Renoprotective Properties of the Low-Dose Antihypertensive Combination Treatment of Patients with Hypertension Combined with Chronic Pyelonephritis

Introduction. According to the current recommendations of the European Society of Hypertension and the European Society of Cardiology, treatment for arterial hypertension (AH) consists not only of the direct reduction of blood pressure to the target values, but also in observance of the principle of organoprotection as the basis for improving the individual and population prognosis. The most promising is the strategy of preserving the functional state of the kidneys. Aim. To study the nephroprotective properties of combined low-dose antihypertensive treatment for the patients with hypertension, combined with chronic pyelonephritis. Materials and methods. The study included 40 patients (28 men and 12 women aged 35-70 years) with grade II hypertension, which was associated with chronic renal failure. Duration of AH was 8 [5; 15], and chronic pyelonephritis – 5 [3; 7] years. Chronic kidney disease stage I (glomerular filtration rate – 117.5 [98.5; 126.5] ml/min × 1.73 m2) was detected in 24 (60.0%) patients with hypertension and chronic pyelonephritis, in 16 (40.0%) patients was chronic kidney disease of the II stage (glomerular filtration rate was 84.6 [76.2; 89.1] ml/min × 1.73 m2). Results. In the patients with hypertension combined with chronic pyelonephritis, prior to treatment, the kidney dysfunction was characterised by the increased levels of microalbumin, β2-microglobulin (β2-mg), C-reactive protein (CRP) in urine and elevated urine creatinine concentrations compared to those in healthy people (p <0.05). Under the influence of combined low-dose antihypertensive treatment, the content of microalbumin in the urine decreased by 29.1% (p <0.05), and in six months by 35.2% (p <0.05). Such a dynamics of the regression of the content of microalbumin in the urine was accompanied by a decrease of the urine creatinine concentration by 22.1% (p <0.05) and 29.4% (p <0.05) in one and six months respectively. A decrease of the albumin/creatinine ratio in urine – by 13.7% (p <0.05) and 22.7% (p <0.05) in the response to use of arginine perindopril, indapamide, amlodipine, and atorvastatin was observed after one and six months. The nephroprotective properties also indicated a decrease of the content of β2-mg in the urine by 23.8% (p <0,05) a month and by 33.6% (p <0,05) during six months after the using the combination of low doses of antihypertensive drugs mentioned above. It has been found that combined low-dose antihypertensive treatment with the inclusion of perindopril arginine, indapamide, amlodipine and atorvastatin has nephroprotective properties. This is confirmed by a decrease of the content of microalbumin, β2-mg, CRP in urine and a decrease of creatinine concentration in urine under the influence of treatment. Conclusions. A fixed combination of low doses of antihypertensive drugs (perindopril arginine, indapamide, amlodipine) and atorvastatin has pronounced the nephroprotective properties, potentiates the decrease of the content of microalbumin, β2-mg, PSA in urine and decreases the creatinine concentration in urine, and therefore is expedient for the widespread