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Antihypertensive drugs commonly used in nephrology
Is still one of the most valuable anti hypertensive drugs. Including the furosemide excretion of potassium diuretics as the representative of the high Xiaopan diuretics and hydrochlorothiazide as the representative of the effect of thiazide diuretics for diabetic nephropathy sodium and water retention, but the tendency of hypokalemia, hyperuricemia and hyperglycemia. With spironolactone on behalf of aldosterone receptor blocker is a potassium sparing diuretic, antihypertensive diuretic effect also inhibited aldosterone, and can alleviate the damage of aldosterone on the cardiovascular system, because of its potassium sparing effect, patients with renal insufficiency with caution. Indapamide, which has diuretic and calcium antagonism, is especially suitable for mild and moderate hypertension. The utility model has the advantages of lasting effect, stable blood pressure and no disturbance of metabolism of sugar, lipid and uric acid.
(2) calcium antagonist (CCB):
It mainly reduces blood pressure by dilating peripheral resistance vessels, and has no dilation effect on the volume vessels at therapeutic doses. Including two non dihydropyridine and two hydrogen pyridine two categories, two dihydropyridine drugs such as nifedipine, amlodipine, felodipine, currently recommend the use of long-acting or sustained-release preparations, the short acting agents can cause blood pressure fluctuations and disorder of glucose and lipid metabolism, increased urine protein, is not recommended. Because calcium antagonists can reduce glomerular capillary pressure, reduce macromolecular substance deposition in glomerular mesangial region, inhibit the proliferation of mesangial cells and matrix to reduce the development of glomerular sclerosis, which has renal protective effect.
(3) receptor blocker:
Beta blockers can inhibit sympathetic pressor effect, representative drug atenolol, metoprolol, but need to pay attention to heart side effects, slow conduction block, bronchial asthma with caution.
A1 receptor antagonist can selectively block vascular smooth muscle postsynaptic A1 receptor, the blood vessels, causing peripheral vascular resistance and decreased blood volume decreased, and its effects on heart rate blood pressure, small, does not affect the renal blood flow and glomerular filtration rate. On behalf of the drugs are prazosin, terazosin and urapidil.
Alpha and beta blockers is a kind of new antihypertensive drugs, can promote glomerular capillary endothelial cells to release nitric oxide, resulting in intracellular ATP outflow, so that the glomerular microvascular relaxation expansion, improve microcirculation. For example, Arotinolol and Carvedilol, combined with calcium antagonists, not only show an effective hypotensive effect, but also effectively alleviate the further deterioration of renal function and cardiovascular complications. In addition, alpha - and beta receptor blockers mostly have high protein binding rates, and dialysis patients do not need to adjust their dosage or manner. But because carvedilol blocks the action of beta 1 and beta 2 receptors, they are nonselective. Attention should be paid to its side effects on glucose metabolism and respiratory diseases.
(4) angiotensin converting enzyme inhibitor (ACEI):
ACEI can block the formation of angiotensin II, aldosterone synthesis decreased, reduce blood pressure from reducing vascular resistance and blood volume of two; in addition, ACEI can also function in the kidney of RAS, expansion, glomerular afferent arterioles, and expansion of the efferent arteriole is stronger than the afferent arteriole, improve glomerular cross membrane pressure, high filtration, high perfusion, delay the renal damage process; improve the permeability of glomerular filtration membrane of albumin, reduce urinary protein; reduce the accumulation of glomerular extracellular matrix, reduce glomerular hardening. Now that the ACEI effect in protecting kidney antihypertensive drugs in the affirmative, ACEI drugs commonly used with captopril and benazepril, ramipril, Bea Knapp Leigh and Phu Simpson Leigh. When using ACEI, start with a small dose, gradually increase the volume, and keep your blood pressure at a satisfactory level. Is generally believed that the serum creatinine (Scr) below 265 mol/L can be used safely, if the drug increased Scr less than 50%, and no withdrawal can recover in 2 weeks is normal reaction; if Scr increased by more than 50% or more than the absolute value of L33 mol/L, taking 2 weeks not to drop, which is abnormal should be, should be discontinued. Benazepril is highly permeable to the renal tissue and the metabolite is excreted partly through bile, only in the creatinine clearance rate (Ccr).
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