Медикаментозная терапия позволяет нормализовать кровяное давление и привести сосуды в норму. Таблетки, понижающие давление, различают по составу и прямому действую на организм.
В случаях, когда изменение образа жизни и правильное питание не помогают нормализовать артериальное давление (АД), назначают лекарственные препараты. Многие антигипертензивные препараты продаются без рецептов, но назначаются врачом индивидуально. Это зависит от проведенного диагностического исследования и степени заболевания.
Например, для постоянного приема препаратов, которые поддерживают жизненный ритм у пожилых назначают одни таблетки. Если необходимо срочно понизить давление, то применяют более мощные средства.
Существует 5 основных классов гипотензивных препаратов: бета-блокаторы, диуретики, игибиторы АПФ, антагонисты кальция, блокаторы рецепторов ангиотензина. И два дополнительных: альфа блокаторы и агонисты имидазолиновых рецепторов.
Таблетки от повышенного давления необходимо принимать строго по схеме врача!
Если у больного диагностируют начальную стадию артериальной гипертензии, то лечение начинается с приема одного препарата. В случае неэффективного лечения рекомендуют заменить лекарственное средство на другой препарат. Если АД по-прежнему не удается нормализовать, назначают терапию с комбинацией нескольких лекарственных препаратов.
Схема лечения при повышенном АД
Схема лечения пациентов с высоким АД(риск высокий)
Терапия из 2-х лекарственных препаратов | |
Смена других препаратов
Добавляется 3-й препарат
Комбинация из 3-х препаратов в полной дозе
Таблетки для снижения артериального давления разделяют в зависимости от состава и свойств.
В странах СНГ гипертоникам назначают препараты:
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Диуретики (мочегонные) средства для уменьшения объема циркуляции крови в сосудах.
При гипертоническом кризе часто назначают Фуросемид, который быстро снижает АД. Но принимать данный препарат необходимо под контролем врача. Данное мочегонное средство выводит много калия, поэтому обязательно принимается с лекарствами, восстанавливающие баланс.
Частое и бесконтрольное употребление Фуросемида может привести к сильной аритмии и сердечному приступу!
Среди мочегонных препаратов для поддержания уровня содержания калия в крови можно выделить Верошпирон и Триамтерен. Препараты назначают в малых дозах, в сочетании с калийсберегающими средствами.
Побочные действия от диуретиков проявляются быстрой утомляемостью и усталостью. В редких случаях больные жалуются на головную боль, тошноту и сухость во рту.
Бета-адреноблокаторы. Данные лекарственные средства часто используют для лечения гипертонии.
Главное свойство – это блокирование центральных бета-адренорецепторов, изменяя ответ органов и тканей на нервные импульсы. После приема лекарств, сердце начинает работать ритмичнее, а кровь перестает поступать в сосуды в больших количествах.
Бета-адреноблокаторы разделяют на селективные и неселективные. К первым относят Метаналол и Атенолол. Селективные средства блокируют только адренорецепторы, которые связаны с сердечно-сосудистой системой, не причиняя вреда всему организму.
Неселективные бета-адреноблокаторы блокируют адренорецепторы, которые связаны со всеми органами. Известные препараты Обзидол и Анаприлин. Неселективные средства быстрее снижают артериальное давление, но часто вызывают побочные действия (спазм бронхов, обострение язвенной болезни).
Бета-адреноблокаторы не рекомендуются к использованию:
- Пациентам с легочными заболеваниями;
- Беременным женщинам;
- Людям с сахарным диабетом;
- Больным с хроническими заболеваниями желудка.
- Хроническим алкоголикам.
Бета-адреноблокаторы нельзя сочетать с алкоголем, оральными контрацептивами и барбитуратами.
В России используют таблетки Капотен, Эналаприл, Престариум.
АПФ хороши тем, что снижают АД, не вызывая при этом усталости сонливости и не повышая уровень холестерина. Препараты АПФ нельзя принимать одновременно с мочегонными лекарственными препаратами, которые сберегают калий. Врачи также запрещают ингибиторы беременным женщинам.
Побочные действия от АПФ проявляются в виде: головной боли, головокружения, кашля, сыпи.
Антагонисты кальция. Лекарства данной группы препятствуют поступлению ионов кальция в сосуды и сердце. После приема препаратов сосуды расширяются, а сердечное сокращение уменьшается.
Популярные препараты: Изоптин, Коринфар, Веропамил, Дилтиазем. Антагонисты кальция быстро снижают сердечное давление и часто используются при гипертоническом кризе. Принимать препараты нужно с особой осторожностью, так как они быстро расширяют сосуды.
Блокаторы рецепторов ангиотензина II. Препараты предназначены для расширения сосудов. Фармакотерапия представлена препаратами: Эпросартан, Лозартан, Ирбесартан, Вальсартан.
Возможные побочные действия выражаются в виде головокружения и усталости. Препараты противопоказаны беременным женщинам, людям с повышенным содержанием калия и сужением почечных артерий.
Препараты центрального действия альфа-агонисты. Препараты блокируют мозговые импульсы артериям о сужении. В России при артериальной гипертензии назначают Допегит и Клофелин.
Центральные альфа-агонисты назначают в редких случаях, когда другие препараты не оказывает положительного эффекта. Прием и отмена препаратов производится строго под контролем врача.
Допегит и Клофелин нельзя сочетать с алкоголем. Это всегда приводит к потере сознания и резкому снижению артериального давления.
Эффективные препараты
Таблица: Клинические рекомендации медикаментозного лечения высокого АД
Класс препаратов | Эффективные таблетки от давления список, название и доза |
---|---|
β-адреноблокатороры | Кардиоселективные препараты: Атенолол (25-100 мг в сутки), Метопролол (50-200 мг/сут), Небиволол (2,5 – 5,0 мг/сут) |
кардиоселективные таблетки с внутренней симпатомиметической активностью: Талинолол (150-600 мг/сут)
некардиоселективные средства: Пропранолол (20-160 мг/сут), Окспренолол (20-480 мг/сут)
препараты с a-адреноблокирующимдействием: Лабеталол (200-1200 мг/сут), Карведиол (25-100 мг/сут)
селективные α1-адреноблокаторы: Празозин (0,0015 – 0,003 мг/сут), Доксазозин (1-15 мг/сут), Теразозин, Бендазолол
Как правильно принимать таблетки
При длительной терапии артериальной гипертензии предпочтение отдается препаратам с пролонгированным действием (прием 1 таблетки в сутки).
Количество лекарственных препаратов назначают в зависимости от симптомов, степени гипертонии, осложнения и самочувствия пациента. На начальной степени болезни, при отсутствии риска поражения органов мишеней, рекомендовано начинать лечение с маленьких доз. Позже увиливают дозировку и количество препаратов по ходу лечения.
Рекомендации по медикаментозной терапии:
- Все лекарства от снижения артериального давления должен назначить врач. Нельзя принимать таблетки просто потому, что кто-то их советует!
- Назначенные препараты необходимо принимать в одно и то же время суток. Время и дозу лекарства можно прочитать в назначении врача.
- Нельзя резко бросать прием лекарств, даже если АД не снижается. Если препарат не дает положительного эффекта необходимо сообщить об этом лечащему врачу.
- Важно придерживаться четкой схемы, которую укажет врач. Это время суток, до и после еды, количество таблеток. Нельзя самостоятельно дополнять схему лучения БАД и другими средствами, понижающими давление.
- Покупайте препараты только в государственных учреждениях. Опасайтесь подделок! Обязательно читайте инструкцию и внимательно смотрите на срок годности.
- Таблетки нужно принимать в стоячем положении, запивая небольшим количеством воды.
- Препараты от давления нельзя сочетать с алкоголем и курением.
- Если вы почувствовали себя плохо после приема лекарств, сразу вызывайте скорою помощь!
Таблица: Противопоказания для приема таблеток и препаратов, снижающих АД
Препараты от гипертонии | Строго запрещено | Не рекомендуется |
диуретики | подагра | метаболический синдром, нарушенная толерантность к глюкозе, гипер- и гипокалиемия, беременность |
β-блокаторы | атриовентрикулярная блокада |
2-3 степени гипертензии
бронхиальная астма
2-3 степени заболевания, хроническая сердечная недостаточность, сниженная фракция выброса левого желудочка сердца
беременность, концентрация электролитов калия (K+),
почечных артерий
почечных артерий
альдостерона
Какие таблетки от давления помогут быстро снизить АД при скачках и кризе? При высоком артериальном давлении, для предотвращения тяжелого гипертонического криза и инсульта, используют: Клофелин, Нифедипин, Капотен, Дибазол, Метопролол, Празозин.
Использование таблеток при очень высоком АД и осложненном кризе: Нитроглицерин, Натрия нитропруссид, Нимодипин, Эналаприлат, Верапамил, Пропранолол, Эсмолол, Магния сульфат, Фуросемид.
Препараты, назначенные врачом необходимо принимать регулярно! Отклонение в лечении может быстро вызвать гипертонический криз.
Как понизить давление без таблеток? В экстренных случаях в домашних условиях помогут горчичники на ноги и горячая ванна для ног. Для комплексного лечения и профилактики нужно нормализовать ритм жизни, отказаться от вредных привычек и улучшить рацион питания, полезными продуктами.
ИМЕЮТСЯ ПРОТИВОПОКАЗАНИЯ
НЕОБХОДИМА КОНСУЛЬТАЦИЯ ЛЕЧАЩЕГО ВРАЧА
Автор статьи Иванова Светлана Анатольевна, врач-терапевт
Чтобы быстро снизить давление, необходимо выбрать безопасный и эффективный препарат. При гипертонической болезни помогают таблетки от высокого давления быстрого или длительного действия, комбинированные препараты. С выбором поможет рейтинг наиболее действенных средств от давления с наименьшими побочными эффектами.
Что принимать для быстрого эффекта
В критических ситуациях необходим прием препарата, который быстро купирует симптомы гипертонической болезни. Действенные средства позволяют нормализовать состояние в течение 20-40 минут. В список самых эффективных быстродействующих препаратов входят:
Длительность действия — от 5 до 12 часов. Выбирать наиболее подходящие таблетки при высоком давлении быстрого действия можно только после прочтения инструкции.
Клофелин
Клофелин оказывает гипотензивное действие за счет стимуляции альфа 2-адренорецепторов и снижения тонуса вазомоторного центра продолговатого мозга. После применения снижается общее периферическое сосудистое сопротивление, уменьшается частота сердечных сокращений. Оказывает седативный эффект. Понизить кровяное давление удается в течение 30-40 минут на 8-12 часов. Не следует резко прекращать прием из-за возможного синдрома отмены.
Выпускают средство в виде таблеток, а также 0,01% раствора для инъекций. Принимать можно при гипертоническом кризе, абстинентном синдроме и в составе комплексной терапии при артериальной гипертензии. Чтобы понизить давление, пьют по 0,075 мг трижды в сутки. При гипертоническом кризе вводят по 0,3-0,45 мг в сутки. Осторожность нужно проявлять при брадиаритмии, сахарном диабете, полинейропатии, склонности к запорам, нарушении функции почек.
Анаприлин
Анаприлин — неселективный бета-адреноблокатор. Действующим компонентом является пропранолол. Средство уменьшает частоту сердечных сокращений, снижает потребность сердечной мышцы в кислороде. Таблетки быстро оказывают антиаритмическое и гипотензивное действие. При регулярном применении снижает внутриглазное давление и оказывает седативное действие.
Анаприлин снижает вероятность развития сердечно-сосудистых осложнений, и его можно пить при высоком давлении для быстрого улучшения состояния. Действие наступает в течение 1 часа и продолжается до 24 часов. Принимать нужно по 40 мг дважды или трижды в сутки. Противопоказан прием при синусовой брадикардии, остром инфаркте миокарда, сахарном диабете, бронхиальной астме и острой сердечной недостаточности.
Папазол
Папазол помогает быстро снизить давление за счет сосудорасширяющего действия. Активными компонентами являются дибазол и папаверина гидрохлорид. Препарат снимает спазм гладкой мускулатуры и вызывает расширение сосудов. Активные компоненты усиливают кровообращение и уменьшают возбудимость сердечной мышцы. Таблетки при гипертонии принимают по 1 шт. 2-3 раза в сутки. Эффект наступает в течение 1 часа.
Принимать с осторожностью нужно при сниженной перистальтике кишечника, недостаточности функции печени или почек, гипотиреозе, гиперплазии предстательной железы. Лечение не следует начинать при наличии эпилепсии и бронхообструктивного синдрома. Лекарство помогает снять спазм на некоторое время, поэтому лучше использовать средство в комбинации.
Фуросемид
Фуросемид — петлевой диуретик. Содержит одноименное действующее вещество. Усиливает выведение из организма ионов кальция, калия и магния. Оказывает выраженный, но кратковременный эффект. Фуросемид уменьшает отечность тканей. Давление нормализуется в течение 15-30 минут, а при внутривенном введении — в течение 5 минут. Действие длится 6-8 часов.
Какие средства длительного действия самые эффективные
Нормализовать давление помогут препараты от гипертонии длительного действия. Прием нужно осуществлять 1-2 раза в сутки. К медикаментам пролонгированного действия относят Индапамид, Энап, Верошпирон, Глицин и другие. Они имеют минимум побочных эффектов и оказывают мягкое действие на организм в течение длительного времени.
Индапамид
Препарат относится к группе тиазидоподобных диуретиков. В составе содержится аналогичное действующее вещество, которое усиливает выведение из организма ионов кальция, натрия, хлора и магния. Способствует снижению чувствительности стенки сосудов к ангиотензину 2. Максимальное действие достигается в течение суток. При длительном применении выраженное снижение давления отмечается через 1-2 недели.
При гипертонии лекарство принимают по 5-20 мг. Если проводилась терапия диуретическими средствами, рекомендуемая дозировка — 5 мг. Противопоказан прием при ангионевротическом отеке в анамнезе, порфирии, дефиците лактазы и непереносимости лактозы. С осторожностью назначают препарат при заболеваниях почек и печени, гипертрофической обструктивной кардиомиопатии и сахарном диабете. Запрещено во время лечения принимать иммунодепрессанты и диуретики.
Верошпирон
Диуретический калийсберегающий препарат обладает пролонгированным действием. Содержит спиронолактон. Давление снижается за счет мочегонного эффекта. Препарат способствует выведению с мочой воды, ионов натрия и хлора. Действие проявляется на 2-5 день приема и сохраняется в течение 3 дней после отмены лечения.
При повышенном давлении начальная дозировка — 50 мг. Можно постепенно повышать до 100-200 мг в сутки. При повышенном содержании кальция в крови, метаболическом ацидозе, сахарном диабете, циррозе печени, нарушении менструального цикла и в пожилом возрасте нужно принимать с осторожностью.
Глицин
Глицин относится к фармакологической группе нейротропных средств. Препарат от гипертонии без побочных действий регулирует обмен веществ, улучшает работу центральной нервной системы, стимулирует работу мозга. За счет снижения вазоспазма артериол Глицин помогает нормализовать давление. Оказывает антиоксидантное, антидепрессивное и антитоксическое действие.
Психостимулятор назначают при ишемическом инсульте, сниженной умственной работоспособности, повышенной возбудимости. Чтобы сбить высокое давление таблетками, нужно принимать средство в течение 14-30 дней по 1 шт. трижды в сутки. Можно размельчить таблетку в порошок или положить под язык. Через 30 дней курс можно повторить. Глицин противопоказан при индивидуальной чувствительности к компонентам.
Нифедипин
Нифедипин блокирует кальциевые каналы и способствует расширению сосудов. Может временно увеличиться сердечный выброс и частота сердечных сокращений. Средство уменьшает нагрузку на сердечную мышцу, препятствует склеиванию тромбоцитов, улучшает работу сердечно-сосудистой системы.
Назначают по 10 мг дважды в сутки. Если рассасывать таблетку, действие проявляется через 5-10 минут и сохраняется до 20 часов. Прием лекарства от гипертонии запрещен при кардиогенном шоке, аортальном стенозе, хронической сердечной недостаточности в стадии декомпенсации.
Микардис
Препарат помогает снизить давление без побочных эффектов. Он блокирует рецепторы ангиотензина 2. В результате происходит расширение сосудов. Оказывает влияние на рецепторы АТ1. Действующее вещество — телмисартан. Под влиянием активного компонента уменьшается концентрация альдостерона в крови.
Эффект наблюдается спустя 2-3 часа и длится до 24 часов. Длительность лечения — от 4 до 8 недель. Препаратом не снижают давление при нарушении проходимости желчевыводящих путей, наследственной непереносимости фруктозы, аллергии на компоненты, болезнях печени и почек.
Допегит
Допегит стимулирует альфа2-адренорецепторы и препятствует повышению артериального давления. В составе присутствует метилдопа. Оказывает легкое седативное действие и усиливает почечный кровоток. После первого применения может появиться кратковременная гипертензия.
Действие наступает через 4-5 часов и достигает максимума на 2 сутки. В первые 2 суток по 250 мг утром и вечером нужно выпить, чтобы понизить давление. Постепенно дозировку увеличивают. Курс составляет 1-2 месяца. Лечение запрещено начинать при феохромоцитоме, депрессивных состояниях, паркинсонизме, остром инфаркте миокарда и цереброваскулярных заболеваниях.
Моксонидин
Моксонидин уменьшает периферическое сосудистое сопротивление за счет связывания центральных имидазолиновых рецепторов. Содержит одноименное вещество. Оказывает успокоительное действие. Действовать начинает в течение 2-4 часов и продолжает до 12 часов.
Комбинированные препараты
Комбинированные препараты воздействуют на организм комплексно. Если лечение гипертонии лекарствами оказалось неэффективным, врачи советуют выбирать препараты, которые позволяют комбинировать несколько действующих компонентов. Лучшие средства от гипертонии — Адельфан Эзидрекс, Арител Плюс, Нолипрел.
Адельфан Эзидрекс
Гипотензивное средство содержит резерпин, дигидралазин сульфат и гидрохлоротиазид. Компоненты уменьшают тонус симпатической нервной системы, расширяют сосуды, выводят лишнюю жидкость из организма и оказывают седативное действие. Эффект появляется через 1-2 часа и сохраняется до 12 часов.
Арител Плюс
Препарат содержит бисопролол и гидрохлоротиазид. Оказывает мочегонное, сосудорасширяющее и антиаритмическое действие. Блокирует β1-адренорецепторы сердца, снижает активность РААС, усиливает выведение почками ионов калия и магния. Давление снижается в первые 3-4 часа после приема. Лечить гипертонию необходимо в течение 1-2 месяцев.
Принимать нужно по 2,5 мг бисопролола + 6,25 мг гидрохлоротиазида 1 раз в сутки. Увеличивают при необходимости через 14 дней. Комбинированный препарат для лечения гипертонии не назначают при бронхиальной астме, декомпенсированной ХСН, вариантной стенокардии, трудноконтролируемом сахарном диабете и гиповолемии.
Нолипрел
Нолипрел — ингибитор АПФ. Препятствует образованию ангиотензина 2, который вызывает сужение сосудов. После приема улучшается эластичность артерий, снижается общее периферическое сосудистое сопротивление. Препапат содержит периндоприла аргинин и индапамид. Стойкий эффект наблюдается после 1 месяца лечения.
Назначают по 1 таблетке в день. Действовать начинает в течение 3-4 часов. Комбинированные лекарства от гипертонии данной группы противопоказано принимать пациентам с отеком Квинке в анамнезе, гипокалиемией, тяжелыми нарушениями функции почек и печени. Нолипрел намного эффективнее комбинации медикаментозных препаратов с содержанием аналогичных компонентов.
Лекарства от повышенного нижнего давления
Если происходит спазм сосудов, нижнее давление повышается. Средства от высокого давления помогают улучшить работу сердца и наладить кровообращение.
Каптоприл
Эффективное средство для снижения повышенного нижнего давления. Каптоприл предотвращает образование ангиотензина 2 из ангиотензина 1. Прекращается высвобождение альдостерона, расширяются сосуды и улучшается кровоток в почках. Давление снижается в течение 15-45 минут. Действие длится 6-12 часов. Средство оказывает кардиопротективное действие.
Принять нужно 50 мг в сутки, чтобы нормализовать состояние. Через 2-3 недели можно увеличить до 100 мг в день. При нарушениях функции почек не используют большую дозировку. Пациентам с гиперчувствительностью к компонентам, наследственным или идиопатическим отеком Квинке, первичным гиперальдостеронизмом лечение противопоказано.
Рамиприл
Рамиприл подавляет синтез ангиотензина 2. После приема расширяются сосуды и уменьшается риск развития тяжелых заболеваний сердечно-сосудистой системы. Препарат усиливает кровообращение в органах, выводит с мочой ионы натрия. Действие развивается в течение 1 часа и сохраняется более 24 часов.
Начальная суточная доза — 0,0025 г. Принимать таблетки нужно утром. При артериальной гипертензии на фоне сахарного диабета принимают по 0,00125 г. Запрещено начинать терапию при аллергии на ингибиторы АПФ, ангионевротическом отеке, тяжелых аутоиммунных заболеваниях, недостаточности коронарного или мозгового кровообращения.
Резерпин
Резерпин относится к фармакологической группе симпатолитиков. Это лучшее лекарство от гипертонии. Способствует высвобождению норадреналина и нарушению его транспорта, оказывает нейролептическое действие. Эффект наблюдается в течение нескольких дней и сохраняется до 2-5 недель.
Средство, понижающее давление, нужно принимать по 0,1 мг дважды в сутки. Лечение запрещено начинать пациентам с депрессией, болезнью Паркинсона, язвенной болезнью в период обострения, желчно-каменной болезнью, бронхиальной астмой и атеросклерозом.
Лозап
Многие пациенты интересуются, какие таблетки от давления самые эффективные. Лозап — действенный препарат при гипертензии. Он блокирует АТ1-рецепторы ангиотензина 2. Активное вещество — лозартан калия быстро всасывается. Мощный вазоконстриктор улучшает состояние в течение 4-5 часов. Эффект сохраняется на длительное время при курсовом приеме не менее 6-7 недель.
Суточное количество — 50 мг. Можно увеличить постепенно до 100 мг. При сниженном объеме циркулирующей крови уменьшают дозу до 25 мг. Прием осуществляют с осторожностью при двустороннем стенозе, патологиях печени, дегидратации, гипонатриемии, застойной сердечной недостаточности и циррозе.
Что давать пожилым людям
Лекарства от высокого давления для пожилых выбирают в зависимости от причины заболевания. Существуют таблетки от высокого давления быстрого действия, короткого действия и комбинированные средства. Главный критерий выбора — безопасность. Лучше отдать предпочтение средствам с минимальными побочными эффектами. Выделяют следующие группы лекарственных препаратов при гипертонии:
- Мочегонные средства. Выводят из организма лишнюю жидкость, уменьшают отечность стенок сосудов. На начальных этапах болезни назначают Гидрохлортиазид. Рекомендуется принимать по 25-50 мг в течение 1 месяца. Действие развивается через 30-40 минут и сохраняется до 12 часов. Мочегонным действием обладает средство Индап. От гипертонии пожилым дают по 1,25-2,5 мг в сутки. Максимальное действие проявляется после курсового лечения.
- Антагонисты ионов кальция. Данная группа средств уменьшает всасывание кальция и способствует расслаблению сосудов. В аптеке можно приобрести Нифедипин, Кордафлекс, Дилзиатем или Клентиазем. Антагонисты кальция второго поколения принимают по инструкции 3-4 раза в сутки. Длительность курса — от 3 недель.
- Бета-блокаторы. Эффективны после перенесенного инфаркта. Бета-блокаторы угнетают действие гормонов, которые способствуют сужению просвета сосудов. Наиболее популярные средства — Атенолол и Пропранолол. Средства обладают антиаритмическим и антиангинальным действием. Прием Атенолола начинают с 25 мг, повышая при необходимости до 50 мг. Пропранолол назначают в дозировке 40 мг дважды в день. Действие развивается в течение 1 часа.
- Ингибиторы АПФ. Препятствуют образованию ренина из ангиотензина, который способствует сужению сосудов. Среди ингибиторов АПФ, которые помогают сбивать давление, выделяют Каптоприл. Начинает действовать в течение 30-90 минут. Лекарство от высокого давления для пожилых людей назначают в дозировке 12,5 мг трижды в сутки. Врачи советуют Лизиноприл. Медикамент принимают по 2,5 мг в день.
- Альфа-адреноблокаторы. Угнетают сосудосужающее действие альфа-адренорецепторов. Современными средствами считаются Сермион и Урорек. Можно принимать Клофелин. Дозировку в пожилом возрасте нужно подбирать с учетом индивидуальных особенностей организма и реакции на лечение.
Лекарства при гипертонии в пожилом возрасте нужно выбирать после обследования. Медикаменты имеют разные побочные эффекты и противопоказания. Перед применением необходимо посоветоваться с лечащим врачом, чтобы выбрать подходящую дозировку.
Повышенное АД – одна из частых причин обращения за медицинской помощью. Состояние характеризуется рядом признаков, снижающих качество жизни больного. Оптимальным методом коррекции, позволяющим достигнуть результата в 90% случаев, является приём таблетированных гипотензивных средств. Способ комфортен для пациента, не требует инвазивных вмешательств и может использоваться человеком в отсутствии медицинского работника. Все таблетки от гипертонии – это средства экстренной помощи и планового лечения.
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Когда нужно снижать давление
Повышенными считаются цифры АД более 139/89 мм рт. ст. При этом наличие у человека клинической симптоматики не учитывается. Давление необходимо снижать, даже если больной адаптирован к имеющимся показателям. Измерение проводят трижды, с интервалом 5–10 минут, на одной и той же руке. Перед этим следует убедиться, что пациент не принимал веществ, способствующих повышению АД.
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При подборе лекарств учитывают разницу между гипертонией и гипертонической болезнью. В первом случае подъём является однократным, вызванным действием провоцирующего фактора:
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- Употребление большого количества кофе, крепкого чая, соли.
- Активное курение, стресс.
- Приём лекарств, повышающих давление (Цитрамон).
ГБ – хроническое заболевание, проявляется постоянно повышенным давлением, снизить которое удаётся только при системном приёме лекарств. В группу риска по артериальной гипертензии входят:
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- Люди в возрасте старше 50 лет.
- Пациенты с гипертрофией левого желудочка, ХПН, сосудистой недостаточностью, ожирением, нарушением работы ренин-ангиотензиновой системы.
Существует предположение, что в формировании АГ играет роль генетическая предрасположенность. Указанным категориям граждан рекомендовано ежедневное измерение АД и ведение соответствующей статистики. Заподозрить гипертонию можно по наличию следующих симптомов:
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- Боль в затылке.
- Головокружение.
- Оптические иллюзии (мушки перед глазами).
- Кардиалгия.
- Тахикардия, ощущение сердцебиения.
- Носовые кровотечения на фоне других признаков.
При присутствии указанной симптоматики и объективном подтверждении подъёма АД больному назначают таблетки от высокого давления. Первичную помощь может произвести фельдшер СМП (скорой медицинской помощи), системную терапию подбирает врач.
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Отказ от лечения за несколько лет приводит к формированию органических изменений в сердце, головном мозге, почках, сосудах. У больного в несколько раз возрастает риск геморрагического инсульта, инфаркта миокарда, ХПН при развитии вторичной сморщенной почки. Сказанное не означает, что однократный эпизод гипертонии не требует купирования. Если есть предрасположенность (ломкость сосудов, атеросклероз) осложнения могут развиваться мгновенно, уже при дебюте болезни.
Таблетки от гипертонии с быстрым эффектом
Лекарства с коротким временем наступления фармакологического действия применяются для купирования эпизодических повышений АД у пациентов, не страдающих гипертонической болезнью. А также у людей, получающих системное лечение. К числу средств быстрой помощи относят 4 препарата.
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Клофелин
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Сильнодействующий гипотензивный медикамент, применение которого обосновано при значительном повышении показателей артериального давления. Влияние наступает через 10–15 минут после употребления терапевтической дозы и достигает максимума через 1–2 часа. Количество препарата на 1 приём в среднем составляет 0.075 мг. Необходимый режим терапии определяют на основании цифр АД, других гипотензивных, принятых больным.
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Действие Клофелина основано на стимуляции альфа1 и альфа2 адренорецепторов. Вначале происходит кратковременное сужение, а после дилатация сосудов, что приводит к стабилизации давления. Побочное действие: повышение аппетита, сонливость, ортостатический коллапс. После приёма рекомендуется лежать. Инструкция предписывает использовать Клофелин преимущественно в качестве средства экстренной помощи.
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Анаприлин
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В отличие от предыдущего препарата, действует более мягко. Является неселективным бета-адреноблокатором. Ослабляет влияние парасимпатической нервной системы на тонус сосудистой стенки, купирует аритмию, снижает силу сердечного выброса, ослабляет сердцебиение.
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Максимальное действие наступает относительно быстро, через 1–1.5 часа с момента приёма. Терапевтическая доза: 10–20 мг. Лечение таблетками производят за 30 минут до еды. Препарат запивают 200–300 мл воды. Побочные эффекты – диспепсия, нарушение функции печени, брадикардия (низкий пульс). При однократном приёме не развиваются.
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Папазол
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Комбинация папаверина с дибазолом. Безопасный препарат, обладающий спазмолитическим и сосудорасширяющим влиянием. Гипотензивное действие слабое, наступает в течение 1–2 часов после приёма. Подходит для купирования умеренной гипертонии, вызванной стрессом, психическими переживаниями, употреблением большого количества напитков, содержащих вещества с вазоконстрикторными свойствами.
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Папазол противопоказан при сердечных блокадах, обструкции бронхов, эпилепсии, угнетении дыхания, возрасте менее 1 года. При системном использовании возможно развитие тошноты, потливости, сонливости, головокружения. Терапевтическая доза при единичном приёме – 2 таблетки, при системном – 1 т трижды в день.
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Фуросемид
Таблетки длительного действия
Средства для долговременной терапии употребляются на протяжении нескольких месяцев и более. Часто гипертоник вынужден принимать лекарства пожизненно.
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Индапамид
Калийсберегающий диуретик, обладающий ещё и вазодилатирующим эффектом. Селективно блокирует каналы кальция медленного типа, повышает эластичность артериальных стенок, уменьшает общее сосудистое сопротивление. Средство принимают по 2.5 мг, один раз за сутки, курсом 4–8 недель и более. Возможные побочные эффекты – диспепсия, общая слабость, полиурия. Противопоказания – анурия, дисэлектролитемия, беременность.
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Ингибитор ангиотензинпревращающего фермента. Приводит к снижению АД в течение одного часа, эффект сохраняется длительно. Стабилизация показателей происходит после 1–2 недель регулярного приёма. С целью системного лечения энап назначают по 5–10 мг 1 р/сут. Снижение давления на фоне приёма средства не сопровождается тахикардией (учащённая пульсация) и не приводит к ортостатическим явлениям. Противопоказан при порфирии, беременности и лактации, аллергических реакциях в анамнезе. Побочное действие – гипогликемия, анемия, головная боль, депрессия.
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Верошпирон
Калийсберегающее мочегонное. Влияет сходным с индапамидом образом. Назначается в составе комплексной терапии по 50 мг 1 раз в день. Курс 2–4 недели. Не используется при гиперкалиемии и гипонатриемии, во время лечения возможны явления диспепсии, головокружения.
Глицин
Не обладает гипотензивным действием, опосредованно снижает давление при стрессах и повышенной психической нагрузке. Однократный приём не приносит заметного эффекта. Средство используют системно, по 1 таблетке 1–2 раза в сутки, сублингвально (под язык). Противопоказан при аллергии и фенилкетонурии. Побочные эффекты не выявлены.
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Нифедипин
Селективно блокирует медленные кальциевые каналы, расширяет периферические и коронарные артерии, снимает спазм сосудистой стенки, способствует снижению АД. Препарат можно использовать для разового приёма, чтобы однократно сбить давление, однако, чаще его назначают для системной терапии. Дозировка – 10 мг 2 р/день, курс – до отмены (пожизненно). Противопоказан при аортальном и митральном стенозе, ОИМ, кардиогенном шоке и коллапсе. Во время лечения может развиваться гиперемия лица, тахикардия, диспепсия.
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Микардис
Блокатор рецепторов ангиотензина 2. Устраняет сосудосуживающий эффект альдостерона. Назначается по 40 мг/день. Противопоказан при обструкции желчевыводящих путей, существенном снижении функции печени и почек. Побочное действие – головная боль, утомляемость, тревожность, тахикардия, гипотония. Максимальный эффект достигает через 4–8 недель регулярного приёма. Цена упаковки — 1000 рублей.
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Допегит
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Гипотензивное средство центрального действия. Снижает активность симпатической нервной системы за счёт стимуляции альфа2-рецепторов. В начале лечения принимают по 250 мг перед сном, далее дозу увеличивают. Побочные эффекты – сухость во рту, отёки, ортостатические явления. Противопоказан при гемолитической анемии, почечной и печёночной недостаточности.
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Моксонидин
Комбинированные препараты
Средства, в состав которых входит сразу несколько действующих веществ, являются золотым стандартом лечения гипертонии и относятся к новому поколению гипотензивных медикаментов. Они позволяют одновременно воздействовать на несколько звеньев патогенеза, снижают риск поражения органов-мишеней, уменьшают количество таблеток, которые вынужден принимать больной. К числу таких лекарств относят три препарата.
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Адельфан-Эзидрекс
Арител плюс
Гидрохлоротиазид в комплексе с бисопрололом. Действие мочегонное и гипотензивное. Снижение АД происходит путём блокирования бета1-адренорецепторов и уменьшения синтеза цАМФ из АТФ. Показан при умеренном повышении АД. Режим приёма – по 1 капсуле 1 раз в сутки. Во время лечения возможна гипотония, брадикардия, экстрасистолия, судороги. Эффекты развиваются преимущественно при несоблюдении рекомендуемых дозировок. Противопоказан при стенокардии Принцметала, сахарном диабете, гиповолемии, острой почечной недостаточности.
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Нолипрел
Индапамид + аргинин (ингибитор АПФ). Увеличивает эластичность артерий, блокирует фермент, превращающий Ang-1 в Ang-2, тем самым устраняет один из факторов подъёма давления. Используется длительно, не менее 1 месяца. Режим приёма – 1 таблетка по утрам. Побочные эффекты – анемия, обморок, нарушение сна, головная боль. Противопоказания – гипокалиемия, почечная и печёночная недостаточность, беременность, лактация.
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Комбинированные средства облегчают лечение и делают его более удобным для пациента. При этом они имеют большее количество противопоказаний и побочных эффектов. Это обусловлено наличием в составе 2–3 действующих веществ одновременно.
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Таблетки от высокого нижнего давления
Показатель характеризует неправильную работу почек, в частности, нарушения в процессе образования ренина. Это приводит к повышенному тонусу периферических артерий. Проще говоря, у больного развивается сосудистый спазм. Купировать его можно с помощью ингибиторов АПФ и симпатолитиков.
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Каптоприл
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Блокирует выработку ангиотензина 2 путём уменьшения синтеза АПФ. Препарат быстрого действия. Эффект развивается через 60–90 минут после приёма. Доза для курсового лечения – 25 мг 2 р/день. При необходимости её увеличение производят плавно, в несколько этапов, не чаще 1 раза в две недели. Побочное действие – гиперкалиемия, тахикардия, ортостатический коллапс. Противопоказания – азотемия, стеноз устья аорты, кардиогенный шок.
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Эналаприл – см. «Энап».
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Рамиприл
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Пролекарство, активный метаболит – рамиприлат. Обладает сосудорасширяющим действием за счёт прямого снижения эффективности альдостерона. Уменьшает диастолическое давление, риск ОИМ, нефропатии, инсульта. Назначается по 5 мг 1 раз в сутки. Противопоказан при аллергических реакциях на компоненты средства в анамнезе. Побочное действие – боль в груди, аритмия, диспепсия, непродуктивный кашель.
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Резерпин
Симпатолитик, снижает выделение адреналина в синаптическую щель, тем самым способствуя уменьшению сосудистого спазма. При гипертонии назначается по 0.1 мг дважды в день. Побочные эффекты – гиперемия, головокружение, одышка. Противопоказания – органические поражения сердечно-сосудистого аппарата, острая почечная недостаточность, язвенная болезнь.
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Лозап
Блокирует выработку киназы II, участвующей в каскаде превращений ангиотензина. Назначается 1 раз в день, по 50 мг. Во время лечения возможно развитие диспепсии. Нельзя использовать при недостаточности выделительных систем, гипотензии, сниженном ОЦК.
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В статье приводится неполный список противопоказаний и побочных действий рассмотренных лекарств. Указаны только наиболее распространённые явления и состояния. Объективный перечень приводится в официальной инструкции, которая прилагается к каждой упаковке с препаратом.
Заключение врача
Артериальная гипертензия – тяжёлое хроническое заболевание, вызывающее поражение внутренних органов. Подбор терапии при этом производится длительно, с учётом множества факторов и особенностей течения патологии. Человек, не имеющий соответствующего образования и опыта, не в состоянии создать работающую медикаментозную схему. Цена ошибок – здоровье и жизнь. При первых признаках устойчиво высокого давления необходимо обратиться к врачу для обследования и разработки адекватного лечебного режима.
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