Analysis Of Irbesartain's Effect On Early Renal Damage In Essential Hypertension

Objective: Essential hypertension is a common cardiovascular diseases,also one of the common disease which is leading human death,such as cerebral apoplexy,coronary heart disease,kidney function failure,heart failure etc.Kidney is the important organs regulate blood pressure,and it is one of the main organs of affecting hypertension,the pathogenesis is still unclear at present,It maybe associated with renal hemodynamic change and endothelial damage.Irbesartan is the new type of Angiotensin receptor blockers(ARB),with function of reducing urinary protein and improving endothelial.There is no clear standards for the choice of antihypertensive drugs in the clinical patients of primary hypertension with early renal damage.In this experiment,by watching the antihypertensive efficacy of the Irbesartan and Extended release nifedipine tablets used in treating of patients,observing early renal damage index includes serum cystatin C and urinary transferring and urinary microalbumin(UmAlb)and Alpha1microglobulin(?1-MG),?-N-Acetyl glucosaminidase(NAG)levels.Then make a comprehensive analysis,Confirmed that Irbesartan and Extended release nifedipine tablets can give effective treatment to high blood pressure.Irbesartan has protective effect on early renal damage,it can delay the progress of chronic kidney disease,and it improves the patients' life quality,it provides references for clinical treatment.Method:1 Research objects: We choose the outpatient cases in Hengshui Halison International Peace Hospital from September 2011 to September 2013,before entering the group,all the cases are according with China's prevention and control of hypertension guidelines revision committee in China's prevention and control of hypertension guidelines(Revised Edition 2010 Third Edition),all patients have 2nd stage high blood pressure and clinically insignificant,urinary albumin / creatinine the ratio between 30-300mg/g,Cystatin C(Cysc)is high,the coexistence of both or one is larger than normal,and needs to exclude secondary hypertension,primary kidney disease,gout,valvular heart disease,cardiomyopathy,diabetes,infections,blood diseases,liver dysfunction and autoimmune diseases ect.This subject collected 56 patients,randomly divided into Irbesartan group and Extended release nifedipine tablets group,two groups have no significant difference in gender weight and age(P>0.05),they are comparable.2 Method: The starting dosage of Irbesartan group is 150 mg/d,The starting dosage of Extended release nifedipine group is 10 mg/d,If blood pressure is morn than 140/90 mmHg after 1 week,we will gradually increase the drug dose,the maximum dose of Irbesartan is 300mg/d,the maximum dose of Extended release nifedipine Tablets is 40mg/d,take 10 weeks orally continuous.The blood pressure target at sitting position is 140/90 mmHg,we measure their blood pressure at least 4 times a week.After two weeks if their blood pressure can't be controlled to the target blood pressure,add with Metoprolol 25-50 mg/d.If the blood pressure still cannot be controlled,exit this experiment.Irbesartan group exit 2 cases,Extended release nifedipine tablets only exit 1 case.Both of the groups have 1 case was lost to follow up.Once the blood pressure is controlled in the 140/90 mmHg,keep the current dose,and observe adverse drug reactions.3 Observation index: the selected object by measuring blood pressure at least 4 times a week.And respectively before and after treatment in 2nd,4th,8th,10 th weeks of fasting(fasting 8-12 hours)of venous blood 3ml can detect Cysc and at the same time to collect fresh mid-piece urine detection of urinary transferrin in SIEMENS BN II(U-TRF),urinary albumin(UmAlb),Alpha1 microglobulin(U-?1-mG),N protein microspheres ?-acetyl Glucosaminidase(NAG)level.According to the test results difference between Irbesartan group and Extended Release Nifedipine Tablets group treatment.4 Statistical methods: the data were analyzed basic on the statistical software SPSS 19,standard deviation measurement data((?)±s),Line matching t test,the count data to rate,using x2 test.Results were not significant(P > 0.05),the difference results was statistically significant(P < 0.05).Result:1 There is no significantly different between the two group of patients in age,sex,weight,before treatment Cys-c,U-TRF,UmAlb,U-?1-mG of levels(P>0.05)2 the Irbesartan group decreased diastolic blood pressure and systolic blood pressure effectively in grade 2 hypertension patients with significant difference(P<0.05)3 Extended Release Nifedipine Tablets group decreased diastolic blood pressure and systolic blood pressure effectively in grade 2 hypertension patients with significant difference(P<0.05)4 Reducing systolic blood pressure and diastolic blood,the treatment before and after the Irbesartan,compare with the treatment before and after the Extended Release Nifedipine Tablets,hypotensive effect has no statistically significant(P>0.05)5 After the treatment of Extended Release Nifedipine Tablets,Cys-c,U-TRF,UmAlb,U-?1-mG are all decreased,there were some differences compared with treatment before(P<0.05)6 After the treatment of Irbesartan,Cys-c,U-TRF,UmAlb,U-?1-mG are all decreased,compared with before treatment had significant statistical difference(P<0.05)7 Irbesartan group compared with Extended Release Nifedipine Tablets group,it had significant difference in decreasing Cys-c,U-TRF,UmAlb,U-?1-mG(P<0.05)Conclusion: This research data shows that: Irbesartan and Extended release nifedipine tablets treatment 2nd levels of primary hypertension group both were effective;Irbesartan and Extended release nifedipine tablets both can drop Cys-c,U-TRF,UmAlb,U-?1-mG levels drop after treatment.Comparing the two groups,Irbesartan can reduce early renal damage index more effectively.