th National Meeting of the Turkish Society of Hypertension and Renal Diseases 24 – 28 April , 2013

& 2013 International Society of Nephrology 392 Kidney International Supplements (2013) 3, 392–409 ORAL PRESENTATIONS (OP) OP 1 THE ROLE OF HYPERVOLEMIA IN THE PATHOPHYSIOLOGY OF HYPERTENSION: A POPULATION BASED STUDY ENDER HUR, MELİH OZİSİK, CİHAN URAL, GURSEL YİLDİZ, KEMAL MAGDEN, SENNUR BUDAK KOSE, FURUZAN KOKTURK, M. CAGATAY BUYUKUYSAL, IBRAHİM YİLDİRİM, GULTEKİN SULEYMANLAR, KENAN ATES, SONER DUMAN Bulent Ecevit University School of Medicine, Division of Nephrology, Zonguldak, Turkey; Ege University School of Medicine, Department of Internal Medicine, Izmir, Turkey; Ataturk State Hospital, Nephrology Unit, Zonguldak, Turkey; Istanbul Education and Research Hospital, Nephrology Clinic, Istanbul, Turkey; Bulent Ecevit University School of Medicine, Department of Biostatistics, Zonguldak, Turkey; Akdeniz University School of Medicine, Department of Nephrology, Antalya, Turkey; Ankara University school of Medicine, Department of Nephrology, Ankara, Turkey BACKGROUND: Although the relationship between hypervolemia and hypertension is known in patients with renal disease it has not been widely investigated in normal populations. The present study determined the fluid distribution changes with relation to blood pressure. METHODS: A population was surveyed in Turkey and demographics, height, weight, blood pressure, urine analysis and serum creatinine measurements were recorded. Bioimpedance was measured with the Body Composition Monitor. RESULTS: A total of 2034 subjects were included in the survey (71.6% male, mean age 47±12.6 (18–89) years, systolic blood pressure (SBP) 134.7±20, diastolic blood pressure 77.9±11.6 mm Hg, body mass index (BMI) 28.5±4.5 (15.8–50.6) kg/m2 and the overall over hydration index was 0.05±1.05 L) There was a correlation between extracellular water (ECW)/Height and SBP (r1⁄4 0.21, po0.001). Age, BMI, ECW/Height and BSA were significantly higher in normotensives than hypotensives and were even higher in hypertensives than both normotensives and hypotensives (Table 1). Fat tissue index (FTI) was higher in hypertensives than both normotensives and hypotensives. Smoking rate was lower in hypertensives compared to normotensives. Risk factors for high SBP were increased ECW/Height, age, BMI and presence of diabetes. ECW/Height, FTI and SBP increased as BMI increased, (po0.001) and in diabetics compared to non-diabetics (po0.001). FTI and SBP were lower in smokers than non-smokers (po0.001). Determinants of systolic blood pressure are given in Table 2. CONCLUSION: High blood pressure may be accompanied by increased extracellular fluid volume indices. Volume status assessment could be useful in evaluating the effectiveness of pharmacological intervention in the treatment of hypertension. OP 2 ANTIHYPERTENSIVE THERAPY IN PRIMARY GLOMERULAR DISEASES OKTAY ÖZKAN, SAVAŞ ÖZTÜRK, HATİCE KÜÇÜK, MELTEM GÜRSU, EGEMEN CEBECİ, ABDULLAH CEBECİ, MEHMET KÜÇÜK, RÜMEYZA KAZANCIOǦLU Haseki Training and Research Hospital, Division of Nephrology, İstanbul, Turkey; Haseki Training and Research Hospital, İstanbul, Turkey; Okmeydanỳ Training and Research Hospital, Division Nephrology, İstanbul, Turkey; Bezmi Alem University School of Medicine, Department of Nephrology, İstanbul, Turkey BACKGROUND: The primary objective of our study was to investigate effects of antihypertensive treatment on the level of proteinuria in patients with idiopathic focal segmental glomerulosclerosis (FSGS) or membranous glomerulonephritis (MGN). METHODS: The clinical and laboratory data of sixty-eight patients (38 male, 30 female) were recorded at three-month intervals during 18 months of follow-up (Table 1). Thirty-six patients had biopsy-proven idiopathic FSGS and 32 patients with MGN. All patients were on antihypertensive therapy including mostly renin-angiotensin system blocking agents (n1⁄4 58), nondihydropyridine calcium channel blockers (NDHPCCB) (n1⁄4 8), diuretics (n1⁄4 16) and other antihypertensives (n1⁄4 22). Thirtysix patients received additionally an immunosuppressive regimen. RESULTS: The mean age of the patients was 39.6±16.6 years. The patients with MGN were 7 years older than the FSGS group. At the beginning of the study, mean blood pressure was 129±25/81±15 mmHg; after the strict antihypertensive therapy period of 30 months it was decreased to 110±18/73±8 mmHg. Percentage of patients with systolic blood pressure o 125 mmHg was initially %54.4, then increased to 64.3 at 18th month and to %78.5 at 30th month. Percentage of patients with diastolic pressure o 75 mmHg improved from %30.9 at baseline to %53.5 to %57.1 at the end of the study. Proteinuria decreased from 4.19±3.85 g/day to 1.49±2.56 g/day after 18 months and then to 832±872 mg/day at 30th month. CONCLUSION: Optimal blood pressure control is extremely important for reduction of proteinuria and preserving renal function in patients with idiopathic FSGS and MGN. Table 1 | Study parameters in systolic blood pressure categories Parameter Hypotensives (SBPo110 mmHg) (n=133) Normotensives (SBP 110-139 mmHg) (n=1208) Hypertensives (SBP Z140 mmHg) (n=693) BMI (kg/m) 26.38±4.98 27.59±4.39 a 29.49±4.23 a* b* ECW/height (L/m) 9.93±1.58 10.34±1.32 a* 10.78±1.32 a* b* Age 41.47±11.69 44.36±12.38 a 52.84±11.23 a* b* FTI (kg/m) 10.46±5.12 11.22±5.26 13.23±5.14 a* b* BSA (m) 1.82±0.19 1.88±0.17 a* 1.91±0.16 a* b* TBW (L) 38.10±7.14 39.88±6.56 a 40.29±6.64 a* OH (L) 0.09±1.09 0.03±1.01 0.07±1.11 po 0.05, a: Group versus Hypotensives, b: Group versus Normotensives *po 0.001 SBP: Systolic blood pressure, BMI: Body mass index, ECW: Extracellular water, FTI: Fat tissue index, BSA: Body surface area, TBW: Total body water, OH: overhydration Table 2 | Logistic regression analysis for high systolic blood pressure Odds ratio 95% CI p value DM 1.581 1.177–2.124 0.002 ECW/height 1.104 1.003–1.215 0.043 BMI 1.058 1.027–1.090 0.000 Age 1.053 1.043–1.063 0.000 DM: Diabetes mellitus, ECW: Extracellular water, BMI: Body mass index, CI: confidence interval. In Model: OH/ECW, E/I, TBW, ECW/Height, Age, Gender, BMI, LTI, FTI, DM, Time, Smoking. Table 1 | Patients0 biochemical data of 18 months follow up Parameter 0 m 3 m 6 m 9 m 12 m 15 m 18 m Creatinine (mg/dl) 1.06±0.67 1.15±0.94 1.1±0.98 1.07± 1.03±0.72 0.92±0.32 1.03±0.68 Albumin (g/dl) 2.74±0.87 3.16±0.79 3.4±0.86 3.64±0.78 3.6±0.99 3.78±0.9 3.71±0.88 Total cholesterol (mg/dl) 301±107 263±74 242±70 221±83 211±77 209±74 203±77 Proteinuria (g/day) 4.19±3.85 3.43±2.95 2.73±2.47 2.55±3.18 2.33±3.12 1.95±5.63 1.49±2.56 Creatinine clearance (ml/min) 84±36 90±44 93±29 81±34 96±38 86±33 88±32 Kidney International Supplements (2013) 3, 392–409 393 a b s t r a c t s