| BackgroundHypertension and chronic kidney disease are the public health problems that have attracted the global attention in recent years,which with high morbidity and mortality,low awareness and control rate,they consumed a large amount of medical resources,and bring huge troubles and burdens to patients and society.According to statistics,as early as 2010,the number of patients with hypertension worldwide has reached 1.39 billion,and in recent decades,the incidence of hypertension continues to increase,affecting about 30 percent of adults in the world.Although chronic kidney disease is a kind of chronic disease that we have known relatively late,it has a very highly morbidity and mortality in the world.Surveys and studies in many countries around the world have shown that the prevalence of chronic kidney disease in adults is between 10.2%and 20.5%,and it is often accompanied by refractory hypertension.According to statistics,80%?85%patients with chronic kidney disease have hypertension,and the proportion with hypertension in end-stage renal disease patients is higher.There is an important interaction between hypertension and chronic kidney disease,they interact during the start and development of the disease,forming a vicious circle,resulting in a sharp decline in renal function and development to end-stage renal disease rapidly.End-stage renal disease patients need regular dialysis to sustain life usually,which means low quality of life and the high cost of treatment,to basically get treatment can only rely on a kidney transplant,but because of the influence of various factors,only few of patients that waiting for renal transplantation can get the chance of renal transplantation each year,and there are quite a number of patients death in the process of waiting for transplantation every year.Therefore,the guidelines pointed out that for the treatment of patients with hypertension complicated with CKD,the protection of renal function should be considered at the same time of control the blood pressure effectively,aim to delay the progress of patients with CKD,improve the quality of life and the long-term prognosis.RAS inhibitors have been shown to have a positive effect of renal protection,the effect of normal L-type calcium channel blocker(CCB)on the kidney was non-inferiority.However,recent studies have shown that type T and type N calcium channel blockers may also have renal protective function,as a unique L/N/T three-channel blocker,benidipine may has unique advantages and benidipine has been shown to reduce urinary protein in patients with CKD while effectively and steadily controlling blood pressure,thus bringing long-term renal benefits to patients.PurposeTo study the effects of benidipine combined with olmesartan on night blood pressure and proteinuria in patients with hypertension complicated with chronic kidney disease,and to evaluate the effect of benidipine combined with olmesartan on renal protection in patients with CKD.Methods230 patients with hypertension complicated with CKD who had been treated with omesartan 20mg/day alone for more than 4 weeks witch still systolic blood pressure?140mmHg and/or diastolic blood pressure?90mmHg in our hospital from January 2018 to June 2019 were selected as the observation objects,115 patients in benididine group and 115 patients in nifedipine group who were randomly assigned by computer.Benidipine group was treated with benidipine combined with olmesartan.The nifedipine group was treated with olmesartan combined with nifedipine controlled release tablets.The night blood pressure[mean night systolic blood pressure,mean night diastolic blood pressure],urine protein,glomerular filtration rate,incidence of major adverse cardiovascular events?incidence of adverse reactions before and after treatment in benididine group and nifedipine group were compared.ResultsThere was no significant difference in NSBP?NDBP?Pro and GFR levels between the two groups before treatment(P>0.05).NSBP?NDBP and Pro levels in benidipine group and nifedipine group after treatment were significantly lower than before treatment(P<0.001),NSBP?NDBP and Pro levels in benidipine group after treatment were significantly lower than those in nifedipine group(P<0.001).There was no significant difference in GFR between benidipine group and nifedipine group before treatment(P>0.05).After treatment,the GFR of benidipine group and nifedipine group was significantly higher than before treatment(P<0.05),and the GFR level of benidipine group was significantly higher than that in nifedipine group(P<0.001).The incidence of MACE in benidipine group was 12.17%,and that in nifedipine group was 26.09%,which was lower in benidipine group than in nifedipine group(P<0.05).In terms of the incidence of adverse reactions,benidipine group and nifedipine group were 4.35%and 14.78%respectively,and benidipine group was lower than nifedipine group(P<0.05).Conclusion1.Benididine combined with olmesartan can reduced the night blood pressure of patients more significantly;2.Benididine combined with olmesartan can reduce the level of proteinuria more significantly in patients with proteinuria;3.Benidipine combined with olmesartan has a more significant effect on improving the glomerular filtration rate of patients;4.Benidide combined with olmesartan can reduce the risk of MACE effectively compared with nifedipine combined with olmesartan;5.Compared with nifedipine combined with olmesartan,benidipine combined with olmesartan has a more significant clinical value in improving the safety of treatment. |
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