Prehypertension as a risk factor for chronic kidney disease


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Purpose. To reveal the significance of prehypertension as a risk factor for CKD. Material and Methods. The study included 94 men with prehypertension and 57 men with I degree arterial hypertension. The examination included detection of risk factors for CKD. Patients were allocated into 3 groups: 1st- with normal blood pressure (NBP), 2nd - with nigh normal blood pressure (HNBP), and 3rd - with I degree arterial hypertension, (і degree ah). Patients of the 2nd and 3rd groups have received advice on non-drug correction of risk factors; in addition, patients of 3rd group have received valsartan (40-80 mg per day). a year later, examination of patients of the 2nd and 3rd groups was carried out. Results. We have identified modifiable hemodynamic and metabolic factors associated with CKD against the background of HNBP comparable to those of I degree ah. In patients with HNBP the use of non-drug methods of correction of CKD risk factors was ineffective: increase in BMI, insulin resistance (Ir), CRP, hyperuricosuria were detected. The number of patients with increased and high urinary albumin excretion (UAE) increased from 47 to 59%, decrease in GFR (<60 mL/min) was observed in 5% of patients. after year of observation, frequency of detection of early stages of CKD has reached 23%, transformation of VNAD in I degree AH was observed in 27% of cases; the detection rate of non-dippers increased from 33 to 38%, LVMMI by 2.1%. The use of valsartan has allowed to control of systolic and diastolic blood pressure (more than in 80% of patients), reduce the proportion of non-dippers by 27%, decrease in UAE by 25%, CRP by 16%, LVMMI by 2.8%, as well as decrease in uricosuria an Ir. The prevalence of CKD has decreased by 37%. Conclusion. According to our data, HNBP, as a form of prehypertension, is a subclinical stage of arterial hypertension, prone to progression, with high risk of CKD and cardiac complications.

Full Text

Restricted Access

References

  1. Hamm L.L., Hering-Smith K.S. Pivotal Role of the Kidney in Hypertension. Am. J. Med. Sci. 2010;340:30-32.
  2. Segura J., Ruilope L.M. Hypertension in Moderate-to-Severe Nondiabetic CKD Patients. Adv. Chronic Kidney Dis. 2011;18:23-27.
  3. Mangia G., Fagard R., Narkiewicz R., Redon J., Zanchetti A., Böhm M., Christiaens T., Cifkova R., De Backer G., Dominiczak A., Galderisi M., Grobbee D.E., Jaarsma T., Kirchhof P., Kjeldsen S.E., Laurent S., Manolis A.J., Nilsson P.M., Ruilope L.M., Schmieder R.E., Sirnes P.A., Sleight P., Viigimaa M., Waeber B., Zannad F.; Task Force Members. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ECN) and the European Society of Cardiology (ESC). 2013 ESN/ESC Guidelines for the management of arterial hypertension. J. Hypertens. 2013;31(7):1281-1357.
  4. Sipahi I., Swaminathan A., Natesan V., Debanne S.M., Simon D.I., Fang J.C. Effect of antihypertensive therapy on incident stroke in cohorts with prehypertensive blood pressure levels: a meta-analysis of randomized controlled trials. Stroke. 2012;43(2):432-440.
  5. DREAM Trial Investigator, Dagenais G.R., Gerstein H.C., Holman R., Budaj A., Escalante A., Hedner T., Keltai M., Lonn E., McFarlane S., McQueen M., Teo K., Sheridan P., Bosch J., Pogue J., Yusuf S. Effects of ramipril and rosiglitazone on cardiovascular and renal outcomes in people with impaired glucose tolerance or impairedfasting glucose results of the Diabetes Reduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial. Diabetes Care. 2008;31(8): 1007-1014.
  6. The NAVIGATOR study Group; McMurray J.J., Holman R.R., Haffner S.M., Bethel M.A., Holzhauer B., Hua T.A., Belenkov Y., Boolell M., Buse J.B., Buckley B.M., Chacra A.R., Chiang F.T., Charbonnel B., Chow C.C., Davies M.J., Deedwania P., Diem P., Einhorn D., Fonseca V., Fulcher G.R., Gaciong Z., Gaztambide S., Giles T., Horton E., Ilkova H., Jenssen T., Kahn S.E., Krum H., Laakso M., Leiter L.A., Levitt N.S., Mareev V., Martinez F., Masson C., Mazzone T., Meaney E., Nesto R., Pan C., Prager R., Raptis S.A., Rutten G.E., Sandstroem H., Schaper F., Scheen A., Schmitz O., Sinay I., Soska V., Stender S., Tamas G., Tognoni G., Tuomilehto J., Villamil A.S., Vozar J., Califf R.M. Effect of valsartan on the incidence of diabetes and cardiovascular events. N. Eng. J. Med. 2010;362(16):1440-1490.
  7. Котовская Ю.В., Кравцова О.А., Павлова Е.А. Новое в терапевтических стратегиях. Артериальная гипертензия. 2014;20(1):27-32.
  8. LüdersS., Schrader J., Berger J., Unger T., Zidek W., Böhm M., Middeke M., Motz W., Lübcke C., Gansz A., Brokamp L., Schmieder R.E., Trenkwalder P., Haller H., Dominiak P.; PHARAO Study Group. The PHARAO Study:prevention of hypertension with the angiotensin converting enzyme inhibitor ramipril in patients with high normal blood pressure: a prospective, randomized, controlled prevention trial of the German Hypertension League. J. Hypertens. 2008;26:1487-1496.
  9. Julius S., Nesbitt S.D., Egan B.M., Weber M.A., Michelson E.L., Kaciroti N., Black H.R., Grimm R.H. Jr., Messerli F.H., Oparil S., Schork M.A.; Trial of Preventing Hypertension (TROPHY) Study Investigators. Feasibility of treating prehypertension with an angiotensin receptor bloker. N. Engl. J. Med. 2006;354(16):1685-1697.
  10. Смирнов А.В., Шилов Е.М., Добронравов В.А., Каюков И.Г., Бобкова И.Н., Швецов М.Ю., Цыгин А.Н., Шутов А.М. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению. Клиническая нефрология. 2012;4:4-26.
  11. Shiraishi J. et al. KYOTO HEART Study Group. Circ. J. 2011;75(4):186.
  12. Kucukler N., Kurt I.H., Topaloglu C., Gurbuz S., Yalcin F. The effect of valsartan on left ventricular myocardial functions in hypertensive patients with left ventricular hypertrophy. J. Cardiovasc. Med. (Hagerstown). 2012;13(3):1477.
  13. Solomon S.D., Janardhanan R., Verma A., Bourgoun M., Daley W.L., Purkayastha D., Lacourcière Y., Hippier S.E., Fields H., Naqvi T.Z., Mulvagh S.L., Arnold J.M., Thomas J.D., Zile M.R., Aurigemma G.P.; Valsartan In Diastolic Dysfunction (VALIDD) Investigators. For the Valsartan In Diastolic Dysfunction (VALIDD) Investigators. Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomized trial. Lancet. 2007;23(369): 2079-2087.
  14. Yanamaka H.; Japanese Society of Gout and Nucleic Acid Metabolism. Japanese guideline for the management of hyperuricemia and gout: second edition. Nucleosides Nucleotides Nucleic Acids. 2011;30:1018.
  15. Мухин Н.А., Балкаров И.М., Моиссев В.С., Лебедева М.В., Фомин В.В., Краснова Е.А. Хронические прогрессирующие нефропатии и образ жизни современного человека. Терапевтический архив. 2004;9:5-10.
  16. Леванковская Е.И., Новикова М.С., Швецов М.Ю., Зилов А.В., Цинева Л.А., Шилов Е.М. Нефропротективное влияние коррекции инсулинорезистентности у больных с хронической болезнью почек. Эффективная фармакотерапия. Урология и нефрология. 2012;1:52-56.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies