How to choose antihypertensive drugs

Question: in patients with diabetic nephropathy disease: Condition Description: I am male, aged 73, eight years before the diagnosis of diab


Question: in patients with diabetic nephropathy disease: Condition Description: I am male, aged 73, eight years before the diagnosis of diabetes, has received acarbose, gliquidon and NovoNorm, the result is not very ideal. A year ago and diagnosed with high blood pressure (three extremely high risk), after taking Abono a few months later, blood pressure is normal. Before January, because in recent months the postprandial blood glucose 2 hours from the previous 10mmol/L to 14mmol/L and hospitalized in the second hospital of lanzhou. Diabetic nephropathy with chronic renal insufficiency after a series of examinations. The test results were: serum creatinine 134 (upper limit of the normal value of 133), urea nitrogen (8.4 upper limit of the normal value of 8.2) creatinine clearance rate of 51%, 24 hour urinary protein quantitative 0.1g (the maximum reference value is 0.15g). Fasting blood glucose 7.28, hemoglobin 7.3%. The routine urine, urine and urine protein were negative. The main results of ambulatory blood pressure monitoring: the average blood pressure of 120/76mmHg, including: 118/77nnHg in the daytime and nighttime 121/72mmHg, highest value: 148/93 in the daytime and nighttime 127/60, lowest value: 76/52 in the daytime and nighttime 111/61, the type -1.4% (reverse): systolic blood pressure, diastolic blood pressure (5.9% non dipper). Hope to provide help: the hospital diagnosis and treatment results I was very depressed, the psychological state is low. In recent days to Qiangdajingshen good doctor website (I'm five years ago on the site) about my illness information, do not want to actually accidentally on your page see you write the " antihypertensive drugs in preventing diabetes / delay " in the paper, nephropathy; the content is what I am concerned about how the choice of antihypertensive drugs. Because I not long ago when they are discharged from the Department of Endocrinology doctor suggested taking antihypertensive drugs is still an Bono, but recently a renal physician Tell me, with Abono in the diuretic hydrochlorothiazide can damage renal function, can't take any more advice, service Aprovel, but the latter in a year ago I took, feel the effect is not obvious, the doctor later to Abono, after taking the blood pressure control is good. I feel embarrassed now, in the end how to use? Today, you have the pleasure of reading a book about hypertension medication science articles, especially the application of diuretics related knowledge, benefit. And I want to ask you the following questions: 1. What I can continue taking COAPROVEL? 2, if taking Aprovel, whether the amount of the original service in order to achieve the Abono effect? 3, if combined with other antihypertensive drugs, how should we choose? 4, can you give me some points to treat diabetic nephropathy and protect renal function? Department of the hospital: Atlanta Hospital Department of Endocrinology treatment: time: 1982-11-060000-00-00 hospital: Department of ENT on General Hospital of Lanzhou Military Region: radical resection time sinus carcinoma: 0000-00-000000-00-00 hospital departments: not completed did not fill treatment process: 33 years ago sinus carcinoma have had surgery, radiotherapy and chemotherapy drugs: the drug name: COAPROVEL directions: once a day, every time a drug name: novorapid 30 directions: two times a day: as early as 12u. 10u

Reply to the Department of Cardiology Wu Ningbo City Hospital of traditional Chinese medicine: history of acknowledge, the diuretic is controversial and is still the topic now is to advocate the era of evidence-based medicine, there must be conclusive evidence of the effects of drugs and side effects, a number of hydrochlorothiazide experiments show that low doses do not cause blood fat and blood sugar metabolic disorders, renal function will further decline of renal function caused by the scope of compensation; low dose of hydrochlorothiazide in addition to diuretic effect, can alleviate vascular endothelial edema, improve blood vessel elasticity; combined with irbesartan can offset some side effects; there is an equivalent of 3 kinds of hypertension risk factors that control the blood pressure is more important; hypertension is a multifactorial disease, multi drug combination with low dose, blood pressure control effect and the profit is far greater than the single drug dosage. If the blood pressure controlled, it is recommended to continue to apply coaprovel. Renin angiotensin inhibitors (ACEI) and calcium antagonists (amlodipine besylate, amlodipine) may also be selected.

Question: Thank you very much for your quick, detailed and accurate answer to my question,! I can get away in the northwest of the country's most advanced senior medical experts in the guidance, I feel really overjoyed. Previously, I consulted several doctors in the local, the answer is not either or ready to accept either course, make me unable to agree on which is right. With your instructions, I am steadfast. I'll take the medicine exactly as you told me. I believe that under your guidance, I will have a better control of hypertension. Thanks! I wish you a happy new year!

Department of Cardiology, Ningbo Hospital of traditional Chinese medicine: thanks for your gift. To help your confusion, feel very happy, first of all to thank the good doctor this platform, to provide high-quality medical resources for the public, so that we can get the latest medical information, timely and scientific, better cure the disease; secondly, thank you for your detailed, clear and coherent process, put forward reasonable suggestions to.

In question: read your reply really feel shy, you as a famous medical experts, I was free to sacrifice time to rest, eliminating confusion, to solve the practical problems of me, I should be for you to give, you have to thank me, I can't be! Although only a few words, but I know this rally to your deep professional attainments and rich clinical experience and to help your enthusiasm and dedication, which is that the patients, especially in patients with this to me behind the northwest region, it is commendable that. Honestly, this problem I consulted to you this is already the sixth, several front, or no answer, or think my information is too simple that don't have a good answer, or just one word answer, let me unknown. All in all, it's not easy for me to get online consulting experts. In order to solve the urgent problem of taking medicine, I had to go online. I didn't think I was lucky this time! With overjoyed describe my feelings a bit too much. Not only did you answer my questions accurately, but also the knowledge and opinions of the two countries made me admire. Especially you no expert shelf, the attitude is very modest, kind, even thanked me, let me in awe! I'm really lucky, and you're a real good doctor! If there are more like a good doctor like you, what is the relationship between doctors and patients do not worry? The majority of patients worry difficult? Health worry said of an aged person?

Thank you, doctor! Although we be strangers to each other, but I will always remember you, thank you, about you, bless you!

Department of Cardiology, Ningbo City Hospital of traditional Chinese medicine to reply: Thank you for your letter of Wu force ebullience, I believe that in the future there will be more and more good doctor, answering questions, and the friends of the doctor-patient relationship.

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