Alʹmanah Kliničeskoj Mediciny (Jul 2016)
ASSESSMENT OF PARAMETERS OF RENAL FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND ABDOMINAL OBESITY WITH A HISTORY OF ACUTE CEREBROVASCULAR ACCIDENT, DEPENDING ON THE TARGET LEVELS OF SYSTOLIC BLOOD PRESSURE IN THE RECOVERY PERIOD OF THE STROKE
Abstract
Background: Essential arterial hypertension is one of the most common causes of chronic kidney disease. Timely identification of asymptomatic chronic kidney disease may help to prevent development of renal failure and maintain kidney functioning. Aim: To assess changes in renal function parameters in patients with arterial hypertension and abdominal obesity with a history of a stroke, depending on the target levels of systolic blood pressure (SBP) during the recovery period of stroke. Materials and methods: We assessed 88 patients with arterial hypertension with a history of an acute cerebrovascular accident within the last 1 to 6 months (mean age, 58.8±9.5 years). During 2 to 4 weeks of their hospital stay, their antihypertensive treatments were titrated to reach the chosen target levels of blood pressure. Thereafter, the patients were followed up for 8 to 12 months with baseline and follow-up measurements of their antropometric and clinical chemistry parameters including blood urea nitrogen and serum creatinine and estimated glomerular filtration rate (CKD-EPI). Chronic kidney disease was diagnosed by albumin and creatinine measurements with calculation of albumin/creatinine ratio in the morning urine portion. Results: There was a positive correlation between office SBP and serum creatinine (r=0.5, р=0.01), serum albumin (r=0.4, р=0.003) and creatinine in the morning urine portion (r=0,5, р=0.0001). Hip circumference negatively correlated with serum creatinine and albumin/creatinine ration at the end of the follow-up (r=-0.3, р=0.04 and r=-0.3, р=0.04, respectively). Bodyweight correlated positively with the glomerular filtration rate (r=0.3, р=0.04), whereas waist to hip ration correlated with urine albumin at the end of the follow-up (r=0.3, р=0.01). Multiple regression analysis showed an association between mean office SBP and serum creatinine (β=0.43, р=0.04), urine albumin (β=0.33, р=0.02) and urine creatinine level (β=0.39, р=0.005). Conclusion: We found an association between SBP and renal function. SBP levels below 135 mm Hg are associated with an improvement of the renal function, whereas SBP levels below 124 mm Hg are associated with a significant decrease in renal function assessed by glomerular filtration rate and albumin/creatinine ratio. The efficacy of antihypertensive treatment in the recovery period after an acute cerebrovascular accident should be assessed with consideration of renal function measured by glomerular filtration rate and microalbuminuria levels.
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