.

The selection of an appropriate antihypertensive drug should be determined by a doctor based on the specific condition of the patient. For patients with mild hypertension, regular fluctuations, or concurrent diabetes, diuretics such as furosemide and hydrochlorothiazide may be chosen. For younger patients with tachycardia or angina pectoris, beta-blockers such as bisoprolol and calcium channel blockers like nifedipine may be suitable, especially for elderly patients without heart failure. For patients with renal disease, heart failure, myocardial infarction, or obesity, angiotensin-converting enzyme inhibitors may be used. The choice of antihypertensive drugs should not only consider the specific physical condition but also economic factors and availability. It is emphasized that the selection of antihypertensive drugs must be guided by experienced doctors or pharmacists.

① Antihypertensive drugs are used for the long-term treatment of essential hypertension. Therefore, it is advisable to select oral antihypertensive drugs with mild, slow, and lasting effects, few side effects, and easy to use by patients (such as hydrochlorothiazide, reserpine, compound antihypertensive tablets, etc.) as the basis for antihypertensive treatment. Other antihypertensive drugs can be added according to different disease stages.

② Antihypertensive drugs should generally be started at a low dose and gradually increased to achieve the desired blood pressure reduction. Once the target is reached, the maintenance dose can be used to consolidate the effect, aiming to use the smallest maintenance dose to minimize side effects.

③ When using antihypertensive drugs that can cause significant orthostatic hypotension, it is advisable to inform the patient to stand up slowly from a sitting or lying position, especially when getting up to urinate at night, to avoid sudden blood pressure drops that may lead to fainting and accidents.

④ For patients with mild symptoms in the early stage of hypertension, general treatment (including sedatives) may be sufficient, and antihypertensive drugs may not be necessary. If necessary, a small amount of mild antihypertensive drugs such as diuretics, rauwolfia, or compound antihypertensive tablets can be used. In the second stage, patients often require the use of two or more antihypertensive drugs, such as a combination of reserpine, hydralazine, diuretics, enzyme inhibitors, postganglionic sympathetic inhibitors, ganglion blockers, or adrenergic receptor blockers.

⑤ In clinical practice, several antihypertensive drugs are often used in combination. The advantages of this approach include improved efficacy due to synergistic effects, reduced single doses of each drug, reduced side effects of each drug or mutual cancellation of some side effects, and more stable blood pressure reduction. The most commonly used combination is the use of diuretics with other antihypertensive drugs. Diuretics can enhance the efficacy of various antihypertensive drugs and reduce the side effect of edema. When reserpine and hydralazine are used together with beta-blockers and minoxidil, their respective side effects of slowing and increasing heart rate can cancel out each other.