According to the results of ROC analysis, it was found that thyroid stimulating hormone (TSH) can be used as a marker for predicting the progression of chronic kidney disease (CKD).
During prospective study patients (n=89) were divided into two groups depending on the level of TSH: group 1 - 59 patients with arterial hypertension (AH) and CKD with the level of TSH, which meets the criterion of subclinical hypothyroidism (4,0-10,0mIU/l) and group 2 - 30 patients with AH and CKD with normal TSH levels (<4,0mIU/L).
According to the main clinical and laboratory indicators, the study groups differed significantly by the level of GFR, which confirms the data obtained during the retrospective analysis.
The analysis of ABPM results of both groups revealed no significant differences in the main indicators, but a significant effect of thyroid dysfunction on the variability of ABPM was found. Thus, in the first group there was a significantly higher number of patients belonging to the "non-dipper", "over-dipper" and "night peaker" (х2=5,71, p = 0,017).
According to the results of the study, it was found that intima-media complex thickness (IMT) was significantly higher among patients with CKD and hypertension in combination with thyroid dysfunction compared to patients with CKD and hypertension who were in a state of euthyroidism (p=0,018). The specificity of TSH as a marker of atherosclerotic changes was 92,86%, and the size of the AUC allows to characterize the prognostic significance of TSH as "good".
Endothelial dysfunction was found in most patients with CKD and AH, but it was more common among patients with thyroid dysfunction (p=0,005). It was found that an increase in TSH levels has a negative impact on this indicator (ρ=-0,65; p<0,001).
In the third research`s stage, patients with thyroid dysfunction were randomly divided into two subgroups, which were prescribed a combination antihypertensive therapy. Subgroup 1a received a combination of valsartan 160 mg and amlodipine 5 mg, and subgroup 1b received valsartan 160 mg and hydrochlorothiazide 12,5 mg.
Almost 90% of patients in both subgroups reached the target levels of office blood pressure. The effectiveness of both types of combination antihypertensive therapy was also confirmed by the results of ABPM. There was a significant improvement in all indicators of ABPM, except for the average DBP in the active period in subgroup 1b. Positive changes in the structure of the daily blood pressure profile were revealed: the number of "non-dipper" decreased, and the number of "dipper" increased in both subgroups ( p<0,001).
After the analysis of endothelial function after 3 months from the start of antihypertensive therapy, a significant improvement in the functional state of the endothelium was noted with more significant dynamic in 1a subgroup (p<0,001).
For the first time, the possibility of using TSH as one of the additional markers for predicting the development of chronic renal failure in the presence of AH was identified.
It was first proved, the expediency of using the IMT for the purpose of early diagnosis of atherosclerotic changes in hypertension and CKD in combination with thyroid dysfunction.
The prognostic significance of TSH in the development of atherosclerotic lesions of the main arteries in patients with hypertension in CKD has been revealed.
For the first time it was found that against the background of clinical comparability of valsartan 160 mg with amlodipine 5 mg or valsartan 160 mg with hydrochlorothiazide 12,5 mg, the combination with amlodipine shows a more significant positive effect on endothelial function, which is especially important in CKD and subclinical hypothyroidism. There was a significant decrease in mean diastolic blood pressure during the active period with using valsartan and amlodipine as antihypertensive therapy in comparison with the combination of valsartan and hydrochlorothiazide.
The administration of valsartan and amlodipine has shown a positive affect on renal function in patients with CKD in combination with subclinical hypothyroidism.
According to the results of the study, it is proposed to include the determination of TSH levels in the examination plan of patients with AH and CKD, in the presence of atherosclerotic lesions of the arteries. It is recommended to perform ultrasound examination of the main arteries of the head and neck in patients with AH and CKD and TSH levels more than 7,23 mIU/l in order to exclude the presence of atherosclerotic vascular lesions. It has been confirmed that the combination of valsartan 160 mg with amlodipine 5 mg has advantages over the combination of valsartan 160 mg with 12,5 mg hydrochlorothiazide in terms of its effect on the functional state of the endothelium and kidneys. It was found that the combination of valsartan 160 mg with amlodipine 5 mg leads to a significant decrease in mean diastolic blood pressure during the active period.
