The effect of hypertension on renal functions in patients with acute coronary syndrome

Objectives: In patients with acute coronary syndrome, age, ejection fraction, diabetes, hypertension, and chronic kidney disease (CKD) are regarded as independent risk factors for the development of acute kidney disease (ACD). This research evaluated the glomerular filtration rates (GFR) of acute coronary syndrome patient groups who were hypertensive and those who were not. Methods: This retrospective analysis comprised 764 patients with acute coronary syndrome who had applied to our institution before coronary angiography. There were two groups created from these patients. In the first group, there were 383 hypertensive patients; in the second group, there were 381 non-hypertensive patients. To assess how well these patients' kidneys were functioning, GFR was determined and compared. Results: The mean age of the two groups did not significantly differ from one another (p = 0.053). The standard lipid measures of total cholesterol, triglyceride, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol levels did not differ substantially between the two groups. The two groups had no discernible difference regarding high-sensitivity C-reactive protein, N-terminal fragment brain natriuretic peptides, creatinine, and thrombocyte levels. Systolic and diastolic blood pressure, as well as diabetes mellitus, were all considerably higher in the hypertensive patients’ group (p < 0.001). The GFR in hypertensive patients was substantially lower (64.83 ± 19.76 vs. 70.71 ± 19.19, p < 0.001) Conclusions: Our research revealed a strong link between hypertension and diminished renal function. This leads us to believe that hypertension may be a separate risk factor for the decline in renal function in acute coronary syndrome patients.

Keywords:

Acute coronary syndrome, renal failure, glomerular filtration rate hypertension,

PDF

___

1. Dahlöf B, Devereux R, de Faire U, Fyhrquist F, Hedner T, Ibsen H et al. The Losartan Intervention for Endpoint Reduction (LIFE) in hypertension study: rationale, design, and methods. The LIFE Study Group. Am J Hypertens 1997;10(7 Pt 1):705-13.
2. Bongartz LG, Braam B, Verhaar MC, Cramer MJ, Goldschmeding R, Gaillard CA, et al. Transient nitric oxide reduction induces permanent cardiac systolic dysfunction and worsens kidney damage in rats with chronic kidney disease. Am J Physiol Regul Integr Comp Physiol 2010;298:815-23.
3. Hsu CY. Does non-malignant hypertension cause renal insufficiency. Evidence-based perspective. Curr Opin Nephrol Hypertens 2002;11:267-72.
4. Bauman LA, Watson NE Jr, Scuderi PE, Peters MA. Transcutaneous renal function monitor: precision during unstable hemodynamics. J Clin Monit Comput 1998;14:275-82.
5. Buijsen JG, van Acker BA, Koomen GC, Koopman MG, Arisz L. Circadian rhythm of glomerular filtration rate in patients after kidney transplantation. Nephrol Dial Transplant 1994;9:1330-3.
6. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. Glob Heart 2012;7:275-95.
7. Ryden L, Standl E, Bartnik M, Van den Berghe G, Betteridge J, de Boer MJ, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J 2007;28:88-136.
8. Reiner Z, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, et al. ESC/EAS Guidelines for the Management of Dyslipidaemias: the Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32:1769-818.
9. Ruilope LM, Rodicio J L. Renal surrogates in essential hypertension. Clin Exp Hypertens 1999;21:609-14.
10. Chi-yuan Hsu. Does non-malignant hypertension cause renal insufficiency? Evidence-based perspective. Curr Opin Nephrol Hypertens 2002;11:267-72.
11. Jenette J C, Olson J L, Schwartz MM, Silva FG (eds). Heptinstall's Pathology of the Kidney 5th ed., Philadelphia: Lippincott-Raven. 1998: pp. 943-1002.
12. Atlas of end-stage renal disease in the United States. United States Renal Data System. USRDS Annual Data Report. Bethesda, Md, USA: National Institute of Diabetes and Digestive and Kidney Diseases; 2006.
13. Ilyas B, Dhaun N, Markie D, Stansell P, Goddard J, Newby DE, et al. Renal function is associated with arterial stiffness and predicts outcomes in patients with coronary artery disease. QJM 2009;102:183-91.
14. Packard RR, Libby P. Inflammation in atherosclerosis: from vascular biology to biomarker discovery and risk prediction. Clin Chem 2008;54:24-38.
15. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, et al. Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000;58:353-62.
16. Muntner P, He J, Astor BC, Folsom AR, Coresh J. Traditional and nontraditional risk factors predict coronary heart disease in chronic kidney disease: results from the atherosclerosis risk in communities study. J Am Soc Nephrol 2005;16:529-38.
17. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med 2000;342:1478-83.
18. Gradaus F, Ivens K, Peters AJ, Heering P, Schoebel FC, Grabensee B, et al. Angiographic progression of coronary artery disease in patients with end-stage renal disease. Nephrol Dial Transplant 2001;16:1198-202.
19. Goldberg A, Hammerman H, Petcherski S, Zdorovyak A, Yalonetsky S, Kapeliovich M, et al. In-hospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J 2005;150:330-7.
20. Marenzi G, Moltrasio M, Assanelli E, Lauri G, Marana I, Grazi M, et al. Impact of cardiac and renal dysfunction on in-hospital morbidity and mortality of patients with acute myocardial infarction undergoing primary angioplasty. Am Heart J 2007;153:755-62.
21. Nohria A, Hasselblad V, Stebbins A, Pauly DF, Fonarow GC, Shah M, et al. Cardiorenal interactions: insights from the ESCAPE trial. J Am Coll Cardiol 2008;51:1268-74.
22. Cowie MR, Komajda M, Murray-Thomas T, Underwood J, Ticho B. POSH Investigators: Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH). Eur Heart J 2006;27:1216-22.
23. Logeart D, Tabet JY, Hittinger L, Thabit G, Jourdain P, Maison P, et al. Transient worsening of renal function during hospitalization for acute heart failure alters the outcome. Int J Cardiol 2008;127:228-32.
24. Amin AP, Spertus JA, Reid KJ, Lan X, Buchanan DM, Decker C, et al. The prognostic importance of worsening renal function during an acute myocardial infarction on long-term mortality. Am Heart J 2010;16:1065-71.
25. Mielniczuk LM, Pfeffer MA, Lewis EF, Blazing MA, de Lemos JA, Mohanavelu S, et al. The acute decline in renal function, inflammation, and cardiovascular risk after an acute coronary syndrome. Clin J Am Soc Nephrol 2009;4:1811-7.
26. Metra M, Nodari S, Parrinello G, Bordonali T, Bugatti S, Danesi R, et al. Worsening renal function in patients hospitalized for acute heart failure: clinical implications and prognostic significance. Eur J Heart Fail 2008;10:188-95.