How to reduce the hypertension of chronic renal failure?

The purpose of antihypertensive therapy for patients with chronic renal failure, in addition to lower blood pressure, can also delay the progress of chronic renal failure. Compared with essential hypertension, renal hypertension progress faster, higher morbidity and mortality of cardiovascular diseases. The beginning of antihypertensive treatment of patients with chronic renal failure should be to limit salt and maintain water balance, especially for dialysis patients to achieve dry weight, can make 80% to 90% of patients with normal blood pressure or easy to control. If you reach the right balance of capacity, blood pressure continued, will apply to antihypertensive drugs. Most antihypertensive drugs are to varying degrees, excreted by the kidney, should be used with small dose to start, and then adjust the dose of the treatment effect, increasing blood pressure control, side effects or conventional maximum amount. Here are just some of antihypertensive drugs:
(1) loop diuretics: water and sodium retention in the pathogenesis of hypertension play an important role, Scr in of ≥ 221tmaol few CRF patients almost always require loop diuretics. Due to chronic renal failure F elevated serum potassium tendency to avoid the use of potassium-sparing diuretics to prevent hyperkalemia. When GFR <30ml/min, thiazide diuretics are usually very small role. Therefore, when the water load CRY, patient choice of diuretics to control blood pressure, often used loop diuretics.
(2) the class of calcium channel antagonists ((CCB): inhibition of extracellular calcium into cells, and promote the expansion of small arteries, reducing peripheral resistance, can achieve lower blood pressure. Agents also reduce the patients' left ventricular hypertrophy a role.
(3) angiotensin-converting enzyme inhibitors (ACEI): to reduce the angiotensin II generation, reducing the degradation of vascular bradykinin and prostaglandins. Can reduce peripheral vascular resistance without altering cardiac output and heart rate.Should be noted, however, CRF patients treated with ACEI, there are two special side-effects: to reduce the EP () activity; enable the application of polystyrene the nitrile dialysis membrane in patients allergic reactions. Scr ≥ 354t ~ mol / L patients, the use of ACEI can increase the impaired renal function, can also cause hyperkalemia. ACEI treatment usually start from the low-dose, dose adjustment according to renal function, blood chemistry and blood pressure.
(4) B-receptor blocker: Due to increased sympathetic nervous system activity in chronic renal failure, so the central or peripheral adrenergic blockers for high blood pressure also have a certain effect. β one of the servants blockers benefit patients with angina pectoris or recent myocardial infarction, but should try to avoid long-term use of propranolol, due to the drug can be reduced GFR,
(5) angiotensin II receptor blockers (ARB): ARB CRF hypertension, there are certain advantages, such as losartan (1 [osartan) and Jie losartan (of valsartan). And ACEI, the ARB does not affect kinin metabolism and therefore does not cause coughing.