paloma manea, md,phd,faccp, lecturer, … · 2017-02-01 · comparison between hs-c reactive...
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![Page 1: Paloma Manea, MD,PhD,FACCP, Lecturer, … · 2017-02-01 · COMPARISON BETWEEN HS-C REACTIVE PROTEIN AND MICROALBUMINURIA LEVELS FOR THE PROGNOSIS OF RENOVASCULAR HYPERTENSION Paloma](https://reader030.vdocument.in/reader030/viewer/2022040814/5e5ad444101b4618b16aa66b/html5/thumbnails/1.jpg)
COMPARISON BETWEEN HS-C REACTIVE
PROTEIN AND MICROALBUMINURIA
LEVELS FOR THE PROGNOSIS OF
RENOVASCULAR HYPERTENSIONRENOVASCULAR HYPERTENSION
Paloma Manea, MD, PhD, FACCP,
Lecturer, “GrigoreT.Popa” University of
Medicine and Pharmacy, Iasi, Romania
“Promedicanon” Private Office, Iasi
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HISTORY OF RAA SYSTEM
1. 1898: Tigerstedt RENIN discovery
kidney extract rabbits hypertension
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HISTORY OF RAA SYSTEM
2. 1934 Goldblatt experimental renovascular hypertension
clampation of renal arteries hypertension
(dogs)
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HISTORY OF RAA SYSTEM
3. 1939 Braun- Menendez ANGIOTENSIN
renin
angiotensinogen angiotensin
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HISTORY OF RAA SYSTEM
4. 1993 Skeggs ANGIOTENSIN I , II
ACE
angiotensin I angiotensin II
hypertension
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INTRODUCTION
1.Renovascular hypertension diagnosis trap
2.Life threatening complications ( after ACEI !)
Dr. Paloma Manea ‘s collection
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INTRODUCTION
3.Modern therapy DISCORDANCE Practical reality
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PURPOSES
hsCRP / microAuria: prognosis markers + therapeutic implications
MATERIALS AND METHODS
76 patients ,43- 86 years , 67% males , renovascular hypertension, 24 months
1. Clinical examination : quarterly
- exclusion criteria : - actually smoker/ alcohol drinker
- evolutive neoplasia
- autoimmune disorders
- diabetes mellitus- diabetes mellitus
- obesity
- active infection
- inclusion criteria:
-difficult control of hypertension
-paradoxical hypertension after ACEI
-periumbilical bruits
clipartbest.com
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MATERIALS AND METHODS
2. EKG , quarterly: - standard 12 leads EKG - LVH
3. Ecocardiogram : -transthoracic, M mode, 2D mode
-color Doppler; continuous Doppler
LVH, LV mass, LV performance
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MATERIALS AND METHODS
4. Renal artery sonogram
peak velocity , resistivity index
5. Abdominal computed tomography angiogram
if sonogram ≠ clear
6. Laboratory findings : quarterly6. Laboratory findings : quarterly
Creatinine clearance, hs-C Reactive Protein, microAuria
7.M -Indapamide 1.5 mg, Amlodipine 5-10mg, Nebivolol 5-10 mg
-Atorvastatin 10-40 mg, Rilmenidine 1-2 mg
-Aspirin 100 mg/ Clopidogrel 75 mg/Acenocumarol 1-4 mg
8. Interventional : percutaneous angioplasty + stenting(RI < 0.8)
9.Dental treatment: scaling of dental plaque(biannual)
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Dental plaque bacteria (Porphyromonis gingivalis)
1. Interleukin 1 atheromatous plaque formation
2. Interleukin 6 CRP atheromatous plaque disruption
3. Repeated bacteriemia atheromatous plaque inflamation
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RESULTS
1. Clinical examination:
25
30
35
40
45
0
5
10
15
20
25
Periumbilical bruits Paradoxical hypertension after
ACEI
Dificult control of
hypertension
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RESULTS
2. EKG- LVH : 68 patients (89%)
Dr. Paloma Manea’s collection
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RESULTS
3.Echocardiography:
-LVH (wall thickness, mass)
Dr. Paloma Manea’s collection
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RESULTS
3. Echocardiography: - 19% diminished LVH (mass)
- 94%(1m) 75%(24m)
19%
20
30
40
50
60
70
80
Evolution of LVH mass during 24 months observation
0
10
20
3 m6 m
12 m15 m
18 m21 m
24 m
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RESULTS
3.Echocardiography:
- LV diastolic dysfunction
Dr. Paloma Manea’s collection
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Dr.Paloma Manea’s collection
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20
30
40
50
60
Types of diastolic dysfunction(LV)
0
10
20
type 1 type 2 type 3 type 4
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RESULTS
3.Echocardiography: -34% improved LV diastolic function
-80% (1m ) 54%(24m )
34%
50
60
70
Evolution of LV diastolic dysfunction
0
10
20
30
40
50
3 m6 m
9 m12 m
15 m18 m
21 m24 m
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RESULTS
3. Echocardiography:
- LV systolic dysfunction : segmentary kinetics
Dr.Paloma Manea’ s collection
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RESULTS
3. Echocardiography : -28% improved LV EF (EF>30%)
-51%(1m ) low EF 23% (24m)
28%
10
20
30
40
Evolution of significant LV systolic dysfunction (EF< 30%)
0
10
3 m 6 m
9 m12 m
15 m18 m
21 m24 m
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RESULTS
4. Renal arteries sonogram:
Dr.Corina Ursulescu’ s and Dr.Dragos Negru ‘s collection
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RESULTS
4. Renal arteries sonogram:
Dr.Corina Ursulescu’ s and Dr.Dragos Negru ‘s collection
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RESULTS
4. Renal arteries sonogram:
Dr.Corina Ursulescu’ s and Dr.Dragos Negru ‘s collection
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RESULTS
5.Abdominal computed tomography angiogram: 16 pts(21%)
Dr.Corina Ursulescu’s and Dr. Dragos Negru’s collection
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RESULTS
5.Abdominal computed tomography angiogram
Dr.Corina Ursulescu’s and Dr. Dragos Negru’s collection
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RESULTS
6. Laboratory findings:- 25% improved Creatinine clearance
- 53% (1m) low Cr clearance 28% (24m)
25%
50
Evolution of reduced Creatinine clearance
0
10
20
30
40
50
3 m 6 m
9 m12 m
15 m18 m
21 m24 m
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RESULTS
6. Laboratory findings:-48% diminished hs CRP (24m)
-high hsCRP 78%( 1m) 30% (24 m)
48%
-30% high hs CRP/ 28% low Creatinine clearance(p=0.006)
Evolution of pathological hs-CRP values
0
20
40
60
80
3 m6 m
9 m12 m
15 m18 m
21 m24 m
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RESULTS
6.Laboratory findings :-12% diminished microA uria(24m)
-micro A uria 58%(1m) 46%(24 m)
12%
-46% micro Auria / 28% low Creatinine clearance (p=0.004)
60
Evolution of pathological micro Auria
0
20
40
60
3 m6 m
9 m12 m
15 m18 m
21 m24 m
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CONCLUSIONS
1. After 24 m: -improved LV EF 28%
-improved LV diastolic function 34%
-diminished LVH (mass) 19%
-improved Creatinine clearance 25%
-diminished hs CRP 48%
-diminished microA uria 12%
2. hs CRP = a better prognosis marker then microAuria
30% high hs CRP / 46% microAuria / 28% low Creatinine clearance
3. Originality : dental treatment renovascular hypertension prognosis
4. Future direction: analysis of the renal artery atheromatous plaque( biopsy)
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ACKNOWLEDGEMENTS
1. Dr. Corina Ursulescu, Lecturer, Specialist in Radiology
2. Dr. Dragos Negru, Professor, Senior in Radiology
3. Dr. Irina Asandei, Specialist in Laboratory Medicine
4. Dr. Igor Nedelciuc , Specialist in Interventional Cardiology