Arterial hypertension as a trigger for the development of cardiorenal failure in patients of different genders
Authors: Lopina E. A. , Grishina N. P. , Libis R. A. 
Published: November 2019

Aim. To study the peculiarities of changes in the functional state of the kidneys and heart muscle in patients with arterial hypertension.

Materials and Methods. A total of 88 patients with arterial hypertension were included in the study. Chronic kidney disease was detected based on glomerular filtration rate, albuminuria, and cystatin levels in serum and urine. The stage of chronic heart failure was determined according to Strazhesko–Vasilenko classification with functional class according to NYHA; functional class of chronic heart failure was determined based on six-minute walking test. Patient inclusion criteria were the presence of essential hypertension of degree 1–3 and the age from 50 to 70 years. Patients underwent anthropometry, biochemical blood tests, six-minute walking test, and standard echocardiography.

Results. Arterial hypertension of degree 1–2 was diagnosed in 50 patients including 33 women and 17 men. Grade 3 arterial hypertension was found in 38 patients (28 women and 10 men). Patients were divided into two groups according to gender. The groups with arterial hypertension degree 1–2 differed in their blood pressure levels. Echocardiography data showed the formation of heart failure with preserved ejection fraction. The groups differed in the values of left ventricular ejection fraction and end-systolic and end-diastolic sizes of the left ventricle. The levels of cystatin C in serum were elevated in both groups. The serum and urine creatinine levels and glomerular filtration rates differed between groups. Women had more significant decreases in the values of glomerular filtration rate, cystatin C, and urine creatinine. Correlation relationships were found between systolic blood pressure and glomerular filtration rate (r = 0.27, p < 0.05) and between systolic blood pressure and left ventricular back wall thickness (r = 0.41, p < 0.05). Inverse relationship was found between left ventricular ejection fraction and albuminuria (r = –0.31, p < 0.05). Cystatin C level had inverse relationship with glomerular filtration rate (r = –0.47, p < 0.05) and direct relationship with left ventricular myocardial mass index (r =  0.24, p  <  0.05).

Discussion. Chronic kidney disease and chronic heart failure with preserved left ventricular ejection fraction were detected in patients at early stages. In the group of women, more pronounced changes in the renal and cardiac functions were found. Cystatin C is a marker of kidney function reduction and an alternative marker of chronic heart failure. The study showed that the level of cystatin C in blood serum of patients was increased, which correlated with the functional activities of the kidneys and the heart.

Conclusion. In case of arterial hypertension in the presence of chronic kidney disease, the development of the left ventricular hypertrophy and heart failure with preserved ejection fraction was found. Women had more significant changes in the renal and cardiac functions compared with those in men.