Two strategies for arterial hypertension treatment in patients with secondary chronic pyelonephritis

Aim. To compare the antihypertensive effectiveness, cardio- and nephroprotection, and metabolic effects of the combinations "enalapril + indapamide" vs. "enalapril + nifedipine slow release (SR)" in patients with arterial hypertension (AH) and secondary chronic pyelonephritis (CPN). Material and methods. In total, 60 patients with AH and secondary CPN, aged 45-65 years, were divided into two groups: Group 1 (n=30) receiving combined therapy with enalapril (mean dose 15,9 +/- 2,3 mg/d) and indapamide (2,5 mg/d); and Group II (n=30) receiving the combination of enalapril (16,1 +/- 2,4 mg/d) and nifedipine SR (40 mg/d). The complex examination included 24-hour blood pressure monitoring (BPM), echocardiography, measurement of morning urine specific gravity, microalbuminuria (MAU), urine levels of (2)-microglobulines, blood creatinine and glomerular filtration rate (GFR) calculation by MDRD formula, fasting glucose, potassium, uric acid, total cholesterol, and triglycerides. The follow-up time was 12 weeks. Results. The combinations "enalapril + indapamide" and "enalapril + nifedipine SR" had similar effects in terms of BP lowering, MAU reduction, and improvement of proximal renal tubular function. In both groups, there was a decrease in the number of patients with circadian BP rhythm disturbances, adverse left ventricular remodelling types, or diastolic dysfunction. The combination of enalapril and indapamide was significantly more effective in terms of restoring renal concentrating function, compared to the combination "enalapril + nifedipine SR". Both antihypertensive therapies were metabolically neutral, not affecting carbohydrate, purine, lipid, or electrolyte metabolism parameters. Conclusion. The combinations "enalapril + indapamide" and "enalapril + nifedipine SR" demonstrated high antihypertensive effectiveness, cardio- and nephroprotection, and metabolic neutrality.