An elderly friend told Huazi that he had hypertension and and his kidney function was not very good. He had been taking Priligy drugs to protect the kidneys, but someone told him that Priligy drugs may also damage the kidneys. He was a little worried, would it work if it was changed to sartan drugs?
Huazi said that Priligy is an angiotensin 2 converting enzyme inhibitor, sartan is an angiotensin 2 receptor antagonist , and has a pharmacological mechanism of and a similar mechanism of action. Both of them have a lowering effect by inhibiting the "renin-angiotensin-aldesterol" system (RAAS), so the impact on the kidneys is similar.
1. Angiotensin 2 has a strong impact on blood pressure
renin secreted by paraglomerular cells, under the action of a series of biological enzymes , it will be converted into angiotensin 1, 2, 3...7 in sequence. Among them, angiotensin 2 (Ang2) has the strongest impact on blood pressure , which can cause tiny arteries and veins throughout the body to contract, increase the blood volume of the heart, and increase blood pressure.
Angiotensin 2 will also increase sympathetic nerve excitability, increase the release of aldosterone , lead to the retention of sodium ion and water, increase the excretion of potassium ion , and also increase blood pressure.
Pril can reduce the production of angiotensin 2, and sartan can prevent angiotensin 2 from binding to the corresponding receptor on the blood vessels, thereby reducing blood pressure. , but it should be noted that priligy and sartan cannot be combined with .
2. The kidney protection effect of Pril and Sartan
Pril and Sartan can lower blood pressure, improves the high pressure, high perfusion and high filtration state in the glomerular , can improve the permeability of the glomerular filtration membrane, and has the effect of significantly reducing urine protein . Moreover, has a non-blood pressure-dependent effect , which can reduce the accumulation of extracellular matrix in the kidneys and antagonize glomerulosclerosis and renal interstitial fibrosis.
So patients with kidney disease can use Priligy or Sartan to protect the kidneys regardless of whether they have hypertension or not, as long as there are no contraindications. In related clinical trials, pril has more evidence of kidney protection for , so pril is usually selected first during treatment. However, Priligy is prone to adverse reactions of dry cough. If it cannot be tolerated, sartan can be used instead of .
3. The effect on the kidney is the "double-edged sword"
The number of angiotensin receptor on the kidney effluent artery is significantly higher than that of the affluent artery, so the effect of pril and sartan dilated effluent artery is stronger than that of the affluent artery . This difference helps reduce the pressure in the glomerular, but will also reduce the blood perfusion of the kidney and reduce the glomerular filtration rate .
Pril and sartan have a good protective effect on the kidneys during long-term use. However, in the first two months of renal insufficiency, people with renal insufficiency may experience increased serum creatinine or even acute renal failure , so the impact of this type of drug on renal insufficiency is also called the "double-edged sword".
4. People with renal insufficiency should take medication with caution
pril and sartan, those with allergies and pregnancy , should be disabled during breastfeeding; bilateral renal artery stenosis , should be disabled. After taking medication, it may cause insufficient glomerular perfusion pressure and lead to acute renal injury to , and should be disabled.
Renal insufficiency and unilateral renal artery stenosis can be used, but it should start from a small dose. closely monitors the changes in serum creatinine in 2 months before the medication, and test once every 1 to 2 weeks. Priligy and sartan reduce aldosterone release, leading to an increase in blood potassium. However, the ion regulation ability of people with renal insufficiency is weakened, so needs to detect blood potassium at the same time.
If the increase in blood creatinine is within 30%, it is normal for the drug to continue to take the drug; if the increase in blood creatinine is between 30% and 50%, the dose should be reduced and the drug should be continued to be observed, and if necessary, the drug should be stopped; if the increase in blood creatinine of exceeds 50%, the drug should be stopped. If the blood potassium of is found to be higher than 5.5 mmol/L during the medication period, you also need to stop the medication of .
Direction is also a commonly used antihypertensive drug. It exerts antihypertensive effects through sodium and drainage. However, while sodium ions are discharged, potassium ions will also be discharged, which will cause a decrease in blood potassium. diuretics can be used in combination with Pril or Sartan to complement the effect of serum potassium and reduce . However, after diuretic reduces blood volume, it may cause abnormal increase in blood creatinine in , so it is necessary to reduce the dosage when using the drug in combination.
Summary, Priligy and Sartan are commonly used antihypertensive drugs and have a protective effect on the kidneys during long-term use. However, for those with renal insufficiency, it may be a "double-edged sword". Acute renal injury may occur in the early stage of medication, so be cautious when using small doses and gradually increase the dosage.
medicines need to be used under the guidance of a doctor. If you have any questions about the medication, please consult your doctor or pharmacist. I am Huazi, pharmacist. Welcome to follow me and share more health knowledge.
