Arterial stiffness and renal dysfunction in the hypertensive patient

Introduction: To determine factors predictive of renal dysfunction in the hypertensive patient. Methods: We evaluated a group of 60 hypertensive patients at fi rst presentation without preexisting cardiovascular or renal pathology. We determined the value of BUN, creatinine, eGFR, urinary albumin, fasting blood glucose, HbA1c, lipids, the presence of LVH (on ECG, echocardiography) and we estimated the value of central aortic blood pressure and aortic augmentation index (AIX) using radial applanation tonometry with Sfygmocor device. Patients were reevaluated aft er 1 year to determine the progression of renal disease. Results: Chronic kidney disease is found in 20 patients, the mean eGFR value is 52.8 ml/min. (group A) and 84 ml /min. in the group without renal dysfunction (group B). In group A we found more oft en than in group B impaired fasting glucose (IFG) and type 2 DM ( p = 0.04), dyslipidemia ( p = 0.04), LVH (25% vs 22.5%, p = 0.044), longer duration of hypertension (3 years vs 1.7 years), increased central aortic systolic pressure (170 mm Hg vs 159 mm Hg, p = 0.004) and increased AIX (45.7% vs 32.5 %, p = 0.02) and more oft en microalbuminuria. Aft er 1 year eGFR decreased with 4.5 ml/min. in group A vs 1.35 ml/min. in group eGFR had a signifi cant correlation only with AIX at both measurements and with persistence of albuminuria (r = 0.55). Conclusions: Renal dysfunction in hypertensive patient is the result of severity and duration of hypertension, of metabolic derangements; increased arterial stiff ness – parameter of vascular remodeling and of hemodynamic load is a more sensitive marker of the presence and worsening of kidney disease.

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