| Sažetak | Cilj istraživanja: Cilj je bio istražiti učestalost i osobitosti arterijske hipertenzije (AH) u bolesnika sa šećernom bolesti tipa 2 koji se liječe u nefrološkoj ambulanti pri Zavodu za nefrologiju i dijalizu, Klinike za unutarnje bolesti, Kliničkog bolničkog centra Split te postoji li povezanost s parametrima nutritivnog statusa
Materijali i metode: U istraživanje je uključeno 106 ispitanika, 66 (62,3 %) muškaraca i 40 (37,7 %) muškaraca, prosječne dobi 69,5 (u rasponu od 36-75) godina. Za svakog ispitanika zabilježeni su podatci: dob, spol, tjelesna težina i visina, opseg struka i nadlaktice, postojanje AH, koronarne bolesti, kronične bubrežne bolesti (KBB), vrsta i broj antihipertenzivnih lijekova, vrsta terapije za šećernu bolest te podatak o uzimanju statina. Određene su serumske vrijednosti ureje, kreatinina i izračunata je procijenjena brzina glomerularne filtracije (eGFR) te indeks tjelesne mase (ITM). Također, zabilježene su i razine albuminurije. Uz ranije navedeno, za svakog ispitanika su zabilježene su serumske vrijednosti triglicerida, kolesterola-ukupnog, LDL (engl. Low-density lipoprotein) kolesterola, hemoglobina, urata, glukoze i kalija. Za mjerenje arterijskog tlaka korišten je uređaj „Agedio B900“. Izmjerena je brzina pulsnog vala (PWV, engl. Pulse Wave Velocity), periferni (PSAT) i centralni sistolički arterijski tlak (CSAT) te periferni (PDAT) i centralni dijastolički (CDAT) arterijski tlak,. Izračunat je tlak pulsa (PP) te srednji arterijski tlak (MAP) za periferni i centralni arterijski tlak. Nadalje, vaganjem uz pomoć Tanita MC780 Multi Frequency segmentnog analizatora sastava tijela ispitanicima je izmjerena tjelesna masnoća, mišićna masa, skeletna mišićna masa (podatci za sve navedene parametre su izraženi u postotcima i kilogramima) te masa bez masnoće i koštana masa.
Rezultati: Rezultati pokazuju kako 99 (93,4%) ispitanika ima dijagnozu AH. Od ukupnog broja ispitanika (N=106), 45 (42,5%) ispitanika je uzimalo statin u terapiji, dok su 103 (97,2%) ispitanika uzimala antihipertenzivnu terapiju. Fiksnu kombinaciju je uzimalo 40 (38,3%) ispitanika, dok je 61 (58,2%) ispitanik uzimao tri ili više antihipertenzivnih lijekova od kojih je jedan diuretik. Nadalje, istraživanjem je pronađeno da su 62 (58,5%) ispitanika imala postavljenu dijagnozu KBB, dok je 70 (66%) ispitanika imalo razinu eGFR < 60 mL/min/1,73m2. Također, 14 (13,2%) ispitanika je navelo postojanje koronarne bolesti u anamnezi. Statistički značajno veća učestalost koronarne bolesti je bila među onim ispitanicima koji su imali postavljenu dijagnozu KBB (p=0,030). Rezultati ovog istraživanja su pokazali kako postoje statistički značajne razlike u parametrima sastava tijela između muškaraca i žena s AH, ali nisu nađene statistički značajne razlike u parametrima arterijskog tlaka između muškaraca i žena. Također, rezultati su ukazali na statistički značajnu pozitivnu povezanost ITM te CDAT (ρ=0,279, p=0,010) i PDAT (ρ=0,261, p=0,010). Statistički značajna povezanost nađena je i između ITM te MAP za CAT (ρ=0,271, p=0,010) i PAT (ρ=0,206, p=0,040). Međutim, nije nađena statistički značajna povezanost između parametara sastava tijela i izmjerenih parametara centralnog i perifernog arterijskog tlaka među bolesnicima s AH. Nadalje, nađene su statistički značajne razlike u parametrima sastava tijela, ali nisu nađene statistički značajne razlike u odnosu na vrijednosti arterijskog tlaka između tri skupine ispitanika (bolesnici s normalnom težinom, bolesnici s prekomjernom težinom i pretili bolesnici). Rezultati su pokazali kako postoji statistički značajna negativna povezanost između duljine liječenja AH i razine albuminurije u bolesnika sa šećernom bolesti tipa 2 (ρ=-0,508, p=0,007) koji se liječe u nefrološkoj ambulanti. Međutim, nije nađena značajna povezanost između duljine liječenja šećerne bolesti tipa 2 i razine albuminurije u bolesnika sa šećernom bolesti tipa 2 i AH.
Zaključak: Rezultati pokazuju kako je među bolesnicima sa šećernom bolesti tipa 2 prevalencija AH, RAH i KBB visoka. Nadalje, značajan broj bolesnika sa šećernom bolesti tipa 2 nije svjestan postojanja KBB, a to je populacija bolesnika koji imaju i veću učestalost koronarne bolesti. Svi ovi rezultati ukazuju na važnost pravovremene detekcije i adekvatnog liječenja AH u populaciji bolesnika sa šećernom bolesti tipa 2 s ciljem prevencije nastanka i progresije neželjenih komplikacija (KBB, kardiovaskularnih događaja, pretilosti, pogoršanja albuminurije) koje povećavaju poboljevanje i smrtnost ove populacije bolesnika. |
| Sažetak (engleski) | Objectives: The aim was to investigate the frequency and the particularities of arterial hypertension (AH) in type 2 diabetes patients treated in the nephrological clinic at the Department of Nephrology and Dialysis, the Internal Medicine Clinic, Clinical Hospital Center Split, and whether there is any correlation with parameters of nutritional status.
Material and Methods: The study included 106 participants, 66 (62.3%) men and 40 (37.7%) women, average age 69.5 (range 36-75 years). For each patient following data were recorded: patient's age, gender, body weight and height, waist and hip circumference, existence of AH, cardiovascular disease, chronic kidney disease (CKD), type and number of antihypertensive drugs taken, type of therapy for type 2 diabetes and statin data. Urea and creatinine serum values were determined and the estimated glomerular filtration rate (eGFR) and body mass index (BMI) were calculated. The level of albuminuria was also noted. Furthermore, serum values of triglycerides, cholesterol levels, LDL, haemoglobin, urate, glucose and potassium were determined for each participant. The "Agedio B900" device was used to measure arterial pressure. Values of pulse wave velocity (PWV), peripheral (PSAP) and central systolic arterial pressure (CSAP) as well as the values of peripheral (PDAP) and central diastolic (CDAP) arterial pressure were measured. Pulse pressure (PP) and mean arterial pressure (MAP) for peripheral and central arterial pressure were calculated. Also, weighing with the help of Tanita MC780 Multi Frequency segmental body composition analyser values of body fat, muscle mass, skeletal muscle mass (data for all the mentioned parameters were expressed in percentages and kilograms) as well as fat free mass (kg) and bone mass (kg) were determined.
Results: The results showed that 99 (93.4%) participants had the diagnosis of AH. Out of the total number of participants (N=106), 45 (42.5%) participants were taking statin therapy and 103 (97.2%) were taking antihypertensive therapy. The results showed that 40 (38.3%) participants were taking fixed-dose combination while 61 (58.2%) were taking three or more antihypertensive drugs one of which is diuretic. Furthermore, the study showed that 62 (58.5%) participants had diagnosis of chronic kidney disease (CKD) while 70 (66%) participants had eGFR < 60 mL/min/ 1.73m2. Also, 14 (13.2%) participants had coronary disease mentioned in the history of disease. Statistically significant higher frequency of coronary disease was found among the participants that had diagnosis of CKD (p=0.030). The results showed that statistically significant differences exist in the body composition parameters between men and women with AH, but no statistically significant differences were found in the arterial pressure parameters between men and women. Also, results showed statistically significant positive correlation of BMI and CDAP (ρ=0,279, p=0.010) and PDAP (ρ=0.261, p=0.010). Statistically significant correlation was also found between BMI and MAP for central arterial pressure (CAP) (ρ=0.271, p=0.010) as well as BMI and MAP for peripheral arterial pressure (PAP) (ρ=0.206, p=0.040). However, statistically significant correlation was not found for the body composition parameters and measured central and peripheral arterial pressure parameters among the patients with AH. Furthermore, statistically significant differences were found among the body composition parameters but statistically significant differences were not found between the values of the arterial pressure among the three groups of participants (patients with normal weight, overweight patients and obese patients). The results showed that statistically significant negative correlation exists between the duration of the antihypertensive therapy and level of albuminuria in the patients with type 2 diabetes (ρ=-0.508, p=0.007) who are being treated in the nephrological clinic. However, statistically significant correlation was not found between the duration of therapy for type 2 diabetes and the level of albuminuria among the patients with type 2 diabetes and AH.
Conclusions: The results show that prevalence of AH, resistant AH and CKD is high among the patients with type 2 diabetes. Furthermore, significant number of patients with type 2 diabetes are unaware of the existence of CKD and that is population of patients with a higher frequency of coronary heart disease. All these results indicate the importance of timely detection and adequate treatment of AH in the population of type 2 diabetes in order to prevent the occurrence and progression of unwanted complications (CKD, cardiovascular events, obesity, and worsening of albuminuria) that increase the morbidity and mortality of this patient population. |
