Aysun AYBAL KUTLUGÜN, Fatma KAPLAN EFE, Gülsüm BİTEN-GÜVEN

Yeni tanı konulan hipertansif hastalarda antihipertansif ilaç başlanmasının MPV düzeyine etkisi

Trombosit aktivasyonu hipertansiyon patogenezinde rol oynayan bir faktördür. Ayrıca, trombotik olayların gelişimine ve hipertansiyona bağlı hedef organ hasarına katkıda bulunur. Mean platelet volume, platelet aktivasyonunu gösteren kolay ölçülebilir bir parametredir. Bu çalışmanın amacı, yeni tanı almış hipertansif hastalarda antihipertansif ilaç tedavisine başlandıktan sonra MPV düzeylerinde herhangi bir değişiklik olup olmadığını değerlendirmektir. Antihipertansif ilaç tedavisine başlanan 79 hasta retrospektif olarak değerlendirildi. Hastaların% 24.1'inde mikroalbüminüri vardı. Antihipertansif ilacın başlamasından önceki ve sonraki MPV değerleri (5.8=3.6 ay) istatistiksel olarak karşılaştırıldı. Antihipertansif ilaç tedavisine başlandıktan sonra ortalama MPV değerinde istatistiksel olarak anlamlı azalma saptandı (8.92=1.76 fl'ye karşılık 8.38=1.60 fL, p<0.001). Ortalama MPV değeri mikroalbüminürik grupta normoalbüminürik gruba göre daha yüksekti (9.24=1.10 fLvs. 8.49 = 1.75 fL, p = 0.028). Yeni tanı konulan hipertansif hastalarda antihipertansif ilaç başlanmasını takip eden ilk yıl içinde ortalama MPV düzeyinde anlamlı bir azalma tespit edildi.

Anahtar Kelimeler:

hipertansiyon, mean platelet volum, mikroalbuminuri

The effect of initiation of antihypertensive medication on MPV level in newly diagnosed hypertensive patients

Platelet activation is a factor involved in the pathogenesis of hypertension. It also contributes to the development of thrombotic events and target organ damage due to hypertension. Mean platelet volume is an easily measurable parameter indicating platelet activation. To evaluate whether there is any change in MPV levels after starting antihypertensive medication in newly diagnosed hypertensive patients. 79 patients who were started on antihypertensive medication were evaluated retrospectively. 24.1% of the patients had microalbuminuria. MPV values before and after (5.8±3.6 months) the start of the antihypertensive drug were compared statistically. A statistically significant decrease in mean MPV value was found after starting antihypertenive medication (8.92±1.76 fL vs. 8.38±1.60 fL, p<0.001). The mean MPV value was higher in the microalbuminuric group than in the normoalbuminuric group (9.24±1.10 fL vs. 8.49±1.75 fL, p=0.028). A significant decrease in mean MPV level was detected in the first year following the initiation of antihypertensive medication in newly diagnosed hypertensive patients.

Keywords:

hypertension, mean platelet volume, microalbuminuria,

PDF

___

REFERENCES 1. Ordu S., Ozhan H., Caglar O., et al. Mean platelet volume in patients with dipper and non-dipper hypertension. Blood Press. 2010;19:26–30.
2. Guenancia C., Hachet O., Stamboul K., et al. Incremental predictive value of mean platelet volume/platelet count ratio in in-hospital stroke after acute myocardial infarction. Platelets. 2017;28:54–59.
3. Thombson C.B., Eaton K., Princiotta S.M., et al. Size dependent platelet subpopulations: Relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br. J. Haematol. 1982;50:509–519.
4. Klimczak D., Jazdzewski K., Kuch M. Regulatory mechanisms in arterial hypertension: Role of microRNA in pathophysiology and therapy. Blood Press. 2017;26:2–8.
5. Nadar S.K., Blann A.D., Kamath S., et al. Platelet indexes in relation to target organ damage in high-risk hypertensive patients: A substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) J. Am. Coll. Cardiol. 2004;44:415–422.
6. Yarlioglues M., Kaya M.G., Ardic I. Relationship between Mean Platelet Volume Levels and Subclinical Target Organ Damage in Newly Diagnosed Hypertensive Patients; Blood Press; 2011;20(2): 92–97.
7. Gang L, Yanyan Z, Zhongwei Z, Juan D. Association between mean platelet volume and hypertension incidence. Hypertens Res. 2017 Aug;40(8):779-784.
8. Akın H, Bilge Ö, Yavuz B, et al. The relationship between mean platelet volume and resistant hypertension. Clin Exp Hypertens. 2022 Jan 3:1-5.
9. Ates I, Bulut M, Ozkayar N, Dede F. Association between high platelet indices and proteinuria in patients with hypertension. Ann Lab Med. 2015 Nov;35(6):630-4.
10. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
11. Levey AS, Inker LA, Coresh J. "Should the definition of CKD be changed to include age-adapted GFR criteria?": Con: the evaluation and management of CKD, not the definition, should be age-adapted. Kidney Int 2020; 97:37.
12. Guven A, Caliskan M, Ciftci O, Barutcu I. Increased platelet activation and inflammatory response in patients with masked hypertension. Blood Coagul Fibrinolysis. 2013 Mar;24(2):170-4.
13. Varol E, Akcay S, Icli A, et al. Mean platelet volume in patients with prehypertension and hypertension. Clin Hemorheol Microcirc. 2010;45(1):67-72.
14. Surgit O., Pusuroglu H., Erturk M., et al. Assessment of mean platelet volume in patients with resistant hypertension, controlled hypertension and normotensives. Eurasian J. Med. 2015;47:79–84.
15. Mancia G., Fagard R., Narkiewicz K. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2013;31:1281–1357.
16. Tsiara S., Elisaf M., Jagroop I.A. Platelets as predictors of vascular risk: is there a practical index of platelet activity? Clin Appl Thromb Hemost. 2003;9(3):177–190.
17. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286:421.
18. Wachtell K, Ibsen H, Olsen MH, et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med 2003; 139:901.
19. Hillege HL, Fidler V, Diercks GF, et al. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002; 106:1777.
20. Glassock RJ. Debate: CON position. Should microalbuminuria ever be considered as a renal endpoint in any clinical trial? Am J Nephrol 2010; 31:462.
21. Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 2013; 158:825.
22. Michelson A.D. Methods for the measurement of platelet function. Am. J. Cardiol. 2009;103:20A–26A. doi: 10.1016/j.amjcard.2008.11.019.