Arterial hypertension in CKD treatment. Chronic renal failure. How to lower blood pressure folk remedies

High blood pressure is considered one of the main problems of the century, this indicator directly indicates the functionality of blood vessels and the heart. Patients who go to the hospital do not always know how the kidneys affect blood pressure. Between them there is a pathogenetic relationship, the disease belongs to the secondary type of hypertension.

Kidney pressure - what is it

The considered pathology is diagnosed in 10-30% of cases with the development of hypertension. Kidney pressure - what is it? The disease develops with any pathology in the work of the kidneys. This organ in the human body is responsible for filtering arterial blood, removing excess fluid, protein breakdown products, sodium, and harmful substances that accidentally entered the circulatory system.

Increased pressure due to the kidneys appears when there is a violation in the work of the organ. Blood flow is reduced, sodium, water are retained inside, edema is formed. Sodium ions, accumulating, cause the walls of blood vessels to swell, which leads to an increase in their sensitivity. Kidney receptors begin to actively secrete the enzyme "renin", which turns into "angioteniz", then "aldosterone" is obtained from it. These substances affect the vascular tone, the gaps in them decrease, which leads to an inevitable increase in pressure.

Causes of nephrogenic arterial hypertension

The main task of the kidneys is to filter the blood, timely removal of water, sodium. Renal arterial hypertension begins to develop at the moment when the amount of incoming blood decreases. The vessels increase, the susceptibility to enzymes increases, at the same time the system is activated, which increases the production of aldosterone and sodium accumulates. This becomes a provoking factor in the growth of blood pressure and a decrease in the amount of prostaglandins that contribute to its decrease. Nephrogenic arterial hypertension - the causes of the development of this pathology:

• vascular injury;
• thrombosis, dysplasia, embolism, hypoplasia;
• anomaly of the aorta, parts of the urinary system;
• arteriovenous fistula;
• aneurysm;
• atherosclerosis of the artery;
• nephroptosis;
• arterial cysts, hematomas, compressed tumor;
• aortoarteritis.

kidney pressure symptoms

The disease begins, as a rule, suddenly, accompanied by an increase in blood pressure with pain in the lumbar spine. The tendency to this pathology can be inherited from parents. Even when taking medication to lower the pressure, relief does not occur. Renal hypertension manifests itself against the background of pathologies of the organ in question. The trigger mechanism can be: diabetes mellitus, pyelonephritis, glomerulonephritis. Renal pressure - the symptoms will necessarily be associated with the underlying pathology. The most common complaints are:

• urge to urinate more often than normal;
• increase in temperature of a periodic nature;
• pain in the lumbosacral region;
• general malaise, fatigue;
• an increase in the daily norm of urine by 2 times.

Treatment of renal hypertension

It is recommended to treat nephropathy comprehensively, it is necessary to establish the cause of the increase in pressure, eliminate it, and stop the symptoms. Renal hypertension - treatment can be carried out with the help of drugs (tablets, injections of solutions, etc.), folk remedies or through surgery. The last option is an extreme measure, which is necessary for congenital malformations or stenosis of the renal arteries. As a rule, balloon angioplasty or phonation of renal hypertension is performed.

How to lower kidney pressure at home

If the disease is at the initial stage and does not cause serious pain, disturbances in the body, then you can carry out the treatment yourself at home. First, you should consult with your doctor so that he assesses the degree of development of hypertension and tells you how to effectively lower kidney pressure at home. For these purposes, as a rule, diet therapy, infusions and herbs according to folk recipes, light medications are used.

Pills for kidney failure

All therapy is aimed at lowering upper renal pressure, relieving pain, and solving the underlying problem that provokes such a condition in a patient. The signs of PG themselves indicate the development of a disease that affects the kidneys. The specialist must determine the relationship between pathologies and prescribe the correct course of treatment. As a rule, the following tablets are used for kidney failure:

1. Antihypertensive drugs. Prazosin, Dopegyt, especially, have a good effect. with the secondary development of pressure in the kidneys. Medicines have a protective effect on the organ until it restores its functions.
2. Adrenoblockers, thiazide diuretics. Their reception implies the rejection of a number of products (diet without salt), therapy has a long duration without interruption. When developing a course of treatment, the size of the glomerular filtration rate should be taken into account; only a specialist can do this.

With the timely start of treatment, these medicines help regulate pressure (lower and upper). One of the main dangers of this pathology is that renal hypertension progresses very quickly, the brain and heart will be affected, so it is important to start treating the disease as quickly as possible. If the effectiveness of drug therapy is low, it is necessary to do balloon angioplasty.

Folk remedies

This is one type of therapy that may be approved by a doctor. The effectiveness of infusions, decoctions depends on the stage and degree of development of the disease. It is imperative to combine the treatment of kidney pressure with folk remedies with the right diet (eat food without salt, give up alcohol, etc.). You can regulate the pressure using the following recipes:

1. Bearberry infusion. Take 2 tbsp. l. crushed plant, pour into a glass of boiling water. The infusion will be ready in 30 minutes. Drink it 4 times a day for 20 ml.
2. The next recipe is a collection of 5 tbsp. l. flax seeds, 2 tbsp. l. birch leaves, 1 tbsp. l. blackberry and strawberry leaves. Use a coffee grinder to grind all the ingredients, you should get a powder. Take 2 tbsp. l. finished mass for 0.5 liters of boiling water. The remedy should be infused for 7 hours, then take 5 times a day for 3 weeks. Then you should take a break for 7 days and continue taking the folk medicine.
3. The next infusion for the treatment of renal hypertension is prepared from 3 tbsp. l. carrot seeds, which should be ground in advance in a coffee grinder or blender. Place them in a thermos, fill with boiling water and leave for 10 hours. Strain the resulting composition and drink before meals 1 glass 5 times a day. The course of treatment lasts 14 days.

In 1981, Ascalons progesterone was charged with specialization by the intravenous health department. For compotes of work in a blister, 14 fat-like parts were found, more than 100 predetermined causes, equipped with a medicine for pressure in renal failure, transport, nerves; in the central district polyclinics of the Central Regional Hospital, intensive care units were created, a cardio center was opened, a forty-year-old quadrant of the stomatological house of the ASMI was opened, and an eye of the Regional Clinical Hospital began.

Askalonov was the organizer of the medical physics-computational infarction, with his increase, the technology of remote diagnosis of myocardial infarction and other rare diseases was broken.

Tachycardia is significant:

VSD for hypertensive type in children

A timely oil receiver to a cardiologist affects very high pressure.

Pressure medications for kidney failure

It is pushed out that by the effect on the pharmacokinetics in CHF, carvedilol suppresses metoprolol.

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Electrical stimulation in patients receiving the index.

Pressure medications for kidney failure

Locations unfortunately: Severe multichannel or coronary atherosclerosis.

Drugs near are ACE inhibitors or ARA II after their pharmacokinetics reduce the activity of finger-angiotensin-aldosterone thromboembolism of the RAAS, which is characterized by a key role in the treatment of pressure in renal failure and the progression of nephrosclerosis.

ACE dropouts deflate other antihypertensive sites in a nephroprotective manner that, in arterial pizza in part, does not arise from their antihypertensive effect. The favorable effect of the drugs of this group in severe nephropathy is proportional to the incontinence of the glomerulus boiler mouse, improving the filtration modernity of the glomeruli.

On top of that, they are released with potent antiproteinuric activity beyond the inadequacy of their antihypertensive effect. In rheumatology, there is a tendency to form blood pressure; in target officials, it is possible to pass without antihypertensive drugs.

Blood Pressure Medicines for Renal Failure - Use Limitations

Response pathophysiological mechanisms such as vasculopathy, oxygen supply, hypercoagulability, etc. contribute to the flicker of unaccustomed dysfunction in scientific hypertension. Under, the main and bad mood of the arterial responsibility is at the same time the depth of the sexual sphere. Op for the treatment of the patient is no less keenly aware of the possible risk of prescribed drugs in conclusion dynamics.

4 thoughts on Pressure medications for kidney failure

Home » Hypertension » Medicines for high blood pressure: basic principles of administration, types and effectiveness

Medicines for high blood pressure: basic principles of administration, types and effectiveness

Medicines for high blood pressure are immediately prescribed only to those patients who are at high risk: blood pressure is consistently above 160-100 mmHg. Patients who are at low or moderate risk, the doctor, first of all, will advise lifestyle changes, a diet for hypertensive patients and physical activity. acceptable for hypertension.

And only if restrictions on food, salt intake, avoidance of alcohol and smoking, avoidance of stress and other correctable causes of hypertension do not help normalize blood pressure levels, high blood pressure pills will be prescribed.

When taking medications for pressure, the so-called antihypertensive drugs, the following rules must not be neglected:

• Hypertension cannot be treated with short courses of high blood pressure pills. Even when normal pressure levels are reached after 3-5 days, medication cannot be stopped.
• You can not take medicines for pressure only at the time of exacerbation of any symptom of hypertension (headache or palpitations), or when high blood pressure is fixed. The patient must strictly follow the prescribed medication regimen.
• Interruptions in the treatment of arterial hypertension are unacceptable, since this disease is chronic. Stopping the course of taking the pills is fraught with a reverse return of blood pressure to elevated levels.
• Only a specialist can replace one antihypertensive agent with another. All pressure medications differ significantly in indications, mechanism of action, the nature of side effects and contraindications to the appointment. Only your attending physician has complete information about your health status and the results of laboratory and instrumental studies, only he can decide on any change in the course of treatment.

It is a mistake to think that long-term use of pills for high blood pressure can cause liver or stomach disease, while the treatment of hypertension with herbs remains a completely safe treatment.

At a certain stage of hypertension, folk methods alone are no longer enough, while modern antihypertensive drugs are designed for their long-term use without negative effects on the human body, and with daily intake, I provide maximum prevention of dangerous complications of arterial hypertension: heart attack, stroke, heart disease.

In the event of side effects, you should urgently discuss this with your doctor.

Blood pressure lowering drugs: groups, combinations, diuretics and vasodilators

Blood pressure lowering drugs not only help control hypertension, but also prevent the risk of developing cardiovascular disease and dangerous complications.

However, all these drugs have a different mechanism of action and contraindications, so they are usually prescribed in combination.

It is worth noting that diuretics for hypertension are included in almost every such complex.

Some modern antihypertensive drugs have already been released in a combined state, of which the most rational are:

• ACE inhibitor + diuretic;
• beta-blocker + diuretic;
• angiotensin 2 receptor blockers + diuretic;
• ACE inhibitor + calcium antagonist;
• beta-blocker + calcium antagonist.

There are new drugs for the treatment of hypertension - imidazoline receptor antagonists, but so far they are not in the international recommendations for treatment.

Drugs that reduce blood pressure can be conditionally divided into the following main groups :

• Beta blockers. Reduce the heart rate and cardiac output, thereby reducing blood pressure. Economical work of the heart and its slow rhythm prevents the risk of developing coronary disease. Assign to patients after myocardial infarction, with angina pectoris. The main side effect is bronchospasm, so the drugs are not prescribed to patients with bronchial asthma and chronic lung diseases.
• ACE inhibitors(angiotensin-converting enzyme). They suppress the enzyme - renin, produced by the kidneys, which causes an increase in blood pressure. Preparations of this group improve peripheral circulation, contribute to the expansion of coronary vessels. Indicated for heart failure, left ventricular dysfunction, diabetic neuropathy, also after a heart attack. Not prescribed for hyperkalemia, bilateral stenosis of the renal arteries, chronic renal failure of 2 and 3 degrees.
• calcium antagonists. They are used to prevent circulatory disorders: they block the entry of calcium ions into the smooth muscle cells of the heart and blood vessels, which leads to relaxation of blood vessels and a decrease in blood pressure. They have a number of side effects: swelling, dizziness, headache. Contraindicated in congestive heart failure, heart block.
• Angiotensin-2 receptor blockers (ARBs). This group of blood pressure lowering drugs has an effect similar to ACE inhibitors and is prescribed to patients who cannot tolerate ACE inhibitors.
• Thiazide diuretics. in other words diuretics. Increase the amount of urine excreted by the body, eliminating excess fluid and sodium, as a result, lowering pressure. Diuretics for hypertension are the first-line treatment for patients at the initial stage of the disease, they are used much longer than other hypertensive drugs. They practically do not affect the level of fats and glucose in the blood, that is, they are safe for patients with diabetes and obesity. They have shown the ability to prevent the development of cardiovascular diseases. Their use is most effective in elderly patients.

Separately, it should be noted vasodilators in hypertension, the mechanism of action of which is to relax the walls of blood vessels, due to which their diameter increases. These drugs play a less significant role in the treatment of arterial hypertension, however, they are prescribed for its severe forms, when other drugs no longer help.

These medications have serious side effects and are quickly addictive, which reduces their effectiveness to zero. In addition, when taking only vasodilators for hypertension, along with a decrease in blood pressure, the heart rate quickens, the body begins to accumulate fluid, so they are prescribed only in conjunction with diuretics and beta-blockers.

Treatment of hypertension / Phlebologist / medicines for pressure in renal failure

Pressure medications for kidney failure

The main range of these groups of drugs is given. Hell is considered normal if the diastolic pressure is at double. In the presence of severe renal failure (speed.). With renal failure, its frequency increases. The drug enhances the hypotensive effect of other drugs. Folk remedies for low blood pressure during pregnancy. For the terminal (final) phase of renal failure is characteristic. At the 70th kidney dysfunction, hypertension, anemia, etc. can develop. Blood pressure at home what medicines from. Cardiovascular system decrease in blood pressure and increase. In acute renal failure, the drug is prescribed for. An overview of all drugs for high blood pressure. Fosinopril is the drug of choice for renal insufficiency and severe renal impairment.

In your situation, compared to the threat of a heart attack, stroke, or kidney failure, a cough is nothing. This means that even if you improve your lifestyle, it is not a fact that your complexion will fade.

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Acute kidney failure can occur for a variety of reasons, including kidney disease, partial or complete blockage of the urinary tract, and reduced blood volume, such as after severe blood loss.

The dependence of the boiling point of a liquid on its pressure

This can be regarded as a kind of diagnostic sign if the non-renal patient has become much more difficult to reduce blood pressure than before, he needs to check the kidneys up to pulmonary edema due to overload of the left ventricle

About the girl pressure medication for kidney failure

Photo of pressure medication for kidney failure

Effectively reduces pressure, including in renal hypertension, thereby slowing down the development of renal failure. May lead to chronic renal failure. Renal pressure with one type of medication is unlikely to be reduced. With a herniated disc, the nerve roots are compressed, and this. High blood pressure, hypertension or arterial hypertension - unlikely. Kidney and provokes the development of renal failure. With renal hypertension, it is dangerous to self-medicate and. Renal pressure, otherwise renal artery stenosis, is asymptomatic for a long time. Medications nutrition sections of medicine podcasts questions and answers. And until the kidney failure becomes too severe. The drugs of the listed groups should be used only when. Hypertension (arterial hypertension) or high blood pressure is increased pressure in the arteries, the blood vessels that carry blood.

I have been suffering from type 1 diabetes since childhood, for 18 years. What are the best pressure pills? Let's discuss and figure it out with you. If money is tight, then use at least coenzyme q10. Because the disrupted production of this. Pressure sensor from 0 5 to 1 bar. Chronic renal failure (CKD). Chronic renal failure (CKD) is an inevitable outcome for many. Ofloxin (tablets 200 mg and 400 mg, solution for infusions v. Sibazon (tablets 5 mg, injections v.).

For citation: Kutyrina I.M. Treatment of renal hypertension // RMJ. 2000. No. 3. S. 124

Department of Nephrology and Hemodialysis MMA them. THEM. Sechenov

According to the modern classification of arterial hypertension, renal hypertension (PH) is usually understood as arterial hypertension (AH), pathogenetically associated with kidney diseases. This is the largest group among secondary hypertension in terms of the number of patients, which make up about 5% of all patients suffering from hypertension. Even with still intact kidney function, PG is observed 2-4 times more often than in the general population. In renal failure, its frequency increases, reaching 85-70% in the stage of terminal renal failure; only those patients who suffer from salt-losing kidney disease remain normotensive.

A complex system of relationships exists between systemic hypertension and the kidneys. This problem has been discussed by scientists for more than 150 years, and the works of leading nephrologists and cardiologists of the world are devoted to it. Among them are R.Bright, F.Volhard, E.M.Tareev, A.L.Myasnikov, H.Goldblatt, B.Brenner, G.London and many others. According to modern concepts, the relationship between the kidneys and hypertension is presented as a vicious circle, in which the kidneys are both the cause of the development of hypertension and the target organ of its effects. It has now been proven that hypertension not only damages the kidneys, but also dramatically accelerates the development of kidney failure. This provision determined the need for permanent treatment of hypertension at blood pressure levels exceeding 140/90 mm Hg, reducing these values ​​to 120/80 mm Hg. in order to slow down the progression of renal failure.

Of particular importance for nephrological patients is a strict restriction of sodium intake. Given the role of sodium in the pathogenesis of hypertension, as well as the violation of sodium transport in the nephron, which is characteristic of renal pathology, with a decrease in its excretion and an increase in the total sodium content in the body, daily salt intake in nephrogenic hypertension should be limited to 5 g/day. Since the sodium content in prepared foods (bread, sausages, canned food, etc.) is quite high, it is necessary to limit the additional use of salt in cooking (WHO, 1996; H.E. deWardener, 1985). Some expansion of the salt regime is allowed only with the constant intake of salturetics (thiazide and loop diuretics).

Salt restriction should be less severe in patients with polycystic kidney disease, salt-losing pyelonephritis, in some variants of the course of chronic renal failure, when, due to damage to the renal tubules, sodium reabsorption in them is impaired and sodium retention in the body is not observed. In these situations, the patient's salt regimen is determined on the basis of daily electrolyte excretion and the volume of circulating blood. In the presence of hypovolemia and / or with increased excretion of sodium in the urine, salt intake should not be limited.

Much attention is currently being paid to the tactics of antihypertensive therapy. Questions are discussed about the rate of BP reduction, the level to which initially elevated BP should be reduced, as well as the need for permanent antihypertensive treatment of “mild” AH (diastolic BP 95–105 mm Hg).

Based on the observations made, it is now considered proven that:

- the simultaneous maximum decrease in elevated blood pressure should not exceed 25% of the initial level, so as not to impair kidney function;

— in patients with kidney pathology and AH syndrome, antihypertensive therapy should be aimed at complete normalization of blood pressure, even despite a temporary decrease in the depuration function of the kidneys. This tactic is designed to eliminate systemic hypertension and thus intraglomerular hypertension as the main non-immune factors in the progression of renal failure and implies a further improvement in renal function;

— “Mild” hypertension in nephrological patients requires permanent antihypertensive treatment in order to normalize intrarenal hemodynamics and slow down the progression of renal failure.

Basic principles of treatment of renal hypertension

A feature of the treatment of hypertension in chronic kidney disease is the need for a combination of antihypertensive therapy and pathogenetic therapy of the underlying disease. Means of pathogenetic therapy of kidney diseases (glucocorticosteroids, cyclosporin A, sodium heparin, dipyridamole, non-steroidal anti-inflammatory drugs - NSAIDs) themselves can have a different effect on blood pressure, and their combination with antihypertensive drugs can nullify or enhance the hypotensive effect of the latter.

Based on our own experience of long-term treatment of nephrogenic hypertension, we believe that hypertensive syndrome is a contraindication for the appointment of high doses of glucocorticosteroids, except in cases of rapidly progressive glomerulonephritis. In patients with “moderate” nephrogenic hypertension, glucocorticosteroids can increase it if, when administered, a pronounced diuretic and natriuretic effect does not develop, which is usually observed in patients with initial severe sodium retention and hypervolemia.

NSAIDs are inhibitors of prostaglandin synthesis. Our studies have shown that NSAIDs can have antidiuretic and antinatriuretic effects and increase blood pressure, which limits their use in the treatment of patients with nephrogenic hypertension. The appointment of NSAIDs simultaneously with antihypertensive drugs can either neutralize the effect of the latter, or significantly reduce their effectiveness (I.M. Kutyrina et al., 1987; I.E. Tareeva et al., 1988).

Unlike these drugs heparin sodium has a diuretic, natriuretic and hypotensive effect. The drug enhances the hypotensive effect of other drugs. Our experience suggests that the simultaneous administration of sodium heparin and antihypertensive drugs requires caution, as it can lead to a sharp decrease in blood pressure. In these cases, it is advisable to start sodium heparin therapy with a small dose (15-17.5 thousand U / day) and increase it gradually under the control of blood pressure. In the presence of severe renal insufficiency (glomerular filtration rate less than 35 ml / min), sodium heparin in combination with antihypertensive drugs should be used with great caution.

For the treatment of nephrogenic hypertension, the most it is preferable to use antihypertensive drugs that:

. affect the pathogenetic mechanisms of the development of arterial hypertension;

Do not reduce blood supply to the kidneys and do not inhibit renal function;

Able to correct intraglomerular hypertension;

They do not cause metabolic disorders and give minimal side effects.

Currently, for the treatment of patients with nephrogenic arterial hypertension 5 classes of antihypertensive drugs are used:

. angiotensin-converting enzyme inhibitors;

calcium antagonists;

B-blockers;

diuretics;

A-blockers.

Drugs with a central mechanism of action (Rauwolfia preparations, clonidine) are of secondary importance and are currently used only under strict indications.

Among the above 5 classes of drugs proposed for the treatment of nephrogenic arterial hypertension, the drugs of first choice include angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (calcium antagonists). These two groups of drugs meet all the requirements for antihypertensive drugs intended for the treatment of nephrogenic arterial hypertension and, which is especially important, simultaneously possess nephroprotective properties.

Angiotensin-converting enzyme inhibitors

ACE inhibitors are a class of antihypertensive drugs whose main pharmacological action is the inhibition of ACE (aka kininase II).

The physiological effects of ACE are twofold. On the one hand, it converts angiotensin I to angiotensin II, which is one of the most powerful vasoconstrictors. On the other hand, being kininase II, it destroys kinins, tissue vasodilating hormones. Accordingly, pharmacological inhibition of this enzyme blocks the systemic and organ synthesis of angiotensin II and accumulates kinins in the circulation and tissues.

Clinically, these effects are manifested:

. a pronounced hypotensive effect, which is based on a decrease in general and local renal peripheral resistance;

. correction of intraglomerular hemodynamics due to the expansion of the efferent renal arteriole - the main site of application of local renal angiotensin II.

In recent years, the renoprotective role of ACE inhibitors has been actively discussed, which is associated with the elimination of the effects of angiotensin, which determine the rapid sclerosis of the kidneys, i.e. with blockade of the growth of mesangial cells, their production of collagen and epidermal growth factor of the renal tubules (Opie L.H., 1992).

In table. 1 shows the most common ACE inhibitors with their dosages.

Depending on the time of excretion from the body, they secrete first generation ACE inhibitors (captopril with an elimination half-life of less than 2 hours and a haemodynamic effect of 4-5 hours) and second generation ACE inhibitors with a half-life of 11-14 hours and a hemodynamic effect duration of more than 24 hours. To maintain the optimal concentration of drugs in the blood during the day, a 4-fold dose of captopril and a single (sometimes double) dose of other ACE inhibitors are required.

Effects on the kidneys and complications

The effect of all ACE inhibitors on the kidneys is almost the same. Our experience of long-term use of ACE inhibitors (captopril, enalapril, ramipril) in nephrological patients with renal hypertension indicates that with initially intact renal function and long-term use (months, years), ACE inhibitors increase renal blood flow, do not change, or slightly reduce creatinine levels. blood by increasing the glomerular filtration rate (GFR). At the earliest stages of treatment with ACE inhibitors (1st week), a slight increase in the level of blood creatinine and potassium in the blood is possible, but over the next few days it normalizes on its own without discontinuation of the drug (I.M. Kutyrina et al., 1995). Risk factors for a stable decline in renal function are the elderly and senile age of patients. The dose of ACE inhibitors in this age group should be reduced.

Requires special attention therapy with ACE inhibitors in patients with renal insufficiency. In the vast majority of patients, long-term therapy with ACE inhibitors adjusted for the degree of renal failure has a beneficial effect on renal function - creatininemia decreases, GFR increases, and the onset of end-stage renal failure slows down.

ACE inhibitors have the ability to correct intrarenal hemodynamics, reducing intrarenal hypertension and hyperfiltration. In our observations, correction of intrarenal hemodynamics under the influence of enalapril was achieved in 77% of patients.

ACE inhibitors have a pronounced antiproteinuric property. The maximum antiproteinuric effect develops against the background of a low-salt diet. Increased salt intake leads to the loss of antiproteinuric properties of ACE inhibitors (de Jong RE et al., 1992).

ACE inhibitors are a relatively safe group of drugs, adverse reactions with their use occur infrequently.

The main complications are cough and hypotension. Cough can occur at various times of treatment with drugs - both at the earliest and after 20-24 months from the start of therapy. The mechanism of cough occurrence is associated with the activation of kinins and prostaglandins. The reason for the abolition of drugs in the event of a cough is a significant deterioration in the quality of life of the patient. After discontinuation of the drugs, the cough disappears within a few days.

A more severe complication of ACE inhibitor therapy is the development of hypotension. The risk of hypotension is high in patients with congestive heart failure, especially in the elderly, with malignant high-renin hypertension, renovascular hypertension. Important for the clinician is the ability to predict the development of hypotension during the use of ACE inhibitors. For this purpose, the hypotensive effect of the first low dose of the drug (captopril 12.5-25 mg; enalapril 2.5 mg; ramipril 1.25 mg) is evaluated. A pronounced hypotensive response to this dose may predict the development of hypotension during long-term drug treatment. In the absence of a pronounced hypotensive response, the risk of developing hypotension with further treatment is significantly reduced.

Quite frequent complications of treatment with ACE inhibitors are headache, dizziness. These complications usually do not require discontinuation of drugs.

In nephrological practice, the use of ACE inhibitors is contraindicated in:

. the presence of stenosis of the renal artery of both kidneys;

. the presence of stenosis of the renal artery of a single kidney (including a transplanted kidney);

. combination of renal pathology with severe heart failure;

. severe chronic renal failure, long-term treated with diuretics.

The appointment of ACE inhibitors in these cases may be complicated by an increase in blood creatinine, a decrease in glomerular filtration up to the development of acute renal failure.

ACE inhibitors are contraindicated during pregnancy, since their use in the II and III trimesters can lead to fetal hypotension, malformations and malnutrition.

calcium antagonists

The mechanism of the hypotensive action of calcium antagonists (AK) is associated with the expansion of arterioles and a decrease in increased total peripheral resistance (OPS) due to inhibition of the entry of Ca 2+ ions into the cell. The ability of drugs to block the vasoconstrictor effect of the endothelial hormone, endothelin, has also been proven.

According to antihypertensive activity, all groups of prototype drugs are equivalent, i.e. Effect nifedipine in dose of 30-60 mg/day is comparable to the effects verapamil in dose of 240-480 mg/day and diltiazema at a dose of 240-360 mg / day.

In the 1980s there were AK second generation. Their main advantages were a long duration of action, good tolerability and tissue specificity. In table. 2 shows the most common drugs in this group.

According to their antihypertensive activity, AKs represent a group of highly effective drugs. The advantages over other antihypertensive drugs are their pronounced anti-sclerotic (drugs do not affect the blood lipoprotein spectrum) and antiaggregation properties. These qualities make them the drugs of choice for the treatment of the elderly.

Effect on the kidneys

AA have a beneficial effect on renal function: they increase renal blood flow and cause natriuresis. Less clear is the effect of drugs on GFR and intrarenal hypertension. There is evidence that verapamil and diltiazem reduce intraglomerular hypertension, while nifedipine either does not affect it or increases intraglomerular pressure (P. Weidmann et al., 1995). In this connection for the treatment of nephrogenic hypertension from drugs of the AK group, preference is given to verapamil and diltiazem and their derivatives.

All AKs are characterized by a nephroprotective effect, which is determined by a decrease in renal hypertrophy, inhibition of metabolism and mesangial proliferation and, consequently, a slowdown in the rate of progression of renal failure (P. Mene., 1997).

Side effects

Side effects are associated, as a rule, with the intake of short-acting AKs of the dihydropyridine group. In this group of drugs, the period of action is limited to 4-6 hours, the half-life ranges from 1.5 to 4-5 hours. Within a short time, the concentration of nifedipine in the blood varies over a wide range - from 65-100 to 5-10 ng / ml. A poor pharmacokinetic profile with a "peak" increase in the concentration of the drug in the blood, resulting in a decrease in blood pressure for a short time and a number of neurohumoral reactions, such as the release of catecholamines, determine the presence of the main adverse reactions when taking drugs - tachycardia, arrhythmias, "steal" syndrome with exacerbation of angina pectoris, flushing of the face and other symptoms of hypercatecholaminemia, which are unfavorable for the function of both the heart and the kidneys.

Long-acting and continuous release nifedipine provides for a long time a constant concentration of the drug in the blood, due to which it is devoid of the above adverse reactions and can be recommended for the treatment of nephrogenic hypertension.

Due to the cardiodepressive action, verapamil can cause bradycardia, atrioventricular blockade and, in rare cases (when using large doses), atrioventricular dissociation. When taking verapamil, constipation is frequent.

Although AKs do not cause adverse metabolic effects, the safety of their use in early pregnancy has not yet been established.

Reception of AC is contraindicated in initial hypotension, sick sinus syndrome. Verapamil is contraindicated in atrioventricular conduction disorders, sick sinus syndrome, severe heart failure.

Blockers b-adrenergic receptors

β-adrenergic receptor blockers are included in the spectrum of drugs intended for the treatment of PH.

The mechanism of the antihypertensive action of b-blockers is associated with a decrease in cardiac output, inhibition of renin secretion by the kidneys, a decrease in OPS, a decrease in the release of norepinephrine from the endings of postganglionic sympathetic nerve fibers, a decrease in venous inflow to the heart and circulating blood volume.

In table. 3 shows the most common drugs in this group.

There are non-selective b-blockers, blocking both b 1 - and b 2 -adrenergic receptors, cardioselective, blocking predominantly b 1 -adrenergic receptors. Some of these drugs (oxprenolol, pindolol, talinolol) have sympathomimetic activity, which makes it possible to use them in heart failure, bradycardia, and bronchial asthma.

According to the duration of action are distinguished b-blockers short (propranolol, oxprenolol, metoprolol), middle (pindolol) and long (atenolol, betaxolol, nadolol) actions.

A significant advantage of this group of drugs is their antianginal properties, the possibility of preventing the development of myocardial infarction, reducing or slowing down the development of myocardial hypertrophy.

Effect on the kidneys of b-blockers

b-blockers do not cause oppression of the renal blood supply and reduce renal function. With long-term treatment with b-blockers of GFR, diuresis and sodium excretion remain within the initial values. When treated with high doses of drugs, the renin-angiotensin system is blocked and hyperkalemia may develop.

Side effects

In the treatment of b-blockers, there may be severe sinus bradycardia (heart rate less than 50 per 1 min); arterial hypotension; increased left ventricular failure; atrioventricular blockade of varying degrees; exacerbation of bronchial asthma or other chronic obstructive pulmonary disease; the development of hypoglycemia, especially in patients with labile diabetes mellitus; exacerbation of intermittent claudication and Raynaud's syndrome; hyperlipidemia; in rare cases - a violation of sexual function.

b-Adrenergic blockers are contraindicated in severe bradycardia, sick sinus syndrome, atrioventricular block II and III degree, bronchial asthma and severe broncho-obstructive diseases.

Diuretics

Diuretics are drugs specifically designed to remove sodium and water from the body. The essence of the action of all diuretic drugs is reduced to blockade of sodium reabsorption and a consistent decrease in water reabsorption during the passage of sodium through the nephron.

The hypotensive effect of natriuretics is based on a decrease in circulating blood volume and cardiac output due to the loss of part of the exchangeable sodium and a decrease in OPS due to a change in the ionic composition of the walls of arterioles (sodium output) and a decrease in their sensitivity to pressor vasoactive hormones. In addition, during combined therapy with antihypertensive drugs, diuretics can block the sodium-retaining effect of the main antihypertensive drug, potentiate the hypotensive effect and at the same time allow you to slightly expand the salt regimen, making the diet more acceptable to patients.

For the treatment of PH in patients with preserved kidney function, diuretic drugs acting in the area of ​​the distal tubules are most widely used - a group thiazide diuretics (hydrochlorothiazide) and thiazide-like diuretics (indapamide).

Small doses are used to treat hypertension hydrochlorothiazide — 12.5-25 mg 1 time per day. The drug is excreted unchanged through the kidneys. Hypothiazide has the ability to reduce GFR, and therefore its use is contraindicated in renal failure - with a blood creatinine level of more than 2.5 mg%.

Indapamide — a new antihypertensive agent of the diuretic series. Due to its lipophilic properties, indapamide is selectively concentrated in the vascular wall and has a long half-life of 18 hours.

The hypotensive dose of the drug is 2.5 mg of indapamide 1 time per day.

For the treatment of PH in patients with impaired renal function and diabetes mellitus, diuretics acting in the area of ​​the loop of Henle are used. - loop diuretics. Of the loop diuretics in clinical practice, the most common are furosemide, ethacrynic acid, and bumetanide.

Furosemide has a powerful natriuretic effect. In parallel with the loss of sodium, the use of furosemide increases the excretion of potassium, magnesium and calcium from the body. The period of action of the drug is short - 6 hours, the diuretic effect is dose-dependent. The drug has the ability to increase GFR, therefore it is indicated for the treatment of patients with renal insufficiency.

Furosemide is prescribed at 40-120 mg / day orally, intramuscularly or intravenously up to 250 mg / day.

Side effects of diuretics

Among the side effects of all diuretic drugs, hypokalemia is of the greatest importance (more pronounced when taking thiazide diuretics). Correction of hypokalemia is especially important in patients with hypertension, since potassium itself helps to reduce blood pressure. When the potassium content drops below 3.5 mmol / l, potassium-containing preparations should be added. Among other side effects, hyperglycemia (thiazides, furosemide), hyperuricemia (more pronounced with the use of thiazide diuretics), the development of dysfunction of the gastrointestinal tract, and impotence are of importance.

a-Adrenoblockers

Of this group of antihypertensive drugs, prazosin and, most recently, a new drug, doxazosin, are the most widely used.

Prazosin — selective postsynaptic receptor antagonist. The hypotensive effect of the drug is associated with a direct decrease in OPS. Prazosin expands the venous bed, reduces preload, which justifies its use in patients with heart failure.

The hypotensive effect of prazosin when taken orally occurs after 1/2-3 hours and lasts for 6-8 hours. The half-life of the drug is 3 hours. The drug is excreted through the gastrointestinal tract, so dose adjustment of the drug in case of renal failure is not required.

The initial therapeutic dose of prazosin 0.5-1 mg / day for 1-2 weeks is increased to 3-20 mg per day (in 2-3 doses). The maintenance dose of the drug is 5-7.5 mg / day.

Prazosin has a positive effect on kidney function - it increases renal blood flow, the amount of glomerular filtration. The drug has hypolipidemic properties, has little effect on electrolyte metabolism. The above properties make it appropriate to prescribe the drug in chronic renal failure.

Postural hypotension, dizziness, drowsiness, dry mouth, and impotence were noted as side effects.

Doxazosin structurally close to prazosin, but characterized by long-term action. The drug significantly reduces OPS. The great advantage of doxazosin is its beneficial effect on metabolism. Doxazosin has pronounced anti-atherogenic properties - it lowers cholesterol levels, low and very low density lipoprotein levels, and increases high density lipoprotein levels. At the same time, its negative effect on carbohydrate metabolism was not revealed. These properties make doxazosin drug of choice for the treatment of hypertension in diabetic patients.

Doxazosin, like prazosin, has a beneficial effect on renal function, which determines its use in patients with PH in the stage of renal failure.

When taking the drug, the peak concentration in the blood occurs after 2-4 hours; the half-life ranges from 16 to 22 hours.

Therapeutic doses of the drug are 1-16 mg 1 time per day.

Side effects include dizziness, nausea, and headache.

Conclusion

In conclusion, it should be emphasized that the presented range of drugs of choice for the treatment of PH, used as monotherapy and in combination, provides strict control of PH, inhibition of the development of renal failure and a decrease in the risk of cardiac and vascular complications. So, tight control of systemic blood pressure (mean dynamic blood pressure of 92 mm Hg, i.e. normal blood pressure values), according to a multicenter study MDRD, delayed the onset of renal failure by 1.2 years, and the control of systemic blood pressure with ACE inhibitors kept patients alive for almost 5 years without dialysis (Locatelli F., Del Vecchio L., 1999).
Literature

1. Ritz E. (Ritz E.) Arterial hypertension in kidney disease. Modern nephrology. M., 1997; 103-14.

The complex relationship between systemic hypertension and the kidneys, aggravated against the background of existing renal pathology, determines the features of antihypertensive therapy in kidney diseases.

A number of general provisions on which the treatment of hypertension is based - the mode of work and rest, weight loss, reduction in alcohol consumption, increased physical activity, adherence to a diet with restriction of salt and foods containing cholesterol, the abolition of drugs that cause the development of hypertension - retain their significance in the treatment of PH.

Of particular importance for nephrological patients is severe sodium restriction. Bearing in mind the role of sodium in the pathogenesis of hypertension, as well as the violation of sodium transport in the nephron, which is characteristic of renal pathology, with a decrease in its excretion and an increase in the total sodium content in the body, daily salt intake in nephrogenic hypertension should be limited to 5 g / day, which, taking into account the high sodium content in finished food products (bread, sausages, canned food, etc.) practically eliminates the additional use of salt in cooking. Salt restriction should be less severe in patients with polycystic kidney disease, "salt-losing" pyelonephritis, in some variants of the course of chronic renal failure, when, due to damage to the renal tubules, sodium reabsorption in them is impaired and sodium retention in the body is not observed. In these situations, the criterion for determining the salt regimen of the patient is the daily excretion of Na and the volume of circulating blood. In the presence of hypovolemia and / or with increased excretion of sodium in the urine, salt intake should not be limited.

Much attention is currently being paid to the tactics of antihypertensive therapy - the rate of blood pressure reduction, establishing the level of blood pressure to which the initially elevated blood pressure should be reduced, and also the question of whether “mild” hypertension (BP diast. 95-105 mm Hg) requires permanent antihypertensive treatment .).

Based on the observations made, the following is now considered proven:

The single-stage maximum decrease in elevated blood pressure should not exceed 25% of the initial level so as not to impair kidney function;

In patients with kidney pathology and AH syndrome, antihypertensive therapy should be aimed at the complete normalization of blood pressure, even despite a temporary decrease in the depurative function of the kidneys. This tactic is designed to eliminate systemic hypertension and thus intraglomerular hypertension as the main non-immune factors in the progression of renal failure and suggests a further improvement in renal function;

- "Mild" AT in nephrological patients requires constant antihypertensive treatment in order to normalize intrarenal hemodynamics and slow down the progression of renal failure.

A feature of the treatment of hypertension in chronic kidney disease is the need to combine antihypertensive therapy with pathogenetic therapy of the underlying disease. Means of pathogenetic therapy of kidney diseases (glucocorticosteroids, heparin, chimes, non-steroidal anti-inflammatory drugs, sandimmun) themselves can have a different effect on blood pressure, and their combination with antihypertensive drugs can nullify or enhance the hypotensive effect of the latter.

Hypertensive syndrome is a contraindication to the appointment of high doses of glucocorticosteroids, except in cases of rapidly progressive glomerulonephritis. In patients with moderate nephrogenic AH, glucocorticosteroids can increase it if, when administered, a pronounced diuretic and natriuretic effect does not develop, which, as a rule, is observed in patients with initial severe sodium retention and hypervolemia.

Non-steroidal anti-inflammatory drugs(NSPP) - indomethacin, ibuprofen, etc. - are inhibitors of prostaglandin synthesis. A number of studies, including ours, have shown that NSAIDs can have antidiuretic and antinatriuretic effects and increase blood pressure, which limits their use in the treatment of patients with nephrogenic hypertension. The appointment of NSPPs simultaneously with antihypertensive drugs can either neutralize the effect of the latter, or significantly reduce their effectiveness. In contrast to these drugs, heparin has a diuretic, natriuretic and hypotensive effect. The drug enhances the hypotensive effect of other drugs. Our experience suggests that the simultaneous administration of heparin and antihypertensive drugs requires caution, as it can lead to a sharp decrease in blood pressure. In these cases, it is advisable to start heparin therapy with a small dose (15-17.5 thousand units / day) and increase it gradually under the control of blood pressure. In the presence of severe renal insufficiency (glomerular filtration rate less than 35 ml / min), heparin in combination with antihypertensive drugs should be used with great caution.

The selection of antihypertensive drugs and the selection of the most preferred ones for the treatment of nephrogenic hypertension are based on the following principles:

The drugs should affect the pathogenetic mechanisms of the development of hypertension;

Use drugs that do not reduce blood supply to the kidneys and do not depress renal function;

Use drugs that can correct intraglomerular hypertension;

Use drugs that do not cause metabolic disorders and

With minimal side effects.

Start treatment with small doses of drugs, gradually increasing them until a therapeutic effect is achieved.

Antihypertensive (antihypertensive) drugs. Currently, 5 classes of antihypertensive drugs are used to treat patients with nephrogenic arterial hypertension:

ACE inhibitors;

calcium antagonists;

B-blockers;

diuretics;

A blockers.

Drugs of the central mechanism of action (drugs of rauwolfia, a-methyldopa, clonidine) are of auxiliary importance and are currently used only for narrow indications.

First-choice drugs include angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (calcium antagonists).

These two groups of drugs meet all the requirements for antihypertensive drugs intended for the treatment of nephrogenic arterial hypertension and, which is especially important, simultaneously possess nephroprotective properties.

ACE inhibitors are a class of antihypertensive drugs, the basis of the pharmacological action of which is the inhibition of angiotensin-converting enzyme (aka kininase II).

The physiological effects of angiotensin-converting enzyme are twofold. On the one hand, it converts angiotensin I to angiotensin II, which is one of the most powerful vasoconstrictors. On the other hand, being kininase II, it destroys kinins, tissue vasodilating hormones. Accordingly, pharmacological inhibition of this enzyme blocks the systemic and organ synthesis of angiotensin II and accumulates kinins in the circulation and tissues.

Clinically, these effects are manifested:

A pronounced hypotensive effect, which is based on a decrease in general and local renal peripheral resistance;

Correction of intraglomerular hemodynamics, which is based on the expansion of the efferent renal arteriole - the main site of application of local renal angiotensin II.

In recent years, the renoprotective role of ACE inhibitors has been actively discussed, which is associated with the elimination of the effects of angiotensin, which determine the rapid sclerosis of the kidneys, i.e. with blockade of the growth of mesangial cells, their production of collagen and epidermal growth factor of the renal tubules.

In table. 8.2 shows the most common ACE inhibitors with their dosages.

Renal effects of ACE inhibitors. The effect of all ACE-Is on the kidneys is almost the same. Our experience of long-term use of ACE-Is (captopril, renitec, tritace) in nephrological patients with arterial hypertension indicates that, with initially intact renal function, ACE-Is with their long-term use (months, years) increase renal blood flow, do not change or slightly reduce creatinine blood, increasing GFR. In the very initial periods of treatment with ACE inhibitors (the first week), a slight increase in blood creatinine and potassium levels in the blood is possible, which independently return to normal levels within the next few days without discontinuing the drug.
Risk factors for a stable decline in renal function are the elderly and senile age of patients. The dose of ACE inhibitors in this age group should be reduced.

ACE inhibitor therapy in patients with renal insufficiency requires special attention. In the vast majority of patients, long-term ACE-i therapy adjusted for the degree of renal failure has a beneficial effect on renal function: creatininemia decreases, GFR increases, and the onset of end-stage renal failure slows down. In the observations of A.-L.Kamper et al. 7-year continuous treatment with enalapril in patients with severe CRF (initial GFR averaged 25 ml/min) slowed down the onset of end-stage renal disease in 12 of 35 patients (34%), which is 2.5 times higher than the number of patients (5 of 35) who received traditional antihypertensive therapy. AIPRI, a prospective, randomized, multicenter study that ended in 1996, also confirmed the ability of ACE-i to slow the progression of kidney failure. Of 300 patients with severe chronic renal failure treated with ACE inhibitor benazepril for 3 years, hemodialysis or kidney transplantation was required in 31 patients, while in the comparison group of 283 patients treated with placebo, such a need developed in 57 patients; during the continuation of the study (after 6.6 years), terminal renal failure in the group receiving ACE inhibitors developed in 79 people, while in the comparison group - in 102. However, the increase that persisted for 10-14 days from the start of ACE inhibitor therapy blood creatinine and hyperkalemia is an indication for discontinuation of the drug.

ACE inhibitors have the ability to correct intrarenal hemodynamics, reducing intrarenal hypertension and hyperfiltration. In our observations, correction of intrarenal hemodynamics under the influence of renitec was achieved in 77% of patients.

ACE inhibitors have a pronounced antiproteinuric property.

The maximum antiproteinuric effect develops against the background of a low-salt diet. Increased salt intake leads to loss of antiproteinuric properties of ACE-I.

Complications and side effects of ACE inhibitors. ACE inhibitors are a relatively safe group of drugs. They have few side effects.

The most common complications are cough and hypotension. Cough can occur at different times of treatment with drugs - both at the earliest and after 20-24 months from the start of therapy. The mechanism of cough occurrence is associated with the activation of kinins and prostaglandins. The reason for the abolition of drugs in the event of a cough is a significant deterioration in the quality of life of the patient. After discontinuation of the drugs, the cough disappears within a few days.

A more severe complication of ACE inhibitor therapy is the development of hypotension. The risk of its occurrence is high in patients with congestive heart failure, especially in the elderly; with malignant high-renin arterial hypertension, with renovascular arterial hypertension. Important for the clinician is the ability to predict the development of hypotension during the use of ACE inhibitors. For this purpose, the hypotensive effect of the first low dose of the drug (12.5-25 mg of capoten; 2.5 mg of renitec; 1.25 mg of tritace) is evaluated. A pronounced hypotensive response to this dose may predict the development of hypotension with long-term drug treatment. In the absence of a pronounced hypotensive response, the risk of developing hypotension with further treatment is significantly reduced.

Quite frequent complications of treatment with ACE inhibitors are headache, dizziness. These complications usually do not require discontinuation of drugs.

In nephrological practice, contraindications to the use of ACE inhibitors are:

Stenosis of the renal artery of both kidneys;

Stenosis of the renal artery of a single kidney (including a transplanted kidney);

The combination of renal pathology with severe heart failure;

Severe chronic renal failure, long-term treatment with diuretics.

The appointment of ACE inhibitors in these cases can be complicated by an increase in blood creatinine, a drop in glomerular filtration up to the development of acute renal failure.

ACE inhibitors are contraindicated during pregnancy, since their use in the II and III trimesters could lead to fetal hypotension, malformations, malnutrition and death.

calcium antagonists. The mechanism of the hypotensive action of calcium antagonists (AK) is associated with the expansion of arterioles and a decrease in elevated TPS due to inhibition of the entry of Ca2+ ions into the cell. The ability of drugs to block the vasoconstrictor effect of the endothelial hormone, endothelin, has also been proven.

The modern classification of calcium antagonists (AK) distinguishes three groups of drugs:

1) papaverine derivatives (verapamil, thiapamil);

2) dihydropyridine derivatives (nifedipine, nitrendipine, nisoldipine, nimodipine);

3) benzothiazepine derivatives - diltiazem. They are called prototype drugs, or

AK 1st generation. According to antihypertensive activity, all three groups of prototype drugs are equivalent, i.e. the effect of nifedipine at a dose of 30-60 mg/day is comparable to the effects of verapamil at a dose of 240-480 mg/day and diltiazem at a dose of 240-360 mg/day.

In the 80s, AK 2nd generation appeared. Their main advantages were the long duration of action, good tolerability and tissue specificity. In table. 8.3 presents the most common drugs of these two groups.

Renal effects of calcium antagonists. Calcium antagonists have a beneficial effect on renal function: they increase renal blood flow and cause natriuresis. Less clear is the effect of drugs on glomerular filtration rate and intrarenal hypertension. There is evidence that verapamil and diltiazem reduce intraglomerular hypertension, while nifedipine either does not affect it or increases intraglomerular pressure. In this regard, for the treatment of nephrogenic hypertension among drugs of the AK group, preference is given to verapamil and diltiazem and their derivatives.

All AKs have a nephroprotective effect, which is determined by their ability to reduce renal hypertrophy, inhibit metabolism and mesangial proliferation, and thus slow down the rate of progression of renal failure.

Complications and side effects of calcium antagonists. Side effects are usually associated with taking the AK group of short-acting dihydropyridine - 4-6 hours. The half-life ranges from 1.5 to 4-5 hours. Within a short time, the concentration of nifedipine in the blood varies over a wide range - from up to 5-10 ng / ml. A poor pharmacokinetic profile with a peak increase in the concentration of the drug in the blood, resulting in a drop in blood pressure for a short time and a number of neurohumoral reactions, such as the release of catecholamines, activation of the RAS and other "stress hormones", determines the main adverse reactions when taking drugs (tachycardia, arrhythmia , steal syndrome with exacerbation of angina pectoris, flushing of the face and other symptoms of hypercatecholaminemia), which are unfavorable for the function of the heart and kidneys.

Long-acting and continuous release nifedipine (GITS form) provides for a long time a constant concentration of the drug in the blood, and therefore they are devoid of the above adverse reactions and can be recommended for the treatment of nephrogenic hypertension.

Due to the cardiodepressive action, verapamil can cause bradycardia, atrioventricular blockade and, in rare cases (with heart failure in the case of high doses), atrioventricular dissociation. When taking verapamil, constipation often develops.

Although AKs do not cause adverse metabolic effects, the safety of their use in early pregnancy has not yet been established.

Reception of calcium antagonists is contraindicated in case of initial hypotension, sick sinus syndrome. Verapamil is contraindicated in atrioventricular conduction disorders, sick sinus syndrome, severe heart failure.

D-adrenergic receptor blockers are included in the spectrum of drugs intended for the treatment of PH.

The mechanism of the antihypertensive action of blockers is associated with a decrease in cardiac output, inhibition of renin secretion by the kidneys, a decrease in OPS, a decrease in the release of norepinephrine from the endings of postganglionic sympathetic nerve fibers, a decrease in venous inflow to the heart and circulating blood volume. In table. 8.4 presents the most common drugs in this group.

There are non-selective β-blockers (blocking both β1-, β2-adrenergic receptors) and cardioselective, blocking predominantly β1-adrenergic receptors. Some of these drugs (oxprenolol, pindolol, acebutolol, talinolol) have sympathomimetic activity, which makes it possible to use them in heart failure, bradycardia, and in patients with bronchial asthma.

According to the duration of action, short-acting β-blockers (propranolol, oxprenolol, metaprolol, apebutalol), intermediate (pindolol) and long-term (atenolol, betaxolol, sotalol, napolol) action are distinguished.

Renal effects of β-blockers. The drugs do not cause oppression of the renal blood supply and reduce renal function. With long-term treatment, glomerular filtration rate, diuresis and sodium excretion remain within the initial values. When treated with high doses of drugs, PAAC is blocked and hyperkalemia may develop.

Side effects of P-blockers. Severe sinus bradycardia (heart rate less than 50 per minute), arterial hypotension, increased left ventricular failure, atrioventricular blockade of varying degrees, exacerbation of bronchial asthma or other chronic obstructive pulmonary disease, hypoglycemia (especially in patients with labile diabetes mellitus) may develop; exacerbation of intermittent claudication and Raynaud's syndrome; development of hyperlipidemia; in rare cases, there is a violation of sexual function.

β-blockers are contraindicated in acute and chronic heart failure, severe bradycardia, sick sinus syndrome, atrioventricular block II and III degree, bronchial asthma and severe broncho-obstructive diseases.

Diuretics. Diuretics are drugs specifically designed to remove sodium and water from the body. The essence of the action of all diuretic drugs is reduced to blockade of sodium reabsorption and a consistent decrease in water reabsorption during the passage of sodium through the nephron.

The hypotensive effect of natriuretics is based on a decrease in BCC and cardiac output due to the loss of part of the exchangeable sodium and a decrease in OPS due to a change in the ionic composition of the walls of arterioles (sodium output), as well as a decrease in their sensitivity to pressor vasoactive hormones. In addition, during combined therapy with antihypertensive drugs, diuretics can block the sodium-retaining effect of the main antihypertensive drug, potentiate the hypotensive effect, and the salt regimen can be slightly expanded, making the diet more acceptable for patients.

For the treatment of PH in patients with preserved renal function, diuretic drugs acting in the area of ​​the distal tubules are most widely used - a group of thiazide (hypothiazide, ezidrex) and thiazide-like diuretics, such as indapamide (arifon).

Small doses are used to treat AT hypothiazide- 12.5-25 mg 1 time per day. The drug is excreted unchanged through the kidneys. Hypothiazide has the ability to reduce the glomerular filtration rate, and therefore its use is contraindicated in renal failure - blood creatinine levels of more than 2.5 mg%, GFR less than 30 ml / min.

Indapamide (arifon)- a new antihypertensive agent of the diuretic series. Due to its lipophilic properties, Arifon is selectively concentrated in the vascular wall and has a long half-life - 18 hours. The hypotensive dose of the drug is 2.5 mg of Arifon 1 time per day. The mechanism of its hypotensive action is associated with the ability of the drug to stimulate the production of prostacyclin and thereby cause a vasodilating effect, as well as with the ability to reduce the content of free intracellular calcium, which ensures less sensitivity of the vascular wall to the action of pressor amines.

The diuretic effect of the drug develops against the background of taking large therapeutic doses (up to 40 mg of Arifon per day).

For the treatment of PG in patients with impaired renal function and diabetes mellitus, diuretics are used that act in the loop of Henle, - loop diuretics. Of the loop diuretics in clinical practice, the most common are furosemide (lasix), ethacrynic acid (uregit), bumetanide (burinex).

Furosemide has a powerful natriuretic effect. In parallel with the loss of sodium, the use of furosemide increases the excretion of potassium, magnesium and calcium from the body. The period of action of the drug is short - 6 hours, the diuretic effect is dose-dependent. The drug has the ability to increase the glomerular filtration rate, and therefore is indicated for patients with renal insufficiency.

Furosemide is prescribed at 40-120 mg per day orally, intramuscularly or intravenously up to 250 mg per day.

Side effects of diuretics. Among the side effects of all diuretic drugs, hypokalemia is of the greatest importance (more pronounced when taking thiazide diuretics). Correction of hypokalemia is especially important in patients with hypertension, since potassium itself helps to reduce blood pressure. With a decrease in potassium below 3.5 mmol / l, potassium-containing drugs should be added. Among other side effects, hyperglycemia (thiazides, furosemide), hyperuricemia (more pronounced with the use of thiazide diuretics), the development of dysfunction of the gastrointestinal tract, and impotence are of importance.

a-adrenergic blockers. Of this group of antihypertensive drugs, prazosin (Pratsiol, Minipress, Adverzuten) and, in recent years, a new drug, doxazosin (Kardura), have become the most widely used.

Prazosin (pratsiol, minipress, adverzuten)- selective antagonist of presynaptic receptors. The hypotensive effect of the drug is associated with a direct decrease in OPS. Prazosin expands the venous bed, reduces preload, which justifies its use in patients with heart failure.

The hypotensive effect of prazosin when taken orally occurs after 1/2-3 hours and lasts for 6-8 hours. The half-life is 3 hours. The drug is excreted through the gastrointestinal tract, and therefore no dose adjustment is required in case of renal failure.

The initial therapeutic dose of prazosin is 0.5-1 mg / day; within 1-2 weeks, the dose is increased to 3-20 mg / day (in 2-3 doses). The maintenance dose is 5-7.5 mg / day.

Prazosin has a positive effect on kidney function - it increases renal blood flow, the amount of glomerular filtration. The drug has hypolipidemic properties, has little effect on electrolyte metabolism. These properties contribute to the appointment of the drug in chronic renal failure.

Postural hypotension, dizziness, drowsiness, dry mouth, and impotence were noted as side effects.

Doxazosin (cardura) structurally close to prazosin, but has a long-term effect. The drug significantly reduces OPS. The great advantage of doxazosin is its beneficial effect on metabolism. The drug has pronounced anti-atherogenic properties - it lowers cholesterol, LDL and VLDL cholesterol, increases HDL. At the same time, its negative effect on carbohydrate metabolism was not revealed. These properties make doxazosin the drug of choice in the treatment of hypertension in diabetic patients.

Doxazosin, like prazosin, has a beneficial effect on renal function, which determines its use in patients with PH in the stage of renal failure.

When taking the drug, the peak concentration in the blood occurs after 2-4 hours; the half-life ranges from 16 to 22 hours. Therapeutic doses - 1-8 mg 1 time per day.

Side effects include dizziness, nausea, headache, and in the elderly - hypotension.

Treatment of arterial hypertension in the stage of chronic renal failure. The development of severe CRF (GFR 30 ml/min and below) makes its own adjustments to the treatment of hypertension. In chronic renal failure, as a rule, complex therapy of hypertension is required, including salt restriction in the diet without fluid restriction, removal of excess sodium with the help of saluretics and the use of effective antihypertensive drugs and their combinations.

Of the diuretics (saluretics), the most effective are furosemide and ethacrynic acid, the dose of which can be increased to 300 and 150 mg / day, respectively. Both drugs slightly increase GFR and significantly increase potassium excretion. They are usually prescribed in tablets, and in urgent conditions (pulmonary edema) - intravenously. When using large doses, one should be aware of the possibility of ototoxic effects. Due to the fact that hyperkalemia often develops simultaneously with sodium retention in chronic renal failure, potassium-sparing diuretics are rarely used and with great caution. Thiazide diuretics (hypothiazide, cyclometazide, oxodoline, etc.) are contraindicated in chronic renal failure. Calcium antagonists are one of the main groups of antihypertensive drugs used in chronic renal failure. The drugs favorably affect renal blood flow, do not cause sodium retention, do not activate the RAS, do not affect lipid metabolism. A combination of drugs with β-blockers, centrally acting sympatholytics is often used (for example, corinfar + anaprilin + dopegyt, etc.).

In severe, refractory to treatment and malignant hypertension, patients with chronic renal failure are prescribed ACE inhibitors (captopril, renitec, tritace, etc.) in combination with saluretics and β-blockers, but the dose of the drug should be reduced, taking into account the decrease in its release as chronic renal failure progresses . Constant monitoring of GFR and the level of azotemia is necessary, since with the predominance of the renovascular mechanism of AT, filtration pressure in the glomeruli and GFR can sharply decrease.

With the ineffectiveness of drug therapy, extracorporeal methods for removing excess sodium are indicated: isolated ultrafiltration, hemodialysis (HD), hemofiltration. The tactics of treating PH in patients treated with hemodialysis and after kidney transplantation are described in detail in the relevant sections of the manual. We will focus on general provisions.

In the terminal stage of chronic renal failure after switching to program HD, the treatment of volume-sodium-dependent hypertension consists in maintaining an adequate HD and ultrafiltration regimen and an appropriate water-salt regimen in the inter-dialysis period to maintain the so-called dry weight. If additional antihypertensive treatment is needed, calcium antagonists or sympatholytics are used. In severe hyperkinetic syndrome, in addition to the treatment of anemia and surgical correction of arteriovenous fistula, it is useful to use β-blockers in small doses. At the same time, since the pharmacokinetics of β-blockers in chronic renal failure is not disturbed, and large doses of them suppress renin secretion, these same drugs are also used in the treatment of renin-dependent AT in combination with vasodilators and sympatholytics.

More effective in AT not controlled by HD are often β- + α-blockers, calcium antagonists, and especially ACE-I, and it must be taken into account that captopril is actively excreted during the HD procedure (up to 40% for a 4-hour HD). In the absence of the effect of antihypertensive therapy in preparing the patient for kidney transplantation, bilateral nephrectomy is used to convert renin-dependent uncontrolled hypertension into a renoprival volume-sodium-dependent controlled form.

In the treatment of hypertension that develops again in patients on HD and after kidney transplantation (KT), it is important to identify and eliminate the causes: dose adjustment of drugs that contribute to hypertension (erythropoietin, corticosteroids, sandimmune), surgical treatment of graft artery stenosis, resection of the parathyroid glands, tumors, etc. In the pharmacotherapy of hypertension after LT, calcium antagonists and ACE inhibitors are primarily used, and diuretics are treated with caution, since they increase lipid metabolism disorders and may contribute to the formation of atherosclerosis, which is responsible for a number of complications after LT.

In conclusion, it can be stated that at the present stage there are great opportunities for the treatment of PH at all stages of its development: with intact kidney function, at the stage of chronic and terminal renal failure, in the treatment of programmatic HD and after kidney transplantation. The choice of antihypertensive drugs should be based on a clear understanding of the mechanisms of development of hypertension and clarification of the leading mechanism in each case.

Kidney disease can cause secondary hypertension, which is called hypertension in renal failure. The peculiarity of this condition is that, along with nephropathy, the patient has high values ​​of systolic and diastolic pressure. Treatment of the disease is long. Arterial hypertension of any origin is a common cardiovascular disease and occupies 94-95% of them. The share of secondary hypertension accounts for 4-5%. Among secondary hypertension, renovascular hypertension is the most common and accounts for 3-4% of all cases.

Where is the connection?

The occurrence of arterial hypertension in chronic renal failure (chronic renal failure) is due to changes in the normal functioning of the organs of the urinary system, in violation of the blood filtration mechanism. In this case, excess fluid and toxic substances (sodium salts and protein breakdown products) cease to be excreted from the body. Excess water accumulated in the extracellular space provokes the appearance of edema of the internal organs, hands, feet, face.

From a large amount of fluid, the renal receptors are irritated, the production of the enzyme renin, which breaks down proteins, increases. In this case, there is no increase in pressure, but interacting with other blood proteins, renin promotes the formation of angiotensin, which promotes the formation of aldosterone, which retains sodium. As a result, there is an increase in the tone of the renal arteries and the formation of cholesterol plaques, which narrow the cross section of blood vessels, is accelerated.

In parallel, the content of derivatives of polyunsaturated fatty acids and bradykinin, which reduce the elasticity of blood vessels, decreases in the kidneys. As a result, in hypertension of renovascular origin, high blood pressure is persistent. Hemodynamic disorder leads to cardiomyopathy (left ventricular hypertrophy) or other pathological conditions of the cardiovascular system.

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Reasons for the development of renal failure with blood pressure

The most common cause of the development of the disease is pyelonephritis.

The functioning of the renal arteries is impaired in nephropathology. A common cause of nephrogenic arterial hypertension is arterial stenosis. Narrowing of the section of the renal arteries due to thickening of the muscular walls is observed in young women. In older patients, the narrowing appears due to atherosclerotic plaques that impede the free flow of blood.

Factors that provoke high blood pressure in nephropathies can be divided into 3 groups - negative changes in the parenchyma (kidney membrane), damage to blood vessels and combined pathologies. The causes of diffuse pathologies of the parenchyma are:

• pyelonephritis;
• glomerulonephritis;
• lupus erythematosus;
• diabetes;
• urolithic pathologies;
• congenital and acquired anomalies of the kidneys;
• tuberculosis.

Among the causes of vasorenal hypertension associated with the state of the blood vessels, note:

• atherosclerotic manifestations in the older age group;
• anomalies in the formation of blood vessels;
• tumors;
• cysts;
• hematomas.

Nephrogenic hypertension is very resistant to medications that lower blood pressure.

A characteristic feature of nephrogenic hypertension is the ineffectiveness of drugs that reduce blood pressure, even in the case of high values. Provoking factors can have a negative impact both singly and in any combination of damage to the parenchyma and blood vessels. In this situation, it is very important to identify existing problems in a timely manner. For patients with a diagnosis of renal insufficiency, dispensary observation of a doctor is necessary. A competent specialist will be able to choose complex therapy for the underlying pathology and medications to lower blood pressure.

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Course of the disease

Doctors distinguish two types of the course of the disease: benign and malignant. Benign type of renal hypertension develops slowly, and malignant quickly. The main symptoms of various types of renal hypertension are shown in the table:

The disease can cause poor blood flow in the brain.

Arterial hypertension in pathological conditions of the kidneys provokes the following problems:

• violation of the blood flow of the brain;
• changes in blood biochemical parameters (low hemoglobin and red blood cells, platelets, leukocytosis and increased ESR);
• hemorrhage in the eye;
• violation of lipid metabolism;
• damage to the vascular endothelium.

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Symptoms of pathology

Symptoms of nephrogenic hypertension and arterial hypertension are similar:

• high blood pressure numbers;
• headache;
• aggressiveness;
• low work capacity;
• increased heart rate.

Signs of high blood pressure associated with a pathological condition of the kidneys are:

• the appearance of pathology at a young age (up to 30 years);
• pain in the lumbar region;
• a sharp increase in blood pressure without active physical exertion;
• different pressure in the right and left limbs;
• pastosity of the limbs;
• retinopathy.

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Treatment and its features

Treatment is primarily aimed at stabilizing the functioning of the kidneys.

The complex of therapeutic measures for nephrogenic hypertension is aimed at solving the following problems - stabilizing kidney function, restoring normal hemodynamics and lowering blood pressure. To solve these problems, drug therapy, hardware treatment and surgical methods are used. Therapy for lowering blood pressure is aimed at a mild decrease in blood pressure levels.

Patients with a history of diseases of the urinary system should take antihypertensive drugs, despite the deterioration in the excretion of end products of nitrogen metabolism. Requires consideration, the fact that in diseases of the kidneys use basic therapy that affects the level of blood pressure. Drugs can enhance the effect of an antihypertensive drug or inhibit it. An important condition for therapeutic measures is the appointment of complex action medications with the least side effects.

Among the hardware, phonation is the most popular. The impact of sound waves contributes to:

• normalization of kidney function;
• increased excretion of uric acid;
• destruction of sclerotic plaques;
• normalization of blood pressure.

Surgery for renovascular hypertension can be used in the presence of tumors that interfere with the normal functioning of the organ. With stenosis of the adrenal artery, a balloon angioplasty is performed. Thanks to this operation, blood flow improves, the walls of blood vessels are strengthened and pressure is reduced. An extreme measure for the correction of renovascular hypertension is nephrectomy or kidney resection.

Chronic hypertension - symptoms and treatment of the disease

Chronic hypertension is a common disease accompanied by high blood pressure that obstructs blood flow. The danger of the disease lies in its detrimental effect on the work of most internal organs. To avoid the risk of complications will allow timely detection and competent treatment according to the scheme prescribed by doctors. In addition to high blood pressure, chronic hypertension is accompanied by other symptoms.

For the successful treatment of a chronic disease, strict adherence to medical prescriptions is required, because a process stopped halfway through threatens the development of a hypertensive crisis with a pressure jump a quarter higher than normal.

The disease can be caused by malnutrition with excessive consumption of salty foods and fast food, as well as smoking, drinking alcohol, stressful conditions, psycho-emotional overstrain and physical inactivity. Persons with severe weather dependence are most often affected by chronic hypertension - with seasonal changes in the weather, pressure indicators increase significantly and severe malaise is observed.

Signs of the disease

At the very beginning, an attack of hypertension may not be noticed - a slight malaise appears, which is mistakenly perceived as a consequence of overwork. As the disease progresses and the incidence of high blood pressure increases, the symptoms increase. Distinguish the main symptoms of the disease and additional.

Main symptoms

The most common manifestations of the disease include headache, throbbing in the back of the head and temples, aggravated during body movements. Headache is accompanied by darkening of the eyes and dizziness. The manifestation of this symptom is not associated with a specific time of day, but more often the pain occurs at night and early morning hours. There is a characteristic bursting, heaviness in the back of the head and other places. Strengthening of the symptom is observed with coughing, bending over, straining, with the appearance of swelling of the face. Pain reduction occurs as the outflow of blood in the veins improves with an upright position, muscle activity, and massage.

The most common complaints when visiting a doctor include the appearance of special noises in the head and problems with memory. Chronic patients often experience various sleep disorders, insomnia. Depending on the severity of the symptoms (one of the main indicators is blood pressure), there are various forms of the disease.

A sign of the presence of severe lesions of the heart muscle is shortness of breath, which occurs even when the patient is at rest.

Often, chronic arterial hypertension is accompanied by a deterioration in vision, expressed in a decrease in clarity, a cloudy appearance of objects.

There are several stages of this disease, expressed in an increase in pressure under various circumstances:

• the first degree - in stressful situations, the pressure rises sharply within 160/100 mm Hg, and after a while it normalizes without the use of any drugs;
• the second degree - high blood pressure at the level of 180/110 mm Hg. fixed at different times of the day in various states of the patient with a possible further decrease;
• third degree - in addition to high pressure exceeding 180/110 mm Hg, there are additional signs of the disease with the detection of pathologies of the heart, eyes, brain, kidneys.

Additional symptoms

Associated manifestations of the disease include:

• distraction;
• nervousness;
• memory problems;
• nosebleeds;
• general weakness;

• numbness and swelling of the limbs;
• heart pain;
• sweating;
• speech disorder.

The disease can proceed unnoticed for most patients for years, expressed from time to time by a feeling of weakness, which, combined with dizziness, is mistaken for overwork. Such signs require special attention and measurement of blood pressure levels. If the increasing symptoms are ignored, a cerebral infarction may result.

Physical examination of the heart may show left ventricular hypertrophy with thickening of the cardiomyocytes. Starting with the process of thickening along the wall of the left ventricle, an increase in the size of the heart chamber is observed. This manifestation indicates an increasing risk of sudden death or heart failure, coronary artery disease and ventricular arrhythmias. This picture is complemented by shortness of breath when performing activities with exercise, cardiac asthma (paroxysmal shortness of breath), pulmonary edema, heart failure and other heart problems.

Examination by a doctor also shows gross morphological changes in the aorta, its expansion, dissection and rupture. There is a lesion of renal activity with the appearance of protein in the analysis of urine, microhematuria, cylindria.

How is the disease diagnosed?

Diagnosis involves the use of a set of measures aimed at studying the manifestations, establishing the root causes and complications that have arisen.

Collecting anamnesis data from the patient

If characteristic symptoms appear, you should consult a doctor. The first step in the examination is to take a history. The following factors may indicate chronic hypertension:

1. Hereditary predisposition to hypertension, heart attacks, strokes, gout.
2. The presence of relatives suffering from hypercholesterolemia.
3. The presence among relatives of patients with diabetes mellitus, renal pathologies.
4. Overweight.
5. Smoking.
6. Alcohol abuse.
7. Constant physical or mental overload.
8. Regular use of drugs that can provoke a sharp increase in pressure.

After identifying these circumstances, a medical examination is performed.

Blood pressure measurement

At the stage of medical examination, pressure measurements are taken. Systolic and diastolic indicators are taken in full accordance with the measurement rules, because. even the slightest violation can cause distortion of indicators: before taking measurements, the patient needs a state of rest for several minutes. Measurements are performed on the hands alternately with a permissible discrepancy of up to 10 points. If necessary, the procedure is repeated, after at least one hour. This measure is applied if the indicators are from 140/90.

In addition to measuring pressure, the doctor performs a complete examination of the patient, which allows him to assess his condition and clarify the symptoms and causes, followed by the appointment of a treatment regimen:

1. It is necessary to listen to the lungs and heart to identify pathologies of the heart.
2. The necessary measurements are made to determine the ratio of a person’s height to his weight with the possible identification of a tendency to be overweight.
3. Examination and palpation of the abdominal cavity to assess the functioning of the kidneys.

After the examination, laboratory tests and instrumental diagnostics are prescribed.

Medical tests

There are primary and secondary methods of laboratory research.

First of all, the doctor prescribes analytical screening, represented by blood and urine tests (general and specific, aimed at detecting pathologies).

Information obtained through diagnosis, anamnesis, examination will reveal the causes and pathologies that contribute to the development of the disease.

Instrumental diagnostics

During the examination, medical diagnostic equipment is used to assess the condition and functioning of the cardiac and renal systems.

An electrocardiogram (consists of 12 measurements) reveals abnormalities in the work of the heart against the background of problems with blood pressure, or vice versa.

The pathology of the cardiac departments can be detected by radiography.

Ultrasound of the kidneys and adrenal glands is also prescribed to visually detect dysfunction. The results of the ultrasound examination will help determine the influence of the renal nature of hypertension.

An ophthalmological examination of the fundus is indicated because of the risk of increased eye pressure.

For most situations, these types of examinations are sufficient to establish the fact of the disease, however, other methods are used to accurately assess and prescribe treatment.

Additional Methods

A complete picture of the disease will allow you to get the following methods:

• echocardiogram (allows you to assess the risk and clarify the treatment regimen);
• computer diagnostics (tomogram or MRI) of the brain;
• urinary smear microscopy screening;
• visualization of the pathology of the endocrine system;
• Ultrasound of cervical vessels and extremities, etc.

The choice of studies used will depend on the first results of mandatory diagnostics when the underlying cause of the disease is identified.

Methods of treatment

If you suspect the diagnosis of hypertension as a chronic disease, self-medication is absolutely impossible. In order to correctly determine the nature of the disease and develop a treatment strategy, taking into account the current state of the patient, it is necessary to undergo a full examination by specialists. The thoughtless use of medicines can be fatal or lead to disability.

Comprehensive treatment should be started immediately after the diagnosis is made.

Complex therapy is represented by several drugs and compliance with the doctor's recommendations.

Drug therapy

When establishing the diagnosis of chronic arterial hypertension, treatment begins with taking medications in the complex:

1. Diuretic drugs. Diuretics prevent the accumulation of fluid and increase the density of the blood, and also contribute to the removal of salts.
2. calcium channel blockers. Designed to block the influx of calcium. Alpha-, beta-blockers contribute to the control of the heart rhythm, lowering the function of contraction of the heart muscle.
3. ACE inhibitors. Drugs are prescribed to relax smooth muscles, preventing the release of calcium.
4. Angiotensin blockers that inhibit the synthesis of the hormone angiotensin, which causes vasoconstriction.

Only complex therapy allows achieving stable positive dynamics.

Non-drug treatment

Equally important is compliance with the doctor's recommendations regarding the lifestyle and diet of the patient. Medications can temporarily reduce pressure, and maintaining an appropriate lifestyle allows you to achieve a confident result, preventing the further development of the disease and the increase in symptoms.

The key to the success of treatment, first of all, is the observance of certain nutritional rules:

• salt intake is limited (up to 5 grams per day), animal fat;
• exclusion of smoked and fried foods;
• refusal or reduction in the amount of tea and coffee consumed;
• exclusion of alcoholic beverages;
• foods with a high content of potassium and calcium are introduced into the diet;
• avoidance of overeating.

These measures will allow you to get rid of excess weight, which provokes the disease and an increase in blood pressure. It is important to immediately stop smoking if you have an addiction and review your diet.

• introduce nuts, garlic, cabbage, spinach, legumes, beets, dried fruits (dried apricots, raisins, figs), rose hips, black currants into the diet;
• include regular sports activities (skiing, running, swimming) in the daily routine;
• lead an active lifestyle, walk;
• to refuse from bad habits;
• take a contrast shower, water procedures;
• take courses of massage, relaxation;
• minimize stress on the body.

High blood pressure during pregnancy

If high blood pressure is detected during early pregnancy or before it, doctors diagnose the chronic form of the disease, which occurs among pregnant women in 5% of cases.

If the pressure value is 140/90 and higher, a special set of measures is prescribed to stabilize the woman's performance. In especially severe forms, the indicators are above 180/110 mm Hg. Measurement of pressure in pregnant women can be carried out up to several times a day, because values ​​\u200b\u200bare possible to change during the day.

The diagnosis of "gestational hypertension" is made in the presence of high pressure in the second half of pregnancy and in the last stages. The observing gynecologist must distinguish between the nature of hypertension, prescribing the appropriate course, depending on the cause that caused high blood pressure. One of the manifestations of gestational hypertension is the presence of protein in the urine, indicating an increase in the risk of preeclampsia.

The danger of chronic hypertension in pregnant women

Especially dangerous at high pressure in a pregnant woman is the development of preeclampsia, which develops in almost half of the cases in pregnant women suffering from severe chronic hypertension.

The clinical picture of high blood pressure in pregnant women shows a decrease in blood flow through the placenta, causing a lack of oxygen and nutrients to the baby. In this case, doctors testify to a high risk of intrauterine growth retardation, placental abruption and premature birth.

With a mild form of manifestations of the disease, the risks of complications during pregnancy are within the normal range. This means the absence of increasing symptoms of the disease, similar to the conditions of a pregnant woman with normal pressure indicators, if no other disturbing symptoms are observed.

A more severe form of hypertension increases the risk of preeclampsia, especially in situations of high pressure over a long period and the presence of pathologies in the cardiovascular, renal system, or damage to other internal organs. One of the alarming signals is the presence of diabetes mellitus, pyelonephritis or systemic lupus erythematosus in a pregnant woman. If there is a history of these types of diseases, you should tell the doctor about them at the first visit to the doctor when registering in a consultation.

Medical supervision during pregnancy

When contacting a patient with chronic hypertension in the antenatal clinic in the early stages, the doctor will send for the study of urine and blood. In order to control the situation of the work of all internal organs, various types of instrumental diagnostics and clinical examinations can be prescribed:

• regular electrocardiogram;
• observation by an ophthalmologist;
• urinalysis according to the Zimnitsky method (daily analysis);
• other types of research depending on the symptoms.

A complete examination of a pregnant woman will reduce the various risks that appear during pregnancy in a patient with hypertension. In a severe form of the disease, it will be necessary to carefully monitor the pressure indicators throughout the pregnancy, strictly taking the drugs as directed. When writing a prescription and determining the treatment regimen, the doctor will proceed from the need to use a drug that is safe for the future baby. It is unacceptable to refuse medication during pregnancy in patients with severe hypertension, as this can lead to death. If the symptoms are mild, the doctor, based on examinations and tests, will decide to reduce or completely refuse medications, assessing the benefits to the health of the mother and the threat to life for the child and the pregnant woman.

If a patient with a mild form of the disease did not take any medications before pregnancy, the doctor may refuse to prescribe drugs. The reason lies in the generally accepted dynamics of the decrease in the rate of normal pressure in pregnant women in the first two trimesters. By the middle of the term, the pressure in most cases returns to its usual values. Taking medication to lower blood pressure can lead to a significant decrease in the indicator, while reducing blood flow through the placenta.

In the presence of high blood pressure in a pregnant woman, control in a medical institution becomes more frequent, additional examination options are prescribed (in addition to planned ultrasounds, the level of amniotic fluid, growth in fetal size, dopplerometry, various types of testing of the unborn child will be monitored). With a significant jump in pressure, the doctor decides on the hospitalization of the pregnant woman until the indicators stabilize. With the development of preeclampsia, the pregnant woman is in the hospital until the moment of delivery due to the particularly high risk of preterm birth.

All about the drug Perineva and its analogues

1. Regulation of blood pressure in the body
2. Perineva: how it works
3. How to use Perineva
4. When to start using Perineva
5. Reception regimen and principles of dose selection
6. special instructions
7. Overdose and side effects
8. Perineva's analogs
9. Reviews
10. conclusions

Perineva is a drug intended for the treatment of high blood pressure. Perineva's active ingredient, perindopril, belongs to the class of angiotensin-converting enzyme (ACE) inhibitors. The drug is produced by the Slovenian company KRKKA, which has a production branch in Russia.

Regulation of blood pressure in the body

To understand exactly how the remedy works, you need to know how blood pressure is regulated in the body. Regulation mechanisms are systemic and local. Local ones act at the level of the vascular wall and “correct” the result of the work of systemic mechanisms, based on the momentary needs of a particular organ.

Systemic mechanisms regulate blood pressure at the level of the body as a whole. According to the mechanism of action, they are divided into nervous and humoral. As the name implies, nervous mechanisms carry out regulation with the help of the peripheral nervous system. Humoral mechanisms regulate systemic blood flow with the help of active substances dissolved in the blood.

One of the main mechanisms that controls systemic blood flow and, as a result, regulates blood pressure is the Renin-Angiotensin-Aldosterone system.

Renin is a hormone-like substance that is produced in the cells of the arterioles of the vascular glomeruli of the kidneys. It is also synthesized by the endothelium - the inner lining of the vessels of the brain, myocardium, glomerular zone of the adrenal cortex. Renin production is regulated by:

• The pressure in the blood-bearing vessel, namely, the degree of its stretching;
• The content of sodium in the distal tubules of the kidneys - the more it is, the more active is the secretion of renin;
• Sympathetic nervous system;
• By the principle of negative feedback, reacting to the content of angiotensin and aldosterone in the blood.

Renin transforms the angiotensinogen protein synthesized by the liver into the inactive hormone angiotensinogen I. With the blood flow, it enters the lungs, where it is converted into active angiotensin II under the action of angiotensin-converting enzyme (ACE).

Functions of angiotensin II:

• Narrows arteries, including coronary;
• Causes myocardial hypertrophy;
• Stimulates the release of vasopressin (aka antidiuretic hormone) in the pituitary gland, which retains water in the body, reducing its excretion by the kidneys;
• Stimulates the production of aldosterone in the adrenal glands

Perineva: how it works

Perineva blocks ACE, thus reducing the amount of angiotensin II in the body and eliminating its vasoconstrictive effects. In parallel, the secretion of aldosterone decreases, the retention of sodium and fluid in the body decreases. This reduces the volume of circulating blood and, as a result, reduces the pressure in the arterial system.

In general, the effects of the drug can be divided into the following groups:

Changes in the cardiovascular system:

Effects from the kidneys:

• Normalization of intraglomerular hemodynamics;
• Reducing proteinuria.

From the endocrine system:

• Reducing tissue resistance to insulin (important for patients with metabolic syndrome and type 2 diabetes);
• prevention of angiopathy and nephropathy caused by diabetes.

From other metabolic processes:

• Increased excretion of uric acid by the kidneys (important for patients with gout);
• Anti-atherosclerotic action: reduces the permeability of the cells of the inner wall (endothelium) of blood vessels and reduces the amount of lipoproteins in them.

With prolonged regular use, Perineva exhibits the so-called chronic antihypertensive effect. The reproduction and growth of smooth muscle cells in the middle wall of the artery decreases, which increases their lumen and restores elasticity.

How to use Perineva

• arterial hypertension,
• For cardioprotection in chronic heart failure,
• For cardioprotection after myocardial infarction or coronary artery surgery, subject to the stability of the ischemic process,
• To prevent recurrence of stroke in patients who once had it.

When to start using Perineva

The main indication for this is arterial hypertension. It is understood as an increase in systolic, “upper” blood pressure > 140 mm Hg. st and / or diastolic, “lower” blood pressure> 90 mm. rt. Art. An increase in pressure can be secondary, caused by diseases of other organs (glomerulonephritis, adrenal tumors, etc.) and primary, when it is impossible to identify and eliminate the cause of the disease.

Primary (essential) hypertension accounts for 90% of all cases of high blood pressure and is referred to as hypertension. The Ministry of Health of the Russian Federation in clinical guidelines of 2013 proposes the following criteria for its diagnosis:

Reception regimen and principles of dose selection

Recommended targets for blood pressure are less than 140/90 (for patients with diabetes mellitus - less than 140/85). The previously used concept of “working pressure” was recognized as incorrect - in order to prevent complications and reduce the likelihood of cardiovascular death, it is necessary to achieve target indicators. If the pressure is excessively high and its abrupt normalization is poorly tolerated, the correction is carried out in several stages.

In the first 2-4 weeks, blood pressure drops by 10-15% of the initial level, then the patient is given a month to get used to such pressure values. Further, the rate of decline is selected individually. The lower limit of the decrease in SBP is 115-110 mm Hg, DBP is 75-70 mm Hg, at excessively low levels, the risk of myocardial infarction and stroke again increases.

The medicine is taken once a day, in the morning. The initial dosage is 4 mg, for pensioners - 2 mg, gradually increasing to 4 mg. Patients taking diuretics should stop using them 2-3 days before the start of the course of Perineva, or start treatment with a dosage of 2 mg, also gradually increasing to 4 mg. According to the same principle, doses are selected for patients suffering from chronic heart failure.

After a month of regular intake, the effectiveness of the drug is evaluated. If the target blood pressure is not achieved, it is necessary to switch to a dosage of 8 mg.

For patients with stable coronary artery disease, Perineva is prescribed at a starting dosage of 4 mg, after 2 weeks they switch to 8 mg.

Contraindications:

special instructions

Perineva can provoke an excessive decrease in blood pressure when:

• cerebrovascular pathologies,
• Simultaneous use of diuretics,
• Loss of electrolytes: after a salt-free diet, vomiting or diarrhea,
• After hemodialysis,
• Stenosis of the mitral or aortic valves - since cardiac output in these conditions cannot increase, it is not able to compensate for the decrease in peripheral vascular resistance,
• renovascular hypertension,
• Chronic cardiovascular insufficiency in the stage of decompensation.

May exacerbate renal failure in patients with bilateral renal artery stenosis or stenosis of the artery to a single kidney.

Perinev should be used with extreme caution in women of childbearing age. Planned pregnancy is an indication for changing the antihypertensive drug.

Overdose and side effects

In case of an overdose, blood pressure drops excessively, up to shock, kidney failure develops, respiratory intensity (hypoventilation) decreases, heart rate can change both towards tachycardia and bradycardia, dizziness, anxiety, and coughing are possible.

In case of an overdose, it is necessary to lay the patient down, raising his legs, replenish the bcc, by intravenous administration of solutions. Angiotensin II is also administered intravenously, in its absence - catecholamines.

Side effects:

Perineva's analogs

To date, more than 19 drugs based on perindopril have been registered in the Russian Federation. Here is some of them:

• Prestarium. The drug, manufactured by the French company Servier, was the first drug based on perindopril that appeared at the disposal of doctors. It was on this drug that all studies on the effectiveness of perindopril, a decrease in cardiovascular risk (a decrease of 20%), and a positive effect on the condition of the walls of blood vessels were carried out. The cost is from 433 rubles.
• Perindopril-Richter. Production of the Hungarian company "Gedeon-Richter". Price from 245 rubles.
• Parnavel. Production of the Russian company Ozon. Price from 308 rubles.

When choosing from the possible options the best in terms of price-quality ratio, you need to remember that today, of all manufacturers of generic drugs, only KRKKA has proved the bioequivalence (correspondence to the original medicine) of its product.

The cost of Perineva in pharmacies is from 244 rubles.

Ko-Perineva

Monotherapy with perindopril (Perineva) allows achieving the target values ​​of blood pressure in patients with 1-2 stages of hypertension in 50% of cases. In addition, often the therapy of arterial hypertension should immediately begin with a combination of two active substances.

The combination of perindopril and indapamide (thiazide diuretic) has proven to be one of the most effective. For the convenience of patients, this combination is available as a single tablet.

Co-perinev is produced in 3 dosages:

1. Perindopril 2 mg + indapamide 0.625 mg;
2. Perindopril 4 mg + indapamide 1.25 mg;
3. Perindopril 8 mg + indapamide 2.5 mg.

The cost in pharmacies - from 269 rubles.

Contraindications

In addition to those already indicated for perindopril, for Ko-perineva:

• Azotemia, anuria;
• Liver failure.

Side effects

In addition to the adverse events characteristic of perindopril, Ko-perinev can cause:

• Hemolytic anemia, hemorrhagic vasculitis - extremely rare;
• Photosensitivity, erythema multiforme - very rare;