Acta Medica Medianae
Vol. 53, No 4, December, 2014
UDC 61
ISSN 0365-4478(Printed version)
ISSN 1821-2794(Online)
 

Correspondence to:

Boban Milojković

Faculty of Medicine

Bulevar dr Zorana Đindjića 81

18000 Niš, Serbia

e-mail: boban.milojkovic@hotmail.com

Original article                                        

UDC: 616.61-008.61-07:616.12-008.331.1

doi:10.5633/amm.2014.0403

Essential arterial hypertension and risk factors associated with hypertensive nephropathy

Boban Milojković¹, Boris Đindjić ², Sonja Radenković³, Gordana Kocić⁴, Bobana Milojković⁵

University of Niš, Faculty of Medicine in Niš, Serbia¹

University of Niš, Faculty of Medicine, Institute of Pathophysiology, Serbia²

Institute of Nephrology and Hemodyalisis, Clinical Center Niš, Serbia³

University of Niš, Faculty of Medicine, Institute of Biochemistry, Serbia⁴

Clinic for General Surgery, Clinical Center Niš, Serbia⁵

Arterial hypertension is a major risk factor that predisposes to cardiovascular disorders and is responsible for most of the morbidity and mortality in patients. Hypertension is closely associated with the kidney, because kidney disease can be both the cause and consequence of increased blood pressure. Elevation of blood pressure is a strong independent risk factor for hypertensive nephropathy and development of ESRD. The pathogenesis of ischemic hypertensive nephropathy (IHN) is multifactoral, and in addition to blood pressure other factors contribute to the development of this renal pathology and its progression to end-stage renal disease. These include obesity, smoking, male gender and other still unknown risk factors.

The aim of this paper was to analyse the association between essential arterial hypertension and renal hypertensive disease and prevalence of other atherosclerotic risk factors in patients with developed hypertensive renal disease.

In this prospective cross sectional study 283 patients of both genders with diagnosed essential hypertension and hypertensive renal disease were analysed. The anamnestic data related to age, duration of hypertension, history of smoking, presence of hypertensive retinopathy, hypertrophy of the left chamber and data about previous renal diseases were collected through conversation and medical documentation. The clinical examination comprise determination of blood pressure, body mass index (BMI), lipid parameters (total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides), serum urea and creatinine, urine, albumin and protein concentration.

The total number of 283 patients (185 males and 98 females) with HN was analyzed. The analysis revealed significantly higher proportion of males aged over 60 years with IHN. The mean age of examined hypertensive patients with IHN is 62.6±8.8 years with duration of hypertension 19.8±5.9 years. All examined patients had hypertensive retinopathy and hypertrophy of the left chamber. The majority of the examined patients (78.6%) with IHN were overweight with BMI 25-30kg/m². Dyslipidemia was registered in 75% and smoking in 75% of hypertensive patients with IHN. The most common lipid disorders were hypertrigliceridemia with hypercholesterolemia found in 42.1% and combined dyslipidemia in 25.8%. Family history of arterial hypertension (AH) was registered in all patients with IHN.

The correlation analysis revealed a significant positive association between family history of HTA (r=0.62, p<0.05), smoking (r=0.53, p<0.05) and combined dyslipidemia (hypertrigliceridemia and hypercholesterolemia) (r=0.45, p<0.05) with occurrence of IHN.

Hypertensive nephropathy predominatly occurs in older hypertensive males with developed hypertensive micro-  and macrovascular complications. The family history of AH, smoking and lipid disorders, especially combined dyslipidemia are very common risk factors associated with hypertensive nephropathy. Prevention and therapy of these risk factors is an important task in reduction of hypertensive nephropathy. Acta Medica Medianae 2014;53(4):15-21.

Key words: hypertensive nephropathy, arterial hypertension, smoking, dyslipidemia