The effect of blood pressure variability on renal functional reserve at essential arterial hypertension І stage
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
The article presents the results of the investigation impact of variability in blood pressure (BP) on renal functional reserve (RFR) in patients with essential hyper tension (EH) I stage.
The objective: to determine the effect of the blood pressure variability on kidney function at EH І stage.
Patients and methods. The study involved 50 patients. The study group included 30 patients with diagnosed essential hypertension I satge diagnosed according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health of Ukraine (May, 24, 2012 No.384) (mean duration of EH 3,5±0,5 years, women – 12 (40%), men – 18 (60%), average age – 44,6±1,78 years); 20 healthy individ uals as the control group (women – 11 (55%), men – 9 (45%), average age – 41,1±1,96 years). Non – inclusion criteria were: symptomatic hypertension, valvular heart disease, arrhythmias, congestive heart failure, chronic kidney disease, diabetes, coronary heart disease. Patients of the main group were not taking antihypertensive therapy. All patients underwent following tests: clinical examination, general clinical blood and urine tests, urine albumin/creatinine ratio, biochemical blood tests (total protein, urea, creatinine, glucose, lipid profile); ambulatory blood pressure monitoring (ABPM) , ECG, EchO KG and ultrasound of the carotid arteries ), ophthalmoscopy; renal function reserve (RFR) was determined by water and salt load method (under patent Ukraine 42,860). ABPM performed on the monitor ABPM 50 (UK, 2015). The results were analyzed by the soft ware ABPM50.
Results. Рatients of the main group had shown increased BP variability compared to the results of control group: SBP and DBP were significantly higher in EAG patheints (in 74,34% (p<0,001) and 76,74% (p<0,001), respectivel. Analyze of the night BP level has demonstrated that most of patients in main group had abnormal BP reaction: 12 (40%) persons were «non dipper», 3 (10%) – «night peaker», 9 (30%) – «over dipper»; normal circadian rhythm («dipper») was found in only 6 persons (20%). All persons from control group demonstrated «dipper» profile of the night BP. The mean RFR was signifi cantly lower in the main group (14,16±3,86%) than in the control group (34,04±10,63%; p<0,05). The lowest rate of RFR in study patients was determined in «night picker» and «non dipper» subgroups; and in patients with maximum degree of BP variability.
Conclusions. 1. In hypertensive patients RFR is significantly reduced compared with healthy persons (14,16±3,86%) and (34,04±10,63%; p<0,001).
2. Adverse nocturnal blood pressure profile («non dipper», «night peaker») observed in 50% of patients with EH I stage.
3. The maximum reduction in RFR develops in «non dipper» (9,42±3,87%) and «night peaker» (5,56 ± 3,24%) subgroups .
4. Maximal variability in SBP and DBP in EH I stage patients leads to decreased RFR/
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Гоженко А.І. Пат. No 42860 Україна, МПК (2009) А61В 5/20. Спосіб визначення функціонального ниркового резерву / Гоженко А.І., Хамініч А.В., Лебедєва Т.Л.
Наказ МОЗ України No 384 від 24.05.2012 «Про затвердження та впровадження медико технологічних документів зі стандартизації медичної допомоги при артеріальній гіпертензії«: Офіційний сайт [Електронний ресурс] // Міністерство охорони здоров’я України. – Режим доступу: http://www.moz.gov.ua/ua
Н. Абу Шихаб. Варіабельність артеріального тиску та особливості ремоделювання міокарду лівого шлуночка у хворих з гіпертонічною хворобою: Автореф. дис. ... канд. мед. наук. – 2006. – С. 22 (8).
Стародубова А.В., Копелев А.А. Суточное мониторирование артериального давления //Лечебное дело. – 2010. – No 1.
Guidelines Committee. 2003 World Health Organization (WHO) /International Society of Hypertension (ISH) statement on management of hypertension // J. Hypertens. 2003; 21: 1983–1992.
Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Bjorklund Bodegard K, Richart T, Ohkubo T, Jeppesen J, Torp Pedersen C et al. Prognostic value of reading to reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55(4):1049–57.
Kala R., Fyhrquist F., Eisalo A. Diurnal variation of plasma angiotensin II in man Scand J Clin Lab Invest, 31 (1973), pp. 363–365
Kawasaki T., Ueno M., Uezono K. et al. Differences and similarities among circadian characteristics of plasma renin activity in healthy young women in Japan and the United States Am J Med, 68 (1980), pp. 91–96
Shimada K. et al. Guidelines for the clinical use of 24 hour ambulatory blood pressure monitoring (ABPM)(JCS 2010): digest version //Circulation journal: official journal of the Japanese Circulation Society. – 2012. – Т. 76, No 2. – С. 508–519.
Ozkayar N, Dede F., Akyel F et al. Relationship between blood pressure varэability and renal activity of the renin angiotensin system J Hum Hypertens, 30 (2016), pp. 297–302.
Parati G., Ochoa J.E., Bilo G. Blood pressure variability, cardiovascular risk, and risk for renal disease progression //Current hypertension reports. – 2012. – Т. 14, No 5. – С. 421–431.
Redon J. The importance of 24 hour ambulatory blood pressure monitoring in patients at risk of cardiovascular events //High Blood Pressure & Cardiovascular Prevention. – 2013. – Т. 20, No 1. – С. 13–18.
Verdecchia P. et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension //Hypertension. – 1994. – Т. 24, No 6. – С. 793–801.
Velasquez M. T. et al. Ambulatory Blood Pressure in Chronic Kidney Disease: Ready for prime time? //Kidney International Reports. – 2016.
World Health Organization International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee // J. Hypertens. 1999; 17: 151–183.
ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) / G. Mancia, R. Fagard, K. Narkiewicz [et al.] // Eur. Heart J. – 2013. –Vol. 34 (28). – P. 2159–2219.
