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各位朋友大家好，现在是“每天健康三分钟”时间，我是安阳道简医院的医生白传威。今天主要和大家聊聊如何选择降压药物。

降压药物的种类很多，带来的是多样的选择和困惑，很多人是见到隔壁老王或者楼下老李吃什么药自己就吃什么药，或者听从非专业人士的推荐进行购买服药，正确的做法是听从医生的指导，不要自己随意买药进行治疗。那么该如何选择降压药呢，我今天和大家一起聊聊。

常用的降压药物有5种，分别是：

1. 普利类（如卡托普利、依那普利、贝那普利等）；

2. 沙坦类（缬沙坦、厄贝沙坦、替米沙坦等）；

3. 地平类（硝苯地平控释片或缓释片、氨氯地平、左旋氨氯地平等）；

4. 利尿剂（氢氯噻嗪、吲达帕胺等）；

5. β-受体阻滞剂（美托洛尔、比索洛尔、卡维地洛等）。

由于不同药物的作用特点有所不同，因此高血压病人应用哪种降压药需要考虑多种因素。一般来讲，如果仅有高血压，没有并发症（如心脑肾病变）或合并其他疾病（如糖尿病等），各类药物都可以选用。如果同时存在其他疾病，可以按照以下原则选择降压药：

1. 合并左心室肥厚：首选地平类、普利类、沙坦类；

2. 合并冠心病：首选地平类、普利类、沙坦类和b-受体阻滞剂；

3. 曾有心肌梗死病史者：首选普利类、沙坦类和b-受体阻滞剂；

4. 合并心衰：首选普利类、沙坦类、利尿剂或b-受体阻滞剂；

5. 合并房颤：首先普利类或沙坦类；

6. 合并脑血管病：首选地平类、普利类、沙坦类或利尿剂；

7. 合并颈动脉内膜增厚或斑块：首选地平类；

8. 合并蛋白尿或微量白蛋白尿：首选普利列或沙坦类；

9. 老年高血压患者：首选地平类、普利类、沙坦类或利尿剂；

10. 合并糖尿病：首选普利类或沙坦类；

11. 合并高血脂：首选普利类或沙坦类。

多数高血压患者需要应用两种或更多种降压药物才能使血压达标，采用哪种组合方式也需要根据患者具体情况确定。最好的联合用药方案有：地平类与沙坦类、地平类与普利类、沙坦类与利尿剂、普利类与利尿剂，等。两种药物联合应用后仍然不能满意控制血压者，首先考虑联合应用地平类+普利类（或沙坦类）+利尿剂这三种药物的组合方案。一般来讲，不要联合使用普利类和沙坦类；如果没有心衰，不要联合使用普利类与b-受体阻滞剂，也不要联合沙坦类与b-受体阻滞剂。

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【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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