This article is from "Nankai Sun Pharmacist", which is used for medical science popularization for reference. Irbesartan is the preferred antihypertensive drug for essential hypertension, belonging to angiotensin II receptor antagonists, mainly by blocking angiotensin II and its AT1 receptor binding, blocking angiotensin II vasoconstriction, water and sodium retention and myocardial remodeling and other physiological effects, play a hypotensive effect, antihypertensive effect is slow, but long-lasting and stable, 3-4 weeks to achieve the maximum effect, restricting salt intake can make the effect rapid and enhanced, irbesartan long-term safety and good tolerance, There are fewer adverse effects directly related to the drug. In addition, irbesartan can also prevent fibroblast proliferation and endothelial cell apoptosis, reverse myocardial hypertrophy, alleviate heart failure, and prevent atrial fibrillation electrical remodeling, thereby significantly reducing the risk of cardiovascular and cerebrovascular events such as myocardial infarction and stroke, especially suitable for hypertensive patients with left ventricular hypertrophy, heart failure, atrial fibrillation, and coronary heart disease.
Angiotensin II can cause an increase in blood pressure, promote cell growth and proliferation, lead to myocardial hypertrophy, increase in myocardial and vascular collagen content, myocardial fibroblasts and vascular wall cell proliferation, is the leading factor leading to myocardial hypertrophy and vascular remodeling, and can promote the occurrence and development of atherosclerosis, for the kidney, angiotensin II can cause renal arteriosclerosis, resulting in glomerulosclerosis, renal interstitial fibrosis, glomerular basement membrane destruction and other kidney diseases, Irbesartan can reduce proteinuria and protect renal function by reducing the formation of angiotensin II, therefore, irbesartan has no adverse effects on the kidneys, but has a protective effect, but it should be noted that irbesartan can dilate renal blood vessels, and the effect of dilating glomerular outgoing arterioles is stronger than dilating incoming arterioles, so that glomerular filtration pressure decreases, renal function decreases, glomerular filtration rate decreases, and serum potassium and serum creatinine increase, so patients with chronic kidney disease, especially patients in the terminal stage, should use irbesartan with caution, Try to start with a small dose, in the early stage of medication should be closely monitored changes in serum potassium, serum creatinine and glomerular filtration rate, if the glomerular filtration rate or serum creatinine level rises by more than 30%, the dose of the drug should be reduced and continue to observe, if necessary, if the glomerular filtration rate or serum creatinine level rises more than 50%, the drug should be stopped immediately.
Patients with hypertension are often accompanied by hyperuricemia or gout, and losartan, amlodipine, and sinidipine drugs have been found to lower blood pressure at the same time, both have uric acid-lowering effects, and can reduce the risk of gout attacks, in addition, potassium-excreting diuretics such as hydrochlorothiazide, receptor blockers such as metoprolol, angiotensin-converting enzyme inhibitors such as benazepril, and other angiotensin II receptor antagonists such as irbesartan can significantly increase the risk of gout attacks, therefore, irbesartan has a negative impact on blood uric acid levels, It should be avoided in patients with hyperuricemia and gout. In addition, hypertension and diabetes are often accompanied by diabetes, the choice of antihypertensive drugs in diabetic patients should comprehensively consider the antihypertensive efficacy, cardio-cerebral and renal protective effects, safety, compliance and the impact on blood glucose, in various antihypertensive drugs, thiazide diuretics such as hydrochlorothiazide can cause blood sugar to rise, receptor blockers such as metoprolol can mask hypoglycemic symptoms, diabetic patients should avoid use, angiotensin II receptor antagonists such as irbesartan can improve insulin resistance, help lower blood sugar, It can be used as the first choice of antihypertensive drugs for patients with hypertension and diabetes.
In short, irbesartan is a commonly used first-line and preferred antihypertensive drug in clinical practice, suitable for essential hypertension, with clear cardiovascular, renal and improve glucose and lipid metabolism, etc., is the preferred antihypertensive drug for patients with hypertension and diabetes, irbesartan has no adverse effects on the kidneys, but it should be noted that patients with chronic kidney disease, especially patients in the terminal stage, should be cautious with irbesartan, in addition, irbesartan has a negative impact on blood uric acid levels, which can significantly increase the risk of gout attacks, It should be avoided in patients with hyperuricemia and gout.