rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2014-10-1-31-36rpcardio-133Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯCHARACTERISTICS OF RENIN PROFILE AND PARAMETERS OF ARTERIAL STIFFNESS IN PATIENTS WITH PREVIOUSLY UNTREATED HYPERTENSIONХАРАКТЕРИСТИКА РЕНИНОВОГО ПРОФИЛЯ И ПАРАМЕТРОВ АРТЕРИАЛЬНОЙ РИГИДНОСТИ У БОЛЬНЫХ С РАНЕЕ НЕЛЕЧЕНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙКравцоваО. А.KravtsovaO. A.

Кравцова Ольга Александровна – аспирант кафедры пропедевтики внутренних болезней медицинского факультета

kotovskaya@bk.ruПавловаЕ. А.PavlovaE. A.

Павлова Екатерина Александровна – ассистент кафедры пропедевтики внутренних болезней медицинского факультета

kotovskaya@bk.ruКотовскаяЮ. В.KotovskayaYu. V.

Котовская Юлия Викторовна – доктор медицинских наук, профессор, профессор кафедры пропедевтики внутренних болезней медицинского факультета

kotovskaya@bk.ruКобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна – доктор медицинских наук, профессор, заведующая кафедрой пропедевтики внутренних болезней медицинского факультета

kotovskaya@bk.ruРоссийский университет дружбы народов, МоскваРоссияPeoples' Friendship University of Russia, MoscowRussian Federation2014220920151013136Copyright © Kravtsova O.A., Pavlova E.A., Kotovskaya Y.V., Kobalava Z.D., 20152015Кравцова О.А., Павлова Е.А., Котовская Ю.В., Кобалава Ж.Д.Kravtsova O.A., Pavlova E.A., Kotovskaya Y.V., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/133Aim

Aim. To study the characteristics of renin profile and parameters of central pulse wave and arterial stiffness in patients with previously untreated arterial hypertension (HT). Material and methods. Patients (n=83;  39 males (47%); age 57.3±7.6 years) with untreated uncomplicated 1-2 degree HT without associated clinical conditions and diabetes, with glomerular filtration rate>60 ml/min/1.73m2 were enrolled into the study. Plasma renin activity (PRA), plasma renin level and angiotensin II level were evaluated. The analysis of the central pulse wave, and pulse wave velocity (PWV) measurements were performed.

Results

Results. The incidence of volume-dependent HT (PRA <0.65 ng/mL/h) was 69%, and the renin-dependent HT with normal PRA (0.65-6.5 ng/ml/h) – 31% in patients with untreated uncomplicated HT. Patients with low PRA are characterized by older age, higher systolic blood pressure (BP) and higher arterial stiffness (increased PWV, increment pressure, augmentation index with a decrease in pulse pressure amplification) after adjustment for these factors.

Conclusion

Conclusion. The presence of volume-dependent HT is associated with older age, higher level of systolic BP and increase in arterial stiffness independent of age and BP.

Цель

Цель. Изучить характеристики ренинового  профиля и параметры центральной пульсовой волны и артериальной ригидности у больных с ранее нелеченой артериальной гипертонией (АГ).

Материал  и методы

Материал  и методы.  В исследование включено 83 пациента (39 мужчин (47%),  возраст 57,3±7,6 года) с неосложненной нелеченой АГ 1-2 степени без установленных ассоциированных клинических состояний и сахарного диабета, со скоростью клубочковой фильтрации >60 мл/мин/1,73м2. Определяли активность ренина плазмы (АРП), концентрацию ренина и ангиотензина II в плазме. Проведен анализ центральной пульсовой волны, измерение скорости распространения пульсовой волны (СРПВ).

Результаты

Результаты. У больных нелеченой неосложненной АГ частота объем-зависимой (АРП<0,65 нг/мл/ч) АГ составляет 69%, ренин-зависимой АГ с нормальной АРП (0,65-6,5 нг/мл/ч) – 31%. Больные с низкой АРП характеризуются более старшим возрастом, высоким уровнем систолического артериального давления (АД) и более высокой артериальной ригидностью (увеличение СРПВ, давления прироста и индекса аугментации со снижением амплификации пульсового давления) после коррекции по указанным факторам.

Заключение

Заключение. Наличие объем-зависимой АГ ассоциировано с более старшим возрастом, высоким уровнем  клинического  систолического  АД и независимым  от возраста и АД повышением артериальной ригидности.

артериальная гипертонияактивность ренина плазмыартериальная ригидностьскорость распространения пульсовой волныarterial hypertensionplasma renin activityarterial stiffnesspulse wave velocityReferencesPeach M. Renin-angiotensin system: biochemistry and mechanism of action. Physiol Rev 1977;57:313-70.Peach M. Renin-angiotensin system: biochemistry and mechanism of action. Physiol Rev 1977;57:313-70.Paul M., Mehr A.P., Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006;86(3): 747-803.Paul M., Mehr A.P., Kreutz R. Physiology of local renin-angiotensin systems. Physiol Rev 2006;86(3): 747-803.Walmor C. DeMello, Edward D. Frohlich et al. Renin angiotensin system and cardiovascular disease. Humana press USA 2009; 27: 35-59.Walmor C. DeMello, Edward D. Frohlich et al. Renin angiotensin system and cardiovascular disease. Humana press USA 2009; 27: 35-59.Leung PS. The peptide hormone angiotensin II: its new functions in tissues and organs. Curr Protein Pept Sci 2004;5:267-73.Leung PS. The peptide hormone angiotensin II: its new functions in tissues and organs. Curr Protein Pept Sci 2004;5:267-73.Gibbons G.H. The pathophysiology of hypertension: The importance of angiotensin II in cardiovascular remodeling. Am J Hypertens 1998; 11(8): 177-81.Gibbons G.H. The pathophysiology of hypertension: The importance of angiotensin II in cardiovascular remodeling. Am J Hypertens 1998; 11(8): 177-81.Rehman A., Rehman AR, Rasool AH, Naing NN. The effects of angiotensin II on pulse wave velocity in healthy humans. Int J Clin Pharmacol Ther 2001;39: 423-30Rehman A., Rehman AR, Rasool AH, Naing NN. The effects of angiotensin II on pulse wave velocity in healthy humans. Int J Clin Pharmacol Ther 2001;39: 423-30Wilkinson I, MacCallum H, Hupperetz PC, van Thoor CJ, Cockcroft JR,Webb DJ. Changes in the derived central pressure waveform and pulse pressure in response to angiotensin II and noradrenaline in man. J Physiol 2001;530:541-50.Wilkinson I, MacCallum H, Hupperetz PC, van Thoor CJ, Cockcroft JR,Webb DJ. Changes in the derived central pressure waveform and pulse pressure in response to angiotensin II and noradrenaline in man. J Physiol 2001;530:541-50.Laragh JH, Baer L, Brunner HR, Buhler FR, Sealey JE, Vaughan ED, Jr. Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease. Am J Med 1972; 52:633-52.Laragh JH, Baer L, Brunner HR, Buhler FR, Sealey JE, Vaughan ED, Jr. Renin, angiotensin and aldosterone system in pathogenesis and management of hypertensive vascular disease. Am J Med 1972; 52:633-52.Laragh JH. Vasoconstriction-volume analysis for understanding and treating hypertension: the use of renin and aldosterone profiles. Am J Med 1973; 55:261-74.Laragh JH. Vasoconstriction-volume analysis for understanding and treating hypertension: the use of renin and aldosterone profiles. Am J Med 1973; 55:261-74.Laragh J. Laragh’s lessons in pathophysiology and clinical pearls for treating hypertension. Am J Hypertens 2001;14:733-42.Laragh J. Laragh’s lessons in pathophysiology and clinical pearls for treating hypertension. Am J Hypertens 2001;14:733-42.Laragh JH. Laragh’s Lessons in Renin System Pathophysiology for Treating Hypertension and its Fatal Cardiovascular Consequences. New York: Elsevier Science; 2002.Laragh JH. Laragh’s Lessons in Renin System Pathophysiology for Treating Hypertension and its Fatal Cardiovascular Consequences. New York: Elsevier Science; 2002.Laragh JH, Sealey JE. The plasma renin test reveals the contribution of body sodium-volume content (V) and renin-angiotensin (R) vasoconstriction to long-term blood pressure. Am J Hypertens 2011; 24:1164-80.Laragh JH, Sealey JE. The plasma renin test reveals the contribution of body sodium-volume content (V) and renin-angiotensin (R) vasoconstriction to long-term blood pressure. Am J Hypertens 2011; 24:1164-80.Blumenfeld JD, Laragh JH. Renin system analysis: a rational method for the diagnosis and treatment of the individual patient with hypertension. Am J Hypertens 1998; 11:894-6.Blumenfeld JD, Laragh JH. Renin system analysis: a rational method for the diagnosis and treatment of the individual patient with hypertension. Am J Hypertens 1998; 11:894-6.Mahmud A., Feely J. Arterial stiffness and the renin-angiotensin-aldosterone system. JRAAS 2004;5: 102-8.Mahmud A., Feely J. Arterial stiffness and the renin-angiotensin-aldosterone system. JRAAS 2004;5: 102-8.Tigerstedt R, Bergmann PG. Niere und kreislauf. Scand Arch Physiol 1898; 8:223-71.Tigerstedt R, Bergmann PG. Niere und kreislauf. Scand Arch Physiol 1898; 8:223-71.Goldblatt H, Lynch J, Hanzal RF, Summerville WW. Studies on experimental hypertension: I. The production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med 1934; 59:347-79.Goldblatt H, Lynch J, Hanzal RF, Summerville WW. Studies on experimental hypertension: I. The production of persistent elevation of systolic blood pressure by means of renal ischemia. J Exp Med 1934; 59:347-79.Proceeding of the International Symposium on angiotensin, sodium and hypertension. Can Med Ass J 1963; 90:151-341.Proceeding of the International Symposium on angiotensin, sodium and hypertension. Can Med Ass J 1963; 90:151-341.Ganong WF, Davis JO, Sambhi MP. Symposium on control of renin secretion. J Hypertens 1984; 2(Suppl 1):1-153.Ganong WF, Davis JO, Sambhi MP. Symposium on control of renin secretion. J Hypertens 1984; 2(Suppl 1):1-153.Castrop H, Höcherl K, Kurtz A, et al. Physiology of kidney renin. Physiol Rev 2010; 90:607-73.Castrop H, Höcherl K, Kurtz A, et al. Physiology of kidney renin. Physiol Rev 2010; 90:607-73.Guyton AC, Coleman TG, Cowley AV Jr, et al. Arterial pressure regulation. Overriding dominance of the kidneys in long-term regulation and in hypertension. Am J Med 1972; 52:584-94.Guyton AC, Coleman TG, Cowley AV Jr, et al. Arterial pressure regulation. Overriding dominance of the kidneys in long-term regulation and in hypertension. Am J Med 1972; 52:584-94.Sealey JE. Plasma renin activity and plasma prorenin assays. Clin Chem 1991; 37:1811-9.Sealey JE. Plasma renin activity and plasma prorenin assays. Clin Chem 1991; 37:1811-9.Sealey JE, Gerten-Banes J, Laragh JH. The renin system: Variations in man measured by radioimmunoassay or bioassay. Kidney Int 1972; 1:240-53.Sealey JE, Gerten-Banes J, Laragh JH. The renin system: Variations in man measured by radioimmunoassay or bioassay. Kidney Int 1972; 1:240-53.Sealey JE, Laragh JH. Radioimmunoassay of plasma renin activity. Semin Nucl Med 1975; 5:189-202.Sealey JE, Laragh JH. Radioimmunoassay of plasma renin activity. Semin Nucl Med 1975; 5:189-202.Kaess, BM, Rong J, Larson MG, et al. Aortic Stiffness, Blood Pressure Progression and Incident Hypertension. JAMA 2012;308(9):875-81.Kaess, BM, Rong J, Larson MG, et al. Aortic Stiffness, Blood Pressure Progression and Incident Hypertension. JAMA 2012;308(9):875-81.Gonzalez MC, Cohen HW, Sealey JE, et al. Enduring direct association of baseline plasma renin activity with all-cause and cardiovascular mortality in hypertensive patients. Am J Hypertens 2011; 24:1181-6.Gonzalez MC, Cohen HW, Sealey JE, et al. Enduring direct association of baseline plasma renin activity with all-cause and cardiovascular mortality in hypertensive patients. Am J Hypertens 2011; 24:1181-6.Sim JJ, Bhandari SK, Shi J, et al. Plasma renin activity (PRA) levels and antihypertensive drug use in a large healthcare system. Am J Hypertens 2012; 25(3):379-88.Sim JJ, Bhandari SK, Shi J, et al. Plasma renin activity (PRA) levels and antihypertensive drug use in a large healthcare system. Am J Hypertens 2012; 25(3):379-88.

The authors declare that there are no conflicts of interest present.