Antihypertensive therapy optimization and endothelial function in patients with gout and chronic urate tubulointerstitial nephritis

Abstract

Aim: to characterize the markers of endothelial dysfunction and the effect of antihypertensive drugs on them in patients with chronic urate tubulointestinal nephritis (UTIN) and articular gout. Subjects and methods. The study enrolled 81 patients aged 39 to 59 years with gout and urate nephropathy. All the patients were diagnosed as having grade 1-2 arterial hypertension. A lower glomerular filtration rate (GFR) was noted in 49.9%; microalbuminuria (MAU) and elevated serum endothelin-1 (ET-1) levels were recorded in all the patients. Combination antihypertensive therapy based on the use of angiotensin-converting enzyme (ACE) inhibitors and/or an angiotensin II receptor blocker (ARB) in combination with calcium channel blockers was performed during 12 months. The time course of changes in blood pressure, the parameters of target organ lesion, and the markers of endothelial dysfunction were monitored. Results. Before the study, all the examinees were found to have MAU and increased serum ET-1, which are regarded simultaneously as signs of renal lesion and as markers of endothelial function. A combination of an ACE inhibitor or an ARB could diminish albuminuria and reduce ET-1 concentrations, lower systolic and diastolic blood pressure significantly, and increase GFR. Conclusion. The patients with articular gout and chronic UTIN are observed to have signs of endothelial dysfunction eliminated by combination antihypertensive therapy.

Keywords

• gout
• uric acid
• arterial hypertension
• endothelin-1
• albuminuria
• antihypertensive therapy