[PP.21.02] INDIVIDUALS WITH HYPERTENSIVE EMERGENCY PRESENT ASSOCIATION BETWEEN RENAL DYSFUNCTION AND INFLAMMATORY CYTOKINES

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Abstract

Objective:

Chronic hypertension and renal dysfunction are associated. However, scarce studies have evaluated the participation of the inflammatory process in the pathogenesis of acute elevation of blood pressure (BP) (characterized by hypertensive crisis - HC) and kidney dysfunction. Thus, this study had objectives: 1- to identify clinical profile and renal function of the individuals with HC, subdivided in urgency (HU) and hypertensive emergency (HE) and 2- to evaluate relationship between kidney function and inflammatory cytokines: interleukins (IL-1β,IL-6, IL-8, IL-18), tumoral necrosis factor (TNF-α) and anti-inflammatory cytokine 10 (IL-10) in subjects with HC (HU and HE).

Design and method:

We studied 274 individuals: 74 normotensive (NT), 74 controlled hypertensive (CHT), 50 with HU and 78 individuals with HE. The glomerular filtration rate (GFR) was calculated by the Modification of Diet in Renal Disease equation (MDRD). The serum levels of cytokines were made by MULTIPLEX and ELISA technique. The Kruskall Wallis and Mann Whitney tests, and Spearman correlation were used for comparison between groups, with a significance level for p-value <0.05.

Results:

The diastolic BP and heart rate were significantly higher in the HC group (120mmHg and 85bpm, respectively) compared to the CHT group (75mmHg and 68 bpm, respectively). Individuals with HE were older. Potassium was significantly lower in HE group (4,2mEq/l) compared to NT, CH and HU groups (4.5, 4.4 and 4.4mEq/L, respectively; p < 0.05). The GFR was significantly lower in HE group (65 ml/min/m2) in comparison to HU (73), CHT (82) and NT (88 mL/min/m2) (p < 0,001). All measured cytokines were significantly higher in patients with HE compared to NT and CHT groups. It was observed negative correlation among GFR, diastolic BP, and creatinine for all the groups (p < 0,0001). There was also negative correlation between GFR and cytokines in HE individuals (p < 0,05).

Conclusions:

Individuals with HE present GFR reduction in comparison to others studied groups. It is also observed higher cytokines levels in HE group and negative correlation between GFR and inflammatory cytokines. This suggests the involvement of inflammatory cytokines in the pathogenesis of acute hypertensive event and kidney dysfunction.

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