INTRARENAL VASCULAR RESISTANCE IN PATIENTS WITH ARTERIAL HYPERTENSION AND DIABETES MELLITUS: RELATION TO THE LEVEL OF ARTERIAL BLOOD PRESSURE AND VALUE OF GLOMERULAR FILTRATION RATE
Aim: The aim of the study was to elucidate relationships of intrarenal vascular resistance (IVR) with clinical-laboratory parameters and arterial blood pressure (ABP) depending on glomerular filtration rate (GFR) in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). Materials and Methods: The study comprised 130 patients (40/90 m/f; 55.4±7.4 years) with AH and T2DM. Stage 3 chronic kidney disease (CKD) was documented in 11% of patients. 24-h ABP monitoring and ultrasound examination of intrarenal blood flow were performed; GFR was calculated by MDRD formula. Results: resistive index (RI) values in arciform arteries demonstrated positive correlation with patient age and pulse pressure and negative correlation with GFR and diastolic blood pressure during day and night hours (р<0.05). Compared with patients with normal GFR, patients with stage 3 CKD were older and had longer duration of AH (р<0.05). Significant increase in their RI at all levels of blood flow was caused by lower values of end-diastolic rate. Conclusions: In patients with AH and T2DM, the study showed close relationships between abnormal renal circulation, GFR, and increased values of mean 24-h pulse pressure due to decrease in diastolic blood pressure which was the most evident in patients with stage 3 CKD. Characteristic for patients with stage 3 CKD, an increase in intrarenal resistivity along the entire intrarenal circulation was caused by a decrease in its diastolic rate in the presence of low diastolic blood pressure.