PATHOGENETIC DIFFERENCES BETWEEN LABILE AND STABLE ARTERIAL HYPERTENSION

Abstract

The aim of the study was to clarify the differences in renal, vaso-renal, vascular, and endocrine disorders and dysfunctions between labile (borderline and Stage I) and stable arterial hypertension (Stage I-II, and malignant hypertension; ESH/ESC classification, 2007). The study included 1846 patients (837 men, 1009 women; age 16-72 years), divided into 5 age groups: 16-29, 30-39, 40-49, 50-59, and 60-72 years. Each age group was additionally divided into subgroups with labile and stable arterial hypertension (LAH, SAH). A complex clinical, biochemical, hormonal, and instrumental examination was performed 3-5 days after hospital admission and 3-4 weeks after the start of in-hospital treatment. It was shown that pathogenetic differences between LAH and SAH manifested in higher prevalence of vaso-renal pathology in SAH patients, with some forms of vaso-renal disease observed in SAH only. SAH patients were characterised by increased renin activity and microalbuminuria (a marker of renal glomerular pathology), reduced volume of functioning renal parenchyma, and disturbed renal nitrogen and electrolyte excretion. In addition, SAH patients had higher prevalence of AH in family anamnesis, as well as more pronounced left ventricular hypertrophy and arterial remodelling. Metabolic syndrome manifestations, such as diabetes mellitus and overweight, were also more prevalent in SAH individuals. Hypertensive crises developed more often in SAH patients. Finally, in women with SAH, higher plasma levels of gonadotropins LH, FSH, and prolactin were registered.

Keywords

• primary arterial hypertension
• labile and stable clinical course
• renal
• vaso-renal and endocrine causes and dysfunctions