2012


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2012/№6

Efficacy of various combinations antihypertensive drugs at treatment of arterial hypertension in patients with secondary chronic pyelonephritis: focus on nefroprotection

Stacenko M. E., Derevianchenko M. В.

Keywords: antihypertensive therapy, hyperpiesis, treatment, chronic pyelonephritis

DOI: 10.18087 / rhj.2012.6.1720

Relevance. Prevalence of hypertension at chronic pyelonephritis (CP) and its role as the important factor of cardiovascular complications defines relevance of timely and adequate antihypertensive therapy. Objective. Compare antihypertensive efficacy and possibilities of nephroprotection with enalapril + indapamide and enalapril + nifedipine SR in patients with hypertension and secondary CP. Materials and methods. 60 patients with hypertension and secondary CP were divided into two groups: group 1–30 patients receiving the combined therapy with enalapril 15.9±2.3 mg / day and indapamide 2.5 mg / day; group 2–30 patients receiving enalapril 16.1±2.4 mg / day and nifedipine SR 40 mg / day. Duration of treatment was 12 weeks. 24‑hour monitoring of BP was carried out, density of morning portion of urine was determined, microalbuminuria, urine β2‑microglobulin, blood creatinine with calculation of glomerular filtration rate by the MDRD formula. Drug metabolic neutrality was estimated. Results. Against combined therapy, high percent of achievement of BP target values was noted. Percentage of patients with non-dipper and night-peaker curve significantly reduced in both study groups. Urine β2-microglobulin significantly reduced. Number of patients with distal tubule dysfunction (was evaluated by urine density) decreased by 50 % in group 1 (p<0.05) and only 13.3 % in group 2 (p>0.05), inter-groups distinctions are significant. Frequency of microalbuminuria occurrence in 12 weeks in all patients with hypertension and secondary CP was 100 %, but average values reduced. Both hypertension treatment regimen improved glomerular function: in both groups, number of patients with GFR less 60 ml / min / 1.73 m2 decreased by 10 %. During the treatment period, number of patients with hyperuricemy reduced. Conclusion. Combinations of enalapril + indapamide and enalapril + nifedipine SR are comparable by antihypertensive effect, ability to reduce microalbuminuria. Combination of enalapril + indapamide is significantly more effective in restoration of renal concentrating function in comparison with the combined therapy of enalapril and nifedipine SR at treatment of hypertension in patients with secondary CP.
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Stacenko M. E., Derevianchenko M. В. Efficacy of various combinations antihypertensive drugs at treatment of arterial hypertension in patients with secondary chronic pyelonephritis: focus on nefroprotection. Russian Heart Journal. 2012;11(6):351-357.

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