FEATURES MANAGING PATIENTS WITH DIABETIC NEPHROPATHY WITH SECONDARYHYPERTENSION IN THE PRACTICE DOCTOR OF GENERAL PRACTITIONERS AND FAMILY MEDICINE
Authors: Yarmola T.T. , Tkachenko L. , Mohilnik N. , Chernobay A. , Mohnachov A. 
Published: June 2018

The aim of our research was to prove the feasibility of early diagnosis of diabetic nephropathy (DN), to optimize the treatment policy in the management ofpatients in I - II stage of chronic renal failure with hypertension.

Materials and methods. We examined 43 patients with DN and chronic renal failure in I - II stages. Age fluctuations were in the range of 31 - 67 years. The ratio of male to female is, respectively, 1: 3. The disease duration of type 2 diabetes ranges from 2 to 15 years. Patients were evaluated after 1, 3 and 6 months. They were divided into two groups: the control group - 20patients treated: ACE inhibitor enalapril (active ingredient enalapril maleate, a daily dose of10 mg twice daily), if necessary, by combining with a blocker of slow calcium channels dihydropyridine amlodipine (active substance S - amlodipine 5 mg) and a diuretic (hydrochlorothiazide - 12.5 mg daily in the morning) or an aldosterone antagonist (spironolactone - 25 mg daily in the morning); main group - 23patients received an angiotensin IIreceptor antagonist type AT1 valsartan 80 mg or 160 mg or combined preparation  - 80mg, 160 mg of valsartan hydrochlorothiazide - 12.5 mg, if needed and / or early treatment combining amlodipine. Mandatory was to determine the level of daily proteinuria, serum creatinine and GFR calculation of sample Rehberg.

The results of research. Source circadian AH type «dipper» is fixed in 62,8%, «non - dipper» - 27,9%, «over - dipper» - 7,0%, and «night - peaker» - 2,3% ofpatients. In 6 months were fixed an increasing number ofpatients with hypertension daily profile «dipper» up to 76.7%, the lack ofpatients with «night - peaker» and a decrease in the number ofpatients with «over - dipper» to 2.1%, and «non - dipper» - up to 21, 0% in the study group. In the control group these indicators were less pronounced. Statistically, there were no changes in the level of proteinuria as well as a decrease in the index of left ventricular mass in the control and in the main groups.

Conclusions. In the absence of significant differences between the comparison groups of antihypertensive effect nephroprotective action, reducing the index of left ventricular mass, tolerability of treatment in the study group was significantly better than the control. Patients of the main group is significantly less needed for supplemental amlodipine. The use of valsartan hydrochlorothiazide had its preferences: BP control during the day and a single dose of the drug daily. It is known that patients category «non - dipper» have a worse prognosis than the category «dipper»; valsartan eliminates this effect in 76.7% ofpatients of the category «non - dipper», making them comparable to those forecasts in patients category «dipper».

All of the above gives grounds to recommend these drugs to general practitioners (family medicine) as the drug of choice for the management ofpatients with chronic renal failure in I - II stages and hypertension with DN proves the need for comprehensive early diagnosis (including the identification of not only the common analyzes, microalbuminuria and proteinuria daily, and mandatory definition GFR)