PP.35.19

Abstract

Objective: To determine the correlations of mean daily parameters of the central aortic pressure with level of glomerular filtration rate (GFR) and microalbuminuria (MAU), and to assess their dynamics during the 16-week treatment in patients with metabolic syndrome (MS) and arterial hypertension (AH) 1–2 degrees. Design and method: The study included 20 patients with MS combined with hypertension (16 men and 4 women), mean age - 49,9 ± 9,8 years, BMI - 33,4 ± 4,5 kg/m2, WC - 109 8 ± 9,9 cm. An ambulatory BP monitoring using the device BpLab with analysis of vascular stiffness by Vasotens software (Peter Telegin, Russia) was performed to all subjects. The following parameters of central aortic pressure were determined: SBPao, PPao, Aixao. Renal function was assessed by GFR and MAU. GFR was calculated by Cockcroft-Gault equation; MAU was determined by device MIKROLAB-600 (JSC Unimed, Russia). All patients received carvedilol 25–37,5 mg/day, metformin 850–1700 mg/day, atorvastatin 20–40 mg/day. At insufficient antihypertensive effect of monotherapy the nifedipine with prolonged action of 20–40 mg/day was added. The evaluation was performed at baseline and after 16 weeks of treatment. Results: There was a significant inverse relationship between the level of GFR and Aixao (r = −0,38; p < 0.05). MAU was correlated with the mean value of the SBPao (r = 0,45; p < 0,05). During the 16-week treatment according to the daily monitoring of vascular stiffness there was a significant reduction in the SBPao from 134,6 ± 8,9 to 120,3 ± 8,9 mmHg (p < 0,05); PPao from 43 (41; 49) to 40.6 (37; 43) mmHg (p < 0,05). Parameter Aixao decreased significantly by 36% (p < 0,05). MAU initially was identified in 5 patients (0,4 ± 0,07 mg/l), which after 16 weeks of treatment was observed in 1 patient only - 0,2 mg/L (p < 0,05). At baseline, in 40% cases hyperfiltration was observed, during therapy it reduced from 140,6 ± 16,3 to 136,5 ± 14,8 ml/min. Conclusions: the increase in the central aortic pressure in patients with the metabolic syndrome and hypertension is accompanied by a deterioration in renal filtration processes. During the 16 weeks of treatment the regression of large arteries remodeling according to daily monitoring of vascular stiffness, and reducing of hyperfiltration and urinary albumin excretion have been observed