Hypertension and kidney disease is a pair of "brother", when the kidney patients with refractory hypertension at the same time, it becomes a more difficult problem in clinical practice.
Our kidney has its particularity, which is manifested in both the target organ that is affected by high blood pressure, but once it is damaged, it makes the blood pressure particularly difficult to control, often belong to refractory hypertension.
Unfortunately, most patients in the discovery of high blood pressure, did not timely detection of kidney disease, which lost the best time for early treatment. Therefore, the efficient and stable blood pressure caused by the normal level is to protect the kidneys, delay the deterioration of renal function important measures.
That in the treatment of CKD patients, how to set the antihypertensive target, while antihypertensive effect and renal protection
From the buck target alone, there are the following contradictions:
1) blood pressure does not drop to 140/90 mmHg, kidney protection is not, urine protein can not get good control. But patients with cardiovascular and cerebrovascular disease, if the blood pressure is not controlled at 140/90 mmHg below, then the cardiovascular and cerebrovascular complications will be fatal.
2) But on the other hand, when the patient is renal insufficiency, the kidneys become very sensitive to renal perfusion.
It is important to note that the use of ultra-strict blood pressure control (blood pressure reduced to 120/70 mmHg below), such a target set to 3, 4, 5 poor renal function in CKD patients, Blood pressure down at the same time the renal function is further deteriorated.
So, this super-strict blood pressure control is not good for slowing kidney disease progression. At least from the perspective of kidney protection, do not expect blood pressure drop too low; for patients with urinary protein, the target value is slightly lower than 140/90 mmHg, hope that blood pressure is best maintained at 130/80 mmHg or so.
Chronic kidney disease with refractory hypertension 4 points recommended
1. To avoid misdiagnosis, some patients with poor blood pressure control by the poor compliance caused by medication, not really refractory hypertension.
2. Suggested refractory hypertension in patients with low-salt diet, the application of three kinds of adequate antihypertensive drugs combined therapy, and appropriate supplemented by other antihypertensive drugs.
3. Should try to use compound preparation, in order to reduce the combined use of a variety of drugs adverse reactions, reduce the burden of patients with medication.
4. When the treatment effect is poor, the patient should limit salt, the use of diuretics, and finally choose to increase the amount of antihypertensive drugs.
In daily life, we must pay attention to observe their own physical changes. Whether patients with hypertensive nephropathy or renal hypertensive patients, in the course of treatment must be regularly assessed the degree of damage to renal function and consider blood pressure control, so that the same time to maximize blood pressure protection of renal function.