CHARACTERISTICS OF CLINICAL CONDITION, INTRACARDIAC AND SYSTEMIC HEMODYNAMICS IN PATIENTS WITH STAGE II HYPERTENSION WITH SIGNS OF HYPERTENSIVE NEPHROPATHY

The interactions are observed between the cardiovascular and kidney continuum. Nephroangiosclerosis in patients with cardiovascular pathology is one of the main causes of chronic renal insufficiency (CRI). Cardiovascular diseases are the main cause of mortality in patients with terminal CRI, whereby the cardiovascular mortality in patients dialyzed continuously is several times higher than in general population. Some data suggest that the interaction between the cardiovascular and kidney continuum can be already observed at early stages of HTN. Therefore, an early marker for renal impairment, in particular microalbuminuria, is at present considered to be a cardiovascular risk factor. The objective of this study was to investigate the microalbuminuria level and endothelial function in patients with stage II hypertension. 182 patients with stage II hypertension (HTN) were examined. 40 patients with stage II HTN with no sign of other cardiovascular and renal diseases were studied as the control group. The key factor for selection was the absence of MAU in this group of patients. The cardiac and hemodynamics status, the left ventricular systolic and diastolic functions were assessed using the ULTIMA Pro-30 scanner. The renal ultrasound examination was carried out, albumin excretion in urine (MAU, mg/24 h) was determined by the immunoturbidimetric test using the Micral-Test II test kit (Roche Diagnostics GMBH, Germany), the levels of endothelin-I and NO were determined. In patients with stage II hypertension in whom microalbuminuria was detected, the discrepancy between the indicators of the left ventricular systolic function as compared with the group of patients in whom albumin excretion was not been observed. The tendency toward deterioration is observed in the indicators showing the left ventricular diastolic function depending on the presence of microalbuminuria. During the study of systemic hemodynamics according to the arterial hypertension stage (as the disease progressed) and the presence of albumin excretion, there was observed a decrease in the indicators, such as systolic discharge, cardiac output, cardiac index and an increase in total peripheral vascular resistance what resulted in increase in workload on the left ventricle myocardium and decrease in its capacity. The obtained data demonstrate the need to determine the albumin level in patients with hypertension in order to slow down the progression of hypertensive nephropathy.