Effect of Antihypertensive Agents on Renal Function

2015 ◽  
pp. 54-62
Author(s):  
P. L. Malini ◽  
E. Ambrosioni
Keyword(s):  
Renal Function ◽  
Antihypertensive Agents

scholarly journals Effect of Anti-Hypertensive Drugs on Blood Pressure Lowering and Renal Function

2019 ◽  
pp. 1-14
Author(s):  
Olugbenga M. Ajulo ◽  
Oluwatoyin H. Ajulo ◽  
Blessing W. Anietimfon ◽  
Idongesit O. Umoh
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Teaching Hospital ◽  
Phase 1 ◽  
Antihypertensive Agents ◽  
Healthcare Facility ◽  
Drug Regimen ◽  
Antihypertensive Medications ◽  
Hypertensive Patients ◽  
Lowering Effect

Aim: Study aimed at evaluating blood pressure (BP) lowering effect of antihypertensive medications and their effect on renal function. Study Design: This was a progressive observational study, evaluating the lowering effect of selected antihypertensive agents on BP and renal functions of hypertensive patients. Study Location: The study involved moderately hypertensive patients who attended Cardiology clinic and were already receiving antihypertensive drug regimen at the University of Uyo Teaching Hospital, Uyo, Akwa-Ibom state, Nigeria. University of Uyo Teaching Hospital is a tertiary healthcare facility that was established in 1999. Methods: Seventy hypertensive patients who received antihypertensive medications for at least 6 months were recruited for the study. The recruited participants were advised on adherence and were given adherence chart to record time of medication used. A 3 ml blood was collected and Omron digital BP meter was used to take three separate BP readings and the average was recorded. The blood samples were analysed in the laboratory for serum creatinine (Scr) by using Randox’s Scr and blood urea nitrogen (BUN) kits. The Scr was used to calculate the creatinine clearance (CrCl) by using Corkcroft-Gault equation. Participants were followed-up for three months consecutively. Statistical analysis was considered significant at p=.05. SPSS version 20 was used for the analysis. Results: Systolic blood pressure (SBP) reduced from 130±2.64 mmHg in phase 1 to 120±1.13 mmHg in phase 3 while CrCl increased from 82.01±4.49 ml/min to 91.62±4.35 ml/min respectively. Both SBP and BUN were higher in females (131±3.30 mmHg and 2.67±0.19 µmol/l)                         while CrCl was higher in males (102.06±8.91 ml/min). Amlodipine (AM) reduced SBP by                           9 mmHg, Lisinopril+Hydrochlorothiazide (LH) reduced SBP by 7 mmHg and Lisinopril+Amlodipine+Hydrochlorothiazide (LAH) reduced SBP by 22 mmHg. CrCl decreased among participants on AM, LH and LAH by 0.89 ml/min, 0.01 ml/min and 8 ml/min respectively. Conclusion: Antihypertensive medications reduced SBP especially in three-drug combinations but worsened renal function.

scholarly journals P1806OUTCOMES OF PEDIATRIC RENOVASCULAR HYPERTENSON: A SINGLE-CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jiwon Jung ◽  
Joo Hoon Lee ◽  
Kun suk Kim ◽  
Young Seo Park
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Blood Pressure Control ◽  
Antihypertensive Agents ◽  
Good Control ◽  
Pressure Control ◽  
Renovascular Disease ◽  
Antihypertensive Medications

Abstract Background and Aims Renovascular disease is rare but important treatable cause of secondary hypertension in children. We aimed to evaluate the clinical presentations and long-term outcomes of pediatric patients with renovascular hypertension (RVH). Method We retrospectively reviewed medical records of patients with renovascular disease at our center between 1994 and 2019. Clinical courses including status of hypertension control with preservation of renal function during follow up were evaluated. Results 20 patients were diagnosed with RVH. 50 % (n = 10) were male, and median age at diagnosis was 10.1 (range 1.3 – 17.2) years, and median follow up period was 8.7 (range 0.1 – 24.6) years. 50 % (n = 10) presented with incidently detected high blood pressure (8 patients without symptoms, one with headache, and the other one with proteinuria), 25 % (n = 5) first admitted due to heart failure symptoms, and the rest (25 %, n = 5) presented with neurologic symptoms including seizure or paraplegia. Majority had no underlying disease except for 3 patients with Moyamoya disease. 80 % (n = 16) had unilateral renovascular stenosis. All patients showed elevated basal random renin activity (median 20.0, range 2.5 – 62.1 ng/ml/hr), and 45 % (n = 9) patients showed elevated basal random aldosterone level (median 822, range 266 – 2440 pg/ml). All patients needed antihypertensive medications for blood pressure control; 35 % (n = 7) of patients gained good control of blood pressure only with antihypertensive agents including angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), 40 % (n = 8) of patients who underwent percutaneous transluminal angioplasty all still needed antihypertensive agents including ACEI for blood pressure control. 20 % (n = 4) of the patients initially showed profoundly low relative function of involved kidney on diuretic scan, leading to nephrectomy. Three of these patients with nephrectomy successfully discontinued all antihypertensive agent gaining good control of blood pressure. The remaining one patient showed progressive deterioration of relative function on the involved side of kidney during 13 years, ended up with nephrectomy, but couldn’t discontinue ACEI. Glomerular filtration rate (GFR) was within normal range for all patients at diagnosis. For patients without nephrectomy, mean relative function of the involved kidney on diuretic scan was 33.5 ± 11.4 % at diagnosis. There was no significant change or deterioration of relative renal function during a mean follow up period of 10 ± 8 (median 11.5, range 0 – 19.5) years, although they all used ACEI/ARB. All patients including patients with nephrectomy showed normal GFR with a mean of 114.1 ± 19.5 ml/min/1.73 m2 at the last follow up. Conclusion Antihypertensive medications including ACEI and ARB were safely used with no further deterioration of the renal function of the involved side with or without angioplasty. Pediatric RVH is well managed with preserved renal function in long-term follow up.

scholarly journals Efficacy of Antihypertensive Therapy in a Child with Unilateral Focal Fibromuscular Dysplasia of the Renal Artery: A Case Study and Review of Literature

Medicines ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. 9
Author(s):  
Ratna Acharya ◽  
Savannah Ellenwood ◽  
Kiran Upadhyay
Keyword(s):  
Renal Function ◽  
Renal Artery ◽  
Antihypertensive Therapy ◽  
Medical Management ◽  
Fibromuscular Dysplasia ◽  
Surgical Intervention ◽  
Antihypertensive Agents ◽  
Review Of Literature ◽  
Surgical Revascularization ◽  
Blood Pressures

Background: Fibromuscular dysplasia (FMD) is one of the important etiologies of renovascular hypertension in children. It is usually resistant to multiple antihypertensive agents and can cause extreme elevation in blood pressures, which can lead to end organ damage if not promptly diagnosed and treated. Treatment options include medical management with antihypertensive agents, balloon or stent angioplasties, surgical revascularization, and nephrectomy. The aim of the study was to review the efficacy of antihypertensive therapy only in the management of FMD in a very young child. Methods: This is a retrospective chart study with review of literature. Results: Here, we report a 22-month-old toddler who presented with severe resistant hypertension and cardiomyopathy who was found to have focal FMD of the right renal artery. She also presented with proteinuria, hyponatremia that was probably secondary to pressure natriuresis, hypokalemia, hyperaldosteronism, and elevated plasma renin activity. The stabilization of blood pressures was done medically with the usage of antihypertensive medications only, without the need for angioplasty or surgical revascularization. Conclusions: We demonstrate that surgical intervention may not always be necessary in the treatment of all cases of FMD, especially in a small child where such intervention may be technically challenging and lead to potential complications. Hence, medical management alone may be sufficient, at least for the short-term, in small children with controlled hypertension and normal renal function, with surgical intervention reserved for FMD with medication-refractory hypertension and/or compromised renal function.

Therapeutic Options for Preservation of Residual Renal Function in Patients on Peritoneal Dialysis

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 158-163
Author(s):  
Philip KamTao Li ◽  
Yuk Lun Cheng
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Residual Renal Function ◽  
Phosphate Binders ◽  
Kidney Functions ◽  
The Impact ◽  
The Ideal

Dialysis is not the ideal renal replacement therapy because it does not fully restore all kidney functions. Increasing evidence suggests that preservation of residual renal function is associated with a survival benefit, a decrease in morbidity, better nutrition, a lower level of inflammatory markers, an improved quality of life, and cost savings by obviating the need for more peritoneal dialysis exchanges and possibly by reducing the requirement for antihypertensive agents, phosphate binders, and erythropoietin. In the present article, we review the impact of residual renal function on patient outcomes and the renoprotective strategies available in patients on peritoneal dialysis.

scholarly journals Kidney Function and Estimated Vascular Risk in Patients with Primary Dyslipidemia

2009 ◽  
Vol 3 (1) ◽  
pp. 57-68 ◽  
Author(s):  
Konstantinos Tziomalos ◽  
Emmanuel S Ganotakis ◽  
Irene F Gazi ◽  
Devaki R Nair ◽  
Dimitri P Mikhailidis
Keyword(s):  
Renal Function ◽  
Risk Stratification ◽  
Kidney Function ◽  
Predictive Accuracy ◽  
Antihypertensive Agents ◽  
Significant Negative Correlation ◽  
Lipid Lowering ◽  
Vascular Risk ◽  
Improve Risk Stratification ◽  
Framingham Risk

Background: Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation. Aim: To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia. Methods: Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation. Results: In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined. Conclusions: Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.

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