A new method of diagnostics of early subclinical renal damage in hypertensive patients: The potential benefits of various therapeutic approaches

Objective. To evaluate diagnostic value of renal collagen matrix injury in hypertensive patients and to estimate the benefits of antihypertensive therapy in renal dysfunction correction depending on the choice of management approach. Design and methods. A two-stage examination was performed. At the first stage diagnostic value of1^st type tissue inhibitor of matrix metalloproteinases (TIMP-1) was determined in hypertensive patients with normal glomerular filtration rate (GFR) and without microalbuminuria. Patients were divided into two groups depending on GFR level. The first group consisted of 16 patients with GFR more than 60 mL/min/1.73 sq.m; the second group consisted of 15 patients with GFR less than 60 mL/min/1.73 sq.m. At the second stage 60 hypertensive patients with renal dysfunction were divided into two equal groups depending on baseline antihypertensive therapy. Patients from the first group received the fixed combination of eprosartan mesylate 600 mg and hydrochlorthyazide 12.5 mg QID regardless of blood pressure level at the baseline. The second group received either enalapril as monotherapy or its different combinations with hydrochlorothyazide depending on blood pressure level and cardiovascular risk. Results. TIMP-1 increase from 138 to 183 ng/mL was observed in hypertensives with normal GFR and without microalbuminuria. In patients with GFR less than 60 mL/min/1.73 sq.m TIMP-1 level was higher than 183 ng/mL. During therapy patients in the first group showed reliably more expressed correction of renal dysfunction, than in the second one. Particularly, more evident deterioration of unfavorable renal extracellular collagen had been observed when fixed combination of eprosartan mesylate and hydrochlorothyazide was taken compared to enalapril as monotherapy or its different combinations with hydrochlorothyazide. Conclusions. Increased TIMP-1 level in hypertensive patients with normal GFR and without microalbuminuria can be a new method of detection of an early subclinical renal injury. Administration of the fixed combination of eprosartan mesylate and hydrochlorothyazide is the most effective antihypertensive strategy for renal dysfunction correction independently from baseline blood pressure level and cardiovascular risk in untreated hypertensive patients.

arterial hypertension, kidney, 1^st type tissue inhibitor of matrix metalloproteinases, combined antihypertensive therapy

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