3 research outputs found
Changes in kidney function in a population with essential hypertension in real life settings
Introduction. Hypertension has been identified as one of the
commonest modifiable determinants for chronic kidney disease
progression. A variety of antihypertensive drugs are available and
their effect on kidney function has been investigated by a large
number of randomized controlled trials. Observational studies,
although scarcely been used, outpatient can reflect everyday
practice, where drug exposures vary over time, and may provide
an alternative for detecting longitudinal changes in kidney function.
Materials and Methods. We applied mixed model repeated measures
analysis to investigate the effect of antihypertensive drug categories
and their combinations on kidney function change over time in a
cohort of 779 patients with essential hypertension, using the data
from a Greek hypertension outpatient clinic. Antihypertensive
drugs were grouped in 5 categories. Their effect was evaluated
and their combinations with and without renin-angiotensin-system
inhibitors (RASI) to each other. In addition, the combination of
RASI with calcium channel blockers (CCBs) was studied.
Results. Diuretics, RASI, CCBs, and beta-blockers had a significant
renoprotective and blood pressure lowering effect. Combinations
with RASI had a smaller beneficial effect on kidney function
compared to CCBs (0.75 mL/min/1.73 m2
per year of drug use
versus 0.97 mL/min/1.73 m2). There was no additional effect
when combining RASI with CCBs. However, the lowering effect
on systolic blood pressure was greater (-0.83 mm Hg per year of
drug use, P < .001).
Conclusions. RASI were found to have a smaller, although
significant, renoprotective effect. There was no additional effect
on kidney function when combining RASI with CCBs
Oral Calcium Supplementation Ambulatory Blood Pressure and Relation to Changes in Intracellular Ions and Sodium-Hydrogen Exchange
BACKGROUND Calcium (Ca2+) supplementation has been shown paradoxically to reduce intracellular Ca2+ and induce vascular relaxation. The aim of the study was to assess 24-h blood pressure (BP) change after Ca2+ supplementation and to investigate its relation to changes in intracellular ions and the activity of the first isoform of sodium-hydrogen exchange (NHE-1) in subjects with hypertension and type 2 diabetes. METHODS This parallel, randomized controlled, single-blinded trial, consisted of 31 patients with type 2 diabetes, and hypertension who were allocated to receive 1,500 mg of Ca2+ per day (n = 15) or no treatment (n = 16) for 8 weeks. RESULTS In the Ca2+ group a decrease of 1.7 +/- 2.7 mm Hg (mean +/- SE) P = 0.52 for mean 24-h systolic BP (SBP) and 2.1 +/- 1.5 mm Hg, P = 0.19 for mean 24-h diastolic BP (DBP) was recorded. Whereas in the control group an increase of 1.4 +/- 2.7 mm Hg, P = 0.59 for mean 24-h SBP and 1.2 +/- 2.8 mm Hg, P = 0.83 for mean 24-h DBP was observed. Intraplatelet Ca2+ decreased whereas intraplatelet magnesium (Mg2+) and erythrocyte K+ increased in the intervention group. Change in mean 24-h SBP in the pooled group correlated with both change in intraplatelet Ca2+ (r = 0.49, P < 0.05) and NHE-1 activity (r = 0.6, P < 0.001). The contribution of intraplatelet Ca2+ was attenuated when both parameters were entered in a multivariate regression model. CONCLUSIONS The present study shows a weak, statistically nonsignificant trend towards association of Ca2+ supplementation on 24-h BP in hypertensive subjects with type 2 diabetes. However, our results indicated an interrelation of [Ca2+], levels and NHE-1 activity on BP in patients with hypertension and type 2 diabetes