How To Lower Blood Pressure in Patients With Chronic Kidney Disease And Cerebrovascular Disease?

This is a real case. Mr. Wang is 38 years old this year. A recent physical examination revealed that his kidney function has declined. He has a history of hypertension for more than a year. He usually takes antihypertensive drugs, but his blood pressure is still poorly controlled, with the highest blood pressure reaching 190/110 mmHg. He went to our hospital and found that he had a history of hypertension. Proteinuria.

Click to Cistanche for kidney disease

We performed a comprehensive examination for him, and through a comparative analysis of clinical data and examination reports, we considered that decreased renal function and proteinuria were related to poor blood pressure control. So he adjusted his blood pressure reduction plan and finally stabilized his blood pressure at around 120/75mmHg.

After being discharged from the hospital, Mr. Wang developed symptoms of "fatigue, reluctance to move, and sometimes dizziness." However, no abnormalities were found on the head CT, but cerebral artery magnetic resonance imaging found that Mr. Wang had cerebral artery stenosis. After analysis, Mr. Wang's new symptoms were related to insufficient blood supply to the brain caused by low blood pressure.

We adjusted his antihypertensive plan and maintained his blood pressure at around 140/90mmHg. His symptoms disappeared and his kidney function also improved.

1. Is chronic kidney disease more likely to cause cerebrovascular disease?

The answer is yes, for the following reasons:

1. As kidney function declines, the risk of cerebrovascular disease gradually increases;

2. If there is proteinuria, the risk of cerebrovascular disease will also gradually increase; combined with decreased renal function, the risk of stroke will be greatly increased. The higher the proteinuria level, the higher the risk

3. Patients with chronic kidney disease often have other diseases such as hypertension, diabetes, and atrial fibrillation, which can increase the risk of cerebrovascular disease;

4. In the late stage of chronic kidney disease, the body experiences oxidative stress and abnormal calcium and phosphorus metabolism, as well as insufficient cerebral vascular perfusion during dialysis.

Therefore, patients with chronic kidney disease are more likely to develop cerebrovascular disease.

2. Is "intensive blood pressure lowering" recommended for patients with chronic kidney disease?

"It is best for blood pressure not to exceed 130/80mmHg to delay the decline of kidney function." I believe all kidney friends are familiar with this sentence often said by doctors.

Numerous studies have proven that controlling high blood pressure can reduce the risk of cardiovascular and renal disease progression. Classic guidelines for nephrology recommend that, as long as the patient can tolerate it, <130/80 mmHg should be considered as a standard for most hypertensive patients (without cardiovascular complications, or combined with coronary heart disease, chronic heart failure, history of stroke, chronic kidney disease, diabetes, etc.) blood pressure control goals. It is even recommended that the systolic blood pressure be lowered to below 120mmHg in some specific groups.

Are these criteria suitable for all patients with chronic kidney disease?

The answer is that "strengthening blood pressure reduction" requires a specific analysis of specific situations.

For example, in patients with non-diabetic model kidney disease, intensive blood pressure lowering had no further benefit and even increased the risk of renal impairment in one study.

Therefore, intensive blood pressure lowering is not suitable for everyone with kidney disease. Mr. Wang is an example. Mr. Wang's cerebral blood vessels are already narrow, and his blood pressure is too low, causing symptoms of insufficient blood supply to the brain. If not treated in time, it may even lead to more serious complications. serious consequence.

Therefore, for patients with chronic kidney disease, blood pressure lowering needs to be based on what they can tolerate (for example, whether they have dizziness, chest tightness, and other symptoms of cerebral and cardiac hypoperfusion; whether the follow-up serum creatinine is increased by more than 30% compared with before intensive blood pressure lowering, etc.) The premise is that based on the presence or absence of proteinuria, diabetes, and other comorbidities, complete cerebrovascular examinations when necessary to set reasonable blood pressure reduction goals. One size does not fit all, and appropriate blood pressure reduction goals should be formulated based on each person's actual situation. plan.

3. Which antihypertensive drugs are more suitable for young and middle-aged people with high blood pressure like Mr. Wang?

Among young and middle-aged people, vascular compliance is acceptable, and most of them have diastolic hypertension, which is related to overweight/obesity and sympathetic nervous excitement.

Therefore, it is more appropriate to combine drugs that inhibit sympathetic excitation (β-blockers-loral heart rate-lowering drugs) with fewer side effects of antihypertensive drugs (calcium channel blockers-divine); Medications (diuretics, ARB-tartans) may not be appropriate for these patients (especially non-smokers).

Mr. Wang's final antihypertensive plan was beta-blockers combined with calcium channel blockers. After his kidney function improved, his dizziness symptoms completely disappeared.

So in summary, patients with chronic kidney disease, who often have cardiovascular and cerebrovascular diseases or risks, should pay attention to the following during the process of reducing blood pressure:

Monitor your blood pressure frequently to prevent it from going too low or too high.

Regular follow-up of renal function, and complete cardiovascular and cerebrovascular-related examinations if necessary, to prevent blood pressure from falling too low and causing insufficient organ perfusion.

Individualized formulation of antihypertensive targets requires the development of individualized antihypertensive targets based on proteinuria, renal function, personal compliance, age, comorbid diseases, the main mechanism behind hypertension, weighing the benefits of kidneys, heart, and brain, etc. By repeatedly doing these three things in the process of lowering blood pressure, we finally find out the blood pressure target value that is most suitable for each kidney disease patient, to achieve overall health management of kidneys, blood pressure, heart, and brain.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, is a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.