There are so many antihypertensive drugs. How should patients with chronic kidney disease and hypertension choose?

Hypertension is one of the common complications of chronic kidney disease. More than 30% of chronic kidney disease patients have hypertension, but only a small number of them can control their blood pressure at an ideal level. Controlling hypertension is crucial to delaying the progression of kidney disease and preventing cardiovascular and cerebrovascular accidents. The most commonly used treatment for hypertension is medication.

However, there are many types of antihypertensive drugs on the medical market, and patients often seem at a loss due to lack of relevant professional knowledge. How to use antihypertensive drugs correctly to achieve the purpose of lowering blood pressure and minimize adverse drug reactions? Today, let's learn how patients with chronic kidney disease choose antihypertensive drugs.

1 Renin-angiotensin-aldosterone system blockers

These are prils and sartans. These drugs are the first choice for antihypertensive treatment in patients with chronic kidney disease because they not only have antihypertensive effects, but also have renal protective effects. When using these drugs, you should be alert to adverse reactions such as dry cough, increased blood potassium, and increased serum creatinine. In addition, pregnant women and patients with bilateral renal artery stenosis should avoid using these drugs.

2Diuretics

Diuretics are also commonly used antihypertensive drugs. Eyelid and lower limb edema is the most common complaint of patients with chronic kidney disease. The use of diuretics can relieve patients' edema symptoms, improve patients' subjective symptoms, and enhance patients' confidence and treatment compliance. In addition, the reduction of edema can also promote the efficacy of other antihypertensive drugs, achieving the effect of 1+1>2. However, long-term use of diuretics can lead to a series of adverse reactions, such as hypokalemia and abnormal metabolism of blood lipids, blood sugar, and blood uric acid. For patients with decompensated chronic renal failure or more serious ones, thiazide diuretics are no longer effective, and only loop diuretics can be used, but they should not be used for a long time or in large quantities. Patients who have undergone hemodialysis usually have anuria or oliguria, and there is no need to continue using diuretics.

3 Calcium channel antagonists

Calcium channel blockers are represented by nifedipine. This type of drug has a strong antihypertensive effect and a rapid onset of action. It is often used in combination to treat hypertension in patients with chronic kidney disease. Especially for patients with renal failure undergoing dialysis, calcium channel blockers are the first choice for antihypertensive drugs. Some patients may experience symptoms such as palpitations (increased heart rate), headaches, facial flushing, and lower limb edema after use. Some of these adverse reactions may disappear on their own after 1 to 2 weeks or after the drug is reduced.

4β1 receptor blockers

This type of drug is also a common choice for patients with chronic kidney disease combined with antihypertensive drugs. It mainly slows down the heart rate and weakens the contractility of the myocardium to achieve the purpose of lowering blood pressure. Adverse reactions include bradycardia, fatigue, cold limbs, etc. The combination of β1 receptor blockers and calcium channel antagonists can antagonize the adverse reaction of increased heart rate. It should be noted that β1 receptor blockers cannot be stopped suddenly, and the dosage should be reduced slowly to avoid danger.

5α1 receptor blockers

Such drugs include prazosin and terazosin, which have certain antihypertensive effects, but are generally not recommended for use alone. They can be used in combination with other antihypertensive drugs. When using this drug, some patients may suddenly experience unstable standing, blurred vision, dizziness, weakness, incontinence, etc. when they get up in the morning. In severe cases, they may even faint. This is due to low blood pressure caused by insufficient blood supply to the brain due to changes in body position (such as suddenly changing from a supine position to an upright position), which is called "postural hypotension." Therefore, doctors often recommend that patients start with a small dose and take the drug before bed to prevent the occurrence of postural hypotension.