Cystatin C, vascular biomarkers and measured glomerular filtration rate in patients with unresponsive hypertensive phenotype: a pilot study
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Published on: June 16, 2014
Velibor Čabarkapa1, Branislava Ilinčić1, Mirjana Đerić1
1a Clinical Center of Vojvodina , Faculty of Medicine, University of Novi Sad , Novi Sad , Serbia.
Insights
In patients with nonresponsive hypertension, higher cystatin C levels correlate with increased carotid artery thickness, indicating subclinical cardiovascular disease. This finding suggests cystatin C may be a valuable biomarker for assessing CVD risk in this population.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Subclinical cardiovascular disease (CVD) is often estimated using biomarkers in patients with essential arterial hypertension (HT).
- Investigating cystatin C's association with vascular biomarkers in unresponsive hypertension (URHT) is clinically significant.
- Known associations exist between cystatin C and glomerular filtration rate (GFR).
Purpose of the Study:
- To explore the relationship between cystatin C and vascular biomarkers in patients with URHT.
- To determine if cystatin C is an independent predictor of subclinical CVD in URHT.
- To compare vascular biomarkers between responsive hypertension (RHT) and URHT groups.
Main Methods:
- 200 hypertensive patients were stratified into RHT (n=100) and URHT (n=100) groups based on treatment response.
- Glomerular filtration rate (GFR) was measured using an isotopic method (mGFR).
- Vascular biomarkers including intima-media thickness of common carotid arteries (CCIMT), carotid plaque, and renal artery resistance index (RRI) were assessed.
Main Results:
- The URHT group exhibited significantly higher cystatin C serum concentration and CCIMT compared to the RHT group.
- Cystatin C was independently associated with CCIMT, hsCRP, and duration of HT in the URHT group, irrespective of mGFR and age.
- CCIMT and hsCRP were identified as independent predictors of the URHT phenotype.
Conclusions:
- Cystatin C serum concentration is positively and independently associated with CCIMT in patients with URHT and subclinical CVD, beyond its relation to GFR.
- This suggests cystatin C may serve as a valuable biomarker for subclinical CVD in URHT.
- Further prospective studies are warranted to elucidate the clinical significance of this association.
Background:
Biomarkers are commonly used to estimate the presence of subclinical cardiovascular disease (CVD) in patients with essential arterial hypertension (HT). In addition to known association between cystatin C and glomerular filtration rate (GFR), elucidating the association between cystatin C and vascular biomarkers (intima-media thickness of common carotid arteries (CCIMT), carotid plaque and renal artery resistance index (RRI)) in patients with unresponsive hypertensive phenotype could be of significant clinical interest.
Methods:
Participants (n = 200, median age 58 (52-64) years, 49% female) under treatment with antihypertensive drugs were stratified into two subgroups based on their blood pressure level as having responsive hypertension (RHT - compliant and responsive to treatment, n = 100), or nonresponsive (URHT - compliant but nonresponsive to treatment, n = 100). GFR was measured by isotopic (slope-intercept) method (99m Tc diethylene triamine penta-acetic acid - mGFR).
Results:
The URHT group had significantly higher median cystatin C serum concentration (p = 0.02) and CCIMT (p = 0.00) compared to the RHT group, with no significant difference in RRI (p = 0.51) and mGFR among subgroups [69.9 ± 28.2 vs 76.74 ± 23.61 ml/min/1.73m2, p = 0.27]. In the URHT group, cystatin C was found to be associated with CCIMT (p = 0.02), hsCRP (p = 0.01) and duration of HT (p = 0.02), independently of mGFR and age. Independent predictors of URHT phenotype were CCIMT (p= 0.02) and hsCRP (p= 0.04).
Conclusion:
In addition to GFR, cystatin C serum concentration is positively and independently associated with CCIMT in patient with URHT phenotype and subclinical CVD. Prospective larger studies should further investigate the clinical importance of this relationship.
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