The Changes And Its Influencing Factors Of Glomerular Filtration Rate In Middle-aged And Elderly Patients With Essential Hypertension

Objective:To understand the changes of estimated glomerular filtration rate(eGFR) in middle-aged and elderly patients with essential hypertension. To compare the difference of eGFR decreased of middle-aged and elderly patients, analysis of possible related factors. To provide a reference for the prevention and treatment of renal damage of middle-aged and elderly patients with essential hypertension.Methods:Selected and follow-up patients with essential hypertension who go to see a doctor in the hypertension outpatients of First Affiliated Hospital of Kunming Medical University, age≥45, January 2014 to March 2015. All the research objects have the spot investigation use unified questionnaires, survey content includes:basic personal information, nearly a year average blood pressure and pulse rate level, medication, smoking status, previous history of the disease, and blood biochemistry, ECG, heart and blood vessels ultrasound and other inspection data. To determine whether there is any risk of target organ damage, clinical complications, and cardiovascular risk stratification through the medical history and examination. The selected subjects were calculated eGFR and followed up. Using a unified design, structured follow-up table in 10-14 months follow-up, understanding blood pressure control, medication, new hair target organ damage, new complications, etc., and collect relevant information, calculated eGFR. All included in the study as the total population, by age points for the middle-aged group (45 to 59 years old), elderly group (60 to 90 years old), △eGFRtotal population, △eGFRmiddle-aged and △eGFRelderly respectively expressed the change of the eGFR in total population, middle-aged group and elderly group. Statistical analysis the eGFR level of three group and their own differences before and after follow up. Calculation ΔeGFR, Compare the difference of ΔeGFRmiddle-aged and ΔeGFRelderly. Analysis of factors related to the changes in eGFR.Result:1. This study included a total of 251 cases of essential hypertension, age 45 to 90 years old, average age (64.94±9.30) years. middle-aged group 84 cases, mean age (55.83±3.53) years. elderly group 167 cases, average age (69.53±7.80 years).81 males (middle-aged group 14 cases, elderly group 67 cases), women in 170 cases (middle-aged group 70 cases, elderly group 100 cases).2. The eGFR levels in middle-aged and elderly patients with essential hypertension before and after follow-up:The eGFR of total population, middle-aged group, elderly group before follow-up were (88.78±21.05), (100.65±17.11), and (82.81±20.35) ml/(min-1.73m2), follow-up eGFR were (86.32±21.44), (98.00±20.65) and (82.35±24.00) ml/(min-1.73m2). The follow-up eGFR of three groups showed decreased than before, the differences of three groups about their own contrast have statistical significance (P< 0.05).3.The △eGFR in middle-aged and elderly patients with essential hypertension before and after follow-up:ΔeGFRtotal population was -2.26 (-11.36～5.78) ml/(min·1.73m2), △eGFRmiddle-aged was -3.46 (-11.97～0.83) ml/(min·1.73m2) and △eGFRelderly was-1.65 (-10.85～6.79) ml/(min·1.73m2). No significant difference was found in the △eGFRmiddle-aged and △eGFRelderly (P=0.246).4. Multi factor analysis of eGFR related factors in middle-aged and elderly patients with essential hypertension:(1) The change of eGFR in middle aged group was related to triglyceride (P=0.015) and serum creatinine (P=0.001).(2)eGFR changes were associated with gender (P=0.012), the use of ACEI/ARB drugs (P=0.046), waist circumference (P=0.004), and serum creatinine (P< 0.001) in the elderly group. (3) Total population eGFR changes were associated with gender (P=0.009), age (P=0.032), pulse rate (P=0.041), waist circumference (P=0.049), and serum creatinine (P< 0.001).Conclusion:1. EGFR decreased significantly in middle-aged and elderly patients with essential hypertension.2. Triglyceride abnormalities may be an independent risk factor for eGFR in middle-aged patients with essential hypertension.3. The use of ACEI/ARB drugs can delay the decline of eGFR in elderly patients with essential hypertension.4. Pulse rate was independently associated with eGFR decrease in middle-aged and elderly patients with essential hypertension. The risk of eGFR in male patients with hypertension was significantly higher than that in female patients. Abdominal obesity increases the risk of eGFR in middle-aged and elderly patients with essential hypertension, and the risk of eGFR decreased significantly in elderly patients with abdominal obesity.