RESEARCH ARTICLE


Antihypertensive Treatment and Kidney Function in Routine Practice in Patients with Type 2 Diabetes Mellitus: The Results of the Prospective "The Scythian" Trial in Ukraine



Dmitri D Ivanov*, 1, Boris N Mankovsky 2
1 Dept. of Nephrology and Renal Replacement Therapy
2 Dept. of Diabetology, National Medical Academy of Postgraduate Education named by P.L. Schupik, Kiev, Ukraine


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© Ivanov and Mankovsky; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Dept. of Nephrology and Renal Replacement Therapy, National Medical Academy of Postgraduate Education named by P.L. Schupik, Kiev, Ukraine; Tel: +380504448788; Fax: +380442846897; E-mail: ivanovdd@i.kiev.ua


Abstract

Background :

Hypertension, albuminuria and decreased GFR are regarded as independent risk factors that reflect progression of the diabetic kidney disease (DKD). We carried out second phase of prospective study which aim was to learn the possibility of implementation of intensive antihypertensive therapy into the routine clinical practice and assessment of such treatment influence on kidney function in patients with type 2 diabetes mellitus (T2DM).

Methods :

In the study 637 patients were included with DKD and arterial hypertension with BP level more than 130/80 mmHg and less than 1800 mmHg, having chronic kidneys disease (CKD) 1-4. As a basis for intensive antihypertensive treatment fixed combination of perindopril 5 mg and indapamide 1.25 mg were prescribed. If needed, after 4 weeks the dosage was increased up to perindopril 10 mg/ indapamide 2.5 mg to achieve targeted BP less that 130/80 mmHg. If targeted BP had not been achieved other antihypertensive preparations were added.

Results :

After 4 weeks of treatment average levels of systolic and diastolic BP were 141.3±0.5 and 86.3±0.3, after 8 weeks of therapy – 131.6±0.4 and 81.3±0.3 mmHg, and after 12 weeks of treatment –127.2±0.3 and 78.7±0.2 mmHg respectively. Target BP was achieved in 489 patients (73.3%) during 12 weeks of treatment. Statistically significant increase of GFR as a result of 12 weeks of antihypertensive therapy with fixed perindopril/indapamide combination was found to be between 84.3±1.1 and 94.7±1.1 ml/min./1,73m2, р<0.01.

Conclusion :

Antihypertensive therapy with fixed combination of perindopril 5-10 mg/indapamide 1.25-2.5 mg introduced into routine clinical practice of T2DM patients’ treatment, is effective for BP reduction, achievement of its targeted values and resulted in statistically significant trend to kidney function improvement.

Keywords: Combined antihypertensive therapy, Diabetic kidney disease (DKD), glomerular filtration rate (GFR), hypertension, microalbuminuria..