Dynamics of Ambulatory Blood Pressure Monitoring Parameters and Plasma Level of Osteopontin after Treatment with Candesartan in Patients with Non-dialysis Chronic Kidney Disease
Background. The prevalence of arterial hypertension (AH) in the population of patients with chronic kidney disease (CKD) reaches 60–100 %. The role of AH in the processes of cardiovascular remodeling in CKD may be explained by activation of the renin-angiotensin-aldosterone system, accompanied by retention of sodium and water, induction of pro-inflammatory mediators, such as osteopontin (OP). Relations between OP and parameters of ambulatory blood pressure monitoring (ABPM) in patients with non-dialysis stages of CKD require further investigation. The objective of this study was to determine the effect of candesartan daily monitoring indicators and the plasma level of osteopontin in patients with non-dialysis CKD stages. Materials and methods. The study included 52 patients (mean age was 50.5 ± 17.2 years) with CKD stages III–V. Women and men were 18 and 34 patients, respectively (35 and 65 %). All patients before and after treatment with candesartan were examined by ABPM using a digital system of blood pressure automatic registration Cardio Tens (Hungary). Evaluation of plasma OP was performed by enzyme-linked immunosorbent assay. The average dose of candesartan in patients with CKD stage III was 8.2 ± 4.4 mg, stage IV — 10.40 ± 4.22 mg and stage V — 12.40 ± 3.82 mg. The results were statistically processed using parametric (t-test samples from unrelated variants) and non-parametric (Mann-Whitney) methods. Data are presented as mean (M) ± standard deviation (SD). The critical level of significance (P) was taken equal 0.05. Results. In the group of patients with CKD stage III, mean systolic (SBP), mean diastolic (DBP) and mean pulse blood pressure (PBP) significantly decreased by 6.4, 7.8 and 4.8 %, respectively. The reduction of mean SBP, mean DBP and mean PBP by 7.0 % (p < 0.05), 5.2 % (p > 0.05) and 9.6 % (p < 0.05) was observed in patients with CKD stage IV. Values of mean SBP, mean DBP and mean PBP in patients with CKD stage V significantly decreased by 14.0, 8.9 and 19.9 %, respectively. OP plasma level significantly decreased in all the patients after treatment. The greatest decrease under the influence of candesartan therapy was observed in patients with CKD stages III and IV — 66.4 and 37.2 %, respectively, while the concentration of OP in patients with CKD stage V decreased only by 11.7 %. Conclusions. According to ABPM parameters in patients with non-dialysis stages of CKD receiving candesartan, there was a statistically significant positive trend of mean systolic, diastolic and pulse blood pressure and parameters of pressure overload. 12-week treatment with candesartan causes decrease of the plasma level of osteopontin in patients with III, IV and V stage CKD by 66.4, 37.2 and 11.7 %, respectively.
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