Strategy of drug therapy selection in patients with hypertension and renal tubulointersticial injury

A.V. Sokolova, D.O. Dragunov, G.P. Arutjunov

SBEI HPE "Russian National Research Medical University n.a. N.I. Pirogov” of the MH of the RF, Moscow
Objectives. To optimize drug therapy in patients with arterial hypertension and tubulointersticial disease.
Material and Methods. A total of 345 patients were screened of whom 55 were enrolled in the study. The patients were comparable regarding major baseline characteristics. Dietary salt intake was limited to < 6 g/day. After 30 days of the study 13 patients were excluded due to blood pressure normalization and being not required antihypertensive treatment. The patients were randomized into two treatment groups («A» and «T»): azilsartan and torasemide SR, respectively. In all patients at the beginning of drug therapy and at the final visit ABPM was performed, conductivity of the urine and natriuretic activity were assessed. Data management and analysis were performed using Statistica 10.0.
Results. In the group «A» 58.3% of the patients had «non-dipper» BP profile at the D0 visit vs. 18.75% at the final visit, «dipper» 46.6% vs. 81.25%, «night-peaker» 33.3% vs. 0.0%. In the group «T» BP profile «non-dipper» at the D0 visit had 41.6% of patients vs. 11.76% at the final visit, «dipper»53.3% vs. 82.35%, «night-peaker» 66.7%vs 5.88%. At the D0 visit «evening conductivity» in group «A» was 40.7 ± 17.7 ms /cm and 43.5 ± 19.3 7 ms /cm in the group «T» (p> 0.05), «evening natriuresis» was 305.12 ± 130.9 mmol/l in the group «A» and 317.5 ± 139.2 in the group «T»(p> 0.05). At the visit D4 «evening conductivity» was 26.3 ± 10.3 ms /cm and 28.9 ± 15.5 - in the group «A» and «T» (p = 0.58), respectively, «the evening natriuresis» was 203.8 ± 86.76 mg/dL in the group «A» and 205.1 ± 115.7 mg/dL in the group «T» (p = 0.97). At the D0 visit augmentation index (AI) in the aorta in the group «A» was 7.5 [31.0; -6.0] and 17.0% [-5.0; 36.0]% in the group «T»(p = 0.69). IA at the visit D4 in the aorta in the group «A» amounted to -13.5 [-21.0; -2.0] % and to -1.0 [-9.0; 9.0]% in the group «T»(p = 0.03).
Conclusion. Conductivity of the urine and natriuresis, measured in the evening hours, reflect the renal RTT function and can serve as markers of unfavorable blood pressure profile. For patients with a low salt intake (less than 15 g /d) azilsartan is more effective due to producing greater IA changes than torasemide SR (2 [-9.5; 15.5]%) in the aorta (-21 [-29.9; -16]%), affecting the activity of the RAAS. Torasemide SR, increasing sodium excretion, showed the best result in patients with high salt intake (more than 15 g /day) (IA aorta was -9 [-14; -2]%), p = 0.0002.


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About the Autors

Author Information
A.V. Sokolova – Teaching Assistant of the Department of Internal Medicine and General Physiotherapy of the Pediatric Faculty of SBEI HPE "RNRMU n.a. N.I. Pirogov” of the MH of the RF
D.O. Dragunov – Ph.D., Teaching Assistant of the Department of Internal Medicine and General Physiotherapy of the Pediatric Faculty of SBEI HPE "RNRMU n.a. N.I. Pirogov” of the MH of the RF; e-mail:
G.P. Arutjunov – Ph.D., Prof., Head of the Department of Internal Medicine and General Physiotherapy of the Pediatric Faculty of SBEI HPE "RNRMU n.a. N.I. Pirogov” of the MH of the RF

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