Two strategies for arterial hypertension treatment in patients with secondary chronic pyelonephritis
https://doi.org/10.15829/1728-8800-2011-4-39-44
Abstract
Aim. To compare the antihypertensive effectiveness, cardio- and nephroprotection, and metabolic effects of the combinations “enalapril + indapamide” vs. “enalapril + nifedipine slow release (SR)” in patients with arterial hypertension (AH) and secondary chronic pyelonephritis (CPN).
Material and methods. In total, 60 patients with AH and secondary CPN, aged 45-65 years, were divided into two groups: Group I (n=30) receiving combined therapy with enalapril (mean dose 15,9±2,3 mg/d) and indapamide (2,5 mg/d); and Group II (n=30) receiving the combination of enalapril (16,1±2,4 mg/d) and nifedipine SR (40 mg/d). The complex examination included 24-hour blood pressure monitoring (BPM), echocardiography, measurement of morning urine specific gravity, microalbuminuria (MAU), urine levels of ß2-microglobulines, blood creatinine and glomerular filtration rate (GFR) calculation by MDRD formula, fasting glucose, potassium, uric acid, total cholesterol, and triglycerides. The follow-up time was 12 weeks.
Results. The combinations “enalapril + indapamide” and “enalapril + nifedipine SR” had similar effects in terms of BP lowering, MAU reduction, and improvement of proximal renal tubular function. In both groups, there was a decrease in the number of patients with circadian BP rhythm disturbances, adverse left ventricular remodelling types, or diastolic dysfunction. The combination of enalapril and indapamide was significantly more effective in terms of restoring renal concentrating function, compared to the combination “enalapril + nifedipine SR”. Both antihypertensive therapies were metabolically neutral, not affecting carbohydrate, purine, lipid, or electrolyte metabolism parameters.
Conclusion. The combinations “enalapril + indapamide” and “enalapril + nifedipine SR” demonstrated high antihypertensive effectiveness, cardio- and nephroprotection, and metabolic neutrality.
About the Authors
M. E. Statsenko
Volgograd State Medical University, City Clinical Hospital No. 3
Russian Federation
Volgograd
Russian Federation
Volgograd
M. V. Derevyanchenko
Volgograd State Medical University, City Clinical Hospital No. 3
Russian Federation
Volgograd
Russian Federation
Volgograd
References
1. Батюшин М.М., Повилайтите П.Е. Клиническая нефрология. Руководство. Элиста: ЗАОр НПП “Джангар” 2009; 656 с.
2. K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Kidney Disease Outcome Quality Initiative. Am J Kidney Dis 2002; 39 (Suppl 2): S1-266.
3. Проект рекомендаций ВНОК “Диагностика и лечение артериальной гипертензии”, Кардиоваск тер профил 2008;7(6). Приложение 2.
4. Ridao N, Luño J, García de Vinuesa S, et al. Prevalence of hypertension in renal disease. Nephrol Dial Transplant 2001; 16 Suppl 1: 70-3.
5. ESH-ESC Guidelines Committee. 2007 guidelines for management of arterial hypertension. J Hypertension 2007; 25: 1105-87.
6. K/DOQI Clinical Practice Guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 43 (Suppl 1): A1-6.
7. Беленков Ю.Н. и рабочая группа исследования ЭПИГРАФ-2: Эналаприл плюс индапамид в лечении стабильной артериальной гипертонии: оценка эффективности и безопасности рациональной комбинированной терапии. Сердце 2005; 4 (5): 277-86.
8. Chalmers J. Long-term efficacy of a new fixed, very-low-dose angiotensin-converting enzyme-inhibitor/diuretic combination as first line therapy in elderly hypertensive patients. J Hypertension 2000; 18; 327-31.
9. Mourad JJ, on behalf of the investigators of the STRATHE trial. Comparision of different therapeutic strategies in hypertension: a lowdose combination of low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped care approach. J Hypertens 2004; 22: 2379-96.
10. Мартынюк Т.В., Колос И.П., Чазова И.Е. от имени соисследователей программы СТРАТЕГИЯ. Эффективность и безопасность фиксированной комбинации малых доз периндоприла/индапамида у пациентов с артериальной гипертонией в условиях реальной клинической практики. Кардиоваск тер профил 2007; 6 (8): 21-7.
11. Стаценко М.Е., Щербакова Т.Г., Осипова А.О. Органопротекция и качество жизни пожилых больных с артериальной гипертонией при терапии индапамидом. РКЖ 2006; 4 (60): 54-8.
12. Морозова Т. Е., Андрушинина Т.Б. Комбинированная антигипертензивная терапия артериальной гипертензии. Cons Med 2008; 10 (12). http://www.consilium-medicum.com/magazines/cm/medicum/article/17522
13. Marre М, Puig JG, Kokot F, et al. Equivalence of indapamide SR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the NESTOR Study. J Hypertens 2004: 22 (8): 1613-22.
14. Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertensive Optimal Treatment (HOT) randomized trial. Lancet 1998; 351: 1755-62.
15. Рогоза А.Н. Суточное мониторирование артериального давления (по материалам методических рекомендаций ESH 2003). Функц диагн 2004; 4: 29-44.
16. Шиллер Н.Б, Осипов М.А. Клиническая эхокардиография. М.: Практика 2005; 344с.
17. Национальные клинические рекомендации. Сборник. Под ред. Р.Г. Оганова. – 3-е издание. – М.: Изд-во “Сицилия-Полиграф” 2010. 592 с.
18. Verdecchia P, Schillaci G, Reboldi G, et al. Different prognostic impact of 24-hour mean blood pressure and pulse pressure on stroke and coronary artery disease in essential hypertension. Circulation 2001; 103(21): 2579-84.
19. Нефрология. Руководство для врачей. Под ред. И.Е. Тареевой. М.: Медицина 2000; 688с.
Review
For citations:
Statsenko M.E., Derevyanchenko M.V. Two strategies for arterial hypertension treatment in patients with secondary chronic pyelonephritis. Cardiovascular Therapy and Prevention. 2011;10(4):39-44. (In Russ.) https://doi.org/10.15829/1728-8800-2011-4-39-44
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