Modern possibilities of rational renoprotection in patients with hypertensive disease

Abstract

The aim of the study was to determine the renoprotective effect of antihypertensive therapy and to develop differential approach within rational renoprotective strategy in hypertonic disease. According to research protocol all patients without clinically significant kidney failure (107 persons with essential hypertension) were examined through clinical, laboratory and instrumental studies. Patients were divided into 5 groups according to the combinations of antihypertensive therapy (all patients during thiazide-like diuretic Indapamide in a dose of 1.5 mg were prescribed): 1 – angiotensin-converting-enzyme inhibitor, 2 – angiotensin-2 receptor antagonists, 3 – long-acting dihydropyridine calcium antagonists, 4 – beta-adrenergic blocking agents, 5 – imidazoline receptor agonists. After 12 weeks the studies showed that despite comparable antihypertensive effect of the therapy (according to both the data of office blood pressure and to the data of 24-hour blood pressure monitoring), groups were different in achieving renoprotective effect. The most pronounced certain positive dynamics of blood pressure under therapy was in III group. Although, maximally certainly significant reduction of urinary microprotein excretion level (of albuminuria – by 85.24% and of macroglobulinuria – by 67.13%), in parallel with normalization of intrarenal hemodynamics (the increase of renal functional reserve in 2.9 and 2.7 times and regress of interlobar branches of renal arteries resistance by 65.69% and 64.76% respectively) were recorded in I and II groups (χ2=3.91, р=0.041 and χ22=4.02, р=0.014). In the detection frequency of beta-2-microglobulin in most cases there also was a significant reduction in groups 1.2 and 5 (χ2=13.86, р<0.01, χ2=13.12, р<0.01 and χ2=5.29, р=0.022). In such a way, the most certain renoprotective effect was noted in patients who received angiotensin-convertingenzyme inhibitors, angiotensin-2 receptor antagonists and imidazoline receptor antagonists during diuretic therapy