scholarly journals Nephroprotective in patients with metabolic syndrome: approaches to the appointment of antihypertensive drugs

2016 ◽  
Vol 13 (2) ◽  
pp. 77-83
Author(s):  
O D Ostroumova ◽  
A A Zykova ◽  
M L Maksimov
Keyword(s):  
Metabolic Syndrome ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Arterial Hypertension ◽  
Renal Damage ◽  
Antihypertensive Drugs ◽  
Prognostic Significance ◽  
Mechanisms Of Development ◽  
Selection Of

In the article shows the questions of prevalence, diagnosis and prognostic significance of renal damage in metabolic syndrome. Discusses the pathogenetic mechanisms of development and progression of chronic kidney disease in individuals with obesity. Approaches to selection of antihypertensive drugs, advantages and limitations of the major classes of antihypertensive drugs in the treatment of metabolic syndrome, arterial hypertension combined with renal disease.

Proteinuria

2020 ◽  
Vol 13 (3) ◽  
pp. 152-158
Author(s):  
Lauren Copeland ◽  
Keith Gillis
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Kidney Disease ◽  
Early Detection ◽  
Renal Disease ◽  
Independent Risk Factor ◽  
Prognostic Significance ◽  
Urinary Protein ◽  
Progression Of Renal Disease

Measurement of urinary protein is an essential part of the evaluation of chronic kidney disease; it has both diagnostic and prognostic significance. Proteinuria is an independent risk factor for progression of renal disease, but is also independently associated with increased cardiovascular mortality. Despite its far-reaching implications, the definition, diagnosis and treatment of proteinuria can cause confusion in primary care. Early detection of proteinuria in the context of diabetes or otherwise is vital given the potential for intervention to reduce urinary protein losses and improve renal and cardiovascular outcomes. This article will focus on the definition, potential causes and management of proteinuria, including which individuals should be referred to secondary care.

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

scholarly journals Endothelin Receptor Antagonists (ERA) in Hypertension and Chronic Kidney Disease: a Rose with Many Thorns

2013 ◽  
Vol 5 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Doumas M ◽  
Athyros V ◽  
Katsiki N ◽  
Reklou A ◽  
Lazaridis A ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Drugs ◽  
Digital Ulcers ◽  
Endothelin Receptor Antagonists ◽  
Endothelin Receptor ◽  
Water Reabsorption ◽  
Receptor Antagonists ◽  
Pulmonary Arterial

The discovery of endothelin created a lot of enthusiasm and paved new therapeutic avenues for the treatment of arterial hypertension. Endothelin plays a significant role in blood pressure regulation through pronounced vasoconstriction and modulation of sodium and water reabsorption in the kidneys. Endothelin receptor antagonists have been tested in many clinical trials in patients with arterial hypertension, heart failure, pulmonary arterial hypertension, systemic sclerosis, chronic kidney disease, and diabetic nephropathy. However, the results were usually disappointing, except in pulmonary hypertension and scleroderma digital ulcers. The future of ERAs for the treatment of arterial hypertension and chronic kidney disease does not seem bright, and only the combination with other classes of antihypertensive drugs might offer a way out.

scholarly journals Possible Link between Metabolic Syndrome and Chronic Kidney Disease in the Development of Cardiovascular Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Kosaku Nitta
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Damage ◽  
Enzyme Inhibitor ◽  
Visceral Obesity ◽  
Developed Countries ◽  
Lifestyle Modifications ◽  
Renal Protection

Metabolic syndrome (MetS) is a clinical syndrome that consists of visceral obesity, dyslipidemia, hypertension, and impaired insulin sensitivity. Although individual components of MetS have been implicated in the development of chronic kidney disease (CKD), few studies have examined the effect of combinations of the components of MetS on the development of CKD and cardiovascular disease (CVD). The prevalence of MetS is increasing worldwide in both developing and developed countries, and early detection and treatment of MetS would be a cost-effective strategy for preventing the development of CKD. Visceral obesity and insulin resistance are two important features of MetS that may be associated with renal damage. Lifestyle modifications, including caloric restriction and exercise, are necessary to treat MetS. Initial antihypertensive therapy should consist of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. An improved understanding of the mechanism responsible for the association between MetS and renal damage should be helpful in determining the treatment regimens directed at cardiovascular and renal protection.

Fixed combination in patients with arterial hypertension: focus on antihypertensive and nephroprotective properties of fixed combination of lisinopril and amlodipine (clinical example)

2020 ◽  
pp. 19-28
Author(s):  
E. Yu. Ebzeeva ◽  
O. D. Ostroumova ◽  
N. M. Doldo ◽  
E. E. Pavleeva
Keyword(s):  
Kidney Disease ◽  
Arterial Hypertension ◽  
Fixed Combination ◽  
Enzyme Inhibitor ◽  
Antihypertensive Drugs ◽  
Adult Population ◽  
Secondary Damage ◽  
Dihydropyridine Calcium Channel Blocker ◽  
Based Medicine ◽  
Modern Population

Arterial hypertension (AH) remains one of the most significant medical and social problems in the world, its prevalence among the adult population is 30–45%. Along with this, the modern population is characterized by a high incidence of chronic kidney disease (CKD), including due to their secondary damage in the framework of hypertension. In turn, CKD is an important independent risk factor for the development and progression of cardiovascular diseases, including fatal ones. The use of existing approaches to nephroprotection in the treatment of patients with hypertension will significantly improve the prognosis both in patients with risk factors for developing renal dysfunction and in patients with pre-existing kidney disease. According to current recommendations for hypertension in such clinical situations, therapy should begin with fixed combinations of antihypertensive drugs. The combination of an angiotensin converting enzyme inhibitor (ACE) and a dihydropyridine calcium channel blocker (CCВ) demonstrated the greatest effectiveness according to evidence-based medicine in patients with high-risk hypertension, including from the standpoint of nephroprotection. In the presented clinical case, the successful use of a fixed combination of ACE and CCВ in a patient with hypertension and microalbuminuria is described.

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