Effects of initial treatment on the dynamics of renal functional reserve in stage-I hypertensive patients

Влияние раннего медикаментозного лечения на динамику функционального почечного резерва у больных с эссенциальной артериальной гипертензией I стадии
Lyudmila Khimion 1, Lilia Tymoshchuk 1, Mariia Rybytska 1
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1 Department of Family Medicine, P.L.Shupik National Medical Academy of Postgraduate Education, Kyiv, Ukraine
J CLIN MED KAZ, Volume 2, Issue 48, pp. 33-40. https://doi.org/10.23950/1812-2892-JCMK-00560
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ABSTRACT

Objective: To determine the functional state of the kidneys in patients with the I stage essential hypertension with different total risk of cardiovascular complications and to assess the effect of early medication (angiotensin II receptor blocker) on the dynamics of changes in the functional renal reserve.
Material and Methods: This study included 80 patients with the established diagnosis - the I stage essential hypertension of the I-III grade in age from 18 to 60 years (28 women (35 %), the average age is 40,1 (35,0-56,0) years; men - 57 (71%), average age – 40,2 (37,0-53,0) years. A risk factor count was used to assess the overall risk of cardiovascular complications in hypertension. Functional renal reserve and endothelium-independent vasodilation of the brachial artery were defined. Statistical analysis was performed using SPSS Statistics.
Results: In patients with high risk, the depleted and decreased functional renal reserve was most often detected, which was 55% of patients. It is also important to note that patients with even a low risk of cardiovascular complications have already had renal damage as a reduced or depleted functional renal reserve. Patients with a low risk of cardiovascular complications who had not started drug treatment on their first visit had a 2.3-fold (95% CI 1,048-4,896) higher relative risk of developing kidney damage in comparison with patients who had started medication therapy without delay.
Conclusion: Diagnosis of functional renal reserve in patients with a low risk of developing cardiovascular complications in stage I arterial hypertension is an important component for predicting the further development of kidney damage and timely prevention of its progression. The early onset of drug treatment reduces the relative risk of developing kidney damage by 2.3 times in patients with arterial hypertension.
Keywords: essential hypertension, cardiovascular risk factors, renal functional reserve, treatment

CITATION

Khimion L, Tymoshchuk L, Rybytska M. Effects of initial treatment on the dynamics of renal functional reserve in stage-I hypertensive patients. Journal of Clinical Medicine of Kazakhstan. 2018;2(48):33-40. https://doi.org/10.23950/1812-2892-JCMK-00560

REFERENCES

  • Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 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). Eur Heart J 2013; Р-34:
  • An Effective Approach to High Blood Pressure Control: American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol 2014; 63 (12): 1230–8.
  • Clinical Practice Guidelines for the Management of Hypertension in the Community A Statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertension 2014; 32 (1): 3–15.
  • Evidence-Based Guideline for the Management of High Blood Pressure in Adults Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) JAMA. doi:10.1001/jama.2013.284427 Published online December 18, 2013.
  • Nakaz MOZ Ukraїni № 384 vіd 24.05.2012 «Pro zatverdzhennya ta vprovadzhennya mediko-tekhnologіchnikh dokumentіv zі standartizatsії medichnoї dopomogi pri arterіal’nіi gіpertenzії» (On Approval and Implementation of Medical-Technological Documents on Standardization of medical assistance in arterial hypertension) [in Russian]. Ofіtsіinii sait [Elektronnii resurs] // Mіnіsterstvo okhoroni zdorov’ya Ukraїni. – Rezhim dostupu: http://www.moz.gov.ua/ua
  • Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013; 3: 1–150
  • Stehouwer CD, Nauta JJ, Zeldenrust GC, et al. Urinary albumin excretion, cardiovascular disease, and endothelial dysfunction in non-insulin-dependent diabetes mellitus. Lancet. 1992;340(8815):319–323. 
  • Yudkin JS. Microalbuminuria: a genetic link between diabetes and cardiovascular disease? Ann Med. 1992;24(6):517–522.
  • Mani A. Albuminuria in Hypertensive Patients: Where the Choice of Antihypertensive Medications Matters:: Commentary on «Several Conventional Risk Markers Suggesting Presence of Albuminuria Are Weak Among Rural Africans With Hypertension». J Clin Hypertens (Greenwich). 2016; 18, 31-2
  • Macías-Núñez JF, López-Novoa JM: Physiology of the healthy aging kidney; In Macías Núñez JF, Cameron JS, Oreopoulos DM editors.: The Aging Kidney in Health and Disease. New York, Springer, 2008, 93–112.
  • Xu R, Zhang LX, Zhang PH, Wang F, Zuo L, Wang HY: Gender differences in age-related decline in glomerular filtration rates in healthy people and chronic kidney disease patients. BMC Nephrol 2010;23:11–20.
  • Liu KD, Brakeman PR: Renal repair and recovery. Crit Care Med 2008;36:187–192.
  • Sharma A., Mucino M.J., Ronco C. Renal functional reserve and renal recovery after acute kidney injury. Nephron Clin Pract 2014 127: 94–100
  • Gozhenko A. I. i dr. Funktsional’nyi pochechnyi rezerv: fiziologicheskoe znachenie pochechnogo rezerva i obosnovanie metodiki ego opredeleniya(Functional renal reserve: the physiological value of the renal reserve and the rationale for the method of its determination) [in Russian] //Pochki. – 2015. – №. 4 (14).
  • Gaipov A, Solak Y, Zhampeissov N et al. Renal functional reserve and renal hemodynamics in hypertensive patients. Ren Fail 2016; 38:1391–1397
  • Guidelines Committee. 2003 World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J. Hypertens.2003;21: 1983-1992.
  • World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J. Hypertens. 1999; 17:151- 183.
  • Khіmіon L.V., Timoshchuk L.S. Sposіb viznachennya funktsіonal’nogo nirkovogo rezervu u khvorikh na esentsіal’nu arterіal’nu gіpertenzіyu. (A method for determining the functional renal reserve in patients with essential hypertension) [in Russian]. Patent. № 1133692 Ukraїni 2017. Byul. №3.
  • Celermajer, D. S., Sorensen, K. E., Gooch, V. M., Spiegelhalter, D. J., Miller, O. I., Sullivan, I. D., et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. The lancet. 1992; Т. 340.(8828):1111-1115.
  • Sharashova, E. E., Kholmatova, K. K., Gorbatova, M. A., & Grzhibovskii, A. M. Primenenie regressii Koksa v zdravookhranenii s ispol’zovaniem paketa statisticheskikh programm spss (Application of Cox regression in health care using a package of statistical programs spss ) [in Russian].//Nauka i zdravookhranenie. – 2017. – №. 6.
  • Valvo, E., Casagrande, P., Bedogna, V., Dal Santo, F., Alberti, D., Fontanarosa, C., Braggio, P. et al. Renal functional reserve in patients with essential hypertension: effect of inhibition of the renin‐angiotensin system.Clin Sci.1990;78:585–590
  • Zitta, S., Stoschitzky, K., Zweiker, R., Oettl, K., Reibnegger, G., Holzer, H., & Estelberger, W. (2000). Dynamic renal function testing by compartmental analysis: assessment of renal functional reserve in essential hypertension. Nephrology Dialysis Transplantation, 2000. 15(8), 1162-1169.
  • Kobori H, Nangaku M, Navar LG, Nishiyama A. The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease. Pharmacol Rev.2007;59:251-287
  • Paul M, Mehr AP, and Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006.86: 747-803
  • Navar LG, Inscho EW, Majid SA, Imig JD, Harrison-Bernard LM, and Mitchell KD. Paracrine regulation of the renal microcirculation. Physiol Rev. 1996.76: 425-536.
  • Taler S.J. More From SPRINT (Systolic Blood Pressure Intervention Trial): A Closer Look at the Price of Intensive Blood Pressure Control. American Journal of Kidney Diseases.2018.1-4.
  • Haller, H., Ito, S., Izzo Jr, J. L., Januszewicz, A., Katayama, S., Menne, J. et al. ROADMAP Trial Investigators. Olmesartan for the delay or prevention of microalbuminuria in type 2 diabetes. N Engl J Med. 2011; 364: 907–917.
  • Palatini, P., Mormino, P., Dorigatti, F., Santonastaso, M., Mos, L., De Toni, R., Pessina, A. C. Glomerular hyperfiltration predicts the development of microalbuminuria in stage 1 hypertension: the HARVEST. Kidney international. 2006;70(3), 578-584.