PS 08-56 ASSOCIATION BETWEEN SERUM URIC ACID LEVEL AND HYPOTENSIVE EFFECTS OF SUPPLEMENTAL THIAZIDE DIURETIC THERAPY FOR HYPERTENSION PATIENTS WITH SEVERE RENAL DYSFUNCTION TREATED WITH RENIN ANGIOTENSIN SYSTEM INHIBITORS. (September 2016)

• Record Type: Journal Article
• Authors: Miyagi, Tsuyoshi; Kohagura, Kentaro; Yamazato, Masanobu; Ishida, Akio; Sakima, Atsushi; Ohya, Yusuke
• Is Part Of: Journal of hypertension. Volume 34:(2016) Supplement 1
• Publication Date: 2016-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000500750.26238.b2
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: The hypotensive effects caused by thiazide diuretics (TZ) may be reduced in the group of patients with severe renal dysfunction and elevated uric acid levels after starting treatment. We investigated whether there is an association between hypotensive effects induced by TZ and changes in uric acid levels after starting TZ administration. Design and Method: Subjects comprised 20 hypertension patients (13 males) with eGFR levels < 30 mL/min/1.73 m 2 who were on renin angiotensin system inhibitor (RAS-I) therapy and had recently started supplemental TZ therapy. We retrospectively investigated clinical indices before TZ administration and after 2 months of administration. We then divided subjects into two groups depending on whether uric acid levels were elevated or not after TZ administration, and we compared hypotensive effects in the two groups. Results: The group that exhibited uric acid level elevation after TZ administration comprised 13 cases (65%). Significant decrease in mean value of mean blood pressure after TZ administration was noted in 15 cases (75%), from 99 mmHg before administration to 88 mmHg after 2 months of administration. The amount of decrease in mean blood pressure was significantly lower in the uric acid elevation group than in the non-elevation group. In addition to the tendency of eGFR to decrease more in the uric acid elevation group after TZ administration than in the non-elevation group, we noted a tendency of urinary protein to decrease in the uric acid elevation group. Conclusions: A significant increase in hypotensive effects can be expected with the supplemental TZ administration for patients already taking RAS-Is, even for cases of severe renal dysfunction. However, although somewhat weak effects can be expected for patients with increased serum uric acid levels following TZ administration, protective effects for the kidneys can be expected over the long-term as decreases in overall levels of urinary protein were noted in these patients.