title: Renal vascular response to angiotensin II inhibition in intensive antihypertensive treatment of essential hypertension.
abstract: BACKGROUND
  High blood pressure (BP) leads to target organ damage. It is suggested that regression of early organ lesions is possible on condition of BP normalization. The study objective was to assess whether permanent reduction of BP to the recommended values modifies renal vascular response to acute angiotensin II inhibition in the Doppler captopril test (DCT) in patients with essential hypertension (EH).
  
  
  METHODS
  Twenty-nine persons (58 kidneys) were found eligible for the study: 18 patients with EH and 11 healthy volunteers constituting the control group. Glomerular filtration rate estimation (eGFR), 24-h ambulatory BP monitoring (ABPM) and DCT with evaluation of renal resistive index change (ΔRI) were performed before and after a 6-month period of intensive antihypertensive therapy (IAT). Additional ABPM was performed at the end of IAT.
  
  
  RESULTS
  The mean IAT period was 8.5 ±2.4 months. The mean 24-h values of systolic and diastolic BP in the EH group were significantly lower in the IAT period than at the beginning and at the end of the study. Significantly lower systolic and diastolic BP (p < 0.05) and improvement of renal function (eGFR 121 ±38 vs. 139 ±40 ml/min, p < 0.001) were found after IAT as compared to initial values. Before IAT, ΔRI was significantly lower in the EH group as compared to the controls, but no such differences were found after IAT.
  
  
  CONCLUSIONS
  In EH patients, intensive BP lowering to the recommended values was associated with improvement of renal function and normalisation of renal vascular response to acute angiotensin II inhibition.
authors.affiliation: Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Lubas
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Zelichowski
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Próchnicka
authors.forename: Magdalena
authors.initials: M
authors.lastname: Wiśniewska
authors.forename: Marek
authors.initials: M
authors.lastname: Saracyn
authors.forename: Zofia
authors.initials: Z
authors.lastname: Wańkowicz