Cystatin C, vascular biomarkers and measured glomerular filtration rate in patients with unresponsive hypertensive phenotype: a pilot study

Abstract

Background: Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest.Methods: Participants (n = 200, median age 58 (52–64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT – compliant and responsive to treatment, n = 100), or nonresponsive (URHT – compliant but nonresponsive to treatment, n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid – mGFR).Results: The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m2, p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04).Conclusion: In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship.

Independent associations of urinary albumin-to-creatinine ratio and serum cystatin C with carotid intima-media thickness in community-living Taiwanese adults

“…Increased cystatin C levels are associated with carotid IMT in a multi-ethnic study on atherosclerosis [ 24 ], in the general population [ 23 ], in the health check-up population [ 20 ], in postmenopausal women [ 21 ], in metabolic syndrome patients [ 19 ], in patients with hypertension [ 16 , 17 , 25 ], and in patients with type 2 diabetes [ 26 , 41 ]. By contrast, a study investigated 446 Japanese adults without chronic kidney disease and proteinuria and did not find the relationship of cystatin C and carotid IMT [ 22 ].…”

“…Carotid IMT, which is used as a biomarker for the early clinical diagnosis of CVD, is one of the most commonly employed and well established for early surrogate biomarkers of atherosclerosis [ 13 , 14 ] and has been reported to predict CVD and myocardial infarction [ 13 , 15 ]. Recent studies on the association between cystatin C and carotid IMT have yielded inconsistent results [ 16 – 26 ]. Some prior research demonstrated that increased cystatin C is associated with carotid IMT [ 24 ].…”

Clinical Role, Diagnostic and Prognostic Value of Human Cystatin C Through the Body

“…Serum Cystatin C concentration is positively and independently associated with intimamedia thickness of common carotid arteries in patient with unresponsive hypertensive phenotype and subclinical cardiovascular disease 49 .…”

“…Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease in patients with essential arterial hypertension 49 .…”

“…Recent studies suggested that higher serum Cystatin C concentration is found in hypertensive patients, in association with stiffness of large arteries in older adults, and with cardiac structural and functional alterations 49 .…”