Aunt Zhang, a retired worker, began to feel a little unwell two months ago. Frequent dizziness and headaches visit from time to time, and sometimes chest tightness and palpitations. When talking to her, her friends also felt that her face was not as rosy as usual, and suggested that she take her blood pressure. After all, people in this age group have a higher chance of developing high blood pressure.
Aunt Zhang felt that her friends were reasonable, so she decided to self-check her blood pressure at home. I didn't know if I didn't know it, I was shocked when I tested it, and the blood pressure value was 150 100mmHg, which was obviously high. However, she believes that slightly high blood pressure may be the norm for middle-aged and elderly people, and there is no need to be overly nervous, so she did not go to the hospital for further examination. She just asked Aunt Wang, who had high blood pressure, what medicine she was takingI went directly to the pharmacy and bought the same antihypertensive drug sartan.
She strictly followed the instructions and took her medication on time every day. But soon after, she felt back pain, general weakness, a sudden decrease in urine output, and a loss of appetite。At first, Aunt Zhang thought that these were just symbols of age, but the symptoms became more and more serious.
In desperation, she decided to go to the hospital for a detailed examination. The results of the examination were astounding:The serum creatinine is as high as 445 mol l, and the glomerular filtration rate is 45 ml min, which has reached the standard of renal failure. Aunt Zhang and her family were shocked by the result, she had never had a history of kidney disease, why did she suddenly develop kidney failure?
After careful questioning by the doctor,The discovery of sartans was the culprit behind all this。Sartans are indeed effective in lowering blood pressure, but they need to be metabolized by the kidneys. For the elderly or people with renal insufficiency, long-term use of such drugs may increase the burden on the kidneys and even lead to kidney failure.
Aunt Zhang did not have a kidney function test in advance, and took sartan drugs without authorization for a long time, which caused the kidney to be overburdened, and eventually caused kidney failure. The doctor told her earnestly that if she came to the hospital later, the consequences would be really unimaginable.
With the acceleration of the pace of life and the change of dietary structure, hypertension has become a common chronic disease. As commonly used antihypertensive drugs, sartan drugs are trusted by the majority of patients. However, if the necessary tests are not performed, blind administration of sartans can lead to unintended harm. So what are sartans?How do sartans work?Next, this article will delve into the mechanism of action of sartansThe core pharmacological mechanism of sartans, a drug widely used in hypertension, is to antagonize angiotensin receptorsSo as to achieve the purpose of lowering blood pressure. This drug successfully lowers blood pressure by inhibiting the action of angiotensin.
Angiotensin, a key hormone in the human body, has the main function of constricting blood vessels and raising blood pressure. However, the emergence of sartans has successfully blocked their effects and brought good news to patients with high blood pressure.
The metabolism of sartans in the human body is mainly dependent on liver microsomal enzymes. The activity of its metabolite exp3174 even exceeds that of the original drug, and has similar efficacy to sartans. After oral administration or intravenous injection, the half-life of the drug is about 21 hour, peak time about 1 hour. Although the bioavailability of tablets and liquid formulations is similar, the actual bioavailability is not high due to the first-pass effect of the liver.
Sartans and their metabolites are mainly concentrated in the plasma part of the human body and are less distributed in other tissues. and does not easily penetrate the blood-brain barrier. In the human body, most sartans are converted to EXP3174, and only a small part is metabolized in other ways. The proportion of the prototype drug excreted by the kidneys accounted for only 12% of the total.
It is worth noting that the metabolite exp3174 of sartan is about 10 times more active than its parent nucleus and has a half-life of about 6At 4 hours, plasma clearance is only 1 to 10 of sartans. This means that the actual pharmacodynamic effects of sartans are mainly produced by their metabolite exp3174. Approximately 55% of Exp3174 is excreted through the kidneys, and the remainder is excreted through other routes.
Experimental studies by several scholars have further confirmed the excellent effect of sartan drugs in hypertension**。Experiments by Christen et al showed that the effect of sartan against the increase in blood pressure caused by angiotensin is dose-dependent. Weber et al.'s study found that for patients with diastolic blood pressure over 12In patients with 5 kPa, sartans can significantly reduce systolic and diastolic blood pressure. The study by Soffer et al. showed that for those patients with hypertension that is difficult to control with hydrochlorothiazide alone, a significant decrease in blood pressure can be observed with the addition of sartans.
In addition to this, angiotensin II not only helps to constrict blood vessels, raise blood pressure, promote aldosterone biosynthesis and enhance kidney functionIt may also interfere with the replication of vascular smooth muscle cells and stimulate collagen production in fibroblasts, leading to overgrowth of the blood vessel wall and heart。Therefore, it may cause cardiovascular disease by regulating myocardial hypertrophy.
Losartan, an angiotensin I subtype receptor blocker, is able to interrupt this function, suggesting that losartan has the potential to be used in the prevention and development of hypertrophy and vascular dysplasia.
In summary, sartans have a significant effect in lowering blood pressure, and this effect is dose-dependent. In addition, oral sartans have a longer duration of antihypertensive effects. Therefore, for patients with high blood pressure, sartan drugs are undoubtedly an important choice. Through rational medication and individualized regimens, sartan drugs can effectively lower blood pressure, improve patients' quality of life, and reduce the occurrence of cardiovascular diseases.
However, there are differences in response to sartans in different populationsIn particular, the elderly, people with renal insufficiency, people with liver insufficiency, pregnant and lactating women and other special populations, long-term use of sartan drugs may increase the burden on the kidneys, interfere with the body's excretion of potassium and uric acid, and may lead to hyperkalemia and hyperuricemia. Therefore, before taking sartans, it is important to carry out the necessary examinations to ensure that all body indicators are normal.
First check: blood potassium
Sartans lower blood pressure by inhibiting the effects of angiotensin. In the process, sartans may also affect the excretion of potassium by the kidneys. Potassium is an important electrolyte in the body that is essential for maintaining the normal function of the heart, muscles, and nerves, and can have adverse effects on human health when blood potassium levels are too high or too low.
People taking sartans, especially those with concomitant renal insufficiency or diabetes, are more likely to have abnormal serum potassium levels. This is because sartans may reduce the excretion of potassium by the kidneys, leading to an increase in potassium levels in the blood. When potassium levels in the blood are too high, it can lead to serious complications such as arrhythmias, muscle weakness and even cardiac arrest
Therefore, it is important for patients taking sartans to have their blood potassium checked regularly. By monitoring potassium levels in the blood, doctors can detect potential problems in time and adjust the protocol to ensure patient safety. At the same time, patients should also pay attention to their physical conditions, such as muscle weakness, arrhythmia and other symptoms, should seek medical attention in time and inform the doctor that they are taking sartans.
Second check: blood creatinine
There is a strong link between the use of sartan drugs and blood creatinine levels. First of all, we need to understand that the metabolism of sartans in the body is mainly dependent on the kidneys。This means that the state of the kidneys directly affects the metabolism and clearance of the drug.
In clinical practice, the level of serum creatinine is often used as an important evidence to determine whether there is an abnormality in kidney function, the level of its content in the blood can reflect the health of the kidneys. When kidney function is impaired, the metabolism and excretion capacity of the kidneys decreases, which may lead to the accumulation of drugs in the body and an increase in blood concentrations.
In this condition, patients may not only experience unstable blood pressure, but may also be at greater risk of kidney failure. Whereas, kidney failure is a serious condition that may require expensive measures such as dialysis or kidney transplantation.
Therefore, regular monitoring of serum creatinine levels is essential for patients taking sartans. Based on the results of serum creatinine, doctors can assess the patient's renal function status, and then adjust the drug dose or choose other ** regimens.
In addition to this, patients themselves should also be concerned about kidney health. In addition to regular kidney function tests, maintaining a healthy lifestyle and controlling other factors that may lead to kidney damage (such as diabetes, high blood pressure, etc.) are also necessary measures to maintain kidney health.
Three checks: blood urea nitrogen
Patients taking sartans also need to be aware of an important issue: blood urea nitrogen levels. This has been explained in detail in the previous articleIn the process of inhibiting angiotensin receptors, sartans may have some effect on the kidneys. Blood urea nitrogen is one of the important indicators of kidney function.
When the kidneys are damaged, the kidneys' ability to process urea is reduced, causing blood urea nitrogen levels to rise. Therefore, patients taking sartans need to have their blood urea nitrogen levels checked regularly to monitor kidney function.
Persistently elevated blood urea nitrogen levels in patients taking sartans may indicate renal impairment or dysfunction. At this point, the patient should stop taking sartan immediately and seek medical attention as soon as possible. The doctor may recommend that the patient undergo further tests, such as renal function tests, urinalysis, etc., to confirm the diagnosis and develop a corresponding ** plan.
In addition to monitoring blood urea nitrogen levels, patients taking sartans should be aware of changes in physical symptoms. If you have symptoms such as low back pain, decreased urine output, and edema of the lower limbs, you should seek medical attention in time. These symptoms may indicate kidney disease or other serious health problems.
High blood pressure is a common chronic condition that requires long-term** and management. For patients with hypertension, rational medication is the key to controlling blood pressure and preventing complications. In addition to a complete examination before using the required medication, there are many things that need to be paid attention to when taking medication for patients with high blood pressure. To help patients better manage their health, we'll take a closer look at what follows.
First of all, patients need to take their medications strictly according to the doctor's instructions。The doctor will formulate a personalized ** plan according to the specific situation of the patient, including the type, dosage and time of taking the drug. Patients should follow their doctor's advice to take their medications on time and in the right amount, and avoid increasing or decreasing the dose or changing the time of taking the medication.
Secondly, patients need to pay attention to the *** of the drugAny medication can be present*** and high blood pressure medications are no exception. Common *** include headache, dizziness, fatigue, dry cough, etc. If the patient has uncomfortable symptoms, he should inform the doctor in time so that the ** regimen can be adjusted.
In addition, patients need to monitor their blood pressure regularly. Blood pressure control is an important indicator of the effectiveness of the drug**. Patients should measure their blood pressure regularly, know their blood pressure status, and communicate with their doctor in a timely manner. Before measuring blood pressure, you should avoid strenuous exercise, emotional agitation and other influencing factors.
In addition, patients need to pay attention to lifestyle modifications. Medications** are only part of the management of high blood pressure, and a healthy lifestyle is just as important. Patients should maintain a healthy diet, control salt, fat and sugar intake, and increase dietary fiber intake. At the same time, moderate exercise, weight control, quitting smoking and limiting alcohol can also help control blood pressure.
In conclusion, caution is required when taking sartansDon't take it for a long time without permission like Aunt Zhang. Before taking the drug, it is important to undergo the necessary examinations to ensure that all the indicators of the body are normal. At the same time, it is also very important to have regular physical examinations to detect the symptoms of physical discomfort in time and avoid serious health problems. Under the guidance of a doctor, a reasonable selection of drugs can better control blood pressure and protect health.
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3] Yang Zhimin, Chen Ying, Zhang Yixian, et al. Application of losartan and amlodipine in elderly patients with essential hypertension[J].Chin J Health Standards Management, 2023, 14(19): 141-145