Abstract
The aim of the study was to evaluate the effect of nitrates on left ventricular hypertrophy (LVH) in hypertensive patients on chronic peritoneal dialysis (PD). Sixty-four PD patients with hypertension were enrolled in this study. All patients accepted antihypertensive drugs at baseline. Thirty-two patients (nitrate group) took isosorbide mononitrate for 24 weeks. The remaining 32 patients (non-nitrate group) took other antihypertensive drugs. Blood pressure (BP), left ventricular mass index (LVMI) and plasma asymmetric dimethylarginine (ADMA) were monitored. Subjects with normal renal function were included as the control group (n = 30). At baseline, plasma ADMA levels in PD patients were significantly higher than the control group, but there was no significant difference in plasma ADMA levels between the two groups. At the end of the 24-week period, BP, LVMI, LVH prevalence and plasma ADMA levels in the nitrate group were significantly lower than those in the non-nitrate group. BP did not show a significant difference between 12 and 24 weeks in the nitrate group with a reduced need for other medication. Logistic regression analysis showed that nitrate supplementation and SBP reduction were independent risk factors of LVMI change in PD patients after adjusting for age, gender, diabetes history and CCB supplementation. It was concluded that organic nitrates favor regression of LVH in hypertensive patients on chronic peritoneal dialysis, and nitrates may be considered for use before employing the five other antihypertensive agents other than nitrates.
Highlights
Several studies have reported a high prevalence of cardiovascular disease in patients with end-stage renal disease (ESRD)
Patients were randomly grouped by computer-generated random numbers into the nitrate group (n = 32) or non-nitrate group (n = 32)
There was no significant difference between the two groups in terms of age, sex ratio, dialysis duration, smoking, medication kinds of daily antihypertensive drugs, amount of daily antihypertensive drugs, KT/V, plasma levels of asymmetric dimethylarginine (ADMA), Hb, creatinine, BUN, TG, TC, etc., at baseline (p > 0.05)
Summary
Several studies have reported a high prevalence of cardiovascular disease in patients with end-stage renal disease (ESRD). The projected life expectancy of ESRD patients on dialysis is 20%~25% of that of the general population [1,2]. In ESRD patients, left ventricular hypertrophy (LVH) is considered the most important predictor of prognosis [3]. The high blood pressure (BP) frequently seen in ESRD patients is thought to be refractory in nature. Most ESRD patients with hypertension need to use three or more kinds of antihypertensive drugs to control the blood pressure. An expert panel from the USA National Kidney Foundation has recently identified the need for observational studies to ascertain the relation between established cardiovascular risk factors and cardiovascular outcomes and to identify new risk factors as a research priority
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