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NEPHROPROTECTIVE EFFECTS OF LISINOPRIL IN THE THERAPY OF HYPERTENSIVE PATIENTS WITH OBESITY

https://doi.org/10.20996/1819-6446-2018-14-2-223-228

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Abstract

Aim. To investigate the dynamics of biomarkers of early renal damage in patients with hypertension (HT) and obesity treated with lisinopril and diet therapy.

Material and methods. The study included 120 people aged 25 to 55 years (90 patients with HT in combination with obesity and 30 HT patients without obesity). Control group was consisted of 50 healthy respondents without obesity. All HT patients received therapy with lisinopril at a dose of 10-40 mg per day with titration to target blood pressure (BP) values, patients with obesity – additionally diet therapy. Initially and after 6 months we investigated clinical and biochemical parameters, levels of leptin, resistin, cystatin C in blood serum and urine, albuminuria, NGAL (neutrophil gelatinase associated lipocalin) and interleukin 18 (IL-18) in the urine.

Results. We identified the relationships between the serum cystatin C and BP, leptin, resistin, insulin-resistance index (HOMA-IR) and also metabolic indicators. In this study we revealed relationships of subclinical tubular dysfunction markers (urinary cystatin C, IL-18, NGAL) with carbohydrate and lipid metabolism, BP, hormonal activity of adipose tissue. The achievement of target BP values, normoalbuminuria and improving the glomerular filtration rate (GFR) were found after 6 months. The decrease in serum cystatin C in groups was seen: in Group 1 – from 1112 [757.0; 1400.0] to 797 [754; 825] ng/ml (р=0.001), in Group 2 – from 990 [700.0;1110.0] to 791 [770;900] ng/ml (р=0.03). Decrease in markers of tubular dysfunction was identified only in patients who reduced the body weight: urine cystatin C − from 33.0 [18.5; 50.0] to 24[15.3; 60.0] ng/ml (р=0.04) and IL-18 – from 0.33 [0.18; 0.41] to 0.21 [0.14; 0.43] pg/ml (р=0.04). Greater reduction in tubular dysfunction markers excretion was observed in the subgroup of patients with weight loss more than 5% but less than 10% of the initial value.

Conclusion. The obtained relationships between markers of subclinical tubular damage and carbohydrate, lipid metabolism and adipokines prove the contribution of adipose tissue to the formation of tubular damage in patients with HT associated with obesity. Antihypertensive therapy with lisinopril contributes to the achievement of target BP values, improvement of metabolic parameters, increase in GFR, achievement of normoalbuminuria, whereas body weight loss in HT patients with obesity additionally contributes to the reduction in the manifestations of tubular dysfunction.

About the Authors

S. G. Shulkina
Perm State Medical University named after Academician E.A. Wagner
Russian Federation

Sofia G. Shulkina – MD, PhD, Associate Professor, Chair of Outpatient Therapy

Petropavlovskaya ul. 26, Perm, 614000



Е. N. Smirnova
Perm State Medical University named after Academician E.A. Wagner
Russian Federation

Elena N. Smirnova – MD, PhD, Professor, Head of Chair of Endocrinology and Clinical Pharmacology

Petropavlovskaya ul. 26, Perm, 614000



References

1. Oshchepkova E.V, Dolgusheva Iu.A., Zhernakova Iu.V., et al. The prevalence of renal dysfunction in arterial hypertension (in the framework of the ESSE-RF study) Sistemnie Gipertenzii. 2015;12(3):1924. (In Russ.)

2. Mirinova S.A., Zvartau N.E., Konradi A.O. Kidney injury in arterial hypertension: can we trust the old markers? Arterialnaya Gipertenziya. 2016;22(6):536-50. (In Russ.)

3. Chuchelina O.A. Adipokines of adipose tissue and their role in progression of renal disease. Mezhdunarodnyj Medicinskij Zhurnal. 2015;2:24-8. (In Russ.)

4. Hall J.E., do Carmo J.M., da Silva A.A., et al. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ Res. 2015;116(6):991-1006. doi: 10.1161/CIRCRESAHA.116.305697.

5. Gharishvandi F., Kazerouni F., Ghanei E., et al. Comparative assessment of Neutrophil GelatinaseAssociated Lipocalin (NGAL) and cystatin C as early biomarkers for early detection of renal failure in patients with hypertension. Biomed J. 2015;19(2):76-81. doi: 10.6091/ibj.1380.2015.

6. Sokolski M., Zymliński R., Biegus J., et al. Urinary levels of novel kidney biomarkers and risk of true worsening renal function and mortality in patients with acute heart failure. Eur J Heart Fail. 2017;19(6):760-7. doi: 10.1002/ejhf.746.

7. OZzbicer S., Ulucam Z.M. Association Between Interleukin-18 Level and Left Ventricular Mass Index in Hypertensive Patients. Korean Circ J. 2017;47(2):238-44. doi: 10.4070/kcj.2016.0351.

8. Satoh-Asahara N., Suganami T., Majima T., et al. Urinary cystatin C as a potential risk marker for cardiovascular disease and chronic kidney disease in patients with obesity and metabolic syndrome. Clin J Am Soc Nephrol. 2011;6(2):265-73. doi: 10.2215/CJN.04830610.

9. Kushnarenko N.N., Medvedeva T.A., Govorin A.V., Mishko M.Y. Renal filtration function in patients with gout. Rational Pharmacotherapy in Cardiology. 2016;12(4):380-4. (In Russ.)

10. Xiao N., Devarajan P., Inge TH., et al. Subclinical kidney injury before and 1 year after bariatric surgery among adolescents with severe obesity. Obesity (Silver Spring). 2015;23(6):1234-8. doi: 10.1002/oby.21070.

11. Jenkins DJ.A., Boucher D.F., Ashbury F.D. et al. Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors. J Am Coll Cardiol. 2017;69(9):1103-12. doi: 10.1016/j.jacc.2016.10.089.

12. Dzhaiani N.A. Choice of lisinopril for treatment of hypertension in patients with concomitant diseases. Rational Pharmacotherapy in Cardiology. 2014;10(5):565-71. (In Russ.)

13. Statsenko M.E., Derevyanchenko M.V. Cardio-Nephroprotection-the Most Important Goal of Antihypertensive Therapy in Patients With Type 2 Diabetes. Kardiologiia. 2015;55(8):43-8 (In Russ.)


For citation:


Shulkina S.G., Smirnova Е.N. NEPHROPROTECTIVE EFFECTS OF LISINOPRIL IN THE THERAPY OF HYPERTENSIVE PATIENTS WITH OBESITY. Rational Pharmacotherapy in Cardiology. 2018;14(2):223-228. (In Russ.) https://doi.org/10.20996/1819-6446-2018-14-2-223-228

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ISSN 1819-6446 (Print)
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