Russian Heart Failure Journal 2004year Functional state of kidneys and renal hemodynamics in patients of older age groups with arterial hypertension and left ventricular diastolic dysfunction on the background of fosinopril treatment
Functional state of kidneys and renal hemodynamics in patients of older age groups with arterial hypertension and left ventricular diastolic dysfunction on the background of fosinopril treatment
Komissarenko I.A., Levchenko S.A.
Urgency. Arterial hypertension (AH) occupies the third place among causes of chronic renal insufficiency (CRI), while hypertensive and atherosclerotic nephrosclerosis occupy the first place in the general structure of renal pathology in elderly. The study was aimed at determining the complex of factors, which allow prediction of changes in the functional state of kidneys in elderly and senile patients with AH on the background of fosinopril treatment. Materials and methods. Eighty-three patients aged 60 years and older with systolo-diastolic AH (SDH) (42 patients) and with isolated systolic AH (ISH) (41 patients) were evaluated. Examination of the kidney functional state included determination of glomerular filtration rate (GFR) by endogenous creatinine clearance and renal functional reserve (RFR) by the method of protein load. The 24-hour BP monitoring was performed. Results. The GFR<80 ml/min/1.73 m2 was revealed in 29% of patients with SDH and in 65.8% of patients with ISH, primarily in patients older than 75 years. The magnitude of RFR decrease was 1.6 times greater in patients with ISH. The decrease in GFR in patients with ISH correlated with the increase in pulse BP, the high index of time for night BP, the inadequate decrease in BP at night, and «night» hypertension. The fosinopril therapy decreased sBP and/or dBP by 10% more than in 65% of patients in older age groups. The GFR was unchanged or normalized in 71% of patients irrespective of the magnitude of BP decrease. However in the concurrent presence of such factors as age older than 75 years, baseline GFR below 80 ml/min/1.73 m2, and RFR less than 3.06%, the GRF decreased by 11.2 ml/min on the average in 70% of patients treated with fosinopril.