| Introduction2009 ESH/ESC hypertension guidelines updated interpretation of the treatment, pointing out that the majority of hypertensive patients need at least two antihypertensive drugs in combination can make blood pressure compliance. Two kinds of antihypertensive drugs in combination can be used as initial antihypertensive medication. As early as 2007 the European hypertension guidelines have emphasized the joint program antihypertensive drug therapy as the initial treatment strategy for hypertension. Long-acting calcium antagonists are recommended as the guide with renin-angiotensin-converting enzyme inhibitor (ACEI), renin-angiotensin receptor blocker (ARB),β-blockers and diuretics combined basis medication.There are a number of anti-hypertensive drugs in clinical trials proved that amlodipine/valsartan combined with anti-hypertensive at all levels of blood pressure control in hypertensive patients have access to good effect. The newβ-blocker carvedilol with the traditional P-blockers because of their different in angina, heart failure and myocardial infarction and hypertension caused by serious complications of the applications proved to be useful does not cause metabolic disorders, reduce the risk of diabetes, there is the role of vasodilators, does not cause vasoconstriction, may have a beneficial effect on aortic pressure, so amlodipine/Carvedilol can be used as CCB andβ-adrenergic receptor blockers formed a joint program to enter clinical studies. Present amlodipine/valsartan combined step-down group, has multi-center registration studies have shown that in the general hypertensive patients, the drug's efficiency and control rates were 80% and 70% of amlodipine/Carvedilol Luo Joint buck group consisting of a joint program due to fewer on their research focused on the 1980-1990 era, further research is the area with the step-down compound preparation of slowly rise [9,10]. Calcium antagonists and angiotensin receptor blocker (ARB) combined, efficacy is superior to calcium antagonists andβ-blocker combination then? Not yet known, but also on their tolerance and hypertensive renal insufficiency of renal function in patients with large-scale clinical trials, information is still limited, while the two drugs in hypertensive patients with end-stage renal disease application to compare efficacy and fewer with little of.The main purpose of this paper is to study the calcium antagonists and angiotensin receptor blocker (ARB) combined with calcium antagonists andβreceptor blockers combination for chronic renal failure in maintenance hemodialysis patients and the antihypertensive effect of renal protective effect implications.Materials and methods1.Material,grouping and observing items(1) Study taken from January 2009-2010 years in Shenyang City in December 9th People's Hospital in-patient and outpatient maintenance hemodialysis 96 patients, aged 18 to 82 years, with an average 56.12 years old, choose sitting diastolic blood pressure≥95mmHg (1mmHg=0.133kPa) and≤115mmHg by this study. Except for pregnant or nursing women, as well as significant heart, brain, lung function abnormalities, liver disease or other chronic illness, allergies and so on.66 to enter observations, all for chronic renal failure, the maintenance of blood in the dialysis patients.36 cases were male and female 30 cases. In which diabetes in 17 cases,10 males and 7 females, aged 66.94 years old. Primary disease and chronic glomerular nephritis, diabetic nephropathy, hypertension and renal impairment, chronic pyelonephritis, are excluded renal vascular hypertension, endocrine hypertension and clinical factors such as improper use of antihypertensive drugs. General clinical data of two groups of patients, including age, gender, smoking, regular drug use, dialysis cases by rule of time, along with diabetes, high blood lipids, serum potassium, etc. basically the same.(2)The standard hemodialysis (HD) treatment. Use of anti-seepage and bicarbonate dialysate, using the German Fresenius 4008S dialysis machine, F6 polysulfone membrane dialyzer, blood flow to an average of 200ml/min, dialysate flow rate 500ml/min,4 hours/times.2.methods66 cases,34 cases were taking amlodipine besylate 5 mg/d+Valsartan 80mg/d (valsartan group),8 weeks after the average sitting diastolic blood pressure (SDBP)≥ 90mmHg persons, to increase the dose to valsartan 160mg/d, SDBP<90mmHg to maintain their original dose. Observation period of 6 months. The control group amlodipine besylate 5 mg/d+Carvedilol 10mg, on the second oral (carvedilol group).3.observing indexes(1) Detection of two groups of patients with relevant clinical parameters In general two groups were observed, including:age, gender, smoking, regular drug use, dialysis cases by rule the time classification of renal function.(2) changes in blood pressure Palpation before and after treatment, measured sitting blood pressure, heart rate, routine ECG testing.(3) The detection of blood biochemical parameters (3.1), routine blood test, ion, and liver and kidney function RBC count, hemoglobin, serum potassium,24-hour urinary protein, blood urea nitrogen, creatinine, uric acid and other indicators, recording all the side effects. (3.2), blood glucose, blood lipids(4) The incidence of adverse events after taking Observation of orthostatic hypotension, hyperkalemia, edema, irritating dry cough and other adverse reactions.4.testing materials, apparatus, equipmentFresenius 4008B dialysis machine, F6 polysulfone membrane dialyzer, Toshiba automatic biochemical analyzer, Abbott Blood instrument, PHILIPS three-dimensional color Doppler ultrasound instrument, BD6000 portable multi-parameter monitoring systems, Clean Benches, etc.Amlodipine besylate (Norvasc, Pfizer Pharmaceutical Co., Ltd.) 5 mg, valsartan (Diovan, Beijing Novartis Pharmaceutical Co., Ltd.) 80mg, Carvedilol tablets (Schroder, the Beijing giant can Pharmaceutical Co., Ltd.) 10mg.5.statistical treatmentAll data were statistically analyzed, measurement data to the mean±standard deviation (x±s), said; treatment before and after the group 24-hour urine protein, blood urea nitrogen, creatinine, changes in comparison with the paired t test; efficacy and side effects comparison with the chi-square test (x2 test), P<0.05 for significant difference, all data handled by the SPSS11.0 statistical packages.Results1.Comparison of clinical data of two groups of patients Two groups of patient's age, sex, risk factors, drug use, by the government time and high blood pressure level, etc. compared to the situation was no significant difference between the two groups.2.Clinical standards and the results2.1 Comparison of the results of changes in blood pressureAccording to the Ministry of Health standards for clinical evaluation of new drugs, effective in:SDBP drop> 20mmHg or decrease≥10mmHg and decreased to normal (<90mmHg); Effective:SDBP down 10-19mmHg or fall<10mmHg, but dropped to normal; invalid:not reached the above-mentioned criteria. Results valsartan treatment group, markedly effective rate 79.41%, significantly increases the efficiency rate was 85.29%, carvedilol markedly effective rate was 78.13%, markedly effective rate was 93.75% increase. The first 8 weeks after treatment decreased SDPB groups 9.83±6.58mmHg, blood pressure decreased the percentage of 9.81%, respectively. Valsartan group were 29 cases in an effective medication dose 80mg/d were 20 patients,160mg /d in 9 cases, respectively, in force accounted for 31% and 69%.Treatment of 8 weeks and treatment groups after six months compared with those before treatment were significantly higher significance (P<0.05); After 8 weeks, respectively, compared with six months after the treatment was no significant difference (P>0.05). Before and after treatment between the two groups was no significant difference (P>0.05).2.2 serum uric acid, urea nitrogen, creatinine and 24-hour urine protein quantityValsartan group before and after treatment of serum uric acid, urea nitrogen, creatinine and 24-hour urinary protein and serum potassium compared, with the exception of serum uric acid, potassium, each index before treatment and after treatment difference was statistically significant (P<0.05).Carvedilol group before and after treatment of serum uric acid, urea nitrogen, creatinine and 24-hour urine protein quantitative comparison of various indicators of treatment before and after treatment did not differ significantly.Valsartan group and the carvedilol group six months after treatment of serum uric acid, urea nitrogen, creatinine and 24-hour urinary protein quantitative comparisons, in which valsartan group a 24-hour urinary protein and carvedilol group after treatment, the difference was significant significance (P<0.05), the remaining indicators did not differ significantly (P> 0.05).2.3 The two groups before and after treatment medical examination, electrocardiogram, heart rate, serum potassium, and adverse reactionThe two groups before and after treatment physical examination, electrocardiogram, heart rate and no significant changes in serum potassium, no orthostatic hypotension occurs. No drug-related adverse reactions due to the termination of testers. There are five cases of adverse reactions showed mild drowsiness weakness, dizziness, joint pain, diarrhea, stomach discomfort, no cough, and edema, can be tolerated, no patients terminated the treatment, therefore, also failed to take any treatment measures to continue treatment later to reduce or disappear, does not affect the treatment.Conclusion1.the joint effect of valsartan amlodipine besylate amlodipine besylate programs and a joint program of carvedilol compared to both the maintenance hemodialysis patients with hypertension are good, well-tolerated.2.Valsartan combined amlodipine besylate amlodipine besylate programs and a joint program of carvedilol compared to the proteinuria significantly reduce the role of the3.the joint effect of valsartan amlodipine besylate amlodipine besylate programs and a joint program of carvedilol compared to the two pairs of glucose metabolism and electrolytes, blood system were not affected, and few adverse reaction.
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