| Background:High blood pressure is the major global disease,its prevalence is growing,low control rates,high mortality,its the main reason for the development and death of cardiovascular disease,the second largest cause of chronic kidney disease,which can aggravate the progression of hypertension.Malignant hypertension is a severe form of high blood pressure,it can cause serious heart,brain,kidney and other target organ damage,their effects on kidney include high serum creatinine and urine protein,renal failure,wich is the leading cause of death with malignant hypertension.Although there were various types of antihypertensive drugs and different combinations to treatments,many patients cannot effectively control blood pressure with three or more antihypertensive drugs.The concept of refractory hypertension has been proposed and refined,its risk is greater.So we need to find new and more effective antihypertensive regimens to control blood pressure.Carlos L.Alviar’s study on the efficacy and safety of two calcium antagonists combined in the treatment of hypertension provides a new approach and ideas for treatment.Objective:To observe the antihypertensive effect of two calcium antagonists combined in refractory malignant hypertension with chronic kidney disease,and the changes of serum creatinine and urinary protein,the safety status,so as to provide new methods and ideas for the treatment of hypertension.Methods:1.54 patients with refractory malignant hypertension and chronic kidney disease were selected from the department of nephrology,general hospital of tianjin medical university from 2018 to 2020,giving behavior therapy and other foundation treatment,all patients were treated with two dihydropyridine calcium antagonists in combination with antihypertensive therapy,the medication was adjusted according to the blood pressure,the blood pressure changes before and after treatment were observed after the blood pressure was stable,and the serum creatinine and urinary protein before and after treatment were recorded.2.According to the etiology,the patients were divided into hypertensive kidney damage group and non-hypertensive kidney damage group,to compare the difference of antihypertensive effect between the two groups,the changes of serum creatinineand urinary protein before and after treatment in hypertensive kidney damage group.3.Four groups with large sample sizes were selected according to the different combination regimens,there were Nifedipine controlled release tablets with Levamlodipine besylate,Nifedipine controlled release tablets with Lacidipine,Nifedipine controlled release tablets with Felodipine and Levamlodipine besylate with Lacidipine,The compare the antihypertensive effect between the four groups.4.To observe whether the patient has headache,dizziness,nausea,palpitations,hypotension,rash,gingival hyperplasia and other adverse reactions.Results:1.The patients’ systolic and diastolic blood pressure were significantly lower than those before the treatment.The difference was statistically significant(P < 0.05).2.The decrease of systolic blood pressure in the hypertensive kidney injury group was lower than that in the non-hypertensive kidney injury group,and the decrease of diastolic blood pressure was higher than that in the non-hypertensive kidney injury group,but the differences were not statistically significant(P>0.05).3.There was no statistically significant difference in the decrease of systolic blood pressure and diastolic blood pressure between the 4 groups of calcium antagonists in different combinations(P>0.05).4.2 patients with gingival hyperplasia,without other adverse reactions.Conclusions:The combined application of two calcium antagonists was really effectively on the control of blood pressure in patients with refractory malignant hypertension and chronic kidney disease,with renal protective function and little side effects,which is worthy of further clinical observation and research. |
PDF Full Text Request