Comparative Efficacy of Calcium Channel Blocker and ACE Inhibitor in the Treatment of Acute Hypertension in Acute Post Streptococcal glomerulonephritis

Abstract

1.1.Background: Acute Post Streptococcal Glomerulonephritis (APSGN) refers to the immunologic mechanism which triggers inflammation and proliferation of glomerular tissue, characterized by a relatively abrupt onset of variable degrees of gross haematuria, edema, hypertension and renal insufficiency. Patient may develop encephalopathy and or heart failure due to hypertension or hypervolemia as a complication. 1.2.Objectives:The objective of the study was to find out the better drug for hypertension and/or its complications in terms of effectiveness, side effects and compliance. 1.3.Methods: This randomized clinical trial was conducted among 60 children aged3-12 years, who were suffering from Acute Streptococcal Glomerulonephritis (APSGN) with hypertension and/or its complications. After enrolment, the patients were randomly divided into two groups as group A and group B. Both groups received the standard management of APSGN. In addition, children in group A received captopril (dose 0.5 up to 6mg/kg/day) and children in group-B received Nifedipine (0.25 up to 0.5 mg/kg/day). Their effectiveness in relation to timing of response, duration of therapy, duration of hospital stay, side effects and cost effectiveness of the drugs was assessed and compared statistically, and at p value of <0.05 the result was considered significant. 1.4.Results: Most patients had high systolic and high diastolic blood pressure. In captopril group mean systolic and mean diastolic blood pressure were 134.8±9.3 mm of Hg and 94.97±6.3 mm of Hg respectively. In Nifedipine group mean systolic and mean diastolic blood pressure 131.96±8.1 mm of Hg and 92.8±9.1mm of Hg respectively. The mean time needed to normalize both systolic and diastolic blood pressure (<95th percentile) in group A (Captopril) was 4.98±2.07 days and that of group B (Nifedipine) was 3.09±1.83 days. The difference between two group was statistically significant (p<0.05). Duration of antihypertensive therapy was longer in captopril group than in the Nifedipine group (<0.05). There were no significant side effects. 1.5.Conclusion: It is obvious from the study that Nifedipine controlled BP earlier and reduced the duration of hospital stay compared to captopril. For the control of hypertension in APSGN patients, Nifedipine is a better drug. 1.6.Recommendation: Nifedipine should be used in controlling hypertension in acute post streptococcal glomerulonephritis.