Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension

Abstract

IntroductionHigh blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH).Material and methodsTwenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT.ResultsThe mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT.ConclusionsIn EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.

State of the art papers Lipids, blood pressure, kidney – what was new in 2011?

“…If the antihypertensive response to the initial drug is inadequate after reaching the full dose, a second drug from another class should be added, provided the initial drug is tolerated [84, 85]. ACCF/AHA guidelines confirm the current ESH [64] and current NICE recommendations [84] that all main antihypertensive drug classes – diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), and β-blockers – have shown significant benefits in reducing CV outcomes in randomized trials among elderly persons [86–91]. Where possible, a combination therapy should be the method of choice [84, 85].…”

Longitudinal prospective observational type study about determinants of renal resistive index variations in chronic renal failure patients treated with conventional medical and dietetic therapy

“…In effect it was already demonstrated that a significant blood pressure lowering to recommended values is associated with a significant improvement of intrarenal arterial functional properties and renal function (14). Similarly obesity is a major risk factor for essential hypertension, diabetes, and other comorbid conditions that contribute to the development of chronic kidney disease (37).…”

“…Moreover it is also known that RRI decreases with use of renin angiotensin system (RAS) inhibitors, due to the hemodynamic changes induced by these antihypertensive agents. (13) Anyway there are some points that still need to be clarified and among these it is not known whether and how much dietetic and therapeutic interventions may affect RRI (10) except for the fact that RRI, as already mentioned, is known to decrease with use of RAS inhibitors (13) and that it is also known that intensive blood pressure lowering to the recommended values is associated with a significant improvement of intrarenal arterial functional properties and renal function (14). Moreover longitudinal population studies are still needed to clarify whether Doppler changes in intrarenal arteries may be associated to an improvement in the cardiovascular and renal outcome in the hypertensive patients (15).…”

Lipids, Blood Pressure, Kidney-what was New in 2012?

“…If the antihypertensive response to the initial drug is inadequate after reaching the full dose, a second drug from another class should be added, provided the initial drug is tolerated [84,85]. ACCF/AHA guidelines confirm the current ESH [64] and current NICE recommendations [84] that all main antihypertensive drug classes -diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), and β-blockers -have shown significant benefits in reducing CV outcomes in randomized trials among elderly persons [86][87][88][89][90][91]. Where possible, a combination therapy should be the method of choice [84,85].…”