Is Lol the first choice for hypertension? Which one is better, "Method" or "Bisso"?

A friend asked Huazi, I heard that rolol drugs are no longer the first-line drugs for hypertension. Why is that? What are the differences between the commonly used metoprolol and bisoprolol in terms of medication?

Hua Zi said that in some foreign hypertension guidelines, loratadine is no longer considered a first-line antihypertensive drug. But this does not mean that hypertensive patients cannot use loratadine , but they should choose a more appropriate antihypertensive drug based on their individual conditions. The same is true for the choice between metoprolol and bisoprolol, which mainly depends on whether it is suitable for their condition.

1. Hypertension and Lolamine-type drugs

The main function of Lolamine drugs is to slow down the heart rate, reduce myocardial oxygen consumption, and prevent myocardial ischemia. Their antihypertensive effect is weaker than other antihypertensive drugs, and they may affect the metabolism of blood sugar and blood lipids. Therefore , in the treatment of simple hypertension or hypertension accompanied by abnormal glucose and lipids, Lolamine drugs are usually not the first choice .

However , for hypertension accompanied by angina pectoris of coronary heart disease, chronic heart failure, and tachyarrhythmia, the use of Lol drugs is more beneficial . Therefore, for elderly hypertensive patients with heart disease, or young and middle-aged hypertensive patients with a fast resting heart rate (greater than 80), Lol drugs can be used as a priority.

2. The difference between metoprolol and bisoprolol

Metoprolol has a fast metabolism time and is suitable for short-term heart rate control. For example, taking metoprolol tartrate tablets sublingually can quickly control heart rate. However, if you want to achieve a long-term effect, you need to increase the frequency of medication or take a long-acting preparation (metoprolol succinate sustained-release tablets). Metoprolol has large individual differences, and the therapeutic dose ranges from 50 to 200 mg per day .

The absorption of metoprolol tartrate tablets is easily affected by diet, so they must be taken on an empty stomach and cannot be taken with food, but they can be crushed and taken through a nasogastric tube. Metoprolol succinate sustained-release tablets are not affected by diet, and the scored tablets can be broken apart for consumption, but they cannot be crushed or chewed.

Bisoprolol has a slow metabolism time and a slow onset of action but a long duration of efficacy . The therapeutic dose is 2.5 to 10 mg per day, and it can be taken once a day.

3. Safety of Metoprolol and Bisoprolol

Bisoprolol has higher receptor selectivity, so it has less impact on the respiratory tract than metoprolol. For people with chronic obstructive pulmonary disease (COPD), bisoprolol is safer .

By the same token, bisoprolol has a slightly smaller effect on blood lipids and blood sugar. However, all sirolimus drugs can mask the symptoms of hypoglycemia (such as tachycardia and tremor, etc.), so diabetics should be cautious when using sirolimus drugs and pay close attention to blood sugar changes.

Metoprolol has a higher lipid solubility, while bisoprolol is both water-soluble and lipid-soluble, so metoprolol can more easily pass through the blood-brain barrier and enter the central nervous system . Relatively speaking, the incidence of central adverse reactions (such as dizziness, headache, sleep disorders, etc.) is higher.

It should be noted that after long-term use of both drugs, if the drug is suddenly stopped, "withdrawal reaction" may occur , which is manifested as a sudden increase in blood pressure and heart rate, which may induce angina pectoris or even myocardial infarction. Therefore, when stopping the drug, the dosage of both drugs should be gradually reduced . The usual method is to halve the dosage every 3 days until it is reduced to the lowest dosage, and then continue to use the drug for 4 days, and then stop the drug.

In summary, when treating simple hypertension, loratadine is not the first choice; but for hypertension with heart disease, loratadine can be used first. Metoprolol has a faster onset of action, while bisoprolol has a longer duration of action. Relatively speaking, bisoprolol has fewer adverse reactions than metoprolol, but neither can be stopped suddenly.

Drugs must be used under the guidance of a doctor. If you have any questions about medication, please consult a doctor or pharmacist. I am pharmacist Huazi, welcome to follow me and share more health knowledge.