Chronic nephritis, the remaining and (or) the renal unit in a compensatory high hemodynamic state, systemic hypertension will undoubtedly aggravate this condition, leading to progressive glomerular injury, so patients with chronic nephritis should be positive Control of high blood pressure, prevent deterioration of renal function. So how to do high blood pressure chronic nephritis?
Angiotensin converting enzyme inhibitors are used as first-line antihypertensive drugs
In recent years, through a series of studies confirmed that most scholars have angiotensin converting enzyme inhibitors as a first-line antihypertensive drugs. Recently, many clinical studies have confirmed that calcium antagonists, such as nifedipine, nicardipine and other treatment of hypertension and delay the deterioration of renal function have a more positive effect.
Studies suggest that calcium antagonists, despite the slight expansion of the role of small arteries, but because it has significantly reduced the role of systemic blood pressure, it can be involved or only part of the involvement of glomerular hyperthyroidism, high metabolic status In addition, calcium antagonists reduce oxygen consumption, antiplatelet aggregation, through the cell membrane effect to reduce calcium in the interstitial deposition and reduce excessive cell membrane oxidation, so as to achieve the effect of reducing kidney damage and stable renal function.
Clinical reports, short-term (4 weeks) or long (1 to 2 years) with calcium antagonists in the treatment of chronic renal insufficiency nephritis patients, did not find any glomerular injury, but clearly proved that it and angiotensin conversion Enzyme inhibitors have very similar effects of delaying the deterioration of renal function. And angiotensin-converting enzyme inhibitors in different places, it is generally no urinary protein effect. It should be noted that some scholars believe that calcium antagonists on renal function, there is still a need for longer-term observation.
Such as the United States and more peace of mind, amino acid security, renin-dependent hypertension have a better effect. Β-blockers have reduced the role of renin, the drug although the reduction of cardiac output, but does not affect renal blood flow and GFR, it is also used for the treatment of renal parenchymal hypertension. It should be noted that some β-blockers, such as acetohydroxyanine and naphthalene hydroxyl, liposuction is low, since the kidney excretion, so renal insufficiency should pay attention to adjust the dose and prolong the medication time.
Vascular drugs such as hydralazine also have antihypertensive effects
It can be used in combination with β-blockers to reduce vasodilator drugs to stimulate renin? Angiotensin system and other side effects (such as rapid heartbeat, water and sodium retention), and can improve the treatment effect. Hydralazine is generally daily 200mg, but must be alert to the drug induced lupus erythematosus-like syndrome may be. On the obvious edema, if the renal function is good, can be added with thiazide diuretics; poor renal function (blood creatinine "; 200μmol / L), thiazide drugs ineffective or ineffective, should be replaced with marrow loop diuretic Agent. Application of diuretics should pay attention to the body of electrolyte imbalance, and pay attention to increase the tendency of hyperlipidemia, hypercoagulable state.
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