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試試各位朋友大家好，現在是“每天健康三分鐘”時間，我是安陽道簡醫院的醫生白傳威。今天主要和大家聊聊如何選擇降壓藥物。
降壓藥物的種類很多，帶來的是多樣的選擇和困惑，很多人是見到隔壁老王或者樓下老李吃什麼藥自己就吃什麼藥，或者聽從非專業人士的推薦進行購買服藥，正確的做法是聽從醫生的指導，不要自己隨意買藥進行治療。那麼該如何選擇降壓藥呢，我今天和大家一起聊聊。
常用的降壓藥物有5種，分別是：
1. 普利類（如卡託普利、依那普利、貝那普利等）；
2. 沙坦類（纈沙坦、厄貝沙坦、替米沙坦等）；
3. 地平類（硝苯地平控釋片或緩釋片、氨氯地平、左旋氨氯地平等）；
4. 利尿劑（氫氯噻嗪、吲達帕胺等）；
5. β-受體阻滯劑（美託洛爾、比索洛爾、卡維地洛等）。
由於不同藥物的作用特點有所不同，因此高血壓病人應用哪種降壓藥需要考慮多種因素。一般來講，如果僅有高血壓，沒有併發症（如心腦腎病變）或合併其他疾病（如糖尿病等），各類藥物都可以選用。如果同時存在其他疾病，可以按照以下原則選擇降壓藥：
1. 合併左心室肥厚：首選地平類、普利類、沙坦類；
2. 合併冠心病：首選地平類、普利類、沙坦類和b-受體阻滯劑；
3. 曾有心肌梗死病史者：首選普利類、沙坦類和b-受體阻滯劑；
4. 合併心衰：首選普利類、沙坦類、利尿劑或b-受體阻滯劑；
5. 合併房顫：首先普利類或沙坦類；
6. 合併腦血管病：首選地平類、普利類、沙坦類或利尿劑；
7. 合併頸動脈內膜增厚或斑塊：首選地平類；
8. 合併蛋白尿或微量白蛋白尿：首選普利列或沙坦類；
9. 老年高血壓患者：首選地平類、普利類、沙坦類或利尿劑；
10. 合併糖尿病：首選普利類或沙坦類；
11. 合併高血脂：首選普利類或沙坦類。
多數高血壓患者需要應用兩種或更多種降壓藥物才能使血壓達標，採用哪種組合方式也需要根據患者具體情況確定。最好的聯合用藥方案有：地平類與沙坦類、地平類與普利類、沙坦類與利尿劑、普利類與利尿劑，等。兩種藥物聯合應用後仍然不能滿意控制血壓者，首先考慮聯合應用地平類+普利類（或沙坦類）+利尿劑這三種藥物的組合方案。一般來講，不要聯合使用普利類和沙坦類；如果沒有心衰，不要聯合使用普利類與b-受體阻滯劑，也不要聯合沙坦類與b-受體阻滯劑。
今天的分享就到這裡，想了解更多科普知識，請關注我們，咱們下期再見。
【英文版】
How to choose hypertension drugs?
Dear friends, nice to meet you!Now it is time for “health talk for three minutes every day”,My name is Bai Chuanwei, a doctor of Anyang Daojian Hospital.Today, we’ll talk about how hypertension patients choose antihypertensive drugs.
There are many kinds of antihypertensive drugs,which also bring a lot of confusion to patients. Many people choose their own antihypertensive drugs by referring to the antihypertensive drugs taken by their friends, or follow the recommendation of non professionals. The correct way is to follow the doctor's guidance, rather than taking the medicine at will. So how to choose antihypertensive drugs? I'll talk with you today.
There are five commonly used antihypertensive drugs,they are pril (such as captopril, enalapril, benazepril, etc.),sartans (valsartan, irbesartan, telmisartan, etc.), dipine (nifedipine controlled-release tablets or sustained-release tablets, amlodipine, Levamlodipine), diuretics (hydrochlorothiazide, indapamide, etc.),β-blockers (metoprolol, bisoprolol, carvedilol, etc.).
Due to the different action characteristics of different drugs,it is necessary to consider many factors for which antihypertensive drugs should be used in patients with hypertension.Generally speaking, all kinds of drugs can be used if the patients only have hypertension and have no complications (such as heart, brain, kidney lesions) or other diseases (such as diabetes).If patients have other diseases at the same time, antihypertensive drugs can be selected according to the following principles.
1. With left ventricular hypertrophy, the first choice is dipyridamole, pril or sartan.
2. In patients with coronary heart disease, the first choice is dipyridamole, pril, Sartan or β-receptor blockers.
3. Pril, Sartan or β-blockers are the first choice for patients with a history of myocardial infarction.
4. In patients with heart failure, pril, sartan, diuretics or b-blockers are the first choice.
5. For patients with atrial fibrillation, pril or sartan should be the first choice.
6. For patients with cerebrovascular disease, the first choice is dipyridamole, pril, sartan or diuretics.
7. When there are carotid intimal thickening or plaques, the first choice is horizon.
8.If the patient is complicated with proteinuria or microalbuminuria, the first choice is puliler or sartanUrinary.
9. In elderly patients with hypertension, the first choice is dipine, pril, sartan or diuretics.
10. For patients with diabetes mellitus, pril or sartan is the first choice.
11. In patients with hyperlipidemia, pril or sartan is the first choice.
Most patients with hypertension need to use two or more antihypertensive drugs in combination to make blood pressure reach the standard, which combination mode should be determined according to the specific situation of patients.The best combination regimens are the combination of dipine and sartan, the combination of dipine and pril,the combination of sartans and diuretics, the combination of pril and diuretics, etc.If the blood pressure can not be controlled satisfactorily after the combination of the two drugs,the combination of dipyridamole, pril (or sartan) and diuretics should be considered first. In general, do not use the combination of pril and sartan.If there is no heart failure, do not use a combination of pril andβ-blockers,and do not combine sartans withβ-blockers.
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