Ancianos con hipertensión arterial esencial y filtrado glomerular disminuido: seguimiento de la función renal a los 24 meses / The elderly with essential high blood pressure and decreased glomerular filtration rate: a kidney function follow-up at 24 months

RESUMEN

Introducción y Objetivo: La prevalencia de la hipertensión arterial (HTA) en los ancianos es elevada. Su falta de control supone un factor de riesgo para la progresión del daño renal, siendo la HTA junto con la diabetes mellitus las principales causas de insuficiencia renal crónica (IRC). Analizamos la evolución de la función renal (FR) de ancianos con HTA a los 24 meses, considerando la influencia de la FR previa. Pacientes y métodos: Estudiamos a 66 ancianos con una edad media al comienzo del estudio de 82,3±6 años (rango 69–97), siendo varones un 24,2%, estables clínicamente, diagnosticados de HTA esencial. Los pacientes son valorados inicialmente entre enero-abril 2006 y seguidos prospectivamente durante 24 meses. Los ancianos procedían de consultas de Geriatría y Nefrología General y fueron seguidos durante el periodo de estudio por dichos servicios. Según las cifras basales de creatinina sérica (Crs), establecimos dos grupos grupo 1 (n=30, Crs<=1,1mg/dl) y grupo 2 (n=36, Crs>1,1mg/dl). Registramos el número y tipo de agentes antihipertensivos utilizados al inicio del estudio y a los 24 meses, así como la presión arterial (PA) ambulatoria previa a la consulta. Analizamos en sangre creatinina, urea, úrico, y estimamos el filtrado glomerular (FG) con fórmulas de Cockroft-Gault y MDRD abreviado. La estadística se hace con SPSS 11.0, usando un modelo lineal general para medidas repetidas, significación p<0,05. Resultados: Los parámetros de FR analizados de forma global permanecen sin cambios significativos con el paso del tiempo (basal/24 meses creatinina (mg/dl) 1,26±0,48/1,26±0,46 (no significativo); urea (mg/dl) 58,52±29/61,52±30 (no significativo); úrico (mg/dl) 5,94±1/6,13±1 (no significativo); FG (Cockroft) (ml/min) 41,33±13/40,32±14 (no significativo); FG (MDRD) (ml/min) 51,23±15/51,45±16 (no significativo). (..) (AU)

ABSTRACT

Introduction and objective: There prevalence of high blood pressure (HBP) in the elderly is high. Its lack of control is a risk factor for progression of kidney damage. HBP and Diabetes Mellitus are the principal causes of chronic renal failure (CRF). We have analyzed the evolution of the renal function (RF) in the elderly with HBP at 24 months, taking the influence of the previous RF into account. Patients and methods: A total of 66 clinically stable elderly subjects with essential HBP, average age 82.3±6 years (range 69–97) at the onset of the study, 24.2% men, were studied. The patients were evaluated initially between January-April, 2006 and followed-up for 24 months. The elderly subjects came from Geriatrics and General Nephrology Departments and were followed-up by the Departments in question during the study period. We established two groups according to the baseline serum creatinine values group 1 N=30, serum creatinine <=1.1mg/dl and group 2 N=36, serum creatinine >1.1mg/dl. Number and type of antihypertensive agents used at baseline and at 24 months and ambulatory blood pressure (BP) levels prior to the medical visit were recorded. The following were measured in blood creatinine, urea, and uric acid and glomerular filtration rate (GFR) were calculated with the Cockroft-Gault and abbreviated MDRD formulas. Statistics were obtained with the SPSS 11.0 using a generalized linear model with repeated measures, significance, p<0.05. Results: The RF parameters, when analyzed globally, showed no significant changes over time (baseline/24 months serum Creatinine (mg/dl) 1.26±0.48/ 1.26±0.46 (non-significant); urea (mg/dl) 58.52±29/61.52±30 (non-significant); uric acid (mg/dl) 5.94±1 /6.13±1 (non-significant); GFR (Cockroft) (ml/min) 41.33±13 / (..) (AU)