[HTN big plate point] when hypertension meets coronary heart disease, how to take medicine? Collect

Seeing here we know that when high blood pressure meets coronary heart disease, the power of the two to damage your body will double.

So how should this situation be broken?

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Reference value of Chinese average normal blood pressure

The guidelines for the prevention and treatment of hypertension in my country recommend that hypertensive patients with coronary heart disease should control their blood pressure below 140/90 mmHg. If tolerated, it can be reduced to below 130/80 mmHg, but diastolic blood pressure should not be reduced to below 60 mmHg. If it drops too low, insufficient coronary perfusion may occur, leading to cardiovascular events. In elderly patients with severe coronary artery stenosis, blood pressure should not be too low.

Commonly used clinical antihypertensive drugs:

1. β-receptor blocker (β-RB)

β-RB drugs can reduce myocardial contractility and cardiac output in hypertensive patients, thereby reducing peripheral blood volume and reducing systolic blood pressure.

Representative drugs are: atenolol, propranolol, metoprolol, etc.

2. Angiotensin Converting Enzyme Inhibitor (ACEI)

ACEI drugs can inhibit angiotensin-converting enzyme and promote the production of angiotensin Ⅱ to reduce vasodilation, so as to achieve the effect of drug lowering blood pressure.

Representative drugs are: captopril, benazepril, enalapril, etc.

3. Angiotensin Ⅱ receptor antagonist (ARB)

ARB drugs can improve the microcirculation perfusion, ensure the blood and oxygen supply of the myocardium, achieve the effect of lowering blood pressure, and reduce the incidence of adverse reactions of myocardial infarction.

Representative drugs are: Losartan, Valsartan, Irbesartan, etc.

4. Calcium ion antagonist (CCB)

CCB can significantly relax the vascular smooth muscle of patients with hypertension, reduce the peripheral resistance of blood vessels, and slow down arteriosclerosis to achieve the effect of lowering blood pressure.

Representative drugs: felodipine, nifedipine, lacidipine, etc.

5. Diuretics (DA)

DA drugs reduce ventricular end-diastolic volume to achieve the effect of lowering blood pressure.

Representative drugs: furosemide, etanyl acid, bumetanide, etc.

Note: RAS: renin-angiotensin system; SBP: systolic blood pressure; DBP: diastolic blood pressure

1. Hypertension and stable angina

Beta blockers and CCB drugs are preferred, which can reduce myocardial oxygen consumption and reduce angina pectoris. When blood pressure control is not ideal, use ACEI/ARB and diuretics in combination.

2. Hypertension combined with non-ST-segment elevation acute coronary syndrome

Beta blockers and CCB drugs are preferred. When blood pressure control is not ideal, RAS inhibitors and diuretics can be used in combination. When angina pectoris is considered to have vasospasm factors, in order to avoid inducing coronary artery spasm, high-dose β-blockers should not be used

3. Hypertension with acute ST-segment elevation myocardial infarction

Beta blockers and RAS inhibitors are preferred. Long-term use after myocardial infarction as secondary prevention can significantly improve the long-term prognosis of patients. Those without contraindications should be used early. When blood pressure control is not ideal, CCB and diuretics can be combined .

In fact, in daily life, as long as we pay more attention to blood pressure monitoring and choose the correct antihypertensive drugs, it is difficult for the "brothers" of hypertension and coronary heart disease to get together and make waves.