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CURRENT ISSUE

№4' 2020

THERAPY

International Medical Journal, Vol. 26., Iss. 4, 2020, P. 5−11.


DOI (https://doi.org/10.37436/2308-5274-2020-4-1)

DYNAMICS OF FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE ACCORDING TO LONG-TERM FOLLOW-UP


Mishchenko L. A., Matova O. O., Serbeniuk K. I., Bezrodna L. V., Bezrodnyi V. B., Radchenko V. V.

SI National Scientific Center "M. D. Strazhesko Institute of Cardiology of the National Academy of Medical Sciences of Ukraine", Kyiv, Ukraine

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium.

Key words: resistant arterial hypertension, chronic kidney disease, functional state of kidneys, antihypertensive therapy.


REFERENCES


1. Sarafidis P. A., Georgianos P. I., Zebekakis P. E. Comparative epidemiology of resistant hypertension in chronic kidney disease and the general hypertensive population // Semin. Nephrol. 2014. № 34 (5). S. 483−491. doi: https://doi.org/10.1016/j.semnephrol.2014.08.001

2. Rossignol P., Juillard L. Interactions cardio rénales // Nephrol. Ther. 2017. № 13 (6S). R. 6S11−6S15. doi: https://doi.org/10.1016/s1769−7255(18)30035−x

3. Chronic Renal Insufficiency Cohort (CRIC) Study: baseline characteristics and associations with kidney function / J. P. Lash et al. // Clin. J. Am. Soc. Nephrol. 2009. № 4 (8). R. 1302−1311.

4. Blood pressure predicts risk of developing end−stage renal disease in men and women / M. Tozawa et al. // Hypertension. 2003. № 41 (6). P. 1341−1345. doi: https://doi.org/10.1161/01.hyp.0000069699.92349.8c

5. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group / G. L. Bakris et al. // Am. J. Kidney Dis. 2000. Vol. 36 (3). P. 646−661. doi: https://doi.org/10.1053/ajkd.2000.16225

6. The relationship between magnitude of proteinuria reduction and risk of end−stage renal disease: Results of the African American study of kidney disease and hypertension / J. Lea et al. // Arch. Intern. Med. 2005. Vol. 165. P. 947−953. doi: https://doi.org/10.1001/archinte.165.8.947

7. The risk of developing end−stage renal disease in patients with type 2 diabetes and nephropathy: The RENAAL study / W. F. Keane et al. // Kidney Int. 2003. Vol. 63. P. 1499−1507. doi: https://doi.org/10.1046/j.1523−1755.2003.00885.x

8. AMD−Annals Study Group. Apparent Treatment Resistant Hypertension, Blood Pressure Control and the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes / F. Viazzi et al. // Kidney Blood. Press. Res. 2018. Vol. 43. P. 422−438. doi: https://doi.org/10.1159/000488255

9. Inflammation and chronic kidney disease: current approaches and recent advances / S. Mihai et al. // Chronic. Kidney Disease. Rijeka, Croatia: Intech Open. 2018. 16 r. doi: https://doi.org/10.5772/intechopen.72716

10. Interleukin 6 underlies angiotensin ii−induced hypertension and chronic renal damage / W. Zhang et al. // Hypertension. 2012. Vol. 59. P. 136−144.

11. Barnes T. C., Anderson M. E., Moots R. J. The many faces of interleukin−6: the role of IL−6 in inflammation, vasculopathy, and fibrosis in systemic sclerosis // Int. J. Rheumatol. 2011. 721608

12. Update on interleukin−6 and its role in chronic renal failure / R. Pecoits−Filho et al. // Nephrol. Dial. Transplant. 2003. Vol. 18. P. 1042−1045. doi: https://doi.org/10.1093/ndt/gfg111

13. Interleukin−6 in renal disease and therapy / S. A. Jones, D. J. Fraser, C. A. Fielding, W. J. Gareth // Nephrol. Dial. Transplant. 2014. Vol. 3. P. 1−10.

14. Effect of the angiotensin−converting−enzyme inhibitor benazepril on the progression of chronic renal insufficiency / G. Maschio et al. // N. Engl. J. Med. 1996. Vol. 334. P. 939−945. doi: https://doi.org/10.1056/nejm199604113341502

15. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo−controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non−diabetic nephropathy // Lancet. 1997. Vol. 349. P. 1857−1863. doi: https://doi.org/10.1016/s0140−6736(96)11445−8

16. Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial / J. F. Mann et al. // Ann. Intern. Med. 2001. Vol. 134(8). P. 629−636. doi: https://doi.org/10.7326/0003−4819−134−8−200104170−00007

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