ILM-FAN VA INNOVATSIYA
ILMIY-AMALIY KONFERENSIYASI
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42
ANTIHYPERTENSIVE THERAPY IN ELDERLY PATIENTS WITH CHRONIC
KIDNEY DISEASE
Mirzaeva G.P.
Jabbarov O.O.
Tashkent medical academy, Tashkent, Uzbekistan
https://doi.org/10.5281/zenodo.13789467
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 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.
ILM-FAN VA INNOVATSIYA
ILMIY-AMALIY KONFERENSIYASI
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References:
1.
Thomas B, Matsushita K, Abate KH, Al-Aly Z, Arnlov J, Asayama K, et al. Global
cardiovascular and renal outcomes of reduced GFR. J Am Soc Nephrol. 2017;28(7):2167–79.
2.
Ali S, Dave N, Virani SS, Navaneethan SD. Primary and secondary prevention of
cardiovascular disease in patients with chronic kidney disease. Curr Atheroscler Rep.
2019;21(9):32.
3.
Jumanazarov, S., Jabbarov, O., Umarova, Z., Tursunova, L., & Mirzayeva, G. (2022).
Factors affecting platelet hemostasis and resistance to curantil in patients with chronic kidney
disease.
4.
Mirzaeva, G. P. (2023). Evaluation of the effectiveness of antioxidants on the functional
state of the kidneys in patients with diabetic nephropathy.
