Esansiyel Hipertansiyonlu Bireylerde Endotel Disfonksiyonu Biyobelirteçleri Olarak NO, Endotelin ve Microalbümünüri

GİRİŞ ve AMAÇ: Esansiyel hipertansiyonun patogenezinde (EH) endotel disfonksiyonu ve nitrik oksit (NO), endotelin1(ET-1) deki dengesizlik yer almaktadır. Çalışmamızın amacı yeni tanı almış EH’lu bireylerde mikroalbüminüri ile serum NO seviyeleri ve ET-1 ile arasındaki ilişkiyi, dipper ve nondipper HT olan hastalarda NO, endotelin 1 düzeyleri ile ilişkisinin olup olmadığını araştırmayı amaçladık. YÖNTEM ve GEREÇLER: Bu çalışmaya Bülent Ecevit Üniversitesi Uygulama Araştırma Hastanesi Nefroloji polikliniğine başvuran, EH’u olan 18 yaş üstü toplam 54 hasta (kadın=27, (yaş=46,1±12,8 yıl) alındı. NO, Endotelin 1, Ambulatuvar kan basıncı, kreatinin klerensi ve idrarda mikroalbümin değerleri ölçümleri yapıldı. Mikroalbüminüri 30-300mg/gün olanlar pozitif olarak kabul edildi. NO değeri 64,14 µmol/L altında olanları düşük grup, 64,14 µmol/L ve üzerinde olanları normal grup, ET-1 değeri 2,67 pg/ml altında olanları düşük, 2,67 pg/ml ve üzerinde olanları yüksek grup olarak sınıflandırdık. Mikroalbüminürinin endotel disfonksiyonunun kuvvetli bir göstergesi olması dolayısıyla mikroalbüminüri olmayan grup kontrol grubu olarak alındı BULGULAR: ET-1 ve NO düzeyleri endotel disfonksiyonu olan (n=17) ve olmayan (n=37) EH’lu bireylerde benzer bulundu [60.6 (8.3-111.4) ve 62.3 (6.6-271.8), p=AD ve 2.30 (0.32-6.63) ve. 1.59 (0.28-8.87), p=AD ]. Mikroalbuminüri ile ne ET-1 ne de NO düzeyleri arasında herhangi bir korelasyon bulunmadı. Serum albümin düzeyleri endotel disfonksiyonu olan grupta anlamlı olarak düşük bulundu[3.90 (3.4-4.5) ve. 4.10(3.8-4.7), p=0.018]. Dipper ve non-dipper hasta grubunda 24 saatlik idrarda elektrolit atılımında anlamlı bir değişiklik saptanmadı. TARTIŞMA ve SONUÇ: Hipertansiyonun yeni gelişmiş oluşu ve NO biyoyararlanımının bozulup henüz serum NO düzeylerinin düşmemiş olması; esansiyel hipertansiyonlu mikroalbumunürik olan ve olmayan bireylerde NO ve ET-1’in benzer düzeyde oluşunu açıklayabilir

NO, Endothelin and Microalbuminuria as Biomarkers of Endothelial Dysfunction in Subjects with Essential Hypertension

INTRODUCTION: Endothelial dysfunction, imbalance in the nitric oxide (NO) and Endotelin-1 (ET-1) play role in the pathogenesis of essential hypertension (EH). We aim to investigate relationship between microalbuminuria (MA) and NO, ET-1 levels in the newly diagnosed patients with EH, is also to search relationship between MA and NO, ET-1 levels in patients with dipper and non-dipper HT. METHODS: Patients above 18 years old with newly diagnosed EH who presented to outpatient nephrology clinic of Bülent Ecevit University Hospital were included into the study(n=54, female=27, age=46,1±12,8 years). NO, Endotelin1, ambulatory blood pressure, creatine clearance and urinary albumin measurement were done. Whom MA was 30- 300mg/day were accepted as positive. A NO value below 64,14 µmol/ was accepted as lower grup, above that assumed as normal grup. ET-1 value of lower than 2,67 pg/ml was low, above that value was accepted as high grup.MA negative patients with EH was accepted as control grup. RESULTS: Levels of ET-1 and NO were found to be similar among MA positive (n=17) and negative (n=37) patients [60.6 (8.3-111.4) vs. 62.3 (6.6-271.8), p=NS ] and [2.30 (0.32-6.63) vs. 1.59 (0.28-8.87), p=NS ].There were neither correlation of MA with NO nor MA with ET-1.Serum albumin levels were lower in endothelial dysfunction group [3.90 (3.4-4.5) vs. 4.10 (3.8-4.7), p=0.018].There were no significant difference about urinary electrolyte excretion in patients with Dipper and Nondipper HT. DISCUSSION AND CONCLUSION: Recent onset of hypertension, impairment of NO bioavailability and absence of decrease of NO levels can describe similar NO and ET-1 levels in EH with and without microalbumunuria

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