High blood pressure, or high blood pressure, represents an abnormally high pressure of blood on the wall of the arteries. In a problem-free person, blood pressure rises under stress or during physical exertion. In hypertensive patients, blood pressure remains high constantly, even at rest or without stress. In France, 15 million people are affected and only 11 million are taking treatment. Since hypertension is very different depending on the patient, many drugs exist. Update on their mechanisms and side effects.
The angiotensin receptor antagonists II (ARA-II) or sartans
These drugs block the effect of angiotensin II at the angiotensin AT1 receptor. The main side effects are low blood pressure, functional renal failure or hyperkalemia (excess potassium in the blood plasma). They were also accused for a time of increasing the risk of myocardial infarction.
Diuretics
These act on the kidney and are generally associated with other drugs whose action they increase on blood pressure. Unfortunately, they can cause diabetes. In high doses, they can also have harmful consequences on sexuality such as erectile dysfunction or libido.
Converting Enzyme Inhibitors (ACE inhibitors)
They have a favorable action on the arteries and on the heart and are also used to treat heart failure. The main side effect is coughing but it goes away after treatment is stopped.
Aminopeptidase A inhibitors in the brain
“Firibastat is a molecule that has been proposed for several years as being a therapeutic option in humans. It was tested on animal models and then in the healthy volunteer. It is a pro-drug which crosses the blood-brain barrier, which is transformed in the brain into a product which will block aminopeptidase A and cause a diuretic effect but which is not diuretic (this can therefore have an effect especially for hypertensions that are not related to salt), a decrease in the sympathetic nervous system and a decrease in vasopressin. It’s an antihypertensive and not a hypotensive ”, explains Jean-Jacques Mourad, professor of medicine and head of the internal medicine department of the Paris Saint-Joseph hospital group, in a program of Fréquence Médicale on hypertensions difficult to treat.
“Have a molecule that adjusts to the initial level of blood pressure (…) is quite interesting and promising in terms of tolerance, in particular for the population with low renin such as the obese and African-Americans. The latter have a second risk associated with hypertension: diabetes. The problem is that when they are given diuretics, because they only respond to that, it increases the risk of diabetes. So it’s not the best idea. This is why, a diuretic effect adapted to their physiology, free from the complications of diuretics seems an interesting option for them ”, he continues.
However, if “this molecule seems to work on the dedicated population ”, for now, “it’s hard to predict the amount of profit ”. Indeed, “more studies are needed on patients and with a group placebo”. As for side effects, after an eight week clinical trial, “there are no catastrophic things from a biological point of view ”, reports Jean-Jacques Mourad. “We see a bit of a headache but it’s hard to know if it’s really because of this. Some skin reactions have been observed but with less frequency than with diuretics. In particular, polymorphic erythemas have been observed, but in less than 10% of patients, it is a completely reversible phenomenon ”, assures the doctor.
Renin inhibitors (IDR)
They work by blocking a substance secreted by the kidney that causes arteries to contract. They often cause coughing and, much more rarely, rashes or neutropenia (hematological disorder characterized by a low level of granulocytes – or polynuclear – neutrophils in the blood).
Beta blockers
They reduce the frequency and strength of heartbeats by decreasing the activity of the nervous system. They may cause drowsiness or tiredness, wheezing and difficulty breathing, depression, nightmares, cold hands and feet, dizziness or unusual swelling of the feet and ankles.
Calcium antagonists
They soften the arteries and help in angina but can lead to ankle edema.
Alpha blockers
They act directly on the arteries but can cause a drop in blood pressure when standing.
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