Hypertension Treatment

Hypertension Treatment

Approach Considerations

The 2016 American Diabetes Association's (ADA's) standards of medical care in diabetes also indicate that a majority of patients with diabetes mellitus have hypertension. In patients with type 1 diabetes, nephropathy is often the cause of hypertension, whereas in type 2 diabetes, hypertension is one of a group of related cardiometabolic factors.   Hypertension remains one of the most common causes of congestive heart failure (CHF). Antihypertensive therapy has been demonstrated to significantly reduce the risk of death from stroke and coronary artery disease.

Other studies have demonstrated that a reduction in BP may result in improved renal function. Therefore, earlier detection of hypertensive nephrosclerosis (using means to detect microalbuminuria) and aggressive therapeutic interventions (particularly with ACE inhibitor drugs) may prevent progression to end-stage renal disease.

Lifestyle modifications

Lifestyle modifications are essential for the prevention of high BP, and these are generally the initial steps in managing hypertension. As the cardiovascular disease risk factors are assessed in individuals with hypertension, pay attention to the lifestyles that favorably affect BP level and reduce overall cardiovascular disease risk. A relatively small reduction in BP may affect the incidence of cardiovascular disease on a population basis. A decrease in BP of 2 mm Hg reduces the risk of stroke by 15% and the risk of coronary artery disease by 6% in a given population. In addition, a prospective study showed a reduction of 5 mm Hg in the nocturnal mean BP and a possibly significant (17%) reduction in future adverse cardiovascular events if at least one antihypertensive medication is taken at bedtime.

In a study that attempted to formulate a predictive model for the risk of prehypertension and hypertension, as well as an estimate of expected benefits from population-based lifestyle modification, investigators reported that the majority of risk factors have a larger role in prehypertension and stage 1 hypertension than in stage 2 hypertension. The investigators derived multistep composite risk scores by assessing significant risk factors in the progression from prehypertension to hypertension, as well as the regression of prehypertension to normal; they indicated that as the number of risk factors included in intervention programs increases, the size of the expected mean risk score decreases. In men, the 5-year predicted cumulative risk for stage 2 hypertension decreased from 23.6% (in the absence of an intervention program) to 14% (with 6-component intervention); the results were similar in women.

Treatments and drugs

Medications to treat high blood pressure

Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume.

Thiazide diuretics are often the first, but not the only, choice in high blood pressure medications. Thiazide diuretics include hydrochlorothiazide (Microzide), chlorthalidone and others.

If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic. Diuretics or calcium channel blockers may work better for black and older people than do angiotensin-converting enzyme (ACE) inhibitors alone. A common side effect of diuretics is increased urination.

Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. Beta blockers include acebutolol (Sectral), atenolol (Tenormin) and others.

When prescribed alone, beta blockers don't work as well, especially in black and older people, but may be effective when combined with other blood pressure medications.

Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. People with chronic kidney disease may benefit from having an ACE inhibitor as one of their medications.

Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others. People with chronic kidney disease may benefit from having an ARB as one of their medications.

Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for black and older people than do ACE inhibitors alone.

Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.

Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure.

Tekturna works by reducing the ability of renin to begin this process. Due to a risk of serious complications, including stroke, you shouldn't take aliskiren with ACE inhibitors or ARBs.

Additional medications sometimes used to treat high blood pressure

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others.

Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Alpha-beta blockers include carvedilol (Coreg) and labetalol (Trandate).

Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa.

Vasodilators. These medications, including hydralazine and minoxidil, work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

Aldosterone antagonists. Examples are spironolactone (Aldactone) and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid retention, which can contribute to high blood pressure.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

What are the main hazards of nephrotic syndrome?

What are the main hazards of nephrotic syndrome?

Kidney is one of the body's five internal organs, its health or not completely affect the health of the human body. Nephrotic syndrome is a more serious form of kidney disease. We do not know much about this disease in our lives, and its severity is manifested in the fact that it causes many other diseases and can lead to other diseases in the human body. The normal operation of the system.

What are the main hazards of nephrotic syndrome?

1, nephrotic syndrome in the course of the disease a large number of immunoglobulin from the urine will be lost, plasma protein decreased, affecting antibody formation. Adrenal cortical hormones and cytotoxic drug applications, the patient's body resistance decreased, prone to infection, such as skin infections, primary peritonitis, respiratory infections, urinary tract infection, and even induce sepsis.

2, nephrotic syndrome will induce cardiovascular and cerebrovascular diseases, nephrotic syndrome patients usually have symptoms of hypertension, hypertension is also one of the symptoms of nephrotic syndrome, or cause a lot of important factors of disease, we must not overlook the , Nephrotic syndrome in patients with severe hypertension, easily lead to cardiovascular and cerebrovascular diseases and so on. Therefore, the harm caused by high blood pressure can not be overlooked.

3, the incidence of nephrotic syndrome often have hyperlipidemia or hypercoagulable state of the blood, which easily lead to patients with coronary heart disease. According to some reports, the incidence of myocardial infarction in patients with nephrotic syndrome is higher than the normal people more than 8 times. This is a major risk of nephrotic syndrome.

4, nephrotic syndrome will cause serious damage to the regulatory mechanism, according to the survey of experts, patients with nephrotic syndrome are generally a large number of proteinuria and severe edema symptoms, to the patient's physical and mental health are caused great harm . As the onset of nephrotic syndrome hidden, if symptoms can not be timely treatment, leading to disease spread. As patients with nephrotic syndrome, there will be proteinuria, hypoproteinemia, hyperlipidemia, edema, renal regulation of the mechanism of serious damage.

5, nephrotic syndrome, what is the main hazards, nephrotic syndrome patients due to a large number of hyperlipidemia, proteinuria, hypoalbuminemia, resulting in the body is often in the low blood volume and hypercoagulable state. Vomiting, diarrhea, the use of antihypertensive drugs and a large number of diuretic diuretics, can cause a sudden decrease in renal blood perfusion, thereby reducing the glomerular filtration rate, leading to acute renal failure.

6, nephrotic syndrome is generally can lead to the emergence of acute renal failure. This is due to nephrotic syndrome, renal interstitial edema, protein concentration of the formation of the tubular plug the renal tubular and other factors, can induce acute renal failure. This is a common nephrotic syndrome, the main hazards.

Nephrotic syndrome in the pathogenesis often accompanied by symptoms of other diseases, resulting in nephrotic syndrome in the cause of kidney damage will also cause some of the body's other features of the destruction of some, that is, the disease dragged the longer the longer Will endanger the greater the ultimate function of the kidney will eventually failure to complete the function of the kidney is completely lost, is a completely can not delay the disease.

Is nephrotic syndrome harmful?

Is nephrotic syndrome harmful?

Kidney disease experts pointed out that the severity of nephrotic syndrome manifested as renal failure, uremia. In the early stages of nephrotic syndrome, if there is no effective measures to treat it, nephrotic syndrome will cause serious harm to the human body, to people's normal life and work caused a lot of inconvenience. Timely and correct treatment of the disease, so that patients get rid of nephrotic syndrome as soon as possible, with a healthy body.

When the nephrotic syndrome occurs, accompanied by nephrotic patients will occur a series of concurrent symptoms, edema, hyperlipidemia, anemia and so on. These symptoms indicate that the body resistance of patients decreased, while the body's immune regulation system has undergone tremendous changes, which will lead to abnormal expression of the body's protein, resulting in the emergence of hypoproteinemia. Nephrotic syndrome Hypoproteinemia is not only a direct impact on the body's protein needs, but also on the body there are other aspects. The human body is a complex body, its various symptoms are interrelated, mutual influence.

Due to the excretion of large amounts of proteinuria, inadequate supply of synthetic protein in the liver, leading to hypoproteinemia. The emergence of this phenomenon is a very serious nephrotic syndrome hazards. Reduce the blood protein, it will lead to decreased plasma colloid osmotic pressure, colloid osmotic pressure drop imbalance, the water will overflow within the plasma, and accumulation to the organization and body cavity, resulting in a high degree of human edema. At the same time, when the plasma water spills out, the water content in the blood decreases, and the blood volume in the active circulation is insufficient. Therefore, when the blood is reduced in water, it causes a high blood viscosity, easily forms a blood clot, Ischemia and hypoxia. The emergence of these symptoms will aggravate the process of kidney disease.

Nephrotic syndrome This disease is very high in the incidence of children in the group will have a very negative impact on the growth of children. The incidence of nephrotic syndrome is getting higher and higher, which has aroused widespread concern. Whether it can cure this disease has become one of the concerns of many patients.

Treatment for Nephrotic syndrome

Treatment for Nephrotic syndrome

Nephrotic syndrome is a relatively refractory disease, which is its repeated characteristics of the decision, and the treatment process is still relatively long. Therefore, there are many patients very anxious, there will be chaotic medical conditions, this is very wrong.

If you want a good treatment of nephrotic syndrome, we should first understand the common method of treatment in order to choose the right treatment.

First, the early treatment of edema in the disease, which is all patients will occur as a symptom. Therefore, in the treatment of the first to deal with it. Patients with severe edema and hypoalbuminemia should be bed rest. At the same time to the normal amount of high-quality protein diet, to ensure adequate calories to ensure a balanced daily nutrition. And patients with edema should be low-salt diet, if patients with hyperlipidemia should be low-fat diet.

Second, drug treatment This is the treatment of nephrotic syndrome, the most common form of treatment, but will be based on the patient's condition medication. If the patient's symptoms, should be added with a diuretic swelling, or reduce the use of urine protein drugs. Because patients with nephrotic syndrome have significant edema and serous effusion, so the simple limit of salt, water is not significant effect, the doctor can use the recommended diuretics to reduce excessive extracellular fluid. Some antihypertensive drugs can also control the role of hypertension and reduce urinary protein to varying degrees.

Third, the adrenal glucocorticoid This is a drug treatment, an important drug for the treatment of nephrotic syndrome is very effective. However, patients should be used regularly, not self-decrement or sudden withdrawal after long-term use, which may lead to poor treatment or the emergence of some serious side effects.

Patients should not be discontinued when they are treated with medication to achieve cure. If you need to disable or reduce the amount, should be carried out under the guidance of a doctor. Patients with nephrotic syndrome, the daily loss of large amounts of protein from the urine, the course of time will inevitably lead to the lack of protein in the body, then if you do not add protein, will become increasingly scarce.

To know that protein is the source of life, the body lacks protein, not only edema, and will be sick, life-threatening. The spread of kidney disease in the community to abstain from eating meat, eggs, fish without scales is unscientific. On the contrary, these patients would like to eat more protein, in particular, is rich in high quality protein foods such as milk, eggs, lean meat, chicken, fish and so on. Of course, not unlimited ingestion of protein, long-term over-ingestion of protein, not only useless, and will increase the burden on the kidneys, which lead to increased renal damage

Chinese medicine treatment

2. Chinese medicine treatment

Kidney essence from the role can be divided into kidney yin, kidney two aspects, kidney yin and kidney interdependence, mutual restraint, maintain the body's dynamic balance. Such as kidney yin partial failure can not yang, there Yin and yang hyperactivity of the lesion, that is, kidney yin deficiency, manifested as Yaoxisuanruan, five upset hot, dizziness, tinnitus, insomnia, forgetfulness, night sweats, woman spermatorrhea premature ejaculation, , Constipation, red tongue, little moss pulse fine performance. While the partial decline of kidney yang deficiency, manifested as pale or swarthy, Yaoxisuanleng, lack of energy, male impotence and premature ejaculation, female infertility Palace, edema, enuresis, diarrhea and so on. Chinese medicine is very knowledge of kidney, kidney or kidney deficiency is clear is the key. Buyyin drugs are mostly Gan Yao medicine, such as Cordyceps sinensis, Dendrobium, Polygonatum, dogwood, Chinese wolfberry fruit, female, herbal medicine, herbal medicine, herbal medicine, Sagittaria, Loranthaceae, American ginseng and so on.

3. Life maintenance of the old kidney, the body will appear the phenomenon of aging and weakness, and for the kidney itself, in particular, should pay attention to maintenance, to prevent the occurrence of kidney disease.

1, can not underestimate the common cold is a systemic disease, can make immune function, often secondary infection. According to reports, nearly 40% due to a cold caused by chronic nephritis symptoms increased, and chronic nephritis is the first chronic renal failure primary disease, it should attach great importance in daily life to prevent colds.

2, to strengthen exercise kidney disease patients due to cold weather, more reluctant to exercise throughout the winter like to stay in a warm home, or even bed rest. Doctors advise: This is a very wrong and dangerous practice, it will slow down the kidney blood flow, aggravate stasis and renal sclerosis atrophy. Nephropathy in patients with exercise-based approach to walking, sunny as far as possible to participate in outdoor sports, not suitable for outdoor activities should also be an indoor walk, do not stay in bed. For low back pain, the older people will always explain this "old man, all this." In fact, not old to have low back pain, as long as a little improvement in lifestyle and diet, you can relieve pain symptoms, and back pain that "worship." Some elderly people often back pain, can check to check to find the reason, in fact, because the mattress is too soft. Sleep, the spine can not be given appropriate support if the mattress, and the whole night in a state of improper bending, long-term sleep, the back will of course sore. Therefore, if the mattress is really soft, you can add a layer of bamboo mat above to increase the hardness, or simply change the flat bed.

The soup is characterized by "open up the blood", because the Chinese believe that only the blood will lead to soreness, so you can eat this soup to eat Open up blood, relieve pain. Do this soup wormwood to go to the pharmacy to buy, and red dates with water after the fire boil, but also a small fire and cook for 20 minutes, and then drink when the drink residue. Should be noted that the wormwood partial warm, so join the red dates must be cut to the core, or drink will get angry. In addition, if you feel the soup bitter, but also add brown sugar to taste. General drink three days a day, even drink three months, to improve the low back pain is helpful.

Treatment of Nephrotic Syndrome

First, the diet tune up

1, Cordyceps stew black-bone chicken: take 50 grams of Astragalus, 10 grams of Cordyceps sinensis, black-bone chicken 1. The black-bone chicken to the hair and internal organs, scraping clean cut, with the North Astragalus, Cordyceps together into the pot with water stew to be cooked chicken, add seasoning Yin Tang meat. Modern scientific research shows that Cordyceps sinensis is the best treatment of kidney disease in a. But not all Cordyceps have medicinal effect, the brand, the Fulin door Cordyceps sinensis and Beijing Tongrentang Cordyceps sinensis is the industry recognized the two brands. If it is to use health care, it is recommended to use Fulinmen, natural cordycepin and natural amino acid content is higher, the effect and cost-effective than good. Tong Ren Tang Cordyceps price is generally Fook Lam door 2 to 3 times. Cordyceps warm, can be taken throughout the year.

2, Seal Kidney porridge: Take the sea dog kidney 15 grams, 75 grams of rice. Kidney kidney with warm water soak for 24 hours, remove and cut open, remove the urethral layer fascia, cut into pieces, the rice Amoy net stand-by. And then take a porridge pot, into the seal kidney, the amount of water and spices, the kelp kidney cook until cooked into the rice porridge, porridge cooked food. One day. The side temperature and kidney yang effect is good.

3, Erxian stew dog: take Curculigo 10 grams, 10 grams of Faerie spleen, 250 grams of dog meat, cinnamon 6 grams, 9 grams of fennel, ginger 15 grams. Will curculigo, fairy spleen, cinnamon, fennel four drugs washed into the gauze bag Zhakou. Wash the dog meat, cut, placed in the casserole, into the medicine bag, ginger, salt, add water to stew Shoulan, remove the medicine bag, Yin Tang meat. The side of the kidney yang deficiency caused by wind cold dampness arthralgia effect is particularly good.

New progress in diagnosis and treatment of IgA nephropathy

IgA nephropathy is a group of mesangial IgA deposition characterized by mesangial proliferative glomerulonephritis, in 1968 by the French pathologist Berger first reported the disease (the disease was known as Berger's disease). It is now widely accepted that the disease is the most common manifestation of primary glomerulonephritis worldwide. Although IgA nephropathy has been considered to be "recurrent and clinically benign hematuria" in the past, IgA nephropathy is now considered to be one of the leading causes of end-stage renal disease (25-40% development of renal failure), some of which Was malignant after.

IgA nephropathy is the most common glomerulonephritis in the world, the United States and Canada account for about 2-10% of renal biopsy, Europe and Australia about 20-25%, Japan is as high as 30% or more, China is estimated to account for primary renal 20-30% of glomerulonephritis. Data from Germany and France show that IgA nephropathy in the general population incidence of 0.02%, but scholars estimate that this is just the tip of the iceberg, Singapore data show that about 2.0%. IgA nephropathy can occur at any age, but is most common in people aged 11-30 years. The ratio of males to females ranges from less than 2: 1 in Japan to as much as 6: 1 in Northern Europe and the United States. Patients of different ages, their clinical manifestations have some differences. Although primary IgA nephropathy receives the most attention, many other diseases are clinically associated with IgA nephropathy.

Table 1 IgA nephropathy classification of the main reasons

IgA nephropathy allergic purpura

Secondary cause

Liver disease: alcoholic, primary biliary, cryptogenic cirrhosis, hepatitis B;

Intestinal diseases: celiac disease, chronic ulcerative colitis, Crohn's disease

Skin diseases: psoriasis, herpes-like dermatitis

Immune rheumatic diseases: rheumatoid arthritis, Sjogren's syndrome, ankylosing spondylitis, Behcet's disease, Reiter's syndrome, immune thrombocytopenia infection: HIV infection, toxoplasmosis, leprosy

Tumor: mycosis fungoides, lung cancer, mucous secretory cancer

Diseases associated with IgA nephropathy: ANCA-associated vasculitis, diabetic nephropathy, membranous nephropathy

First, the pathology

IgA nephropathy under light microscope the most typical change is focal or diffuse mesangial cell proliferation and mesangial matrix increased. Tubulointerstitial lesions with focal tubular atrophy, inflammatory cell infiltration and interstitial fibrosis more common. IgA nephropathy glomerular lesions of light microscopy performance can vary greatly, including almost all kinds of primary glomerulonephritis pathological manifestations. Glomerular lesions from normal or minor injury to a variety of proliferation and sclerosis can be seen. Proliferation and sclerosis can be focal or diffuse, segmental or global, and can be seen in the mesangial area as well as in capillary loops, with or without necrosis, small crescent or annular body.

Whether immunofluorescence or immunohistochemical methods can detect significant deposition of IgA and C3 in the mesangial area. Further typing can be used to determine the deposition of IgA1 or IgG and / or IgM, but the deposition of C1q and C4 is rare. Active IgA nephropathy IgA can also be seen along the capillary loop deposition. At the same time there are often fibrinogen in the mesangial area, capillary loop and crescent in vivo deposition. Small blood vessel wall can be rich in C3 particles deposition, especially in patients with hypertension.

Electron microscopy showed varying degrees of mesangial cell proliferation and expansion of the mesangial matrix, the common bulk of the electron dense material in the mesangial matrix, and sometimes subendothelial mass can also be seen under the electron dense deposition. Usually basement membrane width is normal, but some patients have local thickening of the basement membrane, fracture and plaque-like changes.

Second, clinical manifestations

Clinical manifestations of IgA nephropathy are diverse, many patients have no obvious symptoms and are not aware of any problems. May be only in conventional screening or other diseases when the suspect and about 20% of IgA nephropathy patients with severe azotemia treatment. However, there are some patients may be expressed as acute lesions. IgA nephropathy mainly include the following types, the incidence of the order of:

1. Repeated gross hematuria (30-40%)

1) occurs in the upper respiratory tract infection (gastrointestinal or urinary tract infection) after a few hours to 1-2 days

2) with no more symptoms, a small number of urinary discomfort, and was diagnosed with acute cystitis

3) gross hematuria Children and adolescents (80-90%) than adults (30-40%) more common

4) has nothing to do with the severity of the disease

5) Kidney pathology is generally Lee's classification II-III level

2. Occult nephritis type (20-30%)

1) microscopic hematuria, 25% with intermittent episodes of gross hematuria

2) with or without proteinuria (+)

3) a small number of high blood pressure

4) Kidney pathology is generally Lee's classification II-III level

3. Chronic nephritis type

1) microscopic hematuria, with or without proteinuria (+ - ++)

2) often high blood pressure

3) renal function may be decreased

4) Kidney pathology is generally Lee grade II-IV

4. A large number of proteinuria or nephrotic syndrome type

1) nephrotic syndrome, with or without microscopic hematuria

2) more than a high blood pressure.

3) some patients showed nephrotic syndrome, kidney light microscope can be: minimal change and mild diffuse proliferative glomerulonephritis.

4) Kidney pathology is generally Lee grade I-IV

5. Malignant hypertension

1) malignant hypertension

2) proteinuria (+ - ++), with or without microscopic hematuria

3) often associated with renal insufficiency 4) renal pathology generally Lee grade III-IV level

6. Progressive nephritis syndrome type:

1) progressive deterioration of renal function, there is progressive oliguria

2) proteinuria (+ - ++), with or without gross hematuria

3) more than a high blood pressure, anemia

4) renal pathology is generally crescentic nephritis, Lee's classification IV-V level