We have already mentioned that for the treatment of hypertension, not one, but two or three drugs are most often used. This mode of treatment is not very convenient, because every day you have to take several tablets, and remember at what time to take certain medications.
For convenience, they produce dosage forms containing a combination of two or three drugs in one tablet. Previously, their disadvantage was the inability to change the dose of drugs included in the combination. Currently, there are combinations with different doses of drugs (smaller or larger), which makes it possible to vary them depending on the degree of increase in blood PRESSURE.
Medications containing a diuretic (diuretic) should be taken in the morning.
Recently, fixed combinations with amlodipine have become very popular. The combination of ARB and AC is one of the most effective and safe in the treatment of hypertension. The addition of amlodipine is not accidental, since it is one of the best drugs from the group of calcium antagonists in terms of effectiveness and duration of action, and practically does not affect the exchange of carbohydrates and fats (metabolic neutrality).
This combination, due to the interaction of components, significantly reduces blood PRESSURE even in patients who are difficult to do this with other drugs, which is achieved due to the possibility of vasodilation at the periphery. Co-administration of ARBS with amlodipine also avoids the side effect of amlodipine, such as swelling of the ankles. The advantage of this combination due to its “metabolic neutrality” is its preference when prescribed for patients with impaired carbohydrate metabolism, including patients with metabolic syndrome and diabetes mellitus.
In addition, combinations of ACE inhibitors with amlodipine have been created, which both in their mechanisms of action and in their high efficiency resemble the above-described combinations of ARBS with amlodipine.
Patient monitoring and collaboration (treatment commitment)
The cooperation of the doctor and the patient is of great importance. It is difficult to overestimate the role of the doctor and his authority in the patient, which is the main prerequisite for cooperation and subsequent adherence to the prescribed treatment. In many hospitals and clinics created the “School for hypertensive patients” for patient education. After classes in these Schools, patients understand the dangers that lie in wait for them if they have an incorrect lifestyle and refuse to regularly take medications that reduce blood PRESSURE.
Patients with hypertension need to be regularly monitored by a doctor in a polyclinic. First, the optimal drug is selected, or more often-a combination of drugs, and the target blood PRESSURE figures are reached. The frequency of visits during dynamic monitoring depends on the patient’s overall risk category and blood PRESSURE level. An important task for the practitioner is to teach the patient self-control of blood PRESSURE. Low-risk patients can visit a doctor once every 6 months. For more severe hypertension, the frequency of sessions may be increased.