FEATURES OF SYSTEMIC HEMODYNAMICS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN COMBINATION WITH ARTERIAL HYPERTENSION DEPENDING ON THE STAGE OF RENAL DYSFUNCTION
Keywords:arterial hypertension, rheumatoid arthritis, chronic kidney disease.
The purpose of the work is to establish the dependence of systemic hemodynamic parameters in patients with rheumatoid arthritis (RA) in combination with arterial hypertension (AH) and decreased renal function.
Materials and methods. The results of studying the data of 99 patients, who were divided into two groups of patients: a) patients with RA in combination with hypertension and glomerular filtration rate (GFR) <60 mm/min/1.73 m2, b) with RA in combination with hypertension and GFR ≥60 mm/min/1.73m2. Laboratory (levels of rheumatoid factor, C-reactive protein (CRP) and creatinine) and instrumental (office blood pressure measurement, ambulatory monitoring of blood pressure (ABPM)) examination methods were carried out.
Results and their discussion. Patients with RA in combination with hypertension and GFR <60 mm/min/1.73m² are characterized by an increase in blood pressure (BP) more pronounced at night (p <0.05), which corresponds to the frequent definition of Night-peackers and Non- dippers (34.8% each). The presence of a more pronounced decrease in renal function causes worse control of both systolic and diastolic blood pressure (on average by 12.2%, p<0.01) and a higher degree of damage to target organs at night (on average by 15.1%, p<0.001). In patients with decreased renal function, insufficient blood pressure control is determined by female gender, older age, visceral manifestations, longer duration of RA and hypertension, and RA activity and seropositivity (p<0.05). The need to take non-steroidal anti-inflammatory drugs and glucocorticosteroids corresponds to an increase in the chances of blood pressure increase at night.
Conclusions. An increase in blood pressure in patients with RA combined with hypertension and a decrease in renal function is more significant at night, characterized by worse blood pressure control and a greater vascular load on organs and systems at night, indicating the need for stricter control of blood pressure during sleep in this cohort patients In patients with RA in combination with hypertension and GFR <60 mm/min/1.73m², Nightpeackers and Non-dippers are more frequently detected, which is prognostically more unfavorable for the development of nocturnal “vascular catastrophes”.
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