THE PROGNOSTIC VALUE OF MARKERS OF MYOCARDIAL AND RENAL DYSFUNCTION IN OLDER HYPERTENSIVE PATIENTS WITH COMORBIDITY

Abstract

Objective: Comorbidity, including chronic kidney disease (CKD), chronic heart failure (CHF)and anemia, worsens the prognosis in older patients with arterial hypertension. Hypoxia is the leading link in pathogenesis. The aim of this study was to investigate the prognostic value of markers of myocardial and renal dysfunction in older hypertensive patients with CHF. Design and method: 72 older hypertensive patients with CHF (27 males and 45 females, mean age 71.8 ± 8.4 years) were examined. Arterial hypertension was defined according to ESC Guidelines for the diagnosis and treatment of arterial hypertension, 2018. CKD was diagnosed and classified according to the KDIGO guidelines (2012). Serum levels of HIF-1, endogenous erythropoietin (eEPO), N-terminal propeptide of type B natriuretic hormone (NT-proBNP), cystatin C were assessed. The follow-up period was 12 months; the primary endpoint was total mortality. Results: CKD was diagnosed in 48 (66.7%) older hypertensive patientswith CHF. The HIF-1 levelwas significantly higher in the group of deceased patients than in the survivors (0.08 (IQR 0.06; 0.11) and 0.05 (IQR 0.04; 0.07) ng / ml, p = 0.02), as well as the level of NT-proBNP (1126.3 (IQR 551.8; 2750.0)and 164.4 (IQR 135.5; 1100.9) pg / ml, p < 0.0001), EPO(16.92 (ICR 5.43; 64.57) and 5.36 (IQR 1.65; 8.85) mIU / ml, p < 0.0001),cystatin C(1.49 (ICR 0.86; 2.13) and 0.99 (IQR 0.82; 1.32) Mg / l, p = 0.0005). Multivariate regression analysis showed an independent relationship between the eEPO level and patient survival (R = 0.61, ß = 0.49, p = 0.0037). Conclusions: The level of eEPOin older hypertensive patients with CHF has an independent and closer relationship with the mortality of patients than the traditional markers of myocardial and renal dysfunction.