Analysis Of Risk Factors In Hypertensive Patients With Chronic Kidney Disease (CKD) And Observation Of The Efficacy Of Sacubitril/valsartan In Improving Renal Function

Objective:1.General data and laboratory indexes of patients with essential hypertension were collected to analyze the related risk factors of hypertension patients with chronic kidney disease.2.To compare the changes of renal function indexes between the two groups of hypertensive patients with CKD after 6 months of treatment,and to evaluate the clinical efficacy of Sacubitril/Valsartan and individualized RAAS inhibitors in improving renal function,so as to provide optimal antihypertensive treatment for hypertensive patients with renal function damage.Methods:1.A total of 746 patients with essential hypertension were selected from the Department of Cardiology and Nephrology of our hospital from June 2021 to November 2022.The Glomerular filtration rate(e GFR)was calculated.The general clinical data and laboratory indexes were collected to analyze the risk factors of hypertension with chronic kidney disease(CKD).2.A total of 400 hypertensive patients with CKD were collected.Antihypertensiv-e drugs included the calcium antagonists,the diuretics,the β-adrenoceptor antagonist-s,the Sacubitril/Valsartan and Renin-angiotensin-aldosterone-system inhibitors(ACEI/ARB).Taking oral Sacubitril/Valsartan as the study group and oral ACEI/ARB as the control group,the related indexes of renal function of the two groups were collected b-efore and 6 months after treatment,including e GFR,creatinine,urea nitrogen,uric ac-id,retinol binding protein,serum Cystatin,urinary protein,urinary albumin creatinine ratio and to analyze the clinical efficacy of Sacubitril/Valsartan and Renin-angiotensin-aldosterone-system inhibitors in improving renal function in hypertensive patients wi th CKD.Results:1.The grade and course of hypertension,BNP,albuminuria,uric acid and low density cholesterol lipoprotein were independent risk factors for hypertension patients with CKD(p<0.05).2.There were significant differences in age,grade of hypertension,course of hypertension and combined use of diuretics between the study group and the control group before treatment(p<0.05).There were significant differences in urinary protein and urinary albumin/creatinine ratio between the two groups(p< 0.05).The tendency score(Propensity score matching,PSM)was used to match the 1:1PSM between the study group and the control group.After matching,there were 141 patients in each group.In the study group,there was no significant difference in serum potassium,blood urea nitrogen,retinol binding protein and serum cystatin(p>0.05)before and after treatment,but there was significant difference in e GFR,serum creatinine and urinary albumin creatinine ratio(p<0.05).After treatment,e GFR was improved and the serum creatinine and urinary albumin creatinine ratio was decreased.In the control group,there was no significant difference in serum potassium,blood urea nitrogen,retinol binding protein and serum cystatin(p>0.05)before and after treatment,but there was significant difference in e GFR,serum creatinine and urinary albumin/creatinine ratio(p<0.05),e GFR was improved and serum creatinine and urinary albumin/creatinine ratio was decreased after treatment.There was no significant difference in urinary protein,serum potassium,blood urea nitrogen,retinol binding protein,serum cystatin and urinary albumin/creatinine ratio(p>0.05)between the two groups before and after treatment,but there were significant differences in the improvement of e GFR and the decrease of serum creatinine between the two groups.The improvement of e GFR and the decrease of serum creatinine in the study group were better than those in the control group.Conclusion:1.The classification and course of hypertension,BNP,urine protein,uric acid and low density lipoprotein cholesterol are independent risk factors for hypertension patients with CKD.2.The renal function of hypertensive patients with CKD was improved by both RAAS inhibitor and Sacubitril/Valsartan.After treatment,the GFR was improved and the serum creatinine and the urinary protein creatinine ratio was decreased in the group treated with Sacubitril/Valsartan.In the group treated with RAAS inhibitor,the GFR was improved and the serum creatinine and urinary protein creatinine ratio was decreased.The group treated with Sacubitril/Valsartan was superior to the group treated with RAAS in delaying the progression of e GFR and reducing the level of creatinine.