Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension

Abstract

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.