Relationship Between TGFβ₁ And Hypertensive Renal Damage

OBJECTIVETo observe the hypertensive patients with microalbuminuria after taking hypotensive drug (angiotensin-converting enzyme inhibitor ACEI or/and angiotensin II type 1 receptor blocker ARB)the alteration of ambulatory blood pressure transforming growth factor-beta 1(TGFβ₁) angiotensin II(Ang II ) urine albumin-to-creatinine ratio (ACR) in pretherapy and post-treatment. To observe the relation between TGFβ₁ and hypertensive renal damage. To investigate the role and mechanism of benzepril and valsartan on preventing hypertensive renal damage, providing further evidence for clinical therapy. METHODS82 consecutive hypertensive patients including 47 males and 35 females with microalbuminuria (group NT) were enrolled and divided randomly into three groups: group B (n=28) were given 10mg/qd benzepril for 12weeks; group V (n=27) were given 80mg/qd valsartan for 12weeks;group C (n=27) were given 10mg/qd benzepril and 80mg/qd valsartan for 12weeks. No significant differences in age and sex through Group B V and C. 26 normotensives were included as normal control group. The diagnostic criteria was Chinese 2005 Guideline Revised Edition for Prevention and Cure for Hypertension. All patients' urina sanguinis and hungry blood were abstracted. Ang II and ACR were detected by radio-immunoassay, TGFβ₁ by a sandwich ELISA, and blood fat blood urea nitrogen (BUN) as well as creatinine(Cr) by an enzymic method. Monitor ambulatory blood pressure for 24 hours were measured. In addition, left ventricular telediastolic internal diameter, interventricular septum diastolic, posterior wall thickness, left ventricular mass index and left ventricular ejection fraction by M-B Mode echocardiography were calculated. All patients' history were recorded in detail, as well as blood pressure height and weight in order to calculate BMI and BSA. In addition, all the patients were asked to detect the routine of blood urine and stool, blood dielectric fat and sugar, hepatic function and electrocardiogram as well. All the patients were given hypotensive drug above-mentioned, returning after taking medicine for 12 weeks, measuring the indicatrix above samely. RESULTS1) The 24hSBP 24hDBP SBP and DBP in the day and night of group B V C were lower than pretherapy significantly, the indicatrix of group C were more lower than B and V. SI of group B V C were higher than pretherapy significantly, the indicatrix of group C were more higher than B and V.2) ACR of group B, V, C were lower than group NT significantly, the indicatrix of group C were more lower than B and V.3) The serum level of TGFβ₁ of group B V, C were lower than group NT significantly, the indicatrix of group C were more lower than B and V.4) AngII were lower than group NT significantly in group B, but higher than group NT significantly in group V. No statistical significance of Ang II in group C than group NT.5) TGF β₁ and Ang II of group NT were higher than normal control group. TGFβ₁i was positive correlation with Ang II and ACR..6) Ambulatory blood pressure and microalbuminuria : ACR was positive correlation with 24hSABPV ,inverse correlation with 24hSIS nSIS . CONCLUSIONS1) After taking benzepril or valsartan ,the indicatrix of ambulatory blood pressure were lower than pretherapy significantly and SI steped up. Combination benzepril and valsartan can control blood pressure more steadily comparing with either one. 2) Microalbuminuria was a predictor of renal dysfunction. TGFβ₁ participated in the occurrence and progression of hypertensive renal damage. The serum level of TGFβ₁ was positive correlation with ACR.After taking benzepril or valsartan , TGFβ₁ and ACR were lower than pretherapy significantly. An additional reno-protective effect of dual blockade of the rennin-angiotensin system (RAS) was found.3) There was a close relationship between TGFβ₁ and Ang II in the occurrence and progression of hypertensive renal damage. The serum level of TGF β₁ was positive correlation with the plasma concentration of Ang II.4) ACR was positive correlation with 24hSABPV ,inverse correlation with 24hSIS nSIS.