Clinical and pathogenetic aspects of formation, early diagnosis, and medicated correction of cardiorenal disorders in men with hypertension against the background of purine metabolism disturbance
DOI:
https://doi.org/10.14739/2409-2932.2022.1.246775Keywords:
hypertension, hyperuricemia, lipocalin-2, cystatin C, early diagnosis, kidney diseases, heart diseases, treatment, perindopril, losartanAbstract
Aim: to review literary sources and analyse the modern view of the mechanisms of development of kidney and heart damage in patients with combination of hypertension (HP) and hyperuricemia and methods of their medicated correction.
Materials and methods. A review of the scientific literature for the last 10 years was done. It demonstrates that today high levels of uric acid (UA) are considered not only as a consequence of deteriorating renal function, but also as one of the factors of renal damage. The role of the kidneys in the pathogenesis and development of hypertension is the subject of a lively debate, whose significance is determined by the presence of a long period of latent renal dysfunction. According to the literature, in patients with essential hypertension, a direct correlation was found between the uric acids level and the left ventricular diastolic dysfunction (LVDD). Early diagnosis of heart lesions is possible using speckle-tracking echocardiography, which is an innovative technology for studying myocardial deformation, allowing subclinical diagnosis of heart muscle lesions. This technique is informative in hypertension even in the absence of hypertrophy and LVDD. The article also elucidates modern methods for diagnosing kidney damage against the background of hypertension, in particular, lipocalin associated with neutrophil gelatinase (NGAL). However, the significance of this biomarker in impaired renal function under conditions of hyperuricemia has not been studied. According to the literature, cystatin C is a marker of early diagnosis of cardiovascular events and a marker of renal glomerular function in the absence of an increase in serum creatinine levels. The role of this marker has been proven for many diseases of the kidneys and the cardiovascular system; however, there are no data on their definition as markers of damage to the heart and kidneys in hypertension in conditions of hyperuricemia.
Conclusions. The identification of causal relationships and mechanisms of complications in hypertensive patients with purine metabolism disturbance needs further study. Therefore, early diagnosis of structural and functional changes in the main target organs (in particular, the heart and kidneys) and the determination of biochemical markers (NGAL, cystatin C) to identify their functional disturbances at the preclinical stage are important.
References
Kovalenko, V. M. & Dorogoi, A. P. (2016). Sertsevo-sudynni khvoroby: medychno-sotsialne znachennia ta stratehiia rozvytku kardiolohii v Ukraini [Cardiovascular disease: medical and social value and strategy of cardiology in Ukraine]. Ukrainskii kardiologichnii zhurnal, (Suppl 3), 5-14. [in Ukrainian].
Derzhavna sluzhba statystyky Ukrainy [State Statistics Service of Ukraine]. http://www.ukrstat.gov.ua/
Zahorodnyi, M. I. (2017). Klinichni osnovy arterialnoi hipertenzii: farmakoterapevtychnyi aspect [Clinical bases of arterial hypertension: pharmacotherapeutic aspect]. Ratsionalna farmakoterapiia, (2), 29-34. [in Ukrainian].
Terenda, N. О. (2015). Osnovni tendentsii zahalnoi ta pervynnoi zakhvoriuvannosti na hipertonichnu khvorobu v Ukraini [Main trends of general and primary morbidity for hypertension in Ukraine]. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorovia Ukrainy, (4), 39-43. [in Ukrainian].
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S. E., Kreutz, R., Laurent, S., Lip, G., … ESC Scientific Document Group (2018). 2018 ESC/ESH Guidelines for the management of arterial hypertension. European heart journal, 39(33), 3021-3104. https://doi.org/10.1093/eurheartj/ehy339
Richette, P., Doherty, M., Pascual, E., Barskova, V., Becce, F., Castaneda, J., Coyfish, M., Guillo, S., Jansen, T., Janssens, H., Lioté, F., Mallen, C. D., Nuki, G., Perez-Ruiz, F., Pimentao, J., Punzi, L., Pywell, A., So, A. K., Tausche, A. K., Uhlig, T., … Bardin, T. (2020). 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout. Annals of the rheumatic diseases, 79(1), 31-38. https://doi.org/10.1136/annrheumdis-2019-215315
Korzh, O. M., & Krasnokutskiy, S. V. Podahra: klinika, diahnostyka ta likuvannia [Gout: clinics, diagnostics and treatment]. Skhidnoievropeiskyi zhurnal vnutrishnoi ta simeinoi medytsyny, (1), 40-47. [in Ukrainian].
Mishchenko, L. A. (2016). Giperurikemiia y arterialna gipertenziia – chy isnuie zv’iazok? [Hyperuricemia and Arterial Hypertension – is There a Correlation?]. Arterial'naya gipertenziya, (5), 55-60. [in Ukrainian]. http://dx.doi.org/10.22141/2224-1485.5.49.2016.83865
Verdecchia, P., Schillaci, G., Reboldi, G., Santeusanio, F., Porcellati, C., & Brunetti, P. (2000). Relation between serum uric acid and risk of cardiovascular disease in essential hypertension. The PIUMA study. Hypertension, 36(6), 1072-1078. https://doi.org/10.1161/01.hyp.36.6.1072
Buzas, R., Tautu, O. F., Dorobantu, M., Ivan, V., & Lighezan, D. (2018). Serum uric acid and arterial hypertension-Data from Sephar III survey. PloS one, 13(7), e0199865. https://doi.org/10.1371/journal.pone.0199865
Grayson, P. C., Kim, S. Y., LaValley, M., & Choi, H. K. (2011). Hyperuricemia and incident hypertension: a systematic review and meta-analysis. Arthritis care & research, 63(1), 102-110. https://doi.org/10.1002/acr.20344
Johnson, R. J., Kang, D. H., Feig, D., Kivlighn, S., Kanellis, J., Watanabe, S., Tuttle, K. R., Rodriguez-Iturbe, B., Herrera-Acosta, J., & Mazzali, M. (2003). Is there a pathogenetic role for uric acid in hypertension and cardiovascular and renal disease?. Hypertension, 41(6), 1183-1190. https://doi.org/10.1161/01.HYP.0000069700.62727.C5
Perlstein, T. S., Gumieniak, O., Hopkins, P. N., Murphey, L. J., Brown, N. J., Williams, G. H., Hollenberg, N. K., & Fisher, N. D. (2004). Uric acid and the state of the intrarenal renin-angiotensin system in humans. Kidney international, 66(4), 1465-1470. https://doi.org/10.1111/j.1523-1755.2004.00909.x
Golovach, I. Yu., Yehudina, Ye. D., & Khaniukov, O. O. (2019). Podagra, kardiovaskulyarnye riski i serdechno-sosudistye zabolevaniya: kristallicheskaya nerazberikha [Gout, cardiovascular risks and cardiovascular diseases: crystal confusion]. Arterialna hipertenziia, (2), 5-19. [in Ukrainian]. https://doi.org/10.22141/2224-1485.2.64.2019.168750
Ofori, S. N., & Odia, O. J. (2014). Serum uric acid and target organ damage in essential hypertension. Vascular health and risk management, 10, 253-261. https://doi.org/10.2147/VHRM.S61363
Khimion, L. V. & Timoshchuk, L. S. (2017). Suchasni pohliady na diahnostyku urazhennia nyrok u khvorykh z arterialnoiu hipertenziieiu z metoiu rannoi profilaktyky [The modern views to diagnosis of kidney damage in patients with arterial hypertension for early prevention]. Ukrainskyi zhurnal nefrolohii ta dializu, (3), 12-16. [in Ukrainian].
Ivankova, A. V. & Ivanova, E. I. (2017). Stan funktsii nyrok u khvorykh na hipertonichnu khvorobu z riznymy formamy ekstrasystolii [Nursing Function Condition in Patients with Hypertonic Disease Including Different Forms of Extrasistoly]. Ukrainskyi zhurnal medytsyny, biolohii ta sportu, (4), 64-67. [in Ukrainian].
Koroliuk, O. (2018). Hipertrofiia livoho shlunochka pry arterialnii hipertenzii: suchasni uiavlennia ta diahnostychno-likuvalnyi pidkhid [Left ventricular hypertrophy in hypertension: modern ideas and diagnostic and therapeutic approach]. Zdorovia Ukrainy, (23), 21-22. [in Ukrainian].
Nyushko, T. Yu. (2015). Strukturno-funktsionalni zminy livoho shlunochka ta sudyn u khvorykh na hipertonichnu khvorobu II stadii v zalezhnosti vid typu dobovoho profiliu arterialnoho tysku [Structural and functional changes of the left ventricle and vessels in the patients with essential hypertension of the 2nd stage depending on the type of the daily profile of arterial pressure]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu, 19(2), 379-385. [in Ukrainian].
Ingle, V. V. (2017). Study of diastolic dysfunction in essential hypertension patients in relation to age and duration of treatment. International Journal of Advances in Medicine, 4(5), 1447-1450. http://dx.doi.org/10.18203/2349-3933.ijam20174301
Sáez, G. C., González, H. R., & López, D. G. (2019). Afectación atrial izquierda en pacientes con hipertensión arterial no complicados. Revista Cubana de Cardiología y Cirugía Cardiovascular, 25(3), 273-285.
Tenekecioglu, E., Agca, F. V., Ozluk, O. A., Karaagac, K., Demir, S., Peker, T., Kuzeytemiz, M., Senturk, M., & Yilmaz, M. (2014). Disturbed Left Atrial Function is Associated with Paroxysmal Atrial Fibrillation in Hypertension. Arquivos brasileiros de cardiologia, 102(3), 253-262. https://doi.org/10.5935/abc.20140009
Ztati, M., Bendriss, L., & Elkhatouri, A. (2017). Left atrium function assessment in hypertensive patients. International Journal of Advanced Research, 5, 963-967. http://dx.doi.org/10.21474/IJAR01/4804
Hrebenyk, M. V., & Kotsyuba, O. I. (2016). Correction particularities of left ventrical diastolic dysfunction in patients with essential arterial hypertension with hyperuricemia. Liky Ukrainy, (3), 62-65. [in Ukrainian]. https://doi.org/10.37987/1997-9894.2016.3(199).203676
Gozhenko, A. I., Kovalevskaya, L. A., & Telyatnikov, O. V. (2015). U poshukakh universalnoho biomarkeru hostroho ushkodzhennia nyrok pry hostromu koronarnomu syndromi (ohliad literatury) [In search of universal biomarkers of acute kidney damage in acute coronary syndromes]. Aktualni problemy transportnoi medytsyny: navkolyshnie seredovyshche; profesiine zdorovia; patolohiia, (4), 33-44. [in Ukrainian].
Kraydashenko, O. V., & Dolinna, M. A. (2015). Tsystatyn S syrovatky krovi yak marker hlomeruliarnoho urazhennia nyrok u khvorykh na khronichnyi hlomerulonefryt zi zberezhenoiu funktsiieiu nyrok [Serum cystatin C as a marker of glomerular kidney damage in patients with chronic glomerulonephritis with saved renal function]. Zaporozhye medical journal, (3), 29-33. [in Ukrainian].
Shulkina,S. G. & Smirnova, E. N. (2017). Diagnosticheskoe znachenie tsistatina S i kollagena IV tipa u bol'nykh arterial'noi gipertenziei i ozhireniem [Diagnostic value of сystatin c and collagen type IV in patients with hypertension and obesity]. Arterial'naya gipertenziya, 23(6), 552-560. [in Russian]. https://doi.org/10.18705/1607-419X-2017-23-6-552-560
Fernando, S., & Polkinghorne, K. R. (2020). Cystatin C: not just a marker of kidney function. Jornal brasileiro de nefrologia, 42(1), 6-7. https://doi.org/10.1590/2175-8239-JBN-2019-0240
Han, J., Gao, Y., Guo, Q., Su, D., Yan, B., Peng, L., Du, Y., Li, K., & Wang, G. (2016). Cross-sectional study on the relationship between the level of serum cystatin C and blood pressure reverse dipping in hypertensive patients. BMJ open, 6(9), e011166. https://doi.org/10.1136/bmjopen-2016-011166
Kolesnyk, M. Yu. (2015). Tsystatyn C yak marker remodeliuvannia miokarda v cholovikiv z arterialnoiu hipertenziieiu bez khronichnoi khvoroby nyrok [Cystatin C as marker of myocardial remodeling in hypertensive males without chronic kidney disease]. Sertse i sudyny, (3), 73-79. [in Ukrainian].
Wali, U., Hussain, M. M., Wali, N., Nadeem, A., & Majeed, F. (2019). Comparison of serum levels of Cystatin-C and traditional renal biomarkers for the early detection of pre-hypertensive nephropathy. JPMA. The Journal of the Pakistan Medical Association, 69(3), 313-319.
Vasilyeva, M. P., Rudenko, T. Ye., Kutyrina, I. M., & Solomakhina, N. I. (2015). Tsistatin S − novyi marker gipertrofii miokarda levogo zheludochka u patsientov s khronicheskoi bolezn'yu pochek [Cystatin C is a new marker for left ventricular hypertrophy in patients with chronic kidney disease]. Terapevticheskii arkhiv, 87(6), 17-22. [in Russian]. https://doi.org/10.17513/spno.29538
Kushnarenko, N. N., Medvedeva, T. A., Govorin, A. V., & Mishko, M. Yu. (2018). Tsistatin C v diagnostike preklinicheskogo porazheniia pochek u bolnykh podagroi [Cystatin C in the diagnosis of pre-clinical kidney injury in patients with gout]. Nefrologiya, 22(1), 75-82. [in Russian]. https://doi.org/10.24884/1561-6274-2018-22-1-75-82
Yakubtsevich, R. E., Spas, V. V., & Protasevich, P. P. (2016). Sovremennye podkhody k otsenke ostrogo povrezhdeniya pochek (novye kriterii otsenki pochechnogo povrezhdeniya). Chast' 2 [Current approaches to acute renal failure assessment (new criteria of acute renal failure assessment). Part 2]. Journal of the Grodno State Medical University, (3), 6-11. [in Russian].
Mironova, S. A., Yudina, Yu. S., Ionov, M. V., Avdonina, N. G., Emelyanov, I. V., Vasil’eva, E. Yu., Zvartau, N. E., & Konradi, A. O. (2018). Markery porazheniia pochek u bolnykh arterialnoi gipertenziiei: novyie protiv starykh [Biomarkers of kidney injury in hypertension: conventional versus novel]. Arterial'naya gipertenziya, 21(2), 223-236. [in Russian]. https://doi.org/10.18705/1607-419X-2018-24-2-223-236
Urazayeva, L. I., & Maksudova, A. N. (2014). Biomarkery rannego povrezhdeniya pochek: obzor literatury [Biomarkers of early renal injury: review of literature]. Prakticheskaya meditsina, (4), 125-130. [in Russian].
Mishchenko L. A. (2018). Kombinovana antyhipertenzyvna terapiia: kryterii vyboru preparative [Combination antihypertensive therapy: criteria for drug selection]. Ukrainskii medychnyi chasopys, (2), 1-5. [in Ukrainian].
Bentsa, T. M. (2020). Obgruntuvannia vyboru antyhipertenzyvnykh preparativ dlia likuvannia patsiientiv iz arterialnoiu hipertenziieiu ta komorbidnoiu patolohiieiu [Rationale for the choice of antihypertensive drugs in patients with arterial hypertension and comorbid pathology]. Liky Ukrainy, (6-7), 19-23. https://doi.org/10.37987/1997-9894.2020.6-7(242-3).212667
Meretskyy, V. M. (2015). Zastosuvannia blokatoriv retseptoriv anhiotenzynu II v likuvanni arterialnoi hipertenzii [Using of angiotensin II receptor blockers in treatment of hypertension]. Zdobutky klinichnoi i eksperymentalnoi medytsyny, (1), 98-101. [in Ukrainian].
Zalevska, T. D. (2017). Pleiotropni efekty preparativ, shcho pryhnichuiut aktyvnist renin-anhiotenzynovoi systemy, yikh znachennia dlia klinichnoi praktyky [Pleiotropic effects of drugs suppressing renin-angiotensin system activity, their importance for clinical practice]. Ukrainskyi kardiolohichnyi zhurnal, (3), 73-78. [in Ukrainian].
Kambachokovam, Z. A., & Aramisovam, R. M. (2018). Trudnosti vedeniya patsientov s podagroi na fone komorbidnykh sostoyanii [Difficulties of Gout Management in Patients with Comorbid Conditions]. Trudnyi patsient, 16(6), 46-52. [in Russian].
Ivanov, V. P. (2013). Blokatory retseptoriv do angiotenzinu II: aspekty klinichnogo zastosuvannia v terapevtychnii praktytsi [Angiotensin II receptor blockers: aspects of clinical use in therapeutic practice]. Ukrainskyi medychnyi chasopys, (1), 97-101. [in Ukrainian].
Nieradko-Iwanicka B. (2018). What is the role of angiotensin receptor blockers in treatment of hyperuricemia coexisting with arterial hypertension?. Reumatologia, 56(2), 106-110. https://doi.org/10.5114/reum.2018.75522
Trisvetova, E. L. (2014). Lozartan v lechenii arterial'noi gipertenzii i komorbidnosti: dostizhenie neskol'kikh tselei [Losartan in the treatment of hypertension and comorbidity: achieving several goals]. Meditsinskie novosti, (8), 20-24. [in Russian].
Ueno, S., Hamada, T., Taniguchi, S., Ohtani, N., Miyazaki, S., Mizuta, E., Ohtahara, A., Ogino, K., Yoshida, A., Kuwabara, M., Yoshida, K., Ninomiya, H., Kotake, H., Taufiq, F., Yamamoto, K., & Hisatome, I. (2016). Effect of Antihypertensive Drugs on Uric Acid Metabolism in Patients with Hypertension: Cross-Sectional Cohort Study. Drug research, 66(12), 628-632. https://doi.org/10.1055/s-0042-113183
Høieggen, A., Alderman, M. H., Kjeldsen, S. E., Julius, S., Devereux, R. B., De Faire, U., Fyhrquist, F., Ibsen, H., Kristianson, K., Lederballe-Pedersen, O., Lindholm, L. H., Nieminen, M. S., Omvik, P., Oparil, S., Wedel, H., Chen, C., Dahlöf, B., & LIFE Study Group (2004). The impact of serum uric acid on cardiovascular outcomes in the LIFE study. Kidney international, 65(3), 1041-1049. https://doi.org/10.1111/j.1523-1755.2004.00484.x
Fares, H., DiNicolantonio, J. J., O'Keefe, J. H., & Lavie, C. J. (2016). Amlodipine in hypertension: a first-line agent with efficacy for improving blood pressure and patient outcomes. Open heart, 3(2), e000473. https://doi.org/10.1136/openhrt-2016-000473
Kosarev, V. V., & Babanov, S. A. (2013) Ratsional'naya farmakoterapiya arterial'noi gipertenzii i assotsiirovannykh sostoyanii: v fokuse [Rational pharmacotherapy for hypertension and associated conditions: Focus on calcium antagonists]. Kardiosomatika, (4), 16-22. [in Russian].
Choi, H. K., Soriano, L. C., Zhang, Y., & Rodríguez, L. A. (2012). Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ, 344, d8190. https://doi.org/10.1136/bmj.d8190
FitzGerald, J. D., Dalbeth, N., Mikuls, T., Brignardello-Petersen, R., Guyatt, G., Abeles, A. M., Gelber, A. C., Harrold, L. R., Khanna, D., King, C., Levy, G., Libbey, C., Mount, D., Pillinger, M. H., Rosenthal, A., Singh, J. A., Sims, J. E., Smith, B. J., Wenger, N. S., Bae, S. S., … Neogi, T. (2020). 2020 American College of Rheumatology Guideline for the Management of Gout. Arthritis care & research, 72(6), 744-760. https://doi.org/10.1002/acr.24180
Khaniukov, O. O., Yehudina, Ye. D., Kalashnykova, & O. S. (2018). Arterialna hipertenziia u patsiientiv z hiperurykemiieiu osnovy patohenezu, klinichne znachennia, diahnostyka [Arterial hypertension in patients with hyperuricemia: the basis of pathogenesis, clinical significance, diagnosis, approaches to treatment]. Arterialna hipertenziia, (3), 37-49. [in Ukrainian]. https://doi.org/10.22141/2224-1485.3.59.2018.139904
Seth, R., Kydd, A. S., Buchbinder, R., Bombardier, C., & Edwards, C. J. (2014). Allopurinol for chronic gout. The Cochrane database of systematic reviews, (10), CD006077. https://doi.org/10.1002/14651858.CD006077.pub3
Dubreuil, M., Zhu, Y., Zhang, Y., Seeger, J. D., Lu, N., Rho, Y. H., & Choi, H. K. (2015). Allopurinol initiation and all-cause mortality in the general population. Annals of the rheumatic diseases, 74(7), 1368-1372. https://doi.org/10.1136/annrheumdis-2014-205269
Zhao, J. D., Dong, P. S., Jia, J. J., Zhao, D., Wang, H. L., Li, D.-L., Yang, X.-M., & Zhang, H. F. (2018). Allopurinol to influence blood pressure in hypertension patients: systematic review and meta-analysis. International journal of clinical and experimental medicine, 11(3), 1390-1400.
Kao, M. P., Ang, D. S., Gandy, S. J., Nadir, M. A., Houston, J. G., Lang, C. C., & Struthers, A. D. (2011). Allopurinol benefits left ventricular mass and endothelial dysfunction in chronic kidney disease. Journal of the American Society of Nephrology : JASN, 22(7), 1382-1389. https://doi.org/10.1681/ASN.2010111185
Landmesser, U., Spiekermann, S., Preuss, C., Sorrentino, S., Fischer, D., Manes, C., Mueller, M., & Drexler, H. (2007). Angiotensin II induces endothelial xanthine oxidase activation: role for endothelial dysfunction in patients with coronary disease. Arteriosclerosis, thrombosis, and vascular biology, 27(4), 943-948. https://doi.org/10.1161/01.ATV.0000258415.32883.bf
MacIsaac, R. L., Salatzki, J., Higgins, P., Walters, M. R., Padmanabhan, S., Dominiczak, A. F., Touyz, R. M., & Dawson, J. (2016). Allopurinol and Cardiovascular Outcomes in Adults With Hypertension. Hypertension, 67(3), 535-540. https://doi.org/10.1161/HYPERTENSIONAHA.115.06344
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
