Clinical Characteristics of Severe Hypertensive Patients with Improved Renal Dysfunction after Blood Pressure Control / 대한신장학회잡지

ABSTRACT

BACKGROUND: Mild renal dysfunction is relatively common in patients with long standing primary hypertension, ranging from 10% to 40% in various studies. The presence of renal dysfunction is associated with high cardiovascular mortality and morbidity rates of patients with primary hypertension. The purpose of this study is to analyze the clinical characteristics of patients with severe hypertension and reVersible renal dysfunction after blood pressure control. METHODS: This retrospective study enrolled 14 patients with severe hypertension and reVersible renal dysfunction after blood pressure control, between January 1993 and December 2002 at Kangnam St. Mary's Hospital and St. Paul's Hospital. We investigated the laboratory data using Wilcoxon signed rank test, and analysed renal biopsy findings and antihypertensive drugs. RESULTS: The mean age of the patients was 38+/-9 years and the number of male patients was 8. During 33.5+/-28.8 months of mean follow-up period, there was a significant decrease in mean arterial pressure and serum creatinine level, and significant increase in hematocrit level. But there was no significant changes in the level of uric acid, total cholesterol, and triglyceride. Each patient took more than 3 antihypertensive drugs consisting angiotensin converting enzyme inhibitor or angiotensin II receptor blocker (22%), calcium channel blocker (21%), and beta blocker (21%). Renal biopsy was done in 6 cases, and histologic diagnosis resulted in 4 cases of benign hypertensive nephrosclerosis and 2 cases of IgA nephropathy. The typical morphological features of hypertensive nephrosclerosis were seen in all cases, and there were varying degrees of glomerular sclerosis from 0% to 92%. But the percent of glomerular sclerosis was not related to the level of initial serum creatinine, mean arterial pressure, and amount of proteinuria per day. CONCLUSION: Careful monitoring of renal function and effective treatment of blood pressure are therefore mandatory in treating young patient with severe hypertension with renal dysfunction.