Strategy of drug therapy selection in patients with hypertension and renal tubulointersticial injury


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Abstract

Objectives. To optimize drug therapy in patients with arterial hypertension and tubulointersticial disease. Material and methods. a total of З45 patients were screened of whom 55 were enrolled in the study. The patients were comparable regarding major baseline characteristics. Dietary salt intake was limited to < 6 g/day. After ЗО days of the study 13 patients were excluded due to blood pressure normalization and being not required antihypertensive treatment. The patients were randomized into two treatment groups («a» and «t»): azilsartan and torasemide Sr, respectively. In all patients at the beginning of drug therapy and at the final visit ABPM was performed, conductivity of the urine and natriuretic activity were assessed. Data management and analysis were performed using Statistica і0.0. Results. In the group «a» 58.3% of the patients had «non-dipper» bp profile at the DO visit vs. і8.75% at the final visit, «dipper» 46.6% vs. 81.25%, «night-peaker» ЗЗ.З% vs. 0.0%. In the group «t» bp profile «non-dipper» at the DO visit had 41.6% of patients vs. 11.76% at the final visit, «dipper»53.3% vs. 82.35%, «night-peaker» 66.7%VS 5.88%. At the DO visit «evening conductivity» in group «a» was 40.7 ± 17.7 ms /cm and 4З.5 ± 19.З 7 ms /cm in the group «t» (p> 0.05), «evening natriuresis» was ЗО5.12 ± 1ЗО.9 mmol/l in the group «a» and 317.5 ± 1З9.2 in the group «T»(p> 0.05). At the visit D4 «evening conductivity» was 26.З ± 10.З ms /cm and 28.9 ± 15.5 - in the group «a» and «t» (p = 0.58), respectively, «the evening natriuresis» was 203.8 ± 86.76 mg/dL in the group «a» and 205.і ± 1 і5.7 mg/dL in the group «t» (p = 0.97). At the DO visit augmentation index (Ai) in the aorta in the group «a» was 7.5 [31.0; -6.0] and 17.0% [-5.0; 36.0]% IN THE GROUP «T»(P = 0.69). ΙΑ at THE visit D4 IN THE aorta IN THE group «a» amounted TO -13.5 [-21.0; -2.0] % and TO -1.0 [-9.0; 9.0]% IN THE group «T»(p = 0.03). Conclusion. Conductivity of the urine and natriuresis, measured in the evening hours, reflect the renal RTT function and can serve as markers of unfavorable blood pressure profile. For patients with a low salt intake (less than 15 g /d) azilsartan is more effective due to producing greater ΙΑ changes than torasemide Sr (2 [-9.5; 15.5]%) in THE aorta (-21 [-29.9; -16]%), affecting the activity of the Raas. Torasemide Sr, increasing sodium excretion, showed the best result in patients with high salt intake (more than 15 g /day) (ΙΑ aorta was -9 [-14; -2]%), P = O.OOO2.

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References

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