The aim of study was to assess torasemide and indapamide effects on magnesium (Mg), potassium (K), calcium (Ca), and sodium (Na) excretion in postmenopausal women with hypertension and heart failure with preserved ejection fraction (HFpEF) depending on Mg exchange. Material and methods. 140 postmenopausal women with hypertension and HFpEF were examined. Based on Mg-tolerance test results, patients were divided into 2 groups: with (n = 72) and without Mg deficiency (n = 68) with randomization into 4 subgroups: 1a, 1b – 36 patients and 2a, 2b - 34 women in each. Subgroups 1a and 2a received torasemide 5 mg, 1b and 2b – indapamide 2.5 mg. Daily diuresis, Na, K, Ca and Mg excretion were determined before and after diuretics use. Results. Diuretics caused equal (p>0.05) increase (p<0.001) in daily urine output and natriuresis by 561 (95%CI: 556–571) ml and 71.0 (95%CI: 68.9– 73.1) mmol/24h. K excretion increased (p<0.0001) only with indapamide use by 21.1 (95% CI: 18.4-23.8) mmol / 24h and 22.3 (95% CI: 19.5-25.0) mmol / 24h in groups 1b and 2b. Mg excretion increase was not detected (p>0.05) only in patients with Mg deficiency torasemide subgroup, but Ca loss remained unchanged (p>0.05) in indapamide subgroups. K/Na and Ca/Na ratio decreased in all groups, while Mg/Na increased with indapamide use and decreased with torasemide use. Torasemide decreased (p<0.001) Mg/Ca excretion ratio, but indapamide decreased (p<0,0001) the one. Conclusion. Indapamide caused significant increase in K, Mg excretion and Mg/Ca, while torasemide increased Ca loss, decreased Mg/Ca, and did not affect K loss in postmenopausal women with hypertension, HFpEF regardless to Mg deficiency. Torasemide did not lead to Mg losses increase in macronutrient-deficiency patients.
The aim of study was to identify markers of bone turnover such as osteoprotegerin (OPG), receptor activator for nuclear factor kappa-B ligand (RANKL), 25-hydroxyvitamin D (25(OH)D), and bone density (BMD) in postmenopausal women with arterial hypertension (AH) and heart failure with preserved ejection fraction (HFpEF), depending on magnesium (Mg) status. Material and methods. 140 postmenopausal women aged 52 to 76 years with AH and HFpEF were examined. Based on the Mg-tolerance test, patients were divided into 2 groups: with Mg deficiency (n=72) and without one (n=68). BMD in the neck and proximal femoral area, as well as L1-L4 vertebrae, was measured in by dual-energy X-ray absorptiometry. OPG, soluble RANKL (sRANKL) and 25(OH)D level was also determined by enzyme immunoassay. Results. In Mg deficiency group were noted lower BMD indices in L1-L4 vertebrae area (0,990±0,159 g/cm2 vs 1,046±0,193 g/cm2; p=0,041) and higher osteopenia incidence (RR=1,60; 95% CI: 1,08–2,38; p=0,019). Also, Mg deficient women had higher level of OPG (85,2 [69,1; 103,1] pg/ml vs 79,9 [63,4; 92,7] pg/ml, p=0,035) and sRANKL (3,98 [2,70; 5,45] pg/ml vs 2,85 [1,95; 3,82] pg/ml, p<0,0001) expression, but lower OPG/sRANKL ratio (22.59 [15.34; 33.71] vs 26.01 [19.42; 41.19], p=0.028) in opposite to control group parameters. At the same time, patients with Mg deficiency had higher 25(OH)D impaired status incidence (97% vs 87%; p=0,028). Conclusion. Lower BMD and OPG/sRANKL ratio, but higher OPG and sRANKL expression and higher frequency of 25(OH)D impaired status were revealed in postmenopausal women with AH, HFpEF and Mg deficiency compared to the control group.
Magnesium (Mg) is essential element for cardiovascular system. Together with known increase in macronutrient deficiency prevalence, as well as the complexity of its assessment, it is relevant to identify independent risk factors and clinical manifestations of Mg deficiency in postmenopausal women with hypertension and heart failure with preserved ejection fraction (HFpEF). 140 postmenopausal women with hypertension and HFpEF were included in the study. According to the Mg retention test, 72 patients (group 1) had macronutrient deficiency, and 68 (group 2) did not have the one. Anamnestic data, patient complaints, as well as clinical examination features, including office blood pressure measurement, were studied. As result of the study, it was revealed that two or more pregnancies were more often recorded (15 % vs 4 %; p = 0.047) in patients with Mg deficiency, hypertension and HFpEF. Group 1 patients more often consumed salt (60 % vs 41 %; p = 0.015), sugar (39 % vs 29 %; p = 0.042) and used diuretics (22 % vs 7 %; p = 0.017), but less used Mg rich foods (18 % vs 31 %; p = 0.002). In addition, women with Mg deficiency were more likely to have such manifestations as chronic constipation (22 % vs 9 %; p = 0.037) and calf muscles cramps (38 % vs 21 %; p = 0.04). As result of logistic regression model constructing, it was determined that the Mg deficiency in postmenopausal women with hypertension and HFpEF is associated with the fact of excessive sugar intake, diuretics use, the presence of skeletal muscle cramps, but absence of excess salt intake and sufficient use of Mg rich foods demonstrates protective properties.
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