Sažetak | Cilj istraživanja: Arterijska hipertenzija (AH) je najveći pojedinačni čimbenik rizika koji doprinosi razvoju kardiovaskularnih, cerebrovaskularnih i bubrežnih bolesti te globalnom mortalitetu. Predviđa se da će u narednom desetljeću porasti prevalencija AH kako u razvijenim tako i u zemljama u razvoju. Nadalje, starenjem populacije i porastom indeksa tjelesne mase (ITM) dolazi do porasta prevalencije rezistentne arterijske hipertenzije (RAH). Slijedom navedenoga, cilj ovog presječnog istraživanja bio je istražiti učestalost AH te RAH među bolesnicima u Nefrološkoj ambulanti Zavoda za nefrologiju i dijalizu, Klinike za unutarnje bolesti, Kliničkog bolničkog centra Split te njezine osobitosti s obzirom na razlike u antropometrijskim parametrima, laboratorijskim vrijednostima i vrijednostima perifernog i centralnog tlaka.
Materijali i metode: U istraživanje je uključen 261 ispitanik, 137 (52,5%) muškaraca i 124 (47,5%) žene. Za svakog ispitanika zabilježeni su podaci: dob, spol, tjelesna težina i visina, opseg struka i nadlaktice, postojanje AH, vrsta i broj antihipertenzivnih lijekova. Također, određene su serumske vrijednosti ureje, kreatinina i izračunata je razina glomerularne filtracije (GFR) te ITM. Uz ranije navedeno, za svakog ispitanika su zabilježene su serumske vrijednosti triglicerida, kolesterola-ukupnog, LDL, hemoglobina, urata, glukoze i kalija. Za mjerenje arterijskog tlaka korišten je uređaj „Agedio B900“. Izmjeren je 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.
Rezultati: Prosiječna dob ispitanika bila je 66 (56-74) godina. Od ukupnog broja svih ispitanika 201 (77%) ispitanik se imao postavljenu dijagnozu AH u anamnezi, dok je 78 (29,9%) ispitanika imalo postavljenu dijagnozu šećerne bolesti. Nadalje, 101 (38,7%) bolesnik je imao KBB, a učestalost KBB je bila statistički značajno viša među ispitanicima s AH (N=201) u uspredbi s bolesnicima bez dijagnoze AH (N=60), (89 (44,3%) vs. 12 (20%), p=0,001). Od ispitanika koji su imali postavljenu dijagnozu AH (N=201), njih 44,3% je imalo RAH (uzimalo tri ili više antihipertenzivnih lijekova od kojih je jedan diuretik). Navedeni ispitanici su imali statistički značajno veći ITM (29,4 (26,1 - 33) vs. 27,8 (24,2-30,5), p<0,001). Nadalje, ispitanici sa RAH su imali statistički značajno niže vrijednost GFR (42,7 (27,6 - 69,4) vs. 56,15 (37,35-87,4), p<0,001) te statistički značajno veće vrijednosti ureje (10,4 (5,2 -10,5) vs. 8,1 (5,2 - 10,5), p=0,001) i kreatinina (136 (92,8 - 173,5) vs. 103 (74,25 - 142,25), p=0,001). Također, nađena je i statistički viša vrijednost PSAT (140 (128,8 - 153,5) vs. 146 (133,3 - 161,5), p=0,04) te MAP za periferni arterijski tlak (107 (97 - 119,3) vs. 112 (103 - 121), p=0,02) u ispitanika sa RAH.
Zaključak: Rezultati ovog istraživanja pokazuju kako je među bolesnicima u nefrološkoj ambulanti visoka prevalencije AH i RAH. Također razvidna je i povezanost nutritivnog statusa, bubrežne funkcije te dobi bolesnika sa RAH u ovoj populaciji bolesnika. Buduća, prospektivna, multicentrična istraživanja trebala bi dati odgovor na pitanje da li se intenzivnim praćenjem nutritivnog statusa i intervencijama (redukcijom tjelesne težine, regulacijom šećerne bolesti, detekcijom i liječenjem KBB) može utjecati na učestalost AH te RAH u ovoj populaciji bolesnika. |
Sažetak (engleski) | Objectives: Arterial hypertension (AH) is the largest single risk factor contributing to the development of the cardiovascular, cerebrovascular and renal diseases and global mortality. It is anticipated that the prevalence of the AH in the coming decade will increase both in developed and developing countries. Furthermore, aging of the population and increase in body mass index (BMI) results in an increase of the prevalence of resistant arterial hypertension (RAH). Consequently, the aim of this cross-sectional study was to investigate the frequency of AH and RAH among patients in Nephrological Ambulance, Department of Nephrology and Dialysis at the University Hospital of Split and its characteristics due to differences in anthropometric parameters, laboratory values and peripheral and central blood pressure values.
Materials and methods: The study included 261 subjects, 137 (52.5%) men and 124 (47.5%) women. Data for age, gender, body weight and height, waist and mid-upper arm circumference, AH existence, type and number of antihypertensive drugs were recorded for each patient. Also, urea serum values, creatinine, and glomerular filtration rate (GFR) and BMI were calculated. In addition to the above, serum triglyceride, cholesterol level, LDL (Low density lipoproteins), haemoglobin, urate, glucose and potassium have been measured for each subject. The device "Agedio B900" was used to measure arterial pressure. Peripheral (PSAT) and central systolic blood pressure (CSAT) and peripheral (PDAT) and central diastolic (CDAT) arterial pressure were measured. Also, pulse pressure (PP) and mean arterial pressure (MAP) were calculated for peripheral and central arterial pressure.
Results: The average age of all study subjects was 66 (56-74) years. Out of the total number of respondents, 201 (77%) had a diagnosis of AH, while 78 (29.9%) of respondents were diabetic. Furthermore, 101 (38.7%) patients had diagnosis of chronic kidney disease (CKD). The incidence of CKD was statistically significantly higher among patients with AH (N=201) compared to patients without diagnosis of AH (N=60), 89 (44.3%) vs. 12 (20%), p=0.001). Of the patients who had a diagnosis of AH (N=201), 44.3% had RAH (three or more antihypertensive drugs were taken, one of which was a diuretic). These patients had statistically significantly higher BMI (29.4 (26.1 - 33) vs. 27.8 (24.2 - 30.5), p<0.001). Furthermore, patients with RAH had statistically significantly lower GFR (42.7 (27.6 - 69.4) vs. 56.15 (37.35 - 87.4), p<0.001) and statistically significantly higher urea and creatinine level (10.4 (5.2 -10.5) vs. 8.1 (5.2 - 10.5), p=0.001), (136 (92.8 - 173.5) vs. 103 (74.25 - 142.5), p=0.001), respectively. Also, there was a statistically higher value of PSAT (140 (128.8 - 153.5) vs. 146 (133.3 - 161.5), p=0.04) and MAP for peripheral arterial pressure (107 (97 - 119.3) vs. 112 (103 - 112), p=0.02) in patiens with RAH.
Conclusion: The results of this study show that there is a high prevalence of AH and RAH among the patients in the Nephrological Ambulance. The relationship between nutritional status, renal function and the age of RAH patients in this patient population is also apparent. Future, prospective, multicentric research should answer the question whether intensive monitoring of nutritional status and interventions (body weight reduction, diabetes regulation, detection and treatment of CKD) may affect the incidence of AH and RAH in this population of patients. |