Efficacy And Mechanism Of Enhanced External Counterpulsation For EarlyRenal Damage In Hypertension

Background:Although antihypertensive drugs have been widely used,there are still many patients with early renal damage in hypertension who have persistent microalbuminuria.Moreover,hypertensive kidney damage is the second cause of chronic kidney disease.Early detection,early diagnosis and early treatment are particularly important to slow the progression of early renal damage in hypertension to chronic kidney disease and reduce the national and domestic economic burden.In previous study,it was shown that enhanced external counterpulsation(EECP)partly improved renal function of patients with coronary heart disease and/or heart failure.However,few studies have explored the efficacy and mechanism of EECP for early renal damage in hypertension.Purpose:The purpose of this study was to investigate the efficacy of EECP for early renal damage in hypertension and to investigate the possible underlying mechanism.Methods:Forty patients with early renal damage in hypertension,who were treated in our hospital,were randomized to either a control group(n=20)or EECP group(n=20).And their clinical and biochemical characteristics were recorded.All patients followed a drug treatment regimen,and patients in the EECP group received EECP therapy additionally(once a day for 45 minutes for a total of 35 times).Before and after treatment,the patients' average nighttime urination frequency,blood pressure and mean arterial pressure were recorded,morning urine was retained to detect urine ?2-microglobulin and urine microalbumin,and serum samples were collected to detect endothelin-1 and nitric oxide.The differences in the above-mentioned indexes before and after treatment were compared to evaluate clinical efficacy.Results:No statistically significant differences were observed in gender,age,height,weight,BMI,duration of hypertension,fasting blood glucose,glycated hemoglobin,blood lipid,serum uric acid,liver and kidney function,previous medication,systolic pressure,diastolic pressure,mean arterial pressure,average nighttime urination frequency,urine ?2-microglobulin or urine microalbumin between the EECP and control groups at study entry.After EECP therapy,average nighttime urination frequency reduced from 1.83±1.02 times/night to 0.877±0.66 times/night(P=0.000),urine ?2-microglobulin lowered from 0.43±0.36 ?g/ml to 0.20±0.24 ?g/ml(P=0.004),and urine microalbumin lowered from 42.00±48.67 mg/L to 23.70±26.85 mg/L(P=0.017).However,there were no changes in average nighttime urination frequency,urine ?2-microglobulin or urine microalbumin in the control group.After EECP therapy,systolic pressure reduced from 127.66±6.22 mmHg to 125.88±7.34 mmHg(P=0.043).However,there was no change in systolic pressure in the control group.After treatment,no significant changes in diastolic pressure or mean arterial pressure were observed in the two groups.After EECP therapy,serum nitric oxide increased(0.14±0.07 ?mol/ml to 0.21±0.13 ?mol/ml,P=0.014)while serum endothelin-1 decreased(50.40±38.18 pg/ml to 32.80±5.93 pg/ml,P=0.001).However,there were no changes in serum endothelin-1 or nitric oxide in the control group.Conclusion:Based on conventional drug therapy,EECP further attenuated earlyrenal damage of patients with hypertension,reduced their nighttime urination frequency,and lowered their urine ?2-microglobulin and urine microalbumin.And the possible underlying mechanism may involve improving vascular endothelial dysfunction.In conclusion,EECP may be an effective therapy for early renal damage in hypertension.