THE EFFECTIVENESS OF MELDONIUM DIHYDRATE IN COMPLEX TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND CHRONIC PYELONEPHRITIS

The purpose of this research was to investigate the effectiveness of the influence of meldoni- um dehydrate on the parameters of elastic properties of vessels and endothelial dysfunction in patients with hy- pertension (HPT) and chronic pyelonephritis (CPN). Materials and methods of research. The study included 40 patients with HPT and CPN, which were divided into two groups depending on the treatment. Group I consisted of 20 patients receiving baseline therapy - a fixed low-dose combination of perindopril arginine 2 mg, indapamide 0.625 mg, amlodipine 5 mg and atorvastatin 10 mg. Group ІІ included 20 patients. They received on the background of basic therapy synthetic angioprotective drug meldonim dihydrate 500 mg daily for 10 days by intravenous administration (5 ml 10, 0% solution) with the subsequent transfer to oral administration at a dose of 750 mg per day for 1 month. A second course of treatment proposed the scheme that was carried out in 6 months. Advanced clinical and laboratory monitoring of patients was conducted four times: before treatment, after 1st, 6th and 12th months of treatment. The evaluation of the effectiveness of meldoni- um dehydrate was determined by the dynamics of the parameters of the elastic properties of the vessels (veloci- ty of the pulse wave - VPW, cardio-ankle vascular index - CAVI, aortic stiffness index - ASI, thickness intima - media complex - TIMC) and endothelial dysfunction (endothelin-1 - ET-1, endothelium dependent vasodilata- tion – EDVD, endothelium independent vasodilatation – EIVD). Results of research. During the treatment, there were decrease in VPW (p<0,05) and CAVI (p<0,05) in patients of the two groups, however, more pronounced changes at the end of research were in patients of group II. At the end of the year, ASI decreased under treatment in all patients equally (p<0.001), but its significant de- crease was noted more rapidly in patients ІІ group - in 1 month (p<0,05) versus 6 months (р <0,001) in patients І groups. Changes in TIMC were observed, which signifi- cantly decreased in group I after 12 months of treatment (p<0.001). Meldonium dehydrate allowed to accelerate this process - a significant decrease in TIMC (p<0,05) was observed in 1 month. During the year, positive changes were growing and were more pronounced in patients of group II. Meldonium dehydrate in the complex treatment contributed to a more pronounced decrease in the content of ET-1 (p<0.001) in comparison with baseline therapy, and there was a significant improvement in endothelium function with a more dynamic increase in EDVD (p<0.001) and EIVD (p<0.001). Thus, the use of meldonium dehydrate signifi- cantly potentiates the effect of combined low-dose anti- hypertensive therapy in patients with hypertension and chronic pyelonephritis due to improvement in the elastic properties of blood vessels - VPW, CAVI, ASI and TIMK and more pronounced and faster improvement of patho- logically altered endothelial function by positive dynam- ics content ET-1 in blood, EDVD and EIVD. Conclusions. 1. Meldonium dehydrate in combi- nation with combined low-dose antihypertensive therapy promotes regression of arterial rigidity in patients with comorbidity of hypertension and chronic pyelonephritis. 2. The use of meldonium dehydrate in patients with hy- pertension and chronic pyelonephritis is expedient, safe and effective.