A New Antihypertensive Strategy In Patients With Refractory Severe Hypertension With Renal Insufficiency

Objective: To observe the efficacy of calcium antagonists,a new antihypertensive strategy in patients with refractory severe hypertension with renal insufficiency,and to provide a feasible solution for common clinical problems.Methods: From March 2017 to November 2018,46 patients with refractory severe hypertension treated in the Department of Kidney,General Hospital of Tianjin Medical University were analyzed retrospectively,which met the diagnostic criteria of refractory hypertension.At the level of severe hypertension [sbp ≥ 180 mmHg and / or dbp ≥ 110mmHg],patients with renal insufficiency.All patients were previously treated with reasonable and sufficient doses of three or more different mechanisms of antihypertensive drugs or all possible antihypertensive regimens,while blood pressure was still ≥ 180 /110 mmHg,24 hours blood pressure monitoring was given.Two kinds of dihydropyridine calcium antagonists were combined with antihypertensive therapy.The monitoring values of blood pressure were recorded,the dosage of drugs was adjusted according to the fluctuation of blood pressure,the treatment was maintained after blood pressure was stable,and the monitoring of blood pressure was stopped.Serum creatinine and urinary protein were reviewed and recorded,and blood pressure was monitored every day during hospitalization.After discharge,the patient was told to insist on self-test blood pressure,and the patients were followed up for a long time by outpatient follow-up and telephone follow-up.The blood pressure,serum creatinine,24-hour urinary protein quantity,liver function abnormality and lower extremity edema were recorded.Abnormal electrocardiogram and other adverse reactions,clinical symptoms at any time to review the relevant tests.Results:The results showed that the systolic and diastolic blood pressure of the patients was significantly lower than that of the treatment(p <0.01),the rate of reduction was 47.83%,and the total effective rate was 97.83%.In the treatment,only 2 patients had gingival hyperplasia,no adverse reactions such as liver function abnormality,palpitations,and lower limb edema were found,and the incidence of adverse reactions was 4.34%.Conclusions:The combined application of two dihydropyridine calcium antagonists has obvious effect on controlling blood pressure in patients with refractory severe hypertension with renal insufficiency,and can effectively protect renal function.No obvious adverse reactions were found in the course of the study.It is helpful to improve the prognosis of patients and is worthy of further clinical observation and research.