Evaluation of seconder hypertension by oscillometric method in dogs with renal failure symptoms and treatment with angiotensin II receptor antagonists

Abstract

In this study, after measurement of the blood pressure by an oscillometric method in dogs with chronic renal failure, the effect of Irbesartan, an angiotensin II receptor antagonist, on the blood pressure was investigated. In the study, a total of 24 dogs including 12 with chronic renal failure (study group) and 12 healthy ones (control group) were enrolled. Irbesartan was given at a dose of 5 mg/kg once daily for the entire period of study. All clinical and laboratory examinations were performed on days 0 (start of the study), 7, 14 and 28 for the study group and once only in the control group. In the study group, the hemograms revealed normocytic normochromic anemia. With administration of irbesartan, the clinical symptoms were observed to abate slightly while the sistolic/diastolic arterial pressure values of 196/144 at 0, decline to 165/120, 144/98, and 137/90 on the 7th, 14th and 28th days respectively. Also, whereas the blood urea nitrogen, creatinine and protein levels significantly decrease, that of albumin was found to have increased. Comparison of the blood pressures between the study and control groups at the end of the study (28th day) showed no significant difference in the sistolic arterial pressure levels while the diastolic arterial pressure values remained significantly higher. Use of irbesartan was found not to have changed most laboratory findings to any significant degree. It was concluded that in dogs with chronic renal failure where the blood pressure is significantly elevated, treatment of the hypertension with irbesartan, an angiotensin II receptor antagonist, is effective, and safe, though at the end of the 28-day treatment period there was a return of the sistolic arterial pressure towards the normal, the diastolic arterial pressure remained slightly elevated above the normal

Keywords

• Angiotensin II receptor antagonist
• dog
• irbesartan
• renal failure
• seconder hypertension

Renal yetmezlik semptomları görülen köpeklerde sekonder hipertansiyonun osilometrik metot ile değerlendirilmesi ve angiotensin II reseptör antagonistleri ile tedavisi

Abstract

Bu çalışmada böbrek yetmezliği semptomları görülen köpeklerde tansiyon değerlerinin osilometrik olarak ölçülmesi ve tansiyon değerleri üzerinde bir angiotensin II reseptör antagonisti olan irbesartanın etkinliğinin belirlenmesi amaçlandı. Çalışmada farklı ırk ve cinsiyette, 12’si böbrek yetmezlikli (Deneme grubu) ve 12’si sağlıklı (Kontrol grubu) olmak üzere toplam 24 köpek kullanıldı. İrbesartan, çalışma süresince, günde bir kez, 5mg/kg dozda kullanıldı. Deneme grubunda, deneme öncesi ve denemenin 7., 14. ve 28 günlerinde, kontrol grubunda ise bir kez olmak üzere klinik kontroller, tansiyon değerleri, hemogram, bazı serum biyokimyasal parametreler, venöz kan gazları ve plazma elektrolit düzeyleri ve idrar muayeneleri yapıldı. Deneme grubundaki köpeklerin tümünün kronik böbrek yetmezlikli olduğu, deneme öncesinde sağlıklılara göre sistolik basınç, diastolik basınç, kan üre nitrojeni, kreatinin ve idrar protein değerlerinin yüksek, alyuvar, albumin ve idrar dansitesi değerlerinin ise düşük olduğu belirlendi. Hemogramda normositik normokromik anemi belirlendi. İrbesartan kullanımı ile klinik semptomların hafiflediği, deneme öncesinde 196/144 olan sistolik basınç ve diastolik basınç değerlerinin sırasıyla 7. günde 165/120, 14. günde 144/98 ve 28. günde 137/90 değerine düştüğü belirlendi. Ayrıca kan üre nitrojeni, kreatinin ve proteinüri değerleri önemli oranda azalırken albumin değeri yükseldi. Kontrol grubu ve deneme grubunun deneme sonu (28. gün) tansiyon değerleri karşılaştırıldığında sistolik basınç değerlerinde fark bulunmazken, diastolik basınç değerinin hala önemli düzeyde yüksek olduğu belirlendi. İrbesartan kullanımının; çoğu hemogram ve serum parametresi, venöz kan gazı ve plazma elektrolit düzeylerinde önemli değişmeler oluşturmadığı saptandı. Sonuç olarak, kronik böbrek yetmezlikli köpeklerde tansiyonun önemli oranda yüksek olduğu, hipertansiyonun tedavisinde bir angiotensin-II reseptör antagonisti olan irbesartanın etkili ve güvenli bir şekilde kullanılabileceği, 28 günlük tedavi süresinde sistolik basınç değerinin normal değerlere dönmesine rağmen diastolik basınç değerinin biraz yüksek kalabileceği kanısına varıldı

Keywords

• Angiotensin II reseptör antagonistleri
• böbrek yetmezliği
• irbesartan
• köpek
• sekonder hipertansiyon

References

1. Akgül A (1997): Üç ve daha fazla grupta uygulanan hipotez testleri 372-380. In: A. Akgül (Ed), Tıbbi Araştırmalarda İs- tatistiksel Analiz Teknikleri.:, Yüksek Öğretim Kurulu Mat- baası, Ankara
2. Amenta F, Mıngını F, Rabbıa F, Tomassonı D and Veglıo F (2002): Protective effect of anti-hypertensive treatment on cognitive function in essential hypertension: analysis of published clinical data. J Neurol Sci, 8732, 1-5.
3. Asmar R, Gosse P, N’tela J T, Gray S and Dudley A (2001): Effects of telmisartan on arterial compliance and en- dothelial function in type 2 diabetes patients with essential hypertension. Am J Hypertens,14, 114
4. Barber P J (1996): Proteinuria. 75-85. In: J Bainbridge and J Eliot (Ed), Manual of Canine and Feline Nephrology and Urology. BSAVA, Shurdington.
5. Bloomgarden ZT (2001): Angiotensin II receptor blockers and nephropathy trials. Diabetes Care, 24, 1834-1838.
6. Bodey AR, Michell AR (1996): Epidemiological study of blood pressure in domestic dogs. J Small Anim Pract, 37, 116- 125.
7. Bovee KC, Litmann MP (1987): Hypertension and renal function. Tijdschr Diergeneeskd, 112, 121-123.
8. Bovee KC, Litmann MP, Crabtree BJ, Aguirre G (1989): Essential hypertension in a dog. JAVMA, 195, 81-86.

9. Brown SA (1996): Chronic renal failure: Recent develop- ments in medical management. 195-208.. In: J Bainbridge, J. Eliot (Ed), Manual of Canine and Feline Nephrology and Urology. BSAVA, Shurdington.
10. Brown SA, Henik RA (1998): Diagnosis and treatment of systemic hypertension. Vet Clin N Am Small Anim Pract, 28, 1481-1494.
11. Brown SA, Henik RA (2000): Therapy for systemic hy- pertension in dogs and cats. 838-841. In:, JD Bonagura (Ed), Kirks Current Veterinary Therapy XIII. Small Animal Practice, W. B. Saunders Co. Philadelphia.
12. Brown SA, Henik RA, Finco DR (2000): Diagnosis of systemic hypertension in dogs and cats. 835-838. In: JD Bonagura (Ed), Kirks Current Veterinary Therapy XIII. Small Animal Practice, W. B. Saunders Co. Philadelphia.
13. Can İ, Oto MA, (2002): Hipertansiyon tedavisinde anjiyo- tensin II reseptor antagonistleri. 175-186. In: A Oto (Ed), Türk Kardiyoloji Seminerleri, 2
14. Carr AP (2001): Measuring blood pressure in dogs and cats. Veterinary Medicine, Symposium, February. 135-143.
15. Chalifoux A, Dallaire A, Blais D, Lariviere N, Pelletier N (1985) : Evaluation of the arterial blood pressure of dogs by two noninvasive methods. Can J Comp Med, 49, 419-423.
16. Coca A, Giner V (1999): Antihypertensive advantages of angiotensin II AT I receptor antagonism. Rev Esp Cardiol, 52, 3-58.
17. Cooke KL, Snyder PS (2001a): Diagnosing systemic hyper- tension in dogs and cats. Veterinary Medicine, Symposium, February, 145-149.
18. Cooke KL, Snyder PS (2001b): Treating hypertension in dogs and cats. Veterinary Medicine, Symposium, February, 151-158.
19. Cowgill LD (1995): Medical management of the anemia of chronic renal failure. 539-554. In: CA Osbome, DR Finco (Ed), Canine and Feline Nephrology and Urology. Waverty Co..
20. Deray G (1999): Are the antagonists of angiotensin II AT I receptors protectors of the kidney? Arch Mai Coeur Vaiss, 92, 903-907.
21. De Rosa ML, Cristofaro A, Rossi M, Baiano A, Cardace P, Albanese L, Vigorito C (2001): Irbesartan effects on renal function in paitents with renal impairment and hyper- tension: a drug-withdrawal study. J Cardiovasc Pharm, 38, 482-489.
22. Dibartola SP (1995): Clinical approach and laboratory evaluation of renal disease. 1706-1719. In: SJ Ettinger, EC Feldman (Ed), Textbook of Veterinary Internal Medicine, 4. Edition, Vol. 1. W. B. Saunders Co. Philadelphia.
23. Dogrell SA (2002): Class benefits of AT I antagonists in type 2 diabetes mellitus with nephropathy. Expert Opin Pharmacother, 3, 625-628.
24. Erdem Y (2002): Hipertansiyon patofizyolojisi.100-107. In: MA Oto (Ed), Türk Kardiyoloji Seminerleri, 2
25. Ferrari P, Marti HP, Pfister M, Frey FJ (2002): Additive antiproteinuric effect of combined ACE inhibition and angiotensin II receptor blockade. J Hypertens, 20, 125- 130.
26. Franscini LMD, Von Vigier RO, Pfister R, Aebischer CC, Fossali E, Bianchetti MG (2002): Effectiveness and safety of the angiotensin II antagonist irbesartan in children with chronic kidney diseases. Am J Hypertens, 15, 1057-1063.
27. Henik RA (1997): Systemic hypertension and its manage- ment. Vet Clin N Am Small Anim Pract, 27, 1355-1372.
28. Koylan N (2002): Hipertansiyon ve ACE İnhibitorleri. 165- 174. In: MA Oto (Ed), Türk Kardiyoloji Seminerleri, 2.
29. Kurtdede A, Börkü MK (1998): Üriner Sistem Hastalıkları. 203-241. In: HY İmren (Ed), Kedi ve Köpek Hastalıkları, Medisan, Ankara.
30. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I, (2001): Re- noprotective effects of the angiotensin-receptor antagonist irbesartan in patents with nephropathy due to type 2 diabetes. N Eng J Med, 345, 851-860.
31. Littman MP, Robertson JL, Bovee CK (1988): Spontaneous systemic hypertension in dogs: five cases (1981-1983). JAVMA, 193, 486-494.
32. Meurs KM, Miller MW, Slater MR (1996): Comparison of the indirect osciliometric and direct arterial methods for blood pressure measurements in anesthetized dogs. J Am Anim Hosp Assoc, 32, 471-475.
33. Polzin DJ, Osborne CA, Bartges JW, James MJ, Churchill JA (1995): Chronic renal failure. 1734-1760. In: SJ Ettinger, EC Feidman (Ed), Textbook of Veterinary Internal Medi- cine, 4. Edition, Vol. 1, W. B. Saunders Co. Philadelphia.
34. Remillard RL, Ross JN, Eddy JB (1991): Variance of indirect blood pressure measurements and prevalence of hy- pertension in clinically normal dogs. Am J Vet Res, 52, 561- 565.
35. Roca-cusachs A, Dalfo A, Badia X, Aristegui I, Roset M (2001): Relation between clinical and therapeutic variables and quality of life in hypertension. J Hypertens, 19, 1913- 1919.
36. Ruilope LM (1997): Renoprotection and renin-angiotensin system blockade in diabetes mellitus. Am J Hypertens, 10, 325-331.
37. Shaw DH, Ihle SL (1997): Urinary tract disease and fluid and electrolyte disorders. 323-382. In: EA Nieginski (Ed), Small Animal Internal Disease. Lippincott Williams&Willkins Co.
38. Soydan İ (1997): Sistemik hipertansiyon. In: G Çagatay, İ. Soydan (Ed), Klinik Kardiyoloji, Saray Medikal Yayıncılık, Izmir.
39. Squires RA (1996): Uraemia. 52-67. In: J. Bainbridge, J Eliot (Ed), Manual of Canine and Feline Nephrology and Urology. BSAVA, Shurdington.
40. Stepien RL (2002): Hypertension in cats and dogs. The 26th Annual Waltham Diets/OSU Symposium, Small Animal Car- diology.
41. Struble AL, Feldman EC, Nelson RW, Kass PH (1998): Systemic hypertension and proteinuria in dogs with diabetes mellitus. JAVMA, 213, 822-825.
42. Toto R (2001): Angiotensin II subtype 1 receptor blockers and renal function. Arch Intern Med, 161, 1492-1499.
43. Toutain PL, Lefebvre HP, Laroute V (1999): New insights on effect of kidney insufficiency on disposition of angiotensin- converting enzyme inhibitors: case of enalapril and benazepril in dogs. J Pharmacol Exp Ther, 292, 1094-1103.
44. Turgut K (2000): Üriner sistem hastalıkları ve testleri. Vete- riner Klinik Laboratuar Teşhis. Genişletilmiş 2. Baskı, Bah- civanlar Basım Sanayi Yayınevi, 322-352. Konya.
45. Vaden SL (2000): Differentiation of acute from cronic renal failure. 856-858. In: JD Bonagura (Ed), Kirks Current Vet- erinary Therapy XIII. Small Animal Practice, W. B. Saunders Co. Philadelphia. Geliş tarihi: 12.03.2004 / Kabul tarihi: 05.04.2004