Динаміка швидкості клубочкової фільтрації як показника субклінічного ураження органів-мішеней під впливом комбінованої антигіпертензивної терапії у пацієнтів з артеріальною гіпертензією, які перенесли ішемічний інсульт
Objective of our trial: to study the effect of different choices of combined antihypertensive therapy on serum creatinine levels and the dynamics of glomerular filtration rate (GFR) in hypertensive patients with ischemic stroke in history. Materials and methods. In the study group - 75 patients (male and female., age 60,85 ± 0,96) with arterial hypertension 1 and 2 degree and ischemic stroke in history, who were randomized into two groups: in group A - 37 patients, prescribed a combination of olmesartan and hydrochlorothiazide in therapeutic doses, group B - 38 patients, prescribed a combination of olmesartan and amlodipine. In group comparisons - 30 patients with hypertension stage II 1 and 2 degree. GFR was determined by the Cockcroft-Gault formula. The observation - 1 year. Results. The level of creatinine in the plasma in the main group of patients was (91,2±2,8 mkmol/l) in the control group this rate did not differ significantly and amounted to (83,7±2,6 mkmol/l, p>0.05).The average value of GFR in patients with hypertension and stroke in history was (81,6±3,5 ml/min), which was significantly lower (p<0,0005) than in the control group (101,4 ±3,6 ml/min). In the study of the relationship of the correlation of GFR and the basic parameters of ambulatory blood pressure monitoring in the main group of patients, we found a moderate positive correlation with the average SBP (r=0,36, p<0,05), with a mean SBP during the day (r =0,39, p<0,05). Average DBP, per night, in the daytime and night time also directly proportional to the mean GFR (r =0,40, r =0,40 and r =0,35 at p <0,05). During antihypertensive therapy showed a comparable reduction in SBP and DBP in groups A and B. The average serum creatinine in group A before treatment was (88±4,7mkmol/l), the therapy - (88,32±2,5 mkmol/l, p>0,05). In Group B, the creatinine level before treatment was comparable to the level of creatinine in the group A to the treatment and was (87,5±3,5 mkmol/l, p<0,05). During therapy with olmesartan and amlodipine average plasma creatinine was significantly decreased and amounted to (80,9 ± 1,7 mkmol/l). In group B before treatment was GFR (80,59 ± 4,32 ml/min), the therapy - (86,35 ± 3,42 ml/min, p <0.05). In group A, prior to treatment was GFR (79,56 ± 3,46 ml/min) for therapy - (83,4 ± 2,73 ml/min, p = 0.06). Conclusions: against the background of the two modes of combination antihypertensive therapy achieved a comparable reduction in mean daily SBP and DBP. In patients with hypertension and stroke in history observed significantly lower levels of GFR, which is an early marker of renal dysfunction. Treatment with amlodipine and olmesartan contributed statistically significant increase in glomerular filtration rate.