Važnost antagonista mineralokortikoidnih receptora u terapiji rezistentne hipertenzije

master's thesis

• Title (english): The importance of mineralocorticoid receptor antagonists n the treatment of resistant hypertension
• Author: Ana Legović
• Mentor: Ingrid Prkačin (mentor)
• Committee member: Nikolina Bašić Jukić (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Ingrid Prkačin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Prevalencija rezistentne hipertenzije (RH) se kreće između 10-30%, a povezana je s višim rizikom oštećenja bubrega i kardiovskularnog sustava. Patofiziologija RH je povezana s povišenom razinom aldosterona zbog čega antagonisti mineralokortikoidnih receptora (MRA) u terapiji igraju važnu ulogu.
Aldosteron je hormon nadbubrežne žlijezde koji se stvara i izlučuje na poticaj angiotenzina II, adrenokortikotropnog hormona (ACTH) i kalija. Vezanjem za mineralokortikoidne receptore (MR) potiče transkripciju i ekspresiju natrijevih kanala (ENaC) koji resorbiraju natrij, a radi osmotske ravnoteže resorbira se i voda i time dolazi do hipervolemije i hipertenzije.
U više istraživanja, među kojima je najvažnije PATHWAY-2, je dokazano da spironolakton kao dodatak na inicijalnu trojnu terapiju (blokatori renin-angiotenzin sustava, diuretici i blokatori kalcijevih kanala) snizuje sistolički krvni tlak <135mmHg u 60% pacijenata.
Osim spironolaktona, isti učinak ima i drugi lijek skupine MRA, eplerenon. Prije propisivanja ovih lijekova, važno je procijeniti bubrežnu funkciju pacijenata zbog mogućeg rizika od hiperkalijemije.

Abstract (english)

The prevalence of resistant hypertension ( RH ) is ranging between 10-30 % , and is associated with a higher risk of kidney and cardiovascular system damage. Pathophysiology of RH is associated with increased levels of aldosterone and because of that, antagonists of mineralocorticoid receptors play significant role in therapy.
Aldosterone is an adrenal hormone which is produced and secreted on the stimulus of angiotensin II, adrenocortical hormone (ACTH) and potassium. It stimulates transcription and expression of sodium channels (ENaC) by binding to mineralocorticoid receptors (MR). These channels absorb sodium, and because of osmotic balance, water is absorbed too thus causing hypervolemia and hypertension.
There have been many researches, in which PATHWAY-2 is the most important, that prove adding spironolactone to initial therapy (renine-angiotensine blockers, diuretics and calcium channel blockers) lowers systolic blood pressure <135mmHg in 60% of patients.
Except spironolactone, the same effect has another drug from MRA group, eplerenone. Before prescribing these drugs, it is important to evaluate renal function because of possible risk of hyperkalemia.

• Keywords: rezistentna hipertenzija; aldosteron; spironolakton
• Keywords (english): resistant hypertension; aldosterone; spironolactone
• Language: croatian
• URN:NBN: urn:nbn:hr:105:362511
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-26 07:34:35