Dynamics of structural and functional state of the heart, blood vessels, kidneys and the blood levels of renin and aldosterone in the treatment of hypertensive patients with concomitant chronic pyelonephritis by RAAS blockers
DOI:
https://doi.org/10.11603/1811-2471.2015.v23.i2-3.5242Abstract
SUMMARY. The dynamics of indicators of structural and functional state of the heart, blood vessels, kidneys and neurohumoral status in patients with essential hypertension (EH) 1 degree with concomitant chronic pyelonephritis (CRD) and chronic heart failure (CHF) II functional class (FC) with preserved left ventricular ejection fraction (LVEF) of the heart was studied. It is proved that the treatment of hypertensive patients with chronic renal failure 1 degree and CHF FC II by renin-angiotensin-aldosterone system (RAAS) blockers – angiotensin-converting enzyme (ACE) inhibitors spirapril a daily dose of 3 mg, candesartan in a daily dose of 16-24 mg, combination ACE inhibitors spirapril a daily dose of 3 mg and direct renin inhibitor aliskiren in a daily dose of 150 mg – leads to reliable comparable increases in distance of the 6-minute walk test, LVEF, endothelium-dependent vasodilation (EDVD), glomerular filtration rate (GFR) and reliable reducing the size of the left atrium, end-diastolic diameter (EDD) and end-systolic diameter (ESD), the mean pulmonary artery pressure (PASP), aldosterone and daily albuminuria. The efficacy of antihypertensive therapy in patients with EH 1 degree with chronic CKD and heart failure class II combination of ACE inhibitors spirapril and direct renin inhibitor aliskiren during 14 weeks exceeds the effects of monotherapy with ACE inhibitors and is accompanied by a significantly greater reduction in the EDD, myocardial mass index, plasma aldosterone blood significantly greater increases in GFR, EDVD and decreased plasma renin activity with an increase in the latter during treatment with ACE inhibitors.
KEY WORDS: RAAS blockers, spirapril, hypertension, chronic pyelonephritis, chronic heart failure.
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