Effects Of Different Blood Pressure Target Values On Renal Function In Hypertensive Patients With High Risk Of Cardiovascular And Cerebrovascular Diseases

Objective: To evaluate the effect of systolic blood pressure less than 120 mm Hg and systolic blood pressure less than 140 mm Hg on renal function in hypertensive patients who suffer from high risk of cardiovascular and cerebrovascular diseases.Methods: This research is a controlled experiment which is forward-looking,randomized and parallel.The research collects the data of patients in Inner Mongolia Medical University who suffers from hypertension(SBP≥130mm Hg)and high risk of cardiovascular and cerebrovascular diseases.The collection is from April 2019 to October 2019 and 144 cases were preliminarily screened.The initially screened patients fully understood the content of this study.The consent forms are well signed by all the related patients and finally 138 of the patients were qualified.Then a method,which is named minimal randomization,is used for this research.It assigns 69 patients in the intensive group(target systolic blood pressure lowering SBP<120 mm Hg)and 69 patients in the standard antihypertensive treatment group(target systolic blood pressure lowering SBP<140 mm Hg)The data will be followed up to 21 months.During the 1st,2nd,and 3rd month follow-up,blood pressure adjustment was mainly performed.Different antihypertensive programs were formulated according to each subject’s basal blood pressure level and five types of first-line antihypertensive drugs were provided free of charge to make the blood pressure reach their respective groups standard.Follow-up visits to the outpatient clinic is taken every 3 months.If blood pressure is not up to standard during follow-up or the detection index is abnormal,the patient will enter the blood pressure setting clinic to adjust the antihypertensive drugs again and review the abnormal index.Serum potassium and serum creatinine need to be monitored during the 1st,2nd,3rd,6th,12 th,18th and 21 st months of follow-up.In the 0th,12 th,and 21 st months of follow-up,the blood samples are collected for the detection of the serum potassium and serum creatinine.In 12 th and 21 st month,morning urine should be collected and used to detect urinary creatinine(UCr),urinary albumin(m ALB),urinary albumin to creatinine ratio(UACR).According to the formula and body weight of patients,finish the calculation of the glomerular filtration rate(e GFR)of every patient.Finally use SPSS.25 to analyze the related indicators of renal function such as m ALB,UACR,e GFR,serum potassium,etc.to determine whether there is a statistical difference of the indication for these two groups.Results: This study completed outpatient follow-up of 122 patients,including 60 patients in the intensive group who are 64±7 years old averagely and 62 patients in the standard who are63±10 years old in average.On the 21 st month,for the result of the mean systolic blood pressure,the intensive group is 119±10mm Hg and the standard group is 134±7mm Hg with the statistical difference less than 0.05.For the all-cause death and cardiovascular and cerebrovascular events,there are 2 cases in the intensive group and 9 cases in the standard group with the statistical difference less than 0.05.The renal function indices of e GFR were89.04±24.88 ml/min and 95.81±27.01 ml/min,m Al B were 6.95 mg/L and 6.80 mg/L and UACR were 10.41 mg/g and 7.87 mg/g in the intensive group and standard group,respectively,and the differences were not statistically significant(P > 0.05).There was no statistically significant difference in renal function between the intensive group at 12 months and 21 months(P>0.05).The serum potassium of the intensive group is 3.98±0.32 mmol/L compared with that of the standard group,which was 4.12±0.43 mmol/L,with a statistical difference between the two groups(P<0.05),but all the data is in the normal scope.Conclusion: For the high-risk patients who have systolic blood pressure less than 140 mm Hg,it means the patients with cardiovascular and cerebrovascular diseases,the research finds that the diseases doesn’t have obvious different renal function between them and patients with blood pressure less than 120 mm Hg.For the patients with low blood pressure,the cerebrovascular events are not hurt with a lower cardiovascular.Therefore,it is a safe and effective blood pressure target value and the patients will get much more benefits.