[Arterial hypertension in clinical assessment of ischemic renal disease].

AIM

To study clinical features and a course of arterial hypertension (AH) in ischemic renal disease (IRD).

MATERIAL AND METHODS

The trial enrolled 48 IRD patients treated in E.M. Tareev clinic of I.M. Sechenov Moscow Medical Academy in 2000-2004. All the patients were examined clinically, biochemical tests were made. Glomerular filtration rate (GFR) was estimated according to Cockroft-Gault formula. AH was classified by ESH-ESC (2203). Fifteen patients have undergone automatic 24-h monitoring of arterial pressure (MAP).

RESULTS

Arterial hypertension (AH) was registered in all the examinees. It was of the first (14.6%), second (29.2%) and third degree (56.2%). Isolated systolic AH occurred in 56.2% cases. These patients had a significant lowering of GFR (p < 0.05) while their uremia and total cholesterol were higher. In 12 of 15 patients MAP detected an insufficient nightfall of arterial pressure. Cardiovascular complications and terminal renal failure occurred more frequently in patients with isolated systolic AH. Before hospitalization most of the patients (97.9%) received ACE inhibitors which deteriorated renal function.

CONCLUSION

Arterial hypertension is an obligatory sign of IRD. It is characterized by high arterial pressure and disturbances of a circadian rhythm of arterial pressure. Frequently observed isolated systolic hypertension is most prognostically unfavourable. Most of IRD patients receive inadequate antihypertensive therapy basing on ACE inhibitors contraindicated in this disease.