| objective The common cause of death in maintenance patients with chronic renal failure is cardiovascular and cerebrovascular diseases caused by hypertension.To reduce the mortality rate of hemodialysis patients,it is necessary to improve blood pressure,maintain blood stability and improve vascular permeability.The purpose of this study is to analyze the actual clinical effects of different hypotensive regimens,and compare the different hypotensive effects and renal protection of calcium antagonists combined with angiotensin receptor antagonists and beta receptor blockers.Methods:80 patients with maintenance hemodialysis and hypertension in the Department of Nephrology of Yibin Second Hospital of Traditional Chinese Medicine on March 2018 were selected as research materials.Firstly,through literature analysis and clinical data of patients,the status of blood pressure control and clinical characteristics of antihypertensive therapy in the population were thoroughly understood,and the corresponding clinical treatment plan was drawn up.According to the treatment drugs,the patients were divided into valsartan group and valsartan group.Amlodipine besylate+valsartan was used in carvedilol group and amlodipine besylate+carvedilol in carvedilol group.Blood pressure and renal function were measured before and after treatment for 8 weeks and 6 months.Relevant data were recorded for comparative analysis.Calcium antagonists were determined by data analysis and comparison of clinical characteristics of hemodialysis patients.Angiotensin receptor antagonist(ARB)combined with calcium antagonist+beta receptor blocker for chronic renal failure patients with maintenance hemodialysis antihypertensive effect and the clinical effect of renal protection.Results:According to the actual clinical situation,the two groups of patients formulated a combined drug regimen.36 cases were treated with amlodipine besylate and carvedilol as carvedilol group,44 cases were treated with amlodipine besylate and valsartan as valsartan group.There was no significant difference in the clinical sex ratio,age,smoking and routine drug use between the two groups.According to the clinical antihypertensive standard of the new drug of the Ministry of Health of China,the blood pressure changes of the patients after 8 weeks of treatment and 6 months of treatment were statistically significant(P<0.05).After treatment,the two groups had the same trend of lowering blood pressure.Compared with diastolic and systolic blood pressure,the effect of lowering blood pressure was obvious,and there was no statistical significance(P>0.05).There was no significant difference between 8 weeks and 6 months after treatment(P>0.05).According to the clinical evaluation criteria of new drugs of the Ministry of Health,24 cases were markedly effective in carvedilol group,8 cases were effective,2 cases were ineffective,24 cases were markedly effective in valsartan group,16 cases were effective and 4 cases were ineffective.The quantity of urinary protein in valsartan group decreased significantly within 1 day after administration,which was significantly higher than that in carvedilol group(P<0.05),but there was no significant difference in serum uric acid,urea nitrogen and creatinine between valsartan group and carvedilol group(P>0.05),but there was no significant difference before and after treatment'(P<0.05).After 6 months and 8 weeks of treatment,the quality of life questionnaire survey was carried out before treatment.It was found that most patients had major problems in emotional function,cognitive function and overall health status.Before treatment,due to diseases,heart rate and blood pressure rhythm were irregular,kidney failure affected,patients'self-emotion regulation function was insufficient,and patients in carvedilol group suffered from these problems.The emotional function and overall health of the patients in valsartan group had the same development trend as those in valsartan group.The readmission rate of the patients in valsartan group was slightly higher than that in carvedilol group after 6 months,but the life index in valsartan group was better than that in carvedilol group,with statistical significance(P<0.05).Conclusion:Amlodipine besylate+valsartan or amlodipine besylate+carvedilol combination can effectively control patients'high blood,reduce the mortality rate of cardiovascular diseases,and have a certain protective effect on renal function in patients with chronic renal maintenance dialysis.Compared with carvedilol,valsartan can significantly improve blood viscosity and erythrocyte aggregation,reduce renal vascular resistance and urinary protein excretion.Valsartan is more effective than carvedilol in clinical treatment,but in terms of economic adaptability,carvedilol is a long-acting preparation,which is more acceptable to patients in terms of compliance and price,so carvedilol is an ideal choice for antihypertensive treatment.Alternatively,the price economy has a strong grassroots promotion value,but amlodipine besylate+valsartan is an ideal choice for patients with hypertension and diabetes caused by complex causes.To sum up,calcium antagonist+ACEI or ARB is a better combination of antihypertensive drugs for improving the prognosis of patients with hypertension on hemodialysis.It can control hypertension in MHD patients and reduce the mortality rate of patients with cardiovascular diseases,improve long-term survival rate and improve long-term and prognosis. |
PDF Full Text Request