Section 1: Non-Pharmacological Treatment

Section 1: Non-Pharmacological Treatment Suitable for all types of hypertensive patients, especially those with mild hypertension; non-pharmacological measures alone can lower blood pressure to a certain extent. (1) Limit Sodium Intake It is generally advisable to moderately restrict sodium intake, such as limiting salt to about 6 grams per day, whereas the average salt intake in China is 10–15 grams per day. Patients must be able to adhere to a low-sodium diet long-term. In addition to helping lower blood pressure, restricting sodium intake also enhances the antihypertensive effect of diuretics and reduces potassium loss caused by diuretics. (2) Lose Weight The relationship between obesity and elevated blood pressure is quite clear, possibly due to increased sodium intake, increased blood volume, heightened vascular reactivity, as well as hyperinsulinemia leading to increased renal tubular sodium reabsorption and increased sympathetic nervous system activity, all of which raise blood pressure. Losing weight mainly involves reducing monthly caloric intake, supplemented by appropriate physical activity. At the same time, limiting sodium makes the blood pressure-lowering effect more pronounced. (3) Exercise Engaging in physical activities such as running, walking, or swimming can lead to an increase in systolic blood pressure accompanied by a smaller increase in cardiac output and heart rate. Tai Chi and other traditional self-exercise practices favored by the general public in China involve relatively little physical exertion and have a modest blood pressure-lowering effect, but they can still benefit from reduced sympathetic nervous system activity. (4) Qigong and Other Methods Qigong is a traditional Chinese healthcare method that uses mental focus and breath regulation to promote self-adjustment and self-control, achieving mental calmness, physical relaxation, and harmonious qi flow, which is conducive to blood pressure regulation. Long-term qigong practice can help hypertensive patients better control their blood pressure, reduce the dosage of antihypertensive drugs needed, and lower the incidence and mortality rates of stroke. The mechanism of action of qigong is through regulating the central nervous system to reduce sympathetic tension, thereby achieving a blood pressure-lowering effect. Similar methods include relaxation, meditation, biofeedback, and Indian yoga (YOGA). Section 2: Antihypertensive Drug Treatment Currently, there are many types of antihypertensive drugs available. An ideal antihypertensive drug should be inexpensive, have proven efficacy, be easily accessible, require few doses per day, and be easy for patients to adhere to. In recent years, antihypertensive drugs have made great progress, and their blood pressure-lowering effects have continued to improve, but very few drugs fully meet all these requirements. In 1993, WHO/ISH recommended the following five classes of drugs as first-line antihypertensives: diuretics, beta-blockers, calcium channel blockers (CCB), angiotensin-converting enzyme inhibitors (ACEI), and alpha-1 receptor blockers. (1) Diuretic Antihypertensives Since chlorothiazide was first used clinically in 1958, it has always been the drug of choice for treating hypertension and serves as a first-line drug in stepwise therapy. It has proven efficacy, is inexpensive, works synergistically with other antihypertensive drugs to reduce their dosages, and remains widely used to this day. There are many types of diuretics currently in clinical use, broadly divided into four categories: ① thiazides (with hydrochlorothiazide as the representative), ② thiazide-like diuretics (such as chlorthalidone and indapamide), ③ loop diuretics (such as furosemide), and ④ potassium-sparing diuretics (such as amiloride and triamterene). Commonly used diuretics include: ① hydrochlorothiazide (hydrochlorothiazide), 25 mg per dose, taken once or twice daily. ② chlorthalidone, 25–50 mg per dose, taken once daily. ③ bendroflumethiazide (nephron), whose sodium-excreting potency is 5–10 times that of hydrochlorothiazide. Take 5 mg, 2–3 times daily. Maintenance dose: 0.5–5 mg per day. ④ cyclopenthiazide, which has a blood pressure-lowering effect but its diuretic effect is about 100 times stronger than that of hydrochlorothiazide. Take 0.25 mg, twice daily. Maintenance dose: 0.25 mg per day. ⑤ furosemide (lasix), which primarily inhibits the reabsorption of sodium in the outer limb of the renal loop, producing a diuretic effect. Take 20–80 mg, twice daily; adults can receive intramuscular or intravenous injections of 20 mg, once or twice daily. Suitable for hypertensive encephalopathy. ⑥ sodium urate, 25–50 mg, taken once daily. Intravenous drip of 25–50 mg, diluted in 250 ml of 5% glucose saline solution (once daily, suitable for hypertensive encephalopathy). ⑦ spironolactone (aldosterone antagonist), a potassium-sparing diuretic that can be used in combination with hydrochlorothiazide to enhance the diuretic effect. Take 20–40 mg, three times daily. ⑧ triamterene (triamterene), which inhibits the Na+-K+ exchange process in the renal collecting ducts, producing a sodium-excreting, diuretic, and potassium-sparing effect. Take 50–100 mg, two to three times daily. (2) Beta-Blockers They have been used clinically for nearly 30 years and are safe and effective antihypertensive drugs. The exact mechanism of action is not yet fully understood, but it may be related to reducing cardiac output, inhibiting renin, suppressing the central nervous system, reducing pre-synaptic beta-blockade to decrease norepinephrine release, and preventing the cardiovascular system from overreacting to catecholamines and stress. There are more than 20 types of beta-blockers currently in clinical use, all of which have the effect of lowering blood pressure. Commonly used beta-blockers include propranolol (Inderal), nadolol (Timolol), atenolol, metoprolol, etc., with few side effects; a small number of people may experience fatigue, impotence, or reduced exercise tolerance. It is best to avoid using any beta-blockers in patients with bronchial asthma. The reason why the dosage of beta-blockers prescribed to Chinese patients is significantly lower than recommended is unknown. Patients with heart failure should use them with caution. Propranolol is the most commonly used beta-blocker, suitable for all patients with hypertension and rapid heart rate (except those with asthma), at a dose of 10–20 mg, three times daily after meals. Labetalol also has alpha-1 receptor blocking effects, which can reduce peripheral vascular resistance; in cases of severe hypertension, it can be administered intravenously—dissolve 25–50 mg of labetalol in 10% glucose solution, 20 ml, and inject slowly over 5–10 minutes, or administer via intravenous drip if the blood pressure-lowering effect is not ideal. Can repeat once after 15 minutes; generally takes effect within 5 minutes. Oral dosage is 200–600 mg per day, divided into 2–3 doses, taken after meals, taking effect 1–2 hours later. Half-life is 4 hours. Few side effects; a small number may experience orthostatic hypotension, sometimes fatigue, nausea, numbness in limbs, and rashes, but generally does not affect heart rate or lipid metabolism disorders. Still contraindicated in cases of cardiac conduction block, heart failure, bradycardia, and asthma. (3) Calcium Channel Blockers The pathology of primary hypertension lies in the excessive opening of calcium ion channels in the smooth muscle cell membranes of blood vessels, leading to excessive influx of Ca²+, causing the sarcoplasmic reticulum inside the cells to release Ca²+, increasing the intracellular Ca²+ concentration, and consequently raising the tension of the vascular smooth muscle and peripheral vascular resistance. Calcium channel blockers may address the root cause of primary hypertension. Since skeletal muscle contraction does not depend on extracellular Ca²+ influx, calcium channel blockers have no inhibitory effect on it. There are three types of calcium channel blockers used clinically to treat cardiovascular diseases. Verapamil and diltiazem, in addition to lowering blood pressure, also act on the myocardium and cardiac conduction; dihydropyridines mainly act on vascular smooth muscle, without affecting myocardial contractility or conduction. Clinically, these antagonists are often chosen for treating primary hypertension, with the following characteristics: ① They work better for elderly patients with low-renin type hypertension and do not cause orthostatic hypotension. ② They mainly dilate arteries and veins rather than reduce cardiac output. ③ They take effect quickly, do not cause drug resistance, and do not lead to water or sodium retention. ④ They do not produce obvious metabolic abnormalities, do not affect blood lipids, blood sugar, uric acid, or renin-angiotensin levels, making them suitable for diabetic patients. ⑤ They dilate coronary arteries, do not cause peripheral vascular or bronchial spasms, making them suitable for patients with angina pectoris or bronchial asthma. ⑥ They increase renal blood flow without affecting kidney function. ⑦ They have few side effects and can improve quality of life. A representative of this class, nifedipine, takes effect quickly but can cause facial flushing and headaches due to capillary dilation, and ankle edema due to pre-capillary arteriole dilation. Calcium channel blockers have a sodium-excreting, diuretic effect, so they should not be mistaken for having excess fluid volume. Since the first-generation dihydropyridine calcium channel blocker nifedipine was introduced into clinical practice, more than ten second-generation formulations have since appeared, characterized by longer durations of action—some only need to be taken once a day (such as lercanidipine and felodipine)—and some have special selectivity for peripheral vessels, enhancing clinical efficacy. Nimodipine mainly acts on cerebral vessels, increasing cerebral blood flow and improving memory; nicardipine can dilate peripheral vessels, coronary arteries, and cerebral vessels; nisoldipine mainly dilates coronary arteries, with an efficacy 50 times greater than nifedipine. When calcium channel blockers alone are not effective, they can be combined with beta-blockers, sometimes achieving good blood pressure-lowering effects. Commonly used drugs include: ① nifedipine, also known as nifedipine or cardipine. It is a dihydropyridine calcium channel blocker that inhibits Ca²+ from entering cells from outside, thereby dilating blood vessels, reducing overall peripheral vascular resistance, slightly inhibiting the myocardium, dilating cerebral and renal vessels and coronary arteries, relieving spasms in cerebral and coronary vessels. It also combats atherosclerosis, inhibits platelet aggregation, promotes the production of prostaglandins (PGA) in vessel walls, and dilates bronchi to protect the myocardium. Suitable for hypertension and angina pectoris. Side effects include facial flushing, headaches, palpitations, nausea, and fatigue. If combined with beta-blockers or diuretics, side effects can be reduced and efficacy enhanced. Take 10–20 mg, three times daily. ② nimodipine has a weaker blood pressure-lowering effect than cardipine. Its main effect is on cerebral vessels, dilating cerebral vessels to increase cerebral blood flow and improve brain function. Suitable for mild to moderate hypertension, ischemic cerebrovascular disease, and subarachnoid hemorrhage causing cerebral vasospasm. Side effects are similar to cardipine but milder. Take 20 mg, three times daily, with a maximum dose of 240 mg per day. ③ nitrendipine, also known as nifedipine ethyl, has strong selectivity for vascular smooth muscle and does not affect cardiac conduction. When used in combination with beta-blockers, diuretics, or captopril, efficacy can be improved. Indications are the same as nifedipine. Start with 5 mg, once or twice daily, gradually increasing the dose according to blood pressure levels, with a maximum dose of 40 mg per day. ④ nicardipine can cross the blood-brain barrier, selectively dilate blood vessels, suitable for ischemic cerebrovascular disease and capable of dilating coronary arteries, as well as having a diuretic effect. High doses can cause bradycardia and conduction block, but have little impact on myocardial contraction. Indications and side effects are the same as nifedipine. Take 5 mg, three times daily, then gradually increase according to condition; common dosage is 30–60 mg per day, with a maximum dose of 120 mg per day. Other options include nisoldipine, which dilates blood vessels 4–10 times more than cardipine, has a longer duration of action, powerful anti-hypertensive effects, and can counteract arrhythmias caused by acute myocardial ischemia. ⑤ diltiazem, also known as diltiazem, has a chemical structure different from cardipine but a similar mechanism and efficacy to nifedipine in lowering blood pressure. It inhibits myocardial contractility and cardiac conduction, but less severely than verapamil. No reflexive sympathetic excitation. Mainly suitable for hypertension and angina pectoris. Contraindicated in sick sinus syndrome, atrioventricular block, bradycardia, and active liver disease. Easily triggers heart failure, occasionally causing fatigue, dizziness, sleepiness, nausea, and vomiting. Take 30 mg, three times daily. ⑥ verapamil is derived from poppies and is a calcium channel blocker. Suitable for mild to moderate hypertension, angina pectoris, arrhythmias, and cardiomyopathy. Its blood pressure-lowering effect is similar to cardipine, and it remains effective with long-term use. The heart rate does not need to be increased, and it can also be used in combination with diuretics, methyldopa, clonidine, and other drugs. 40~120 mg, taken orally 2 to 3 times daily. ⑦ Lohuaxi, also known as amlodipine, amolodipine, and anlodipine, is a dihydropyridine calcium antagonist whose action is similar to that of nifedipine, but it has stronger selectivity for blood vessels, can dilate coronary arteries and systemic blood vessels, increase coronary blood flow, lower blood pressure, and produce a slow but long-lasting effect; therefore, it can be taken once daily, suitable for treating hypertension and also for patients with stable angina pectoris, 5 mg, taken orally once daily, with the dose potentially increased later according to the situation, up to a maximum of 10 mg per day. (4) Angiotensin-converting enzyme inhibitors (ACEIs) ACEIs have been used clinically for more than ten years with very good therapeutic effects. ACEIs not only inhibit angiotensin II (Ang II) in the bloodstream, but also inhibit Ang II produced locally in tissues (especially the vascular wall), thereby reducing peripheral vascular resistance. After using ACEIs, the degradation of bradykinin decreases; bradykinin is a vasodilatory peptide. ACEIs can also activate phosphodiesterase, stimulating the synthesis of arachidonic acid and prostaglandins. Bradykinin and prostaglandins can directly dilate blood vessels and also reduce the responsiveness of blood vessels to pressor substances. This explains why ACEI treatment can also achieve blood pressure reduction in patients with low-renin hypertension. Karl-strom G. (1990) reported that ACEIs can also increase the secretion of medullary hormones, which can cause vasodilation and lower blood pressure. It is now known that captopril 75 mg/day, divided into three doses, can approach the maximum antihypertensive effect; when used in combination with hydrochlorothiazide, it can enhance the antihypertensive effect and correct the latter's side effects, such as hypokalemia. Because it can reduce both preload and afterload, it has a protective effect on the heart. By reducing stimulatory factors such as catecholamines and Ang II, it can reverse left ventricular hypertrophy, scavenge free radicals to prevent ischemic arrhythmias, improve coronary blood flow, and prevent and treat congestive heart failure. Extensive clinical practice has confirmed that ACEIs are antihypertensive drugs with good efficacy and few side effects. The main side effects are hypotension, renal insufficiency, and hyperkalemia. When using ACEIs, attention should be paid to monitoring blood electrolytes and renal function, and they should not be used in combination with potassium salts or potassium-sparing diuretics. Renal insufficiency often occurs in cases of bilateral renal artery stenosis, solitary kidney with renal artery stenosis, or congestive heart failure with insufficient renal blood flow. Another side effect is dry cough, sometimes quite prominent, with an incidence of about 5%, the mechanism of which remains unclear. In addition to captopril, more than ten new products have emerged from ACEIs, such as enalapril, perindopril, benazepril, cilazapril, ramipril, etc. ① Captopril (Capoten, mercaptoproline), is suitable for patients with mild, moderate, and severe hypertension. The initial dosage is 25 mg, taken twice daily, with a maximum daily dose of 150 mg. If the patient is already receiving other antihypertensive medications, the initial dose of 12.5 mg, taken twice daily, is also effective. For patients with renal insufficiency, the dosage should be adjusted according to the decline in creatinine clearance. Toxicity and side effects are related to the dosage; at low doses, the incidence of side effects is very low, with the most important side effects being nephrotoxicity and bone marrow suppression (granulocytopenia, accounting for 0.02%). In patients with renal insufficiency or collagen vascular diseases, the incidence of these two side effects increases. Less common side effects include skin rash (7%), taste disturbance (3%), symptomatic hypotension (5%–10%, especially in patients whose blood volume decreases after taking diuretics), and cough, which may be due to elevated levels of bradykinin in the circulation and disappears after discontinuation of the drug. ② Enalapril (benzylpropionic acid), is a non-thiol converting enzyme inhibitor; after oral absorption, it is metabolized in the liver into an ethyl ester with biological activity before it takes effect. Therefore, the onset of action of enalapril is delayed by 0.5 hours compared to captopril, and its plasma half-life is longer than that of captopril. On this basis, some patients only need to take it once a day. The secondary side effects are similar to those of captopril, but neurogenic edema may occur more frequently with enalapril. The initial dose is 2.5–5 mg per day, with the usual dosage range being 10–40 mg per day, which can be administered all at once or in divided doses. ③ Xinpu acid, also a non-thiol long-acting ACEI, differs from enalapril in that it does not require hepatic metabolism and acts directly. It has no metabolic side effects, and its secondary side effects are similar to those of other converting enzyme inhibitors. The usual initial dose is 5–10 mg per day, taken in one or two doses, with a maximum dose of 40 mg per day. In 1988, the U.S. National Joint Committee designated the above four classes of drugs as first-line antihypertensives. (5) Other commonly used clinical antihypertensive drugs (1) Selective α₁ receptor antagonists (such as prazosin and terazosin). They do not affect the feedback action of norepinephrine through presynaptic α2 receptors, thus avoiding tachycardia, and do not need to be used in combination with β-blockers. They can lower blood lipids, LDL-C, and increase HDL-C. ① Prazosin: is the earliest α1 blocker used clinically and is still often combined with diuretics for antihypertensive treatment. It can dilate small arteries and veins, reducing both the heart's preload and afterload. The initial dose often causes orthostatic hypotension and syncope, so elderly patients should use it with caution. Generally, the initial dose does not exceed 0.5–1.0 mg, taken before bedtime, and can be gradually increased to 10 mg/day, divided into two doses. Since it can cause water and sodium retention, combining it with diuretics can enhance the effect. Side effects at the beginning of use may include nausea, dizziness, headache, drowsiness, palpitations, orthostatic hypotension, occasional dry mouth, skin rash, febrile polyarthritis, etc.; patients with severe heart disease or mental illness should use it with caution. ② Terazosin: is a recently used α₁ receptor blocker with the same mechanism of action as prazosin; taking it once daily is sufficient to maintain 24-hour antihypertensive effect. It has few side effects, occasionally causing dizziness and fatigue. Literature reports that it can also lower blood lipids and reverse left ventricular hypertrophy. (2) Non-selective sympathetic nerve inhibitors. Because they non-selectively block both the sympathetic and parasympathetic systems, they have many side effects, and in severe cases can lead to intestinal paralysis. Guanethidine is a sympathetic nerve terminal blocker that inhibits the release of norepinephrine from postganglionic sympathetic neurons, resulting in strong antihypertensive effects. It was once widely used in patients with moderate to severe hypertension, but due to numerous side effects—mainly orthostatic hypotension and sexual dysfunction—it has been gradually replaced. ① Clonidine: animal experiments have shown that it can stimulate α receptors in the solitary tract nucleus of the medulla oblongata, reducing the excitability of the sympathetic nervous system on the cardiovascular system. For example, if an α receptor blocker (phentolamine) is given before using clonidine, it can block clonidine's antihypertensive effect. Clonidine has a vasoconstrictive effect on peripheral blood vessels; patients with high blood pressure may experience a slight increase in blood pressure within minutes of using clonidine, usually lasting only a short time, after which the central effect takes over. Clonidine also acts on the central nervous system to inhibit ACTH release; by suppressing sympathetic nerve activity, it can also inhibit renin release. When used in combination with diuretics, there is a synergistic effect; some estimate that the combination can control 70% of patients with mild to moderate hypertension. The total daily oral dose should be less than 0.4 mg, which not only reduces side effects but also prevents rebound hypertension upon discontinuation. Orthostatic hypotension is rare. Due to its effects on the central nervous system, it can cause drowsiness and dry mouth, leading about 7% of patients to discontinue use. Now there are transdermal patches available that last a long time, applied once a week, maintaining stable blood concentrations with fewer side effects and easy application. ② Methyldopa: similar to clonidine, it stimulates α receptors in the central nervous system, inhibiting sympathetic nerve activity to produce antihypertensive effects. Previously, it was believed that methyldopa was a false neurotransmitter interfering with norepinephrine synthesis, but this has not been confirmed by animal experiments. The usual dosage is 500–700 mg/day, divided into two or three doses; monotherapy can lead to compensatory water and sodium retention, so it is often used in combination with diuretics for a synergistic effect. The main side effects are drowsiness, dry mouth, sexual dysfunction, and it can also affect memory and thinking; a small number of patients may experience orthostatic hypotension. 25% of patients test positive in the Coombs test, but hemolytic anemia occurs in less than 1%. A small number of patients experience elevated SGPT and drug fever; patients with hepatitis should not use this drug. ③ Reserpine (Xue’anping, snake root alkaloid): its main function is to reduce the storage of norepinephrine and serotonin in the brain and peripheral nerve terminals. Animal experiments show that after using reserpine, catecholamines in nerve terminals begin to decline after 1 hour and reach their lowest point after 24 hours, while also having antihypertensive and sedative effects, able to lower blood pressure and slow heart rate. Its antihypertensive effect is characterized by being slow, gentle, and long-lasting. Blood pressure slowly decreases 2–3 days to 1 week after taking the drug; after several weeks, it reaches its lowest point. The usual dosage is 0.25–0.5 mg per day, taken all at once or divided into three doses. This drug has been used clinically for a long time and is inexpensive, but it has many side effects, such as nasal congestion, asthma, diarrhea; large doses can cause tremors and paralysis, and patients with stomach and duodenal problems may experience bleeding when using this drug. Especially for neurological conditions such as depression and sexual dysfunction, it has gradually been replaced by other antihypertensive drugs. However, due to the low price of compound preparations containing reserpine in China, it still has a relatively large market at the grassroots level. (3) Vasodilators. ① Sodium nitroprusside: a powerful vasodilator that can directly dilate small arteries and veins. It takes effect quickly, but the effect disappears rapidly after stopping the drug. Clinically, it is mainly used to control hypertensive crises because it can reduce both the heart's preload and afterload, thereby improving cardiac function. The antihypertensive effect is certain, with no drug resistance; it can only be administered intravenously, with dosages starting from 0.5–1.0 μg/(kg·min), and blood pressure is controlled by adjusting the infusion rate. During administration, blood pressure should be closely monitored to avoid excessive reduction. The drug metabolizes in the body to produce thiocyanate salts; patients with renal insufficiency or long-term high-dose use are prone to accumulation toxicity, clinically manifested as fatigue, mental disorders, muscle spasms, and methemoglobinemia. The aqueous solution is unstable; during infusion, it should be protected from light, and the prepared solution should not be used after more than 4 hours. ② Hydralazine: mainly dilates small arteries, reducing peripheral resistance and lowering blood pressure. Because it can cause reflexive excitation of the sympathetic nerves, leading to increased renin secretion, faster heart rate, and water and sodium retention, it is often used in combination with diuretics and β-blockers. If the dose exceeds 200 mg/day, it can cause fever and joint pain, even lupus-like syndrome, which limits its use. ③ Minoxidil: its action is similar to hydralazine, but stronger and more durable, with significant antihypertensive effects. The usual dosage is 5.0 mg/day, divided into two doses, which can be gradually increased to 1–20 mg/day, divided into two doses. It can cause water and sodium retention and compensatory sympathetic nerve excitation, so it is often used in combination with diuretics and β-blockers. Hirsutism is a common side effect, often used to treat refractory hypertension and hypertension in patients with renal insufficiency. (6) New antihypertensive drugs The search for new, highly effective, and low-side-effect antihypertensive drugs remains a research hotspot. With advances in pharmacological molecular biology, many new antihypertensive drugs are being launched one after another, such as renin inhibitors, atrial natriuretic peptide regulators, and 5-hydroxytryptamine (5-HT) receptor antagonists and agonists, all of which show promising prospects. (7) Compound formulations According to the principle of combined medication, compound formulations are prepared, including diuretics, β-blockers, vasodilators, and central nervous system depressants; some also replace β-blockers with reserpine, along with other sedatives. ① Compound reserpine: each tablet contains 0.125 mg of reserpine, 12.5 mg of hydralazine, 12.5 mg of hydrochlorothiazide, and 100 mg of potassium chloride. Because the doses of reserpine and hydralazine are relatively small, their respective side effects can be reduced; the addition of hydrochlorothiazide can strengthen the antihypertensive effect; and the inclusion of potassium chloride is to prevent hypokalemia. Take 1–2 tablets each time, 1–2 times a day. ② Compound antihypertensive tablets: each tablet contains 0.032 mg of reserpine, 4.2 mg of hydralazine, 3.12 mg of hydrochlorothiazide, 2.1 mg of promethazine, 2 mg of diazepam, 1 mg each of vitamin B₁, vitamin B6, and calcium pantothenate, plus 30 mg of potassium chloride and 30 mg of magnesium silicate. Suitable for early and mid-stage hypertension, with few side effects. Take 1–2 tablets each time, 3 times a day. ③ Adafin: each tablet contains 10 mg of hydralazine, 0.1 mg of reserpine, and 10 mg of hydrochlorothiazide. Take 1–2 tablets each time, 2–3 times a day. ④ Pulse Shujing: each tablet contains 0.15 mg of reserpine, 10 mg of hydrochlorothiazide, 5 mg of cranial pain reliever, 10 mg of vitamin B₆, 10 mg of methyl orange peel extract, and 30 mg of potassium chloride, suitable for various types of hypertension. Take 2 tablets each time, 3 times a day. Continue taking them until blood pressure returns to normal, then switch to maintenance dosage, 1–2 tablets a day. ⑤ Anda Xueping tablets: each tablet contains 0.1 mg of reserpine and 10 mg of hydralazine. Uses are the same as reserpine. The two ingredients work synergistically, reducing the dosage and corresponding side effects. Take 1–2 tablets each time, 3 times a day. ⑥ New antihypertensive tablets: each tablet contains 0.04 mg of reserpine, 4 mg of hydralazine, 250 mg of summer extract, 5 g of goji berry root extract, 5 g of pearl mother extract, and 2.5 g of plantain extract, suitable for primary or secondary hypertension. Antihypertensive effects begin 3–5 days after taking the drug, with few side effects generally. Take 2 tablets each time, 3 times a day, usually one course lasts a month. After one course, if the condition has stabilized, the dosage can be reduced to 1–2 tablets a day, 1 tablet each time. ⑦ Antihypertensive static tablets: each tablet contains 0.1 mg of reserpine, 10 mg of hydralazine, and 12.5 mg of hydrochlorothiazide, suitable for cases where antihypertensive drugs like Jiaoyuanling have not achieved satisfactory results, also applicable to renal hypertension complicated by arteriosclerosis. Take 1–2 tablets each time, 2–3 times a day. After taking them, blood pressure drops, and you can continue taking them to consolidate the effect; if blood pressure does not drop after 1–2 weeks, add other antihypertensive drugs. Some patients experience palpitations, headaches, and other side effects after taking them, but continuing to take them will gradually alleviate these symptoms. ⑧ Compound clonidine: each pill contains 0.075 mg of clonidine, 4 mg of Jiaoyuanling, 25 mg of hydrochlorothiazide, 20 mg of rutin, 50 mg of vitamin C, and 30 mg of pyridoxine. Take 1 pill each time, 1–2 times a day. The therapeutic effect is better than clonidine, while the side effects are milder (pyridoxine can alleviate dry mouth and fatigue). ⑨ Zhenju antihypertensive tablets (Juleining antihypertensive tablets): formulated from clonidine, pearl powder, wild chrysanthemum, sophora japonica, hydrochlorothiazide, and other Chinese and Western medicines; each tablet contains 30 μg of clonidine, suitable for various types of hypertension, especially stage II hypertension. Take 1 tablet each time, 3 times a day. For refractory cases, the dose can be increased to 2 tablets each time, 3 times a day, and after blood pressure basically stabilizes, switch to 1 tablet each time, 1–2 times a day for maintenance. ⑩ Antihypertensive aerosol: a compound formulation of clonidine, cyclopentathiadine, vitamin E, etc., 14 g per bottle, containing 3 mg of clonidine. Effective for primary hypertension. The antihypertensive effect is fast, with fewer side effects than using clonidine alone; occasionally dizziness and drowsiness may occur, but it is contraindicated for patients with hepatic coma. Usage: therapeutic dose is 3 times a day, 2 sprays each time for inhalation. Maintenance dose: after blood pressure returns to normal, take 1 spray each time, 2 sprays daily.