HYPOTENSIVE AND RENOPROTECTIVE EFFICACY OF A LONG¬TERM APPLICATION OF DIFFERENT REGIMENS OF INHIBITORS OF THE ANGIOTENSIN CONVERTING ENZYME AND BLOCKERS OF RECEPTORS OF ANGIOTENSIN¬2 IN RENOPARENCHYMOUS HYPERTENSION IN PATIENTS WITH CHRONIC GLOMERULONEPHRITIS

THE AIM of the investigation was to compare the hypotensive and renoprotective efficacy of different regimens of taking inhibitors of angiotensin converting enzyme and blockers of angiotensin2 receptors. PATIENTS AND METHODS. 152 patients with chronic glomerulonephritis were examined. The patients were divided into groups depending on the regimen of treatment. Before treatment, at the stage of discharge from hospital and 2.5 years later the assessment of clinicolaboratory manifestations of glomerulonephritis and effects of therapy on the markers of progression of the disease was performed. RESULTS. The maximal antiproteinuric effect was noted after a combined administration of two classes of drugs (especially in combination of perindopril with irbesartan). Hypouricemic ability of losartan and irbesartan was revealed which potentiated when combined with perindopril. The needed figures of pressure were obtained more often by the combined treatment than by using each class separately. Monotherapy and combinations of the drugs failed to influence the degree of hyperlipidemia. The most often causes of discontinuation of taking the inhibitors of the angiotensin converting enzyme were cough, hyperkalemia and hypercreatininemia. Hyperkalemia appeared more often in combined treatment than in monotherapy. The combined therapy facilitated greater frequency of dipper and overdipper, and a reduction of prognostically unfavorable types of hypertension such as nightpeaker and nondipper. CONCLUSION. Combined therapy with inhibitors of angiotensin converting enzyme and angiotensin2 receptor blockers gives a better hypotensive and renoprotective effect in treatment of patients with chronic glomerulonephritis than administration of each class of the drugs separately.

1. Preston RA, Singer I, Epstein M. Renal parenchymal hypertension: current concepts of pathogenesis and management. Arch Intern Med 1996;156 (6): 602611

2. Мосина НВ, Есаян АМ. Артериальная гипертензия и протеинурия – важнейшие факторы прогрессирования почечной недостаточности. Нефрология 2004; (1):2228

3. Remuzzi G, Bertani T. Pathophysiology of progressive nephropathies. New Engl J Med 1998; 339:14481456

4. Пиріг ЛА. Артеріальна гіпертензія як клінічнокла сифікаційна ознака гломерулонефриту (огляд літератури та власних досліджень). Журн АМН України 2002; (2): 291 301

5. Brenner BM. RAS Blockade opens the road to remission of renal disease. Lecture in the Special Session «AMGEN International Prize for Ther-apeutic Advances in Nephrology». World Con-gress of Nephrology. Berlin, 2003

6. Rosert JA, Wauters JP. Recommendations for the screening and management of patients with kidney disease. Nephrol Dial Transplant 2002;17 [Suppl 1]: 1928

7. Мухин НА, Балкаров ИМ, Моисеев СВ и др. Урикозурическое действие лозартана. Клин фармакол и терапия 2003; 12 (5): 5558

8. Папян АВ, Архипов ВВ, Береснева ЕА. Маркеры функции почек и оценка прогрессирования почечной недостаточности. Тер арх 2004; (4):8390

9. Burgess E. Renal effects of angiotensin II receptor аntagonists. Blood Press 2001; 10(1): 1720

10. Csajka C, BuclinT, Brunner AR, Biollaz J. Pharmacokineticpharmacodynamic profile of angiotensin II receptor antagonists. Clin Pharmacokinet 1997; 32: 129