Objective:
To study the activity of low-grade inflammation and determine an interaction of its parameters with hypertensive kidney damage in patients (pts) with resistant arterial hypertension (AH).
Design and method:
A cohort of 109 pts with AH (including 72 pts with controlled AH and 57 pts with resistant AH) has been studied. All pts in addition to routine general clinical examination underwent 24-hours’ blood pressure monitoring; evaluation of blood concentrations of systemic inflammation markers (C-reactive protein (CRP), interleukin 6 (IL-6), tumor necrosis factor alpha (TNF α), fibrinogen), activity of matrix metalloproteinase 12 (MMP-12), cystatin C and citrulline levels; detection of 24-hours’ excretion of albumin.
Results:
Diabetic and hypertensive chronic kidney disease (CKD) has been revealed in 20,5 % of resistant AH pts (GFR 74,9 ± 2,7 ml/min/1,73m2). The average GFR in pts with controlled AH was 82,3 ± 2,0 ml/min/1,73m2, none of them have chronic kidney disease. Albumin excretion rate (by 14.1 %), blood levels of cystatin C (by 8.5 %) and citrulline (by %) were higher in resistant AH pts. These patients also characterize by activation of low-grade inflammation: levels of CRP (by 17.3 %;ρ = 0,02, fibrinogen (by 10.6 %;ρ=0,03), and IL-6 (by 21.8 %; p = 0,01) and TNFα (by 13.0 %; p = 0,003) were significantly higher in pts with resistant AH comparing with those with controlled AH. GFR was associated with concentration of CRP (r = -0,379;ρ=0,01) and TNFα (r = -0,398;ρ = 0,002), MMP-12 activity was correlated with kidney damage markers – cystatin Ç (r = 0.405; P = 0.01) and citrulline (r = 0.338; P = 0.03).
Conclusions:
Kidney damage is significantly more frequent in pts with resistant AH. Activation of low-grade inflammation correlates with decreased renal function, activity of MMP-12 associates with kidney damage markers.
