Some people on the Internet have consulted: You once mentioned that Shatan antihypertensive drugs have a protective effect on the kidneys, but you saw an article on the headline today that it has kidney damage. What is going on here?
The full name of the sartans antihypertensive drugs is called angiotensin II receptor antagonists, abbreviated as ARB, because the names of the drugs are all with the word “sartan”, so called sartans antihypertensive drugs, including: Tan (Cossack), Irbesartan (Ambove), Valsartan (Daivin), Telmisartan (Mecacan), Candesartan (Belos), Olmesartan (Allanttan) , Allisartan et al. The name of the original drug is in parentheses.
Learn about the renin-angiotensin-aldosterone system before learning about satan antihypertensive drugs.
First, Renin-angiotensin-aldosterone system
This is a “devil” system.
When the blood flowing through the kidneys is reduced, or the kidneys suffer various injuries, the kidneys will secrete a substance called “renin,” which is like a “key” and opens the door to the “devil.” Renin is an enzyme that hydrolyzes angiotensinogen to angiotensin I, and angiotensin I becomes angiotensin II again.
Under normal circumstances, this system is necessary to maintain the body’s blood pressure and circulating blood volume. However, a variety of reasons lead to the sustained release of renin, abnormal increase of angiotensin II, it will bring a series of pathological problems.
Angiotensin II is like “the devil’s head” and “destructive” is the largest.
1. Angiotensin II is a substance that strongly constricts blood vessels. Sustained elevation can lead to hypertension and vascular sclerosis.
2, angiotensin II through a series of processes, causing glomerular sclerosis, renal interstitial fibrosis, glomerular basement membrane destruction, myocardial sclerosis, leading to proteinuria, renal failure, heart failure, etc.;
3. Angiotensin II promotes the release of aldosterone, aldosterone causes sodium and sodium retention, and also causes hypertension.
If you can reduce the production of angiotensin II or block its effects, you can control blood pressure, reduce urine protein, and reduce kidney and heart damage.
Second, sartans antihypertensive drugs play a role by blocking angiotensin II receptors
Satan antihypertensive drugs are angiotensin II receptor antagonists, which can selectively block the angiotensin II receptor and block its function, so the satan antihypertensive drugs have antihypertensive and urinary protein And delay the effect of kidney damage, but the dose required to reduce urinary protein and kidney maintenance is greater.
Sandan antihypertensive drugs are commonly used clinically for the treatment of chronic kidney disease, diabetes, cardiac hypertrophy, and heart failure combined with hypertension. In addition, it also has the effect of inhibiting sympathetic nerve stimulation and is also commonly used in the treatment of hypertension in young people. It is not an exaggeration to say that the anti-hypertensive drugs of satan have kidney protection.
In addition, Pulpril antihypertensive drugs mainly inhibit the production of angiotensin II, and therefore have similar effects as satans antihypertensive drugs. However, the incidence of dry cough in Preli-type antihypertensive drugs is high, and the side effects are greater than that of satans antihypertensive drugs, so the use is decreasing.
The antihypertensive effects of sartans antihypertensive drugs and pril antihypertensive drugs are very good, and their effects are long-lasting and stable. Generally, they can be taken once a day. However, the combination of the two does not increase the efficacy, and the side effects increase significantly. Therefore, the combination of the two types of drugs is prohibited.
Third, the side effects of satans antihypertensive drugs
Satan antihypertensive drugs are mainly metabolized by the liver and have no damage to the kidneys. However, these drugs can reduce glomerular blood perfusion in individual cases, resulting in elevated serum creatinine and elevated serum potassium. This side effect is generally seen in patients with chronic renal failure with renal artery stenosis or dehydration, and other conditions rarely occur. Therefore, the use of antihypertensive drugs like Sartan is very safe for ordinary hypertensive patients without excessive worry.
In the past, if serum creatinine was ≥350 μmol/L, it was no longer possible to use satans antihypertensive drugs. Now this concern is found to be superfluous. Clinical practice has shown that a slight increase in serum creatinine (<30%) is a normal phenomenon without sacrificing the use of satans antihypertensive drugs; if the serum creatinine rises more than 30% of the baseline value, it should be reduced and sieved. Check the reason. If it is due to dehydration, lack of effective circulating blood volume and other reasons, it can be restored to the previous dose after correcting the cause; if the increase in serum creatinine> 50%, should be suspended.
Whether it is the increase of serum creatinine or the increase of serum potassium, it can be restored to the original state after stopping the drug and symptomatic treatment, and there is no sequelae.
The guidelines recommend that the use of satan or prednisone should not be used:
- Insufficient tolerance to cough, angioedema, or other allergic reactions in previous medications;
- bilateral renal artery stenosis (Note: not unilateral);
- blood potassium after treatment> 5.5mmol/L
In addition, it can be used with confidence.