I have a problem with high blood pressure and have been taking sartans, but now I don't want to take them anymore, what medication can I change? If you really want to change your medication, then it's better to state the reason for wanting it, rather than thinking, from the beginning, about what medication you should change.

For hypertensive patients, sartans are a very important class of antihypertensive drugs, it is not only able to effectively inhibit vascular tension, control blood pressure, but also for the kidneys, the heart also have a certain target organ protection, the incidence of side effects is also relatively low, it is a very good class of antihypertensive drugs, want to change the drug, I tried to guess, not more than the following aspects of the reason - -

1. Numerous reports: Sartans have carcinogens;

2. I am not getting good control of my blood pressure with sartan-based antihypertensive drugs;

3. Taking sartan-type antihypertensive drugs with intolerable adverse effects in the body.

To give you a brief explanation of each of these 3 scenarios I guess exactly.

Sartans contain carcinogens to be changed?

This story stems from an announcement made in early July 2018 by the European Medicines Agency and Huahai Pharmaceuticals, which has detected genotoxic impurities in valsartan produced by Huahai PharmaceuticalsN-nitrosodimethylamine (NDMA). What is this stuff? It's what we often call nitrites, which are carcinogenic and genotoxic.

However, this matter did not end with a full investigation and announcement, in October 18, the European drug regulator found that the same genotoxic impurity, NDMA, was found in Irbesartan and Chlorosartan produced by two Indian pharmaceutical companies, and will be subjecting a wide range of Sartans, such as Olmesartan esters, Candesartan, Irbesartan, and Chlorosartan, to even more rigorous scrutiny.

As a result of these announcements and related reports, there are a lot of concerns in this regard, and are taking sartans friends, are still struggling with the question of whether to continue to take sartans to lower blood pressure. As of now, on the issue of sartans causing cancer, as there is no other updated news, about whether to change the drug, to give you the following a few tips -

1. If you are taking valsartan, and you are not sure about the valsartan of Huahai Pharmaceuticals and other domestic manufacturers (according to the announcement of the State Drug Administration, there are five related enterprises' products using the batch of valsartan involved in the incident), then you can choose the original drug Daiwen, and Novartis has already issued a statement that the valsartan marketed and sold in China is free of carcinogens;

2. If you are taking Irbesartan, Chlorosartan and other drugs, if it is not produced by the Indian pharmaceutical companies, there is no need to worry too much, after all, there is no relevant announcement that the domestic Irbesartan, Chlorosartan and other raw materials detected carcinogens, if you are not assured of the domestic treatment of the drug, you can choose to imported original drugs, such as Dyven, Cosuya, Meccalcitonin, Ambevi, Vilja, Otan, Biloxi, etc., usually the original research Usually, the quality of original research products is more guaranteed.

3. If you are still unsure, then according to the European Medicines Agency's announcement, which did not include temesartan, you may consider choosing temesartan if your blood pressure is well controlled on other sartans and your body tolerates them well.

For patients who originally took the relevant batch of valsartan containing carcinogens, there is no need to be too alarmed, Huahai Pharmaceuticals valsartan detected carcinogens only due to process modification of the relevant batch of products, and the national regulatory authorities even if the recall and processing, so the possibility of hypertensive patients to take long-term carcinogen-containing valsartan is not large.

How do I change my medication when I'm not doing well on a sartan to lower my blood pressure?

In general, if you are taking sartans and the effect of controlling blood pressure is not good, how to adjust the medication regimen, it is generally not recommended that you adjust the medication regimen on your own, and secondly, you should combine with your own physical condition and consult your doctor or pharmacist to adjust the medication.

For a single dose of sartans blood pressure control is not good, if the sartans are well tolerated, it is generally not recommended to change the drug directly, and more is recommended to use a combination of drugs to control blood pressure, calcium antagonists, such as amlodipine; diuretics, such as hydrochlorothiazide; β-blockers, such as betalactam, can be used in conjunction with sartan drugs to control blood pressure.

How do I change my medication if I have a physical intolerance to taking sartans?

Although the adverse reactions of sartans are fewer and the incidence is not high, but due to the great variety of human physique, the possibility of intolerant adverse reactions such as angioedema, hyperkalemia, etc. also exists, and if you take sartans and your body develops intolerable adverse reactions, you should of course switch to another medication to control your blood pressure. Common antihypertensive drugs have five categories, for the sartan drug intolerance, or take drugs during pregnancy, can not continue to take sartan drugs, according to the actual situation, choose other types of antihypertensive drugs to take, such as diphenhydramine drugs, etc., are good choices.

If the above 3 situations, you do not exist, taking sartans blood pressure control is good, the body does not appear adverse reactions, then there is really no need to change the drug, sartans will not produce drug resistance, is a long-term use of antihypertensive drugs.

Sartan antihypertensive drugs are very good choices for hypertensive patients and should be taken for a long time if there are no contraindications and blood pressure is well controlled. Medical Xin does not know the reason for the subject to replace the sartan, according to the information provided by the subject, the blood pressure 140/90mmHg has not yet reached the standard, if taking sartan for a shorter period of time, you should continue to insist on taking, because sartan lowering blood pressure to reach the standard need for a long time would have been; if you are taking sartan for several months, the blood pressure is still fluctuating in the 140/90mmHg and above, you can add a small diuretics, such as 6.25-25mg hydrochlorothiazide, to enhance the efficacy of antihypertensive therapy. 25mg of hydrochlorothiazide to enhance the antihypertensive efficacy. If the subject insists on replacing sartan, it is not without drugs.

Option 1: Replacement with Prilosec antihypertensive drugs

Pulley and sartan have similar antihypertensive mechanisms, and while lowering blood pressure, they can also inhibit the proliferation and hypertrophy of blood vessels and cardiomyocytes, protect renal function, reverse the thickening of blood vessel walls and left ventricular hypertrophy, inhibit myocardial remodeling, and reduce proteinuria. Therefore, Puli and Sartan are especially suitable for patients with hypertension combined with left ventricular hypertrophy, heart failure, post myocardial infarction, diabetic nephropathy, proteinuria and so on. However, long-term use of Prilosec antihypertensive drugs may cause dry cough, and a very small number of people may develop angioedema; while these adverse reactions occur in the sartan class of antihypertensive drugs are less likely. In terms of contraindications and precautions, both Puli and Sartan are contraindicated in patients with bilateral renal artery stenosis, pregnant women, hyperkalemia, and caution in patients with severe renal insufficiency.

Option 2: Replacement with a calcium channel blocker

Calcium channel blockers that we are familiar with diphenhydramine antihypertensive drugs, mainly through the expansion of small peripheral arteries to reduce blood pressure, the applicable population is mainly for the elderly hypertension, simple systolic hypertension, atherosclerosis, stable angina pectoris patients. However, adverse reactions such as ankle edema, headache, flushing, palpitations, gingival hyperplasia, etc. may occur during the use of calcium channel blockers, which is especially evident in short-acting and potent calcium channel blockers. Compared with sartan antihypertensive drugs, calcium channel blockers have a significant effect on lowering blood pressure, but their cardiovascular and renal protection is much less than that of sartan antihypertensive drugs.

Option 3: Replacement with beta-blockers

Beta-blockers, that is, we are familiar with metoprolol, bisoprolol, etc., mainly through slowing down the heart rate, inhibiting myocardial contractility, inhibiting sympathetic nerve activity to reduce blood pressure. Applicable people are patients with hypertension combined with fast heart rate, heart failure, coronary heart disease, etc. β-blockers can also protect our heart, long-term application, can reduce the mortality rate of patients with hypertension combined with heart failure, coronary heart disease, but compared with sartan, β-blockers do not protect the renal function of this role, may cause insulin resistance, mask or even prolong the hypoglycemic response, the use of which may occur headache, dizziness, and Bradycardia, cold extremities and other adverse effects. Patients with sick sinus node syndrome, high degree of atrioventricular block, and vascular lesions with risk of peripheral gangrene should not use beta-blockers, and switching medications should be done with caution.

In summary, sartan antihypertensive drugs lower blood pressure slowly, blood pressure reaches the standard for a longer period of time, suitable for patients with hypertension combined with left ventricular hypertrophy, heart failure, after myocardial infarction, diabetic nephropathy, proteinuria and so on. If the antihypertensive efficacy of sartan alone is not good, small-dose diuretics can be added. If you want to change the treatment program, you should be under the guidance of a specialist physician, exclude contraindications, combined with the individual situation, can be replaced with prilosec antihypertensive drugs, calcium channel blockers or β-blockers, as appropriate, and can not change the treatment program privately.

Thanks for reading!

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The current medications used to treat hypertension in general consist of five major classes: ACEIs, ARBs, beta-blockers, CCBs, and diuretics.

I. ACEI category

Angiotensin-converting enzyme inhibitors (ACEIs) are drugs that lower blood pressure by reducing the production of angiotensin II and the degradation of bradykinin. Angiotensin-converting enzyme catalyzes the production of angiotensin II from angiotensin I, which is a potent vasoconstrictor and activator of adrenocortical aldosterone release.ACEIs are also commonly known as priligy drugs, including captopril, enalapril, lenopril and so on, and they are used in the treatment of hypertension and heart failure as well as in the treatment of diabetic nephropathy. treatment of diabetic nephropathy, and it also reduces left ventricular remodeling. While the most common adverse effect is cough, ACEIs are contraindicated in bilateral renal artery stenosis, pregnancy, and hyperkalemia.

2、ARB类

Angiotensin II receptor antagonists, is a class of drugs with a high affinity for the angiotensin II receptor subtype AT1 receptor, by antagonizing the conversion of ACE to generate angiotensin II or blocking the generation of angiotensin II catalyzed through the non-classical pathway, compared with ACEI, which has the advantage of not generating the common adverse reactions due to the bradykinin accumulation caused by coughing, etc. The ARB class is the clinically known as the sartan class of drugs, including valsartan, chlorosartan, Irbesartan, timosartan and other drugs, which are less common adverse reactions are dizziness, pregnancy, bilateral kidney, and other adverse reactions. ARBs, commonly known as sartans in clinical practice, include valsartan, losartan, irbesartan, timosartan, and other drugs, which have fewer adverse effects, with dizziness being the most common adverse effect, and should be contraindicated in pregnancy and bilateral renal artery stenosis.

III. Beta-blockers

Beta-blockers are mainly used in young and middle-aged patients with hypertension and patients with tachyarrhythmias (premature beats, tachycardia, atrial fibrillation), myocardial ischemia, and high stress and sympathetic arousal. The common adverse effects are fatigue and bradycardia.

4、CCB类

Calcium channel blockers, it is through the blockade of calcium ions through the cell membrane of the selective calcium channels into the cell, thereby reducing the intracellular calcium ion concentration of a class of antihypertensive drugs, clinically commonly used "diphenhydramine" class of drugs even this type of drug, including nifedipine, amlodipine, nimodipine, nifedipine, etc., is mainly applicable to elderly patients with hypertension and hypertension with atherosclerosis, the common adverse effects of these drugs are facial flushing and ankle edema. The common adverse effects of these drugs are facial flushing and ankle edema.

V. Diuretics

Diuretics are mainly used to lower blood pressure through diuresis and sodium excretion to reduce the volume load. Currently, diuretics used for lowering blood pressure include thiazide diuretics (hydrochlorothiazide, chlorothiazide), cord diuretics (bumetanide, torasemide, etc.), potassium-preserving diuretics (spironolactone, amphotericin, amiloride), and analogues of thiazides (indapamide), among which the cord diuretics with cord diuretics are the strongest ones and are called high-efficiency diuretics, while thiazide diuretics are intermediate-effect diuretics and potassium-preserving diuretics are low-effect diuretics. diuretics, thiazide diuretics are intermediate-acting diuretics, and potassium-preserving diuretics are low-acting diuretics. Intermediate-acting diuretics are often used in the treatment of hypertension, and high-efficiency and low-efficiency diuretics are less frequently utilized; however, attention must be paid to the adverse effects of hypokalemia, and they should be used with caution in patients with hypertension accompanied by gout.

For those who do not want to take sartan antihypertensive drugs, you can choose other antihypertensive drugs, but hypertension is a complex condition, it is recommended that under the guidance of a physician, according to their own situation to switch to other classes of antihypertensive drugs, do not change their own medication.

The above is only a personal opinion, not as a basis for the use of medication, please use the medication under the guidance of a physician, any questions or views are welcome to leave a comment at the bottom of the article.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Understand your feelings, some time ago, China's production of valsartan drug contains cancer-causing ingredients, many drugs were recalled. This face is lost to the international level, really ......

High blood pressure medications are now available in the following main types:

• Diuretics (e.g., hydrochlorothiazide, spironolactone)

• Beta-blockers (e.g., atenolol, metoprolol, etc.)
• Calcium channel antagonists (e.g., amlodipine, nifedipine)
  
• ACEIs (e.g., captopril, ramipril, etc.)
• AII receptor blockers (e.g. irbesartan, valsartan, etc.)

These are the main types of antihypertensive drugs you can choose from.

But!

Different kinds of antihypertensive drugs have different effects and are suitable for different causes of high blood pressure. As I have mentioned earlier, there are many, many different causes of high blood pressure. Therefore, there are all sorts of choices in the selection of drugs.

Moreover, the adjustment of hypertension medication is very complicated, if the blood pressure is not well controlled during the adjustment period, it is easy to have cerebral hemorrhage if it is high, and easy to have insufficient cerebral blood supply if it is low.

The above hypertension medications should also not be paired randomly; for example, beta-blockers (various lorazepam) should not be combined with verapamil; spironolactone should not be combined with ACEI-type hypertension medications.

Therefore adjusting the medicine is also a complicated project. High blood pressure medication is not something that you can take whatever you want and as much as you want, nor is it something that you can take if you want to and not if you don't want to.Whether stopping, adding, reducing, or changing medication, it must be done under the guidance of a professional cardiovascular physician! Remember, do not adjust your medication at your own discretion!

Nifedipine is also good, but go to the hospital for doctor's advice and guidance

Amlodipine, one tablet a day, works well.