RESULTS OF PROLONGED APPLICATION OF CALCIUM CHANNEL BLOCKERS IN TREATMENT OF HYPERTENSIVE PATIENTS WITH CHRONIC GLOMERULONEPHRITIS

THE AIM of the investigation was to assess the influence of representatives of different subclasses of calcium channels on clinicolaboratory indices of hypertensive patients having chronic glomerulonephritis with anephrotic syndrome. PATIENTS AND METHODS. Under observation there were 112 hypertensive chronic glomerulonephritis patients with anephrotic syndrome. The patients were divided into 5 groups on the basis of the specially developed criteria. The patients of each group were of the same age at the beginning of the disease, the same morphological variant of the disease and the same gender. The first group included 25 patients (20 men and 5 women) given prolonged nifedipin (30120 mg/day in two takings); the second group included 26 patients (20 men and 6 women) given verapamil (120480 mg/day in 3 takings), 8 of them were given a retard form of the medicine (120240 mg/day 12 times a day); the third group consisted of 24 patients (19 men and 5 women) given amlodipin (510 mg/ day); the fourth group consisted of 19 patients (10 men and 9 women) given diltiazem (90360 mg/day); the fifth group consisted of 18 patients (10 men and 8 women) given lacidipin (48 mg in one taking). The investigation included the initial period, randomization of the patients into groups of observation and the main period (the beginning of taking the drugs and working through the doses and number of taking). Before the beginning of taking the calcium channel blocker, in 3 weeks after the beginning of treatment and in 3 years after the beginning of observation the patients were investigated for diurnal proteinuria, fibronectinuria. Calculations of glomerular filtration rate, index of glomerular permeability and degree of albuminuria were made. Protein fractions of blood serum, content of total cholesterol and triglycerides were studied. Nephrobiopsy was made as well as monitoring of arterial pressure. RESULTS. Lacidipin, diltiazem and verapamil were found to have renoprotective properties such as the ability to reduce diurnal proteinuria, the degree of albuminuria and glomerular filtration index. In contrast, amlodipin and nifedipin increased the diurnal proteinuria, but significantly reduced the concentration of total cholesterol and triglyceride of blood serum. So they can be recommended for the treatment of secondary hyperlipidemia in hypertensive patients with chronic glomerulonephritis. CONCLUSION. Renoprotective properties of lacidipin, diltiazem and verapamil allow them to be considered as hypotensive medicines of «the first line» in hypertensive patients with chronic glomerulonephritis.

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