Вплив комбінованої антигіпертензивної терапії на структурно-функціональний стан міокарда і ремоделювання сонних артерій у пацієнтів із артеріальною гіпертензією та хронічною хворобою нирок

Abstract

SummaryТhe purpose is to improve the approaches to combined antihypertensive therapy(AHT) on the base of the study of myocardium structural-functional state as well as thethickness intima – media (IMT) of the carotid arteries in patients with arterialhypertension (AH) and chronic kidney disease (CKD).Materials and methods. We examined 156 patients with AH and CKD of IІ-IIIstages, which were allocated depending on the level of glomerular filtration rate (GFR)to 2 groups. Group 1 included patients with AH and CKD stage III (GFR 59–31 mL/min/1.73 m2); n = 68), group 2 – patients with AH and CKD stage II (GFR 60–89 mL/min/1.73 m2); n = 88). Combined AHT with losartan 50-100 mg per day andamlodipine 5-10 mg per day was applied to 40 (58.8%) patients with AH and CKD stageIII (subgroup 1A), and 40 (45.,5%) patients with AH and CKD stage II (subgroup 2A).Combined AHT with enalapril 10-20 mg per day and amlodipine 5–10 mg per day wasapplied to 28 (41.2%) patients with AH and CKD stage III (subgroup 1B), and 48(55.5%) patients with AH and CKD stage II (subgroup 2B). Patients in groups werecomparable by age, sex, disease duration and blood pressure level. Before and after6 months from the beginning of combined AHT patients passed a comprehensiveexamination in accordance with current standards of AH and CKD diagnosis.Results. The target blood pressure level was achieved after 6 months from treatmentbeginning in the most patients with AH and CKD: in 74 (92.5%) patients receivedlosartan and amlodipine, and in 70 (92.1%) patients received enalapril and amlodipine.During enalapril and amlodipine treatment of patients with AH and CKD stage III(subgroup 1B), no significant changes in structural-functional state of the myocardiumwere observed. When combination of losartan and amlodipine was applied to thiscategory of patients, a significant decrease of thickness of the interventricular septum by12.2% as well as thickness of the left ventricle posterior wall by 10.6% (p<0.05) wereobserved, but changes of other indices of structural-functional state of the myocardiumwere not significant. Significant decrease of thickness of the left ventricle posterior wallby 16.6%, decrease of interventricular septum thickness by 15.8%, and increase of theleft ventricular ejection fraction by 15.6% (p<0.05) were found in patients with AH andCKD stage II after 6 months of therapy with losartan and amlodipine (subgroup 2A).After 6 months of treatment with enalapril and amlodipine combination (subgroup 2B),both thickness of the left ventricle posterior wall as well as interventricular septumsignificantly decreased by 13.1% and 16.3%, respectively (p for both cases <0.05).Combined AHT with losartan and amlodipine in patients with AH and CKD stage IIhad a positive impact on the IMT with significant increase of proportion of patients withnormal IMT from 10% to 55% (p<0.05). In patients with AH and CKD after 6 months oftreatment with enalapril and amlodipine (subgroups 1B and 2B) there were notsignificant changes of the IMT.Conclusions. AHT in patients with AH and CKD stage II with combinationslosartan/amlodipine or enalapril/amlodipine had a positive influence on the processesof remodelling of the left ventricle myocardium, which led to significant reduction of thethickness of its walls. Combination losartan/amlodipine in patients with AH and CKDstage II resulted in improvement of intracardiac hemodynamics indices, particularly,increase of left ventricular ejection fraction by 15.6% (р<0.05). Combined AHT withlosartan and amlodipine in patients with AH and CKD was found to be highly effectiveindependently of GFR value, in connection with positive influence not only on processesof remodelling of the left ventricle myocardium (significant decrease of its wallthickness), but also on carotid artery remodelling processes. Latter is confirmed byincrease of the proportion of patients with normal IMT from 10% to 55% (р<0.05).