Denysenko V. The features of the course and treatment of hypertension in the patients with diabetic nephropathy.

Thesis is devoted to optimization of hypertension treatment and prophylaxis in the patients with a diabetic nephropathy with the different stages of severity. In this study the complex analysis of inflammatory mechanisms role, state of the renin-angiotensin-aldosterone system, heart and vascular system remodeling in initiation and development of hypertension in the patients with a diabetic nephropathy was conducted. On the basis of the performed researches the concept of hypertension pathogenesis in the diabetes 2 type patients with diabetic nephropathy was worked out, in the initiation of which inflammatory mechanisms play a major role, and in the progression of whose leading meaning have features of the renin-angiotensin-aldosterone system state. On this background the features of heart and vascular system remodeling and their contribution in hypertension progression at this category of patients were studied. Recommendations on the use of antihypertensive drugs combinations depending on the state of target-organs and taking into account assessment of pressor components of the renin-angiotensin-aldosterone system levels were given. The blockers of aldosterone synthesis have a special role in antihypertensive drugs combinations at the treatment of the patients with a diabetic nephropathy without kidney insufficiency. The new method of hypertensive patients with a diabetic nephropathy treatment with the use of medicinal agents with angioprotective properties was firstly offered and introduced in practice. Recommendations in relation to the use in the complex treatment of diabetic nephropathy and hypertension metabolically active drugs (Gliclazide and Phenofibrate) in quality of organoprotective agents were developed.