DOI: https://doi.org/10.22141/2224-1485.3.35.2014.82722

Influence of the Circadian Rhythm of Blood Pressure, Proinflammatory and Metabolic Cardiovascular Risk Factors on the Hypertensive Nephropathy Development in Hypertensive Patients

V.B. Bezrodny

Abstract


In order to determine the relationship of renal function with a daily profile of blood pressure (BP), carbohydrate and lipid metabolism in essential hypertension (EH) we examined 98 patients with EH stage II–III, 1st — 2nd degree.
All patients underwent office measurement and daily BP monitoring. The content of lipids, uric acid and C-reactive protein (CRP) in the blood plasma were determined, as well as glomerular filtration rate (GFR) by endogenous creatinine clearance and microalbuminuria.
It is found that in patients with EH the deterioration of renal function is associated with impaired circadian BP rhythm by non dipper type, increasing variability of systolic blood pressure (SBP) during a day, chronic hemodynamic overload during the day: the most close correlation with GFR was set with average daily SBP values for all periods of the day and with the average daily diastolic blood pressure (r = –0.384,
p < 0.001).
In patients with EH we revealed significant inverse correlation of GFR with HOMA index (r = –0.417; p < 0.001), the content of insulin and glucose in plasma glucose fasted (r = –0.248, p < 0.05; r = –0.397, p < 0.001, respectively) and insulin level on the 60th minute of glucose tolerance test (r = –0.308; p < 0.001).
Using multivariate regression analysis, we showed that factors associated independently of blood pressure with reduced GFR in patients with EH are CRP (β = –0.285, p < 0.01), total cholesterol (β = –0.249, p < 0.03), microalbuminuria (β = –0.242, p < 0.05) and HOMA index (β = –0.238, p < 0.05).
Increased levels of uric acid, triglycerides, and CRP in the blood plasma in patients with EH are associated with increased manifestations of hypertensive nephropathy (GFR decline and increased microalbuminuria).
Hypertensive nephropathy in hypertensive patients is associated with lipid metabolism disorders — an increased blood plasma levels of total cholesterol, low-density lipoproteins and triglycerides.


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