Renal Function Status Among Patients of Essential Hypertension

Background: Essential hypertension is typically described as elevated blood pressure without an identifiable underlying cause. However, there are important clinical, pathologic, and hemodynamic features that characterize this entity. Hypertension and renal impairment share a two-way cause and effect relationship, with each one being a common etiology of the other. Early diagnosis and proper management of hypertension reduced the burden of renal insufficiency. ObjectiveTo evaluate correlation of renal function status with blood pressure of subjects having essential hypertension. Materials and Method: This cross-sectional analytical study was carried out in the Department of Physiology, Sylhet M.A.G Osmani Medical College in collaboration with OPD of department of medicine, SOMCH, Sylhet, during the period between July 2020 to June 2021. Total 130 subjects were selected for study and allocated into two groups, 65 in each. Group A, patients with essential hypertension (as case) and group-B, age-sex matched normotensive subjects (as control) were taken. Exclusion criteria was pregnancy, any acute illness, chronic disease(heart disease, renal disease)Diabetes mellitus &other endocrine & metabolic disease, Drugs OCP containning oestrogens, steroids. Study subjects were selected by convenient sampling technique and ethical approval was obtained from the ethical review committee. Comprehensive socio-demographic information was obtained from the participants using a structured questionnaire. Clinical examination and relevant investigation were done. A venous blood sample was obtained from each patient for routine hematology, biochemical testing. The laboratory report was analyzed using standard methods. eGFR was calculated by Modification of diet in renal disease (MDRD) formula. Renal dysfunction was considered the presence of eGFR <60 ml/min/1.73 m2 and normal eGFR is >60ml/min/1.73sqm. Statistical analysis and data processing were performed utilizing computer program SPSS and Microsoft excel. Result: In this study age ranging from 18 to 50 years. It was observed that majority, e.g., 83(63.8%) patients belonged to age 41-50 years. Out of 130 cases 82(63.0%) cases were male and 48(36.9%) were female. Male and female ratio was 1.7:1. The mean serum creatinine (mg/dl) was 1.98 ± 0.43 in group-A; whereas 0.96 ± 0.43 in group-B. The mean serum creatinine was significantly higher in group-A than that of group-B (t=-10.659; p<0.001). On evaluation of eGER, maximum patients in group-A (e.g., 41.5%) had 60-89 ml/min/1.73 m2, whereas in group-B 45(69.2%) patients had >90 ml/min/1.73 m2. The mean e-GFR was significantly reduced in group-A than that of group-B (p<0.001). The occurrence of renal dysfunction was 29.2% in group-A or patients with essential hypertension, whereas this occurance was 4.60% in group-B or normal healthy subject. Positive significant correlation (r=0.637; p=0.001) between the serum creatinine, proteinuria and blood pressure. It was evident from this study, a negative significant correlation (r=-0.176; p=0.001) between the GFR and blood pressure. This indicates that as blood pressure increases, there is a corresponding decline in kidney function, reflected by a reduction in the glomerular filtration rate. Conclusion: Hypertension contributes to a higher likelihood of developing renal dysfunction. This study revealed a 29.2% prevalence of CKD in hypertensive patients. Hypertension and CKD are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. Therefore, proper evaluation and appropriate management of HTN is pivotal for prevention of complication.