Seven years ago, 58-year-old Lao Zhang was diagnosed with hypertension during a physical examination. He had previously fainted due to high blood pressure, which made him very worried. Therefore, for the past five years, Lao Zhang has been taking medication on time, fearing that problems would arise if he missed a dose.
Not long ago, Lao Zhang suddenly noticed an increase in the number of times he had to go to the bathroom at night, almost three to four times every night. He also frequently found his eyes and legs swollen, feeling tired and weak. This raised his concerns about kidney health, so he went to a specialized hospital for consultation.
However, the test results surprised Lao Zhang. His creatinine levels had reached 219, and his glomerular filtration rate exceeded the normal range, indicating that he had entered the stage of renal function impairment.
Lao Zhang immediately doubted whether there was a problem with his hypertension medication. He asked the doctor if the renal failure was caused by long-term use of antihypertensive drugs.
However, his attending physician told him that he had been taking the medication correctly as per the advice, and it was unlikely to have an impact on his kidney function.
The Relationship Between Hypertension and Kidney Disease
The actual cause of kidney failure is related to kidney disease caused by hypertension. High blood pressure can damage blood vessels, leading to decreased vascular elasticity, which can trigger various organ damage, including the heart, brain, and kidneys.
Kidney damage from hypertension is usually due to refractory hypertension, which is hypertension lasting for more than 10 years. This situation may lead to decreased kidney function and even kidney failure.
To prevent kidney disease caused by hypertension, the best approach is to follow medical advice, use medication properly to maintain blood pressure within the normal range. Although some people are concerned about the potential side effects of long-term medication use, doctors generally consider individual circumstances to minimize the risk of side effects. Maintaining stable blood pressure is more important than the potential side effects.
There are various medications available on the market for lowering blood pressure, including ACE inhibitors and ARBs. These drugs not only control blood pressure but also play a positive role in reducing proteinuria and protecting kidney function. However, it should be noted that both ACE inhibitors and ARBs can cause elevated creatinine and potassium levels, so they are not suitable for patients with impaired kidney function or severe kidney damage.
Why does persistently correct medication use still lead to kidney failure?
ACE inhibitors have long been considered to have renal protective functions, but why, in cases like Lao Zhang’s, did he eventually develop kidney failure despite adhering to taking antihypertensive drugs every day? This is not an isolated case, and similar situations occur frequently. Based on Lao Zhang’s case, doctors concluded that his kidney failure was mainly attributed to three errors:
Firstly, although Lao Zhang followed the prescribed dosage and schedule of medication, he did not regularly monitor his blood pressure. He believed that since he did not experience obvious symptoms like dizziness, he thought his blood pressure was effectively controlled. However, regular blood pressure measurements are crucial because hypertension can be a changing situation. Even if symptoms are not apparent, blood pressure could rise unnoticed, emphasizing the importance of regular monitoring.
Secondly, Lao Zhang persisted in consuming heavy foods, despite the doctor advising him to control his diet, especially reducing salt intake, and quitting smoking and drinking. However, Lao Zhang did not follow these suggestions, indulging in rich foods in work and social settings, even enjoying delicacies without regard for their effects while taking antihypertensive medication. Such poor dietary habits could diminish the effectiveness of medication, increase the burden on the heart and kidneys, ultimately leading to kidney failure.
Lastly, Lao Zhang did not regularly undergo kidney function re-evaluations. Although antihypertensive drugs can help control blood pressure, each patient’s constitution and response are different, warranting adjustments and monitoring based on individual circumstances. Doctors need to decide whether treatment plans need to be adjusted based on a patient’s response to medication and changes in blood indicators. Without regular examinations and feedback, opportunities for timely adjustment to medication dosage may be missed, thereby increasing the potential risks of side effects.
Therefore, this case serves as a reminder that merely taking antihypertensive medication on time is not enough; regular re-evaluations, including kidney function and electrolyte indicators, are necessary. If symptoms such as dizziness or headaches occur after taking medication, timely feedback to the doctor is essential for suitable adjustments.
Three types of antihypertensive drugs have been “eliminated,” and switching is recommended depending on the situation
Some antihypertensive drugs have gradually been phased out, so doctors may advise considering changing to other medications based on individual circumstances. These discontinued medications include:
1. Nitrendipine tablets
In the 1980s, nitrendipine tablets, also known as Adalat, were widely popular for their rapid antihypertensive effects. However, its rapid hypotensive action was accompanied by frequent side effects. Patients taking nitrendipine tablets may experience flushing, headaches, palpitations, tachycardia, and even hypotension, these symptoms can stimulate the sympathetic nervous system, leading to cardiovascular accidents, even sudden death. Long-term use of nitrendipine tablets may also cause gingival hyperplasia and ankle edema issues. In addition, the large blood pressure fluctuations caused by nitrendipine tablets during hypotension process are unstable and require multiple doses, hence it has been gradually eliminated.
2. Compound Reserpine tablets
Compound reserpine is a compound preparation containing hydrochlorothiazide and methyldopa as antihypertensive ingredients. Long-term and high-dose use of fixed compound preparations containing hydrochlorothiazide may lead to lupus-like skin changes, thus it is not the recommended first-line drug for hypertension treatment. Although methyldopa can dilate blood vessels, it can cause increased heart rate and myocardial contractility, posing harm and damage to the heart with long-term use. Similar to nitrendipine tablets, the hypotensive effect of Compound Reserpine tablets lasts for a short time, requiring multiple doses, and hence is no longer one of the preferred medications.
3. Traditional compound preparations containing Reserpine
Traditional compound preparations containing Reserpine, such as Reserpine tablets or other compound preparations, may affect the health of the nervous system, especially when used long-term and in high doses. These medications may stimulate gastric acid secretion, inhibit the central nervous system, and deplete the catecholamines at peripheral sympathetic nerve endings, leading to problems in the nervous system, including psychological and mental discomfort. Therefore, when selecting antihypertensive medications, doctors typically consider safer and more effective alternative medications.
In conclusion, depending on the patient’s specific condition, doctors may suggest changing antihypertensive medications to ensure effective management of hypertension and reduce the risk of side effects. Moreover, drug therapy should generally be combined with healthy lifestyle habits, such as a balanced diet and regular exercise, to better control hypertension and reduce the risk of cardiovascular diseases.
