What are the common antihypertensive drug adverse reactions and countermeasures?
Generally in the treatment of high blood pressure, heart physicians are more concerned about the efficacy of drugs, but not enough attention to the adverse effects of antihypertensive drugs on the body. Especially when hypertension patients have complications or other diseases, it is necessary to use a variety of drugs at the same time, which is more likely to produce adverse reactions.
So, what are the common antihypertensive drug adverse reactions and countermeasures?
Medication is a kind of art as well as a kind of medical skill. How to apply medicine because of illness, at the same time the use of more than two drugs when the compatibility, dosage and patient body conditions and so on must be seriously considered, the only way to make the efficacy of the drug 1 + 1 > 2, and adverse reactions 1 + 1 < 2. Several commonly used adverse drug reactions (ADRs) and their management are briefly described as follows:
Diuretic adverse reaction.
Because the diuretic causes the kidney to expel the potassium increase and causes the hypokalemia, the main symptom is the limbs is powerless, a few patients appear each kind of arrhythmia.
As usual attention to the intake of potassium magnesium vegetables and fruits generally will not cause but during the medication if the patient has unknown reasons for fatigue should be timely inspection of potassium. If blood potassium lowers want to complement potassium chloride in time, and eat sugary food less, eat vegetable fruit more. Should monitor blood potassium, sodium regularly, pay attention to maintain water and electrolyte balance, especially the elderly and other high-risk groups, pay attention to timely potassium.
Be caused by the excretion of urine sodium increased, performance for nausea, vomiting, general discomfort, vertigo, lethargy, confusion, polyuria or oliguria or even anuria, and less prone to daily diet hyponatremia.
The study found that about 30% of patients in the long-term use of diuretics after hyponatremia symptoms, long-term use of thiazide drugs in patients with hyponatremia incidence is 5 times higher. Age, body mass index (BMI), and glomerular filtration rate were also associated with hyponatremia.
By micturition is much and did not add moisture to cause in time, performance is dry of mouth, lack of strength, syncope, wait, especially when used together with blood vessel dilator is easy to happen. Some patients are very sensitive to diuretics, conventional doses can cause a large number of urination. Therefore, the use of diuretics to start a small dose, and pay attention to the right amount of drinking water, timely blood pressure measurement, general diuretics and vasodilators should not be used together.
Hypokalemia, hyponatremia and hypotension can occur simultaneously when diuretics cause large amounts of micturition. This is a group of serious adverse reactions and emergencies, should be vigilant.
After taking medicine, some patients with slight increase in blood uric acid in the short term, but small doses of long-term treatment can be restored to normal mostly. Diuretics generally do not cause gout, but the original gout patients may induce joint swelling and other gout attacks. Hyperuricemia and gout patients had better not use diuretics.
- Elevated blood sugar.
With hydrochlorothiazide treatment for 3 weeks, fasting blood glucose may be higher than before treatment, so general hyperglycemia and diabetes patients had better not use diuretics. Indapamide can interfere with glucose metabolism in some patients with impaired glucose tolerance. Patients with hypertension and impaired glucose tolerance should be reexamined regularly.
The above adverse reactions often occur in large doses of diuretics and long-term drug use, small doses do not generally produce adverse reactions. During the use of diuretics to eat fruits and vegetables and to supplement water. If diuretics are used in combination with ACEI or ARB, the incidence of hypokalemia and other adverse reactions can be reduced.
- Renal insufficiency.
Different diuretics can directly or indirectly cause renal hemodynamic changes, leading to reduced renal blood flow perfusion, glomerular filtration rate decreased, serious and may even lead to renal tubular necrosis.
Thiazide diuretics are banned when hypertension is associated with moderate or severe renal failure and may be replaced by furosemide. The use of indapamide in patients who are allergic to sulfonamides has fewer adverse reactions to the sustained-release agents.
Adverse reactions of angiotensin converting enzyme inhibitors.
The incidence of the most common adverse reactions varied with different preparations. Most are dry cough, more intense, cough medicine effect is poor, to this kind of cough reaction stops medicine 1, 3 weeks can disappear, need not special treatment.
A small number of patients with slight increase in blood potassium after medication, but will not cause serious hyperkalemia. Severe hyperkalemia can occur in hypertensive patients with renal insufficiency or bilateral renal artery stenosis. Long-term blood pressure control, especially in patients with severe hypertension should first check renal function before considering the use of such drugs. Except for hypokalemia, ACEI should not be used in combination with potassium chloride and potassium diuretic spironolactone.
Renal dysfunction and proteinuria.
Because ACEI may aggravate the disease in patients with renal insufficiency, it should be considered to stop the treatment when the serum creatinine increases more than 50% of the basic state, or the absolute value exceeds 2. 5 mg/L, but for patients with hypertension nephropathy and diabetic nephropathy. Appropriate use can significantly delay the further deterioration of renal function and reduce the excretion of proteinuria.
Rash and angioedema.
The rash is a drug allergy and should be stopped as soon as it appears. Vasculoedema is rare, this reaction generally occurs within 4 weeks after medication, laryngeal edema can affect respiratory function, severe may asphyxia. Take medicine period if produce larynx to always have blocking feeling and breath not smooth wait for a symptom, want to notice to produce this disease, should see a doctor in time.
Rare side effects include severe granulocytopenia, thrombocytopenia, and aplastic anemia, which may increase the risk of acute pancreatitis.
Adverse reactions of angiotensin II receptor antagonist.
Except that cough is rarely caused, the adverse reactions are similar to ACEI. The risk of hyperkalemia and other adverse reactions is increased in combination with ACEI, so it is generally not suitable to be used in combination with ACEI in antihypertensive therapy.
The common adverse reactions were ankle edema, blushing, headache, dizziness and gingival hyperplasia, most of which occurred within 1 to 2 years after treatment, and subsided spontaneously within 1 to 2 months after drug withdrawal. Blushing, headache, dizziness caused by vasodilation of the head, can be alleviated or disappeared after 1 week and 2 weeks.
Ankle edema often occurs after taking medicine for a long time, and is not easy to subside. Although this response does not affect the efficacy of no adverse consequences, but patients are often difficult to accept psychologically, it is better to use other antihypertensive drugs. If you still need to use, you can add a small dose of diuretic, edema will be reduced or subsided. In addition, the withdrawal of calcium antagonists may occur rebound blood pressure rise, excitement, anxiety and other drug withdrawal reaction, but the incidence is very low.
Verapamil, a non-dihydropyridine calcium antagonist, can reduce heart rate and myocardial contractility, so it should not be used in hypertensive patients with bradycardia or cardiac insufficiency.
β -adrenergic receptor blocker.
With the increase of the dose, the heart rate decreased and conduction block occurred, even cardiac arrest. Therefore after the use of drugs there is a significant sinus atrial block or sinus arrest should be considered to stop or reduce. Atrioventricular block of degree ⅱ or above should be discontinued after administration. In patients with bradycardia, it is best to carry out dynamic electrocardiogram examination to judge the degree and nature of bradycardia. After medication as blood pressure drop heart rate will slow down, this is a normal response to treatment, the average heart rate of 50 / min or more will not have much problem.
- Cardiac insufficiency.
In clinic, β-blockers are often used to treat patients with mild to moderate cardiac insufficiency, but we should pay attention to the fact that β-blockers can reduce the rate of myocardial contraction, so they are forbidden in patients with hypertensive heart disease complicated with acute left ventricular insufficiency. For hypertensive patients with cardiac dysfunction, diuretic therapy can reduce blood pressure and alleviate heart failure, which can be described as “killing two birds with one stone”.
β-blockers may cause bronchospasm, induce or aggravate dyspnea, and are therefore prohibited in patients with bronchial asthma and chronic obstructive pulmonary emphysema .
- Central nervous system symptoms.
Because metoprolol is fat-soluble, it is easy to pass through the blood-brain barrier after oral absorption, the concentration of cerebrospinal fluid is 70% of the concentration of plasma, when patients appear obvious mental symptoms such as lethargy, anorexia and depression after taking metoprolol, it should be considered as a result of metoprolol. After oral absorption, the concentration of atenolol in the brain was only 20% of that in plasma, which could be changed to water-soluble atenolol.
- Withdrawal syndrome.
β-blocker sudden withdrawal of drugs or drug reduction will appear sympathetic excitement symptoms, the occurrence of rebound hypertension. At this time the blood pressure quickly recovered to the level before treatment, even higher than before treatment, can occur serious arrhythmia, angina pectoris attack, myocardial infarction, sudden death and so on. A small number of patients after long-term use of drugs can increase myocardial oxygen consumption and platelet aggregation phenomenon, more in the withdrawal of drugs within 2 to 7 days after onset. In addition, beta-blockers can occasionally raise blood pressure in patients with pheochromocytoma or severe diabetes. Therefore, patients can not stop drugs at will, such as blood pressure rebound phenomenon can be immediately reused stopped drugs to alleviate symptoms, while adding other antihypertensive drugs, until the blood pressure stabilized and then gradually discontinued.
- Effects on blood glucose, blood lipid and physical strength.
β-blockers tended to increase blood glucose, propranolol and atenolol slightly increased triglyceride and decreased high density lipoprotein, but metoprolol and bisoprolol had little effect on blood lipid and blood glucose. In addition, β-blockers not only reduce the metabolic rate, but also have effects on muscle strength and vasomotor function, which can cause fatigue, skin paleness and sexual dysfunction. Therefore, the patients with hyperglycemia, hyperlipidemia and fatigue syndrome should not use β -blockers except for special cases. If drugs must be used, they can be taken at the same time when the primary disease is effectively controlled.