How to choose valsartan and valsartan combined with hydrochlorothiazide?😵😵😵

Valsartan and hydrochlorothiazide tablets are commonly used clinically combined preparations. Clinically, what is the difference between valsartan hydrochlorothiazide and valsartan? Which one should I choose? How to use valsartan and hydrochlorothiazide correctly?

1. How to use valsartan and hydrochlorothiazide tablet?

Currently, there is only one dose of valsartan and hydrochlorothiazide tablets (80mg/12.5mg), each containing 80mg of valsartan and 12.5mg of hydrochlorothiazide.

Dosage: One tablet each time, once a day. The maximum antihypertensive effect can be achieved within 2 to 4 weeks of taking the medicine. According to the efficacy of the drug, the dosage can be adjusted every 1 to 2 weeks.

Because hydrochlorothiazide can cause hyperuricemia, hyperlipidemia and hyperglycemia. They are related to the dosage. If the blood pressure still fails to reach the target after 4 weeks, the patient should not increase the dosage without authorization, and adjust the medication regimen under the guidance of the doctor. Food does not affect the absorption of hydrochlorothiazide. Although food can significantly reduce the absorption of valsartan, valsartan can be taken with or without food. In order to reduce blood pressure fluctuations, patients should take the medication at a fixed time, either before or after meal. For most patients, in order to avoid increased nocturia, it is recommended to take it in the morning.

2. The combination of valsartan and hydrochlorothiazide can exert the effect of 1+1>2.

Complementary mechanisms to reduce blood pressure:

Valsartan belongs to angiotensin II receptor antagonist. It can block the effect of angiotensin II. Angiotensin II is one of the important active ingredients of the renin-angiotensin-aldosterone system. It binds to specific receptors on cell membranes of various tissues and exerts different physiological effects, including direct or indirect regulation of blood pressure. Angiotensin II is a strong vasoconstrictor substance. It can exert a direct effect of raising blood pressure. It can also promote the reabsorption of sodium and stimulate the secretion of aldosterone. In addition, valsartan is a specific angiotensin II receptor antagonist. It does not inhibit angiotensin converting enzyme. This enzyme converts angiotensin I into angiotensin II and degrades bradykinin. The retention of bradykinin can cause coughing. Therefore, valsartan does not cause coughing.

Hydrochlorothiazide excretes natriuresis and diuresis. It can reduce blood volume. At the same time enhance plasma renin activity. This stimulates the production of angiotensin I and II. Hydrochlorothiazide mainly acts on the proximal end of the distal convoluted tubule. It inhibits sodium chloride transport at the proximal end of the distal convoluted tubule and inhibits the cotransport of sodium and chloride ions. This directly increases the excretion of sodium and chlorine, and indirectly reduces blood volume. Then increase plasma renin activity, aldosterone secretion and potassium excretion. This lowers the blood potassium concentration. Renin-angiotensin-aldosterone system is depending on angiotensin II. Combination with angiotensin II receptor antagonists can reduce blood potassium loss associated with thiazide diuretics.

Reduce the incidence of hypokalemia:

Hydrochlorothiazide promotes sodium and potassium ion exchange and aldosterone secretion. This increases the excretion of potassium ions, which can cause hypokalemia.

Valsartan inhibits the release of aldosterone mediated by angiotensin II and reduces potassium excretion, which can reduce the risk of hydrochlorothiazide-related hypokalemia.

3. How to choose valsartan or valsartan combined with hydrochlorothiazide?

For blood pressure less than 160/100mmHg, valsartan can be used.

Patients with blood pressure ≥160/100mmHg or higher than the target blood pressure of 20/10mmHg should prefer valsartan and hydrochlorothiazide.

People who are allergic to sulfanilamide drugs should not use valsartan and hydrochlorothiazide tablets. Patients with hyperuricemia and hypercalcemia should avoid valsartan and hydrochlorothiazide tablets.

4. Precautions for valsartan and hydrochlorothiazide tablets.

Valsartan and hydrochlorothiazide tablets can still cause hypokalemia:

In addition to hypokalemia, hydrochlorothiazide can also cause hypomagnesemia, hyponatremia and so on. Therefore, electrolyte levels should be monitored regularly during medication.

When combined with calcium supplements and vitamin D, valsartan and hydrochlorothiazide tablets should be used with caution:

Thiazide diuretics can reduce calcium secretion and increase blood calcium levels. During medication, if calcium supplements and/or vitamin D are used, serum calcium levels should be monitored. If it is necessary, adjust the dosage of calcium supplements and vitamin D.

Hydrochlorothiazide can cause photosensitivity rashes, moss-like reactions, and lupus erythematosus. Patients should avoid exposure to the sun during medication. Hydrochlorothiazide can reduce glucose tolerance. Patients with latent diabetes mellitus may have symptoms. Therefore, diabetics may need to adjust the dose of hypoglycemic drugs.

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The reasons why the blood pressure is sometimes high and low.💞💞💞

For patients with hypertension, blood pressure is the most frequently checked physical sign. But will your blood pressure be sometimes high and low? Will your blood pressure control be unstable? Will your blood pressure fluctuate too much? This situation is actually very common, but what causes this situation? The following reasons are why the blood pressure is sometimes high and low.

To understand the fluctuation range of normal blood pressure.

The blood pressure of a normal person has a fluctuation range and it is not a fixed value. The normal blood pressure range is 90-139mmHg for systolic blood pressure and 60-89mmHg for diastolic blood pressure. If it fluctuates between this range, it is the normal fluctuation range.

To understand the fluctuation rule of blood pressure.

When person woke up in the morning, blood pressure began to rise and achieved the highest at 8:00 to 10:00, then decline slightly. It was another peak period of blood pressure at 16:00 to 18:00. After that, the blood pressure began to drop and it achieved the lowest at 22:00 to 2:00. Therefore, from 8:00 to 10:00 every morning is the time of the highest blood pressure. It is called the morning peak blood pressure. This time is the best time to measure blood pressure.

Whether to follow the doctor's prescription.

Oral antihypertensive drugs should be taken consistently. You should not only take the drugs when the blood pressure rises. Do not stop the drugs immediately after the blood pressure drops. The drugs must keep taking even if your blood pressure is in a normal range. If you only take the drugs when blood pressure rises and stop taking when blood pressure drops, it will cause drastic fluctuations in blood pressure.

Whether to change the drugs frequently.

Some people originally took a drug and their blood pressure was already under control. But when they see someone else taking another medicine and think that the medicine taken by others is better. Then they switch to other medicines by themselves. This will change the original blood pressure. Therefore, never change the medicines yourself.

Take short-acting antihypertensive drugs.

Short-acting antihypertensive drugs have a relatively short time of action and need to be taken 2 to 3 times a day. It will cause fluctuations in blood pressure. Therefore, it always try to choose long-acting antihypertensive drugs. For example, long-acting sustained-release tablets or controlled-release tablets, they are taken once a day. They are more convenient to take and can keep blood pressure stable.

The blood pressure should be measured in a calm state.

If it is after eating, exercise, defecation or emotionally, the blood pressure measured will be higher. Therefore, after waking up in the morning, empty the bladder and urine, then measure the blood pressure in a calm state as the standard.

Long-term mental stress, high pressure and lack of sleep.

If you suffer from sleep deprivation for a long time, even on the basis of taking antihypertensive drugs, it may cause high blood pressure and blood pressure fluctuations. Therefore, in the case of taking antihypertensive drugs and blood pressure is still high, we should also pay attention to improving the quality of sleep.

Drinking and smoking can cause blood pressure fluctuations.

If blood pressure measured after drinking alcohol or smoking, since they can affect blood vessels, thereby affecting blood pressure.

👆The above are the common causes of blood pressure fluctuations. Evaluating the causes of blood pressure fluctuations can help stabilize blood pressure control.

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Introduction to the time of taking common antihypertensive drugs.👍👍👍

As more and more people suffer from high blood pressure, antihypertensive drugs have become a common medicine. Hypertension is also a chronic disease and antihypertensive drugs need to be taken for a long time. Therefore, every hypertensive patient should learn how to properly take antihypertensive drugs.

Concept of taking time.

• Fasting: Take 1 hour before a meal or 2 hours after a meal.
• Before meal: Take 15-60 minutes before a meal.
• During meal: Take the medicine after have eaten a little meal and continue to eat after taking the medicine.
• After meal: Take 15-30 minutes after a meal.

The effects of antihypertensive drugs and food intake are mainly considered in two aspects:

1. Does food affect the absorption of drugs?
2. Adverse drug effects: For drugs with gastrointestinal adverse effects, taking the drug after a meal can alleviate the gastrointestinal adverse effects. Antihypertensive drugs basically have no gastrointestinal adverse reactions, so the drugs are generally not related to eating.

1. Angiotensin II receptor blockers

The names of drugs usually end with "-sartan", such as candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, etc.

The time of taking these drugs has no significant relation with eating. Some drugs, such as telmisartan and valsartan, can reduce their absorption when taken. But they have no significant effect on the clinical efficacy.

2. Angiotensin-converting enzyme inhibitors

The names of drugs usually end with "-pril", such as benazepril, captopril, enalapril, fosinopril, imidapril, lisinopril, perindopril, ramipril.

Captopril and perindopril can be reduced the absorption by food in the stomach. Therefore, they should be taken 1 hour before a meal. The absorption of other is not affected by food or less affected. Therefore, they can be took before, during or after a meal.

3. α1-blockers

Drug names usually end with "-zosin", such as alfuzosin, doxazosin, terazosin and so on.

Alfuzosin controlled-release tablets should be taken after dinner. Eating can increase its absorption. Taking doxazosin with food can reduce its absorption, but does not affect the efficacy. Terazosin should be taken before going to bed to reduce the risk of orthostatic hypotension.

4. β-blockers

The names of medicines usually end with "-lol", such as bisoprolol, labetalol, metoprolol, propranolol, etc. 

Bisoprolol and labetalol have no influence with eating. Propranolol can be taken on an empty stomach or with food. Its bioavailability will increase when taken with food. 

Since metoprolol ordinary tablets can increase the bioavailability by 40% with eating. It should be taken on an empty stomach to reduce the occurrence of adverse effects. Metoprolol sustained-release tablets has no effect with has a meal.

🔔All β-blockers should not stopped suddenly. It will cause rebound hypertension.

5. Dihydropyridine calcium antagonists

Drug names usually end with "-dipine", such as amlodipine, cilnidipine, felodipine, lacidipine, nifedipine, etc.

Cilnidipine has digestive tract dysfunction and should be taken after a meal. The other drugs can be took before, during or after a meal.

6. Diuretics

Most common diuretics are furosemide, hydrochlorothiazide and spironolactone. The absorption of hydrochlorothiazide and spironolactone can be increased with food. It should be taken during or after meals. Furosemide has no effect with eating.

In order to reduce the occurrence of sleep enuresis, it is recommended to take diuretics in the morning.

👉In addition to the pharmacological effects, adverse reactions, drug absorption and metabolism and other characteristics of different drugs, the taking time of drugs also varies from person to person. Even if the same type of drugs are taken at different times. Different dosage forms of the same drug have different taking time. Some patients have gastrointestinal adverse reactions after taking the medicine, they should choose to take it after meals.

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Know the common side effects of commonly used antihypertensive drugs.😎😎😎

Angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), β receptor blocker, dihydropyridine calcium channel blockers (CCB) and diuretics are used commonly antihypertensive drugs in clinical. These antihypertensive drugs have their own characteristics, priority indications and adverse effects.

1. Angiotensin converting enzyme inhibitors (ACEI)

Common drugs: Captopril, enalapril and lisinopril.

Mechanism: It inhibits angiotensin-converting enzyme and block the production of renin-angiotensin II. It also inhibit the degradation of bradykinin and cause a hypotensive effect.

• Adding diuretics or limiting salt intake can increase the antihypertensive effect of ACEI.

Priority indications: Hypertensive patients with chronic heart failure, cardiac insufficiency after myocardial infarction, prevention of atrial fibrillation, metabolic syndrome, diabetic nephropathy, non-diabetic nephropathy, proteinuria or microalbuminuria.

Adverse effects: 

1. Dry cough: About 30% of patients can cause a persistent dry cough. It often gets worse after lying down. Non-smokers and women are more likely to develop dry coughs. Dry cough may be related to increased bradykinin and prostaglandin levels. Non-steroidal anti-inflammatory drugs inhibit prostaglandin synthesis. They can suppress coughing, but increase the risk of kidney damage.
2. Angioedema: It can affect the tongue, glottis, or larynx. It usually occurs within a few hours or 1 week after the medication. If angioedema occurs, patients should be discontinued using ACEI.
3. Hyperkalemia: Bradycardia, nausea and fatigue are the early manifestations. Patients with diabetes and renal insufficiency are more likely to occur.

2. Angiotensin II receptor antagonists (ARB)

Common drugs: Losartan, valsartan, olmesartan and irbesartan.

Mechanism: It blocks angiotensin II receptor (type 1). It cause decreasing secretion of vasopressin, decreasing synthesis and secretion of aldosterone. That exerts vasodilation and antihypertensive effect.

Priority indications: Patients can not tolerate ACEI who can choose ARB.

Adverse effects: 

1. Back pain: ARB antihypertensive drugs can cause back pain. The results of clinical trials showed that the incidence of back pain caused by valsartan was 1.6% and the incidence of joint pain was 1.0%. Different ARB drugs have different incidences of adverse effects in the musculoskeletal system. If musculoskeletal pain occurs when  taking a ARB drug, you can try to alter another ARB drug.
2. Hyperkalemia: Both ACEI and ARB antihypertensive drugs can cause hyperkalemia.

3. β receptor blocker

Common drugs: Metoprolol and atenolol.

Mechanism: It inhibits β receptor. It lead to inhibit myocardial contractility and slow down the heart rate. Therefore, it produces a hypotensive effect.

Priority indications: Patients with tachyarrhythmia, coronary heart disease and chronic heart failure.

Adverse effects: 

1. Slow heartbeat and pulse: β-blockers have greatly variance among individuals and patients should monitor their heart rate. For patients with hypertension and coronary heart disease, the resting heart rate should be slowed down to 50-60 beats/min while controlling blood pressure.
2. Rebound phenomenon: Sudden discontinuation of β blockers can cause severe angina pectoris and even sudden cardiac death. The dose must be gradually reduced under the guidance of a doctor and the entire withdrawal process should take at least 2 weeks.

4. Dihydropyridine calcium channel blockers (CCB)

Common drugs: Felodipine, nifedipine and amlodipine.

Mechanism: It can inhibit the calcium channel on vascular smooth muscle cells. Therefore, it can lead to dilate blood vessels and lowering blood pressure.

Priority indications: Elderly patients with hypertension or isolated systolic hypertension  associated with coronary and carotid atherosclerosis, stable angina and peripheral vascular disease.

Adverse effects: 

1. Constipation: All dihydropyridine calcium channel blockers can cause constipation.
2. Gingival hyperplasia: Felodipine, nifedipine, amlodipine and so on can cause gingival hyperplasia.
3. Increased heart rate: Calcium channel blockers can reflexively cause tachycardia. It can worse heart failure. Except for felodipine and amlodipine, other calcium channel blockers are not recommended for the treatment of patients with hypertension and heart failure.
4. Ankle edema: It is related to the dosage. Elevating the foot can reduce the symptoms of edema. Mainly due to the expansion of the precapillary arterioles, not due to fluid retention. Combined use of ACEI or ARB can reduce the symptoms of edema.

5. Diuretics (Thiazides diuretics)

Common drugs: Chlorothiazide, hydrochlorothiazide and indapamide.

Mechanism: It acts on the ascending limb of Henle's loop and the distal convoluted tubules in the renal cortex. It increases to excrete sodium and urine and reduce blood volume.

Priority indications: Elderly hypertension, isolated systolic hypertension, refractory hypertension, etc.

Adverse effects: 

1. Photosensitivity: It can cause skin rash. Patients taking thiazide diuretics should avoid direct sunlight.
2. Hypokalemia: The main symptoms include nausea, anorexia and fatigue. It can be improved when combined with antihypertensive drugs that may cause hyperkalemia such as ACEI and ARB, but electrolyte levels still need to be monitored regularly.
3. Hyperuricemia: Patients with gout should prohibit using thiazide diuretics. If the blood uric acid level is ≥480μmol/L, it is recommended to change to other antihypertensive drugs.
4. Hypercalcemia: Patients should be cautious when using it in combination with calcium and vitamin D supplements. Thiazide diuretics can reduce urinary calcium excretion and may cause hypercalcemia.

6. Diuretics (Loop diuretics)

Common drugs: Furosemide.

Mechanism: It inhibits the cotransporter of Na⁺⁄ 2Cl^-⁄ K⁺ in the ascending limb of Henle's loop. It reduces the recycle of Na⁺, K⁺ and Cl^- to achieve diuretic effect.

Priority indications: It can take effect quickly. Therefore, it can be used for patients with acute edema symptoms.

Adverse effects: 

1. Hypokalemia and hyperuricemia: Similar to thiazide diuretics.
2. Ototoxicity: Loop diuretics may cause ototoxicity. Be careful when combining with other ototoxic drugs (such as aminoglycoside antibiotics).

7. Diuretics (Potassium-sparing diuretics)

Common drugs: Spironolactone, eplerenone and amiloride.

Mechanism: Spironolactone and eplerenone can antagonist aldosterone. Amiloride blocks sodium ion channels and produces effects similar to aldosterone antagonists.

Priority indications: It often combined with thiazides diuretics or loop diuretics. Aldosterone antagonists usually effect to resistant hypertension (It refers to use 3 or more types of antihypertensive drugs still not achieve the target blood pressure).

Adverse effects: 

1. Hyperkalemia: It can decrease to excrete potassium in urine. Be careful when combined with the drugs that may cause hyperkalemia such as ACEI and ARB.
2. Gynecomastia and Irregular menstrual periods: The chemical structure of spironolactone is similar to some sex hormones. Therefore, spironolactone may cause gynecomastia and Irregular menstrual periods.

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Do the season and temperature affect blood pressure??⛄⛄⛄

Blood pressure is affected by many factors, including season and temperature. A study
has found that the average blood pressure in winter is 12/6mmHg (systolic/diastolic  blood pressure) higher than the average blood pressure in summer. For every 1°C decreases in temperature, the systolic blood pressure rises by 1.3mmHg and diastolic blood pressure rises by 0.6mmHg. 

In winter, the decreasing of temperature and the cold weather lead to increase sympathetic nerve excitement. It causes increasing heart rate, the release of catecholamines, increasing cardiac systolic function and myocardial oxygen consumption, peripheral vasoconstriction, increasing peripheral vascular pressure and blood pressure. At the same time, less sweating in winter lead the blood volume higher.  Those are also the causes of blood pressure fluctuations in winter. 

In summer, as the temperature gradually rises, the blood vessels dilate and blood pressure gradually decreases. The amount of sweating is more than in winter. The water in the body is lost more. The blood volume decreases. In some patients, the blood pressure declines or is close to normal.

Therefore, season and temperature changes may cause blood pressure fluctuations. Patients with hypertension should regularly monitor their blood pressure according to changes in temperature. Based on the changes in blood pressure, consult the doctor to adjust the medicine in time. Make sure to feel relax, avoid anxiety and excitement, eat lightly and avoid complications of hypertension.

👀Winter is here, keep yourself warmer~~

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