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TREATMENT OF HIGH BLOOD PRESSURE IN ELDERLY PATIENTS
WITH CHRONIC KIDNEY DISEASE
Mirzaeva Gulchexra Payzullayevna
Nazarova Nigina Otabekovna
Rakhimova Gulsum Polatboyevna
Xasanova Malika Akramovna
Tashkent medical academy, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.14162103
Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) and
angiotensin receptor blockers (ARBs), which have nephroprotective effects, are
first-line drugs (FL) for treatment of arterial hypertension (AH) in patients with
chronic kidney disease (CKD). However, these groups of drugs have a number of
contraindications, certain adverse drug reactions, unwanted drug interactions
and therefore cannot be prescribed in all AH patients with CKD. Therefore, real
clinical practice studies are needed to assess the real frequency of
nephroprotective drugs prescription, especially in the elderly.
Methods: We analyzed 75 case histories of elderly patients treated in the
nephrology department of the 3-clinic of the Tashkent medical academy. The
average duration of hospitalization was 12,79±0,26 days. The mean age of
patients was 66,24±0,56 years (60% - women). AH of the 1st degree was
revealed in 4% of patients, AH of the 2nd degree - in 36%, AH of the 3rd degree -
in 60%. Stage II CKD had 2.7% of patients, stage III CKD - 61.3%, stage IV CKD -
28%, stage V CKD - 8%. Proteinuria less than 300 mg/day was detected in 24%
of patients, proteinuria 300-3000 mg/day in 32%, and proteinuria over 3000
mg/day in 5.3%. Pharmacotherapy was analyzed by prescription sheets. Results:
Combined antihypertensive therapy was administered in 97.3% of patients. The
average number of simultaneously prescribed antihypertensive drugs per
patient was 3.12±0.14. Beta-adrenoblockers (BABs) were given to 70.7% of the
patients (of which bisoprolol in 58.5% of cases, metoprolol in 32.1%, nebivalol
in 5.7%, atenolol in 3.8%, and carvedilol in 3.8%). Calcium antagonists (CA)
were administered in 69.3% of patients (including amlodipine in 76.9%,
nifedipine in extended forms in 14.7%). Diuretics (D) were received orally by
65.3% of patients (indapamide - 71.4%, furosemide - 22.4%, thorasemide -
18.4%, spironolactone - 6.1%). In addition, 14.7% of patients received
intravenous furosemide. ARBs were prescribed in 45.3% of patients (fosinopril -
61.8%, enalapril - 41.2%). Centrally acting drugs were received by 25.3% of
patients (rilmenidine - 68.4%, moxonidine - 38.5%). ARBs were received by
CURRENT APPROACHES AND NEW RESEARCH IN
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26.7% of patients (losartan - 90%, telmisartan - 5%, eprosartan - 5%). 6.7% of
patients received the alpha-adrenoblocker doxazosin. In 18 cases, when ACEIs
were not used, ARBs were prescribed. Thus, the total number of patients who
received nephroprotective drugs (ACEIs and BRA) was 69.3%. The incidence of
hyperkalemia was 39.1% and the incidence of stage V CKD was 34.8% in the
group of patients who received neither (ACEIs) nor ARBs During the performed
therapy,
blood
pressure
(BP)
significantly
decreased
from
157.79±3.02/92.27±1.18 to 128.47±1.07/82.33±0.83 mm Hg. Target BP (target
BP (<140/80 mm Hg) at the time of discharge was achieved in 53.3% of patients.
Conclusion: The majority of elderly patients with CKD and AH received
nephroprotective drugs (ACEIs and ARBs ), which is in line with the current
recommendations. In 30.7% of patients they were not prescribed, apparently
due to hyperkalemia and the presence of marked azotemia.
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