Влияние петлевых диуретиков с различным периодом полувыведения на динамику изменения натрийуреза у гипертоников с разным профилем артериального давления

Abstract

The aim is to study the interaction of natriuresis curves with 24-h blood pressure (BP) profile, as well as to study the effect of diuretic therapy on natriuresis changes and on the BP profile.Materials and methods. From the group of patients who participated in the study on the types of natriuretic curves we selected patients (n=56) with signs of deterioration of chronic heart failure (CHF) and who should be prescribed diuretic therapy. Patients received torasemide SR or IR. Results. It was demonstrated that type of natriuresis curves and blood pressure (BP) profile could be changed. Deterioration of natriuresis more oftener and earlier were observed in torasemide IR group compared with torasemide SR group of patients (p<0,05).The type of natriuresis curve is associated with increasing of Tamm-Horsfall protein (THP) level, switching from one to another type of curveand duration of GB. It was shown that long-lasting hypertension (GB) was associated with high level of angiotensin II (AII). The likelihood of changes in 3ed curve to 2ed one is 83,93% (ОR 11,667); the likelihood ofchanges in 2ed curve to 1st one - 92,86% (ОR 120,00). The main predictors of BP profile could cause side effects were over use of salt (ОR 1,4), long-lasting GB (ОR 3,5), the type of natriuresis curves (OR 3,4). The likelihood of daily BP non-dipper or night-peaker profile to be changed is 83,3% (OR 21,00).Conclusion. The significant impairment of sodium excretion and increasing THP excretion are the markers of progressive renal tubulointerstitial fibrosis in the patients with modified natriuresis. The activity of AII is increasing and BP profile is changing and all these changes prove the necessity for monitoring natriuresis.