Renal function, rigidity of magistral arteries and vascular age in patients with arterial hypertension and type 2 diabetes mellitus

The aim: to evaluate the renal function in conjunction with the rigidity of the magistral arteries and the vascular age in patients with arterial hypertension (AH) and diabetes mellitus (DM) type 2.

Patients and methods. 280 hypertensive patients 45-65 years old with unachieved target blood pressure (BP) values were divided into two groups comparable by clinical and demographic characteristics: the 1 (main) group included patients with AH and DM type 2, the 2 (control) group included patients with AH without DM type 2. Clinical examination, assessment of the renal function, rigidity of the magistral arteries and vascular age were conducted.

Results. A significant increase in the level of albuminuria (AU) - 223.4 [91.4; 329.2] vs 26.4 [8.88; 65.0] mg/g, and β2-microglobulins in the urine (0.445 [0.300; 0.612] vs 0.228 [0.114; 0.398] mg/l) and a statistically significant decrease in glomerular filtration rate (GFR) in patients of group 1 compared with patients of group 2 (63.0 [55.0; 73.0] vs 72 [61.5; 88] ml/min/1.73 m²) were noted. The pulse wave velocity through the vessels of the elastic and muscular types (PWVe. and PWVm.) were higher in patients with AH and DM type 2 than in patients with AH without comorbid pathology (10.2 [9.0; 12.2] vs 9,0 [8.0; 10.7] m/s and 9.1 [7.9; 10.4] vs 8.4 [7.5; 9.6] m/s, respectively, p<0.05 ). The vascular age was significantly higher in the main group than in the control group (69.0 [64.0; 73.0] vs 64.0 [57.0; 71.0] years, respectively). We revealed highly reliable relationship between renal function, the rigidity of large vessels and vascular age.

Conclusion. The study showed a significant progressive deterioration of the renal function and the elasticity of the vascular wall of the magistral arteries, the growth of the vascular age, an increase in the 5-year risk of cardiovascular complications in hypertensive patients with type 2 diabetes compared with patients with “isolated” AH with comparable office blood pressure in the studied groups.

1. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH Guidelines for the Management of Arterial Hypertension. EurHeart J 2018; 39(33):3021-3104. Doi:10.1093/eurheartj/ehy339

2. Statsenko ME, Derevyanchenko MV. Rol' sistemnogo vospaleniya v snizhenii elastichnosti magistral'noy arterii i progressirovanii endotelial'noy disfunktsii u bol'nykh arterial'noy gipertenziyey v sochetanii s ozhireniyem, sakharnym diabetom 2 tipa. Rossiyskiy kardiologicheskiy zhurnal 2018;23(4):32-36

3. Statsenko ME, Derevyanchenko MV. The condition of large vessels and microcirculation is a new target of antihypertensive therapy in patients with arterial hypertension and type 2 diabetes mellitus. Ratsional'naya farmakoterapiya v kardiologii 2016;12(1):21-25

4. Statsenko ME, Derevyanchenko MV. Vozmozhnosti korrektsii disfunktsii endoteliya na fone kombinirovannoy antigipertenzivnoy terapii u bol'nykh arterial'noy gipertoniyey s sakharnym diabetom 2-go tipa. Kardiologiya 2015;55(3):17-20

5. Statsenko ME, Derevyanchenko MV. Korrektsiya disfunktsii endoteliya u bol'nykh arterial'noy gipertenziyey s sakharnym diabetom 2-go tipa na fone kombinirovannoy antigipertenzivnoy terapii. Terapevticheskiy arkhiv 2014; 86 (8): 90-93

6. D’Agostino RB, Vasan RS, Pencina MJ. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117(6):743-753. Doi:10.1161/CIRCU-LATIONAHA.107.699579

7. Troitskaya YeA, Vel'makin SV, Kobalava ZhD. Kontseptsiya sosudistogo vozrasta: novyy instrument otsenki serdechno-sosudistogo riska. Arterial'naya gipertenziya 2017; 23 (2): 160-171. Doi: 10,18705/1607-419X-2017-23-2-160-171]

8. Dahlof B, Sever PS, Poulter NR et al. Prevention of cardiovascular events with an antihypertensive regimen of am-lodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA): a multicenter randomised controlled trial. Lancet 2005;366 (948):895-906. Doi:10.1016/S0140-6736(05)67185-1

9. Prieto-Merino D, Dobson J, Gupta AK et al. ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data. J Hum Hypertens 2013;27(8):492-496. Doi:10.1038/jhh.2013.3

10. Statsenko ME, Derevyanchenko MV. Funktsional'noye sostoyaniye pochek i serdechno-sosudistyy risk u bol'nykh s arterial'noy gipertenziyey i ozhireniyem: rol' leptina i adiponektina. Nefrologiya 2018;22(5):51-57

11. Statsenko ME, Derevyanchenko MV, Shilina NN i dr. Funktsional'noye sostoyaniye pochek u bol'nykh s serdechno-sosudistymi zabolevaniyami i ozhireniyem Nefrologiya 2016; 20 (5): 43-49

12. Nedogoda SV, Barykina IN, Salasyuk AS. Natsional'nyye klinicheskiye rekomendatsii po ozhireniyu: kontseptsiya i perspektivy. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta 2017;1(61):134-140

13. Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150:604-612

14. Nedogoda SV, Marchenko IV, Chalyabi TA i dr. Sravnitel'naya otsenka effektivnosti nifedepina-retard i isradipina pri terapii izolirovannoy sistolicheskoy arterial'noy gipertenzii u pozhilykh bol'nykh. Vest Aritmolog 2005; 39: 37-41

15. Chalmers L, Kaskel FJ, Bangbola O. The role of obesity and its bioclinical correlates in the progression of chronic kidney disease. Adv Chronic Kidney Dis 2006;13:352-364

16. Statsenko ME, Derevyanchenko MV. Osobennosti strukturno-funktsional'nogo sostoyaniya pochek i endoteliya u bol'nykh s arterial'noy gipertenziyey v sochetanii s metabolicheskimi narusheniyami. Nefrologiya 2017; 21 (5): 14-21

17. Statsenko ME, Derevyanchenko MV. Vliyaniye kombinirovannoy antigipertenzivnoy terapii na funktsional'noye sostoyaniye pochek i insulinorezistentnost' u bol'nykh arterial'noy gipertenziyey i sakharnym diabetom 2 tipa. Terapiya 2016; 5: 56-61

18. Laurent S, Marais L, Boutouyrie P The Noninvasive assessment of vascular aging. Can J Cardiol 2016;32(5):669-679. Doi:10.1016/j.cjca.2016.01.039