PHENOTYPES OF HYPERTENSION IN PATIENTS WITH PRIMARY AND SECONDARY GLOMERULAR DISEASE

 

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PHENOTYPES OF HYPERTENSION IN PATIENTS WITH PRIMARY AND SECONDARY GLOMERULAR DISEASE

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Bibisoro
Komilova
Bibisoro Komilova drkomilova0404@gmail.com Khatlon State Medical University Internal Medicine Dushanbe Tajikistan *
Natalia Kozlovskaya nkozlovskaya@yandex.ru Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
Ksenia Demyanova ksedem@gmail.com Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
Elezaveta Kotova mauschen@inbox.ru Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
Tatiana Bondarenko tatiana.v.bondarenko@mail.ru State Budget Healthcare Institution of Moscow Healthcare Department “City Hospital n.a.A.K. Eramishantsev Nephrology Moscow Russia -
Mariya Kozachenko kozachenkomg@gmail.com State Budget Healthcare Institution of Moscow Healthcare Department “City Hospital n.a.A.K. Eramishantsev Nephrology Moscow Russia -
Alexia Sinforosa Eyenga Odjama Nchama Alex.sinfo@mail.ru Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
Nasimzhon Fozilov doc.fozilov@yandex.ru Khatlon State Medical University Internal Medicine Dushanbe Tajikistan -
Shirin Geldieva shiringeldieva7@gmail.com Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
Zhanna Kobalava zkobalava@mail.ru Peoples' Friendship University of Russia Internal Medicine Moscow Russia -
 
 
 
 
 

Hypertension (HTN) is closely associated with glomerular diseases (GD). Elevated blood pressure (BP) significantly contributes to the progression of chronic kidney disease (CKD), impacts treatment outcomes and prognosis. Despite significant progress in reducing cardiovascular mortality, the risk of fatal outcome with a combination of kidney damage of any etiology and HTN increases. The combination of HTN with kidney damage in diabetes mellitus (DM) and with an estimated glomerular filtration rate (eGFR) of <60 ml/min has been extensively studied, while the combination of HTN with primary GD and kidney damage in systemic diseases remains insufficiently studied. Therefore, the aim of our study is to investigate the prevalence and clinical features of HTN phenotypes in patients with GD

A single-center, observational cohort study was conducted. The study included 93 patients (56% M , median age 46 years) with primary glomerulonephritis n=81 (87%, 66 (71%) patients with biopsy-proven) and kidney damage in systemic diseases n=12 (13%). Office BP was measured three times in both arms for all patients. Ambulatory blood pressure monitoring (ABPM) was performed in 66 (71%) patients according to the standard protocol. Clinical HTN was defined as office BP ≥140/90 mm Hg, while ambulatory HTN was defined as a 24-hour average BP ≥130/80 mm Hg. The BP phenotypes were identified: masked HTN - office BP ≤140/90 mm Hg with ambulatory BP >130/80 mm Hg; normotension - office BP <140/90 mm Hg with ambulatory BP <130/80 mm Hg; sustained HTN - office BP ≥140/90 mm Hg with ambulatory BP ≥130/80 mm Hg; nocturnal HTN - nighttime systolic BP ≥120 mm Hg and/or diastolic BP ≥70 mm Hg; isolated nocturnal HTN - daytime BP <135/85 mm Hg with nighttime BP ≥120/70 mm Hg.

Blood pressure phenotypes (n=66)Office blood BP ≥140/90 mm Hg was detected in 65 (60%) patients. ABPM was performed in 66 patients, including those with office BP ≤140/90 mm Hg. According to ABPM results, sustained HTN was identified in 26 (39.4%) patients, masked HTN in 13 (19.7%), and isolated nocturnal HTN in 4 (6.1%). All patients with newly diagnosed masked HTN had normal office BP readings. Normotension was confirmed in 23 patients (34.8%). (Figure 1) The most common nocturnal systolic BP profile was the non-dipper pattern (36.3%).

In ¼ of patients with GD ABPM reveals specific phenotypes: masked HTN (19.7%) and isolated nocturnal HTN (6.1%). As eGFR declines, the HTN phenotype changes, with sustained AH becoming predominant starting from CKD stage 3b. These findings highlight the inadequacy of single office BP measurements for assessing the true BP profile in patients with GD. Wider implementation of ABPM is necessary for the timely diagnosis of HTN in patients with early-stage CKD and for guiding appropriate antihypertensive treatment.

Kewords