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Jul22
CATION (CALCIUM & MAGNESIUM) STATUS IN ESSENTIAL HYPERTENSION AND RESPONSE TO
AIM:
1. To study the divalent cation status in essential hypertension and to observe the response to different antihypertensive drugs based on divalent cation status.
2. To emphasize the importance of calcium and magnesium status in essential hypertension to serve as surrogate markers of plasma rennin activity and to initiate antihypertensive drugs accordingly as close as physiological antidote.

MATERIALS AND METHODS:
The present study was conducted among essential hypertensive patients, aged >18years with SBP  140 mmHg and DBP  90 mmHg after exclusion of severe essential hypertension and secondary hypertensions in the department of Medicine. V.S.S. Medical College & Hospital, Burla from January 2004 to January 2006. There were 50 patients included in the study without any complication or morbidity. Detailed clinical and laboratory examination were performed. Patients with serum ionized calcium values were grouped into three groups i.e., Group 1 with 2.09  0.03, Group 2 with 2.24  0.03 and Group 3 with 2.34 0.03 mEq/L of ionized calcium and similarly three groups of patients with serum magnesium values i.e., Group 1 with 2.07 0.03 , Group 2 with 1.94 0.03 and Group 3 with 1.830.02 mEq/L magnesium according to Laragh et al. These groups represent surrogate of low rennin, normal rennin and high rennin activity status of essential hypertension respectively. Again these patients were divided into two groups i.e, Group A having surrogate of low renin and normal renin activity - surrogate (LREH/NREH) and constituted 40 patients and Group B surrogate of high rennin activity status of essential hypertension (HREH) and constituted 10 patients. Initially Group A patients were treated with Amlodipine and the cross over to Ramipril for 12 weeks with a washout interval of one month between the two treatments. Group B patients were similarly initially treated with Ramipril and the cross over to Amlodipine after a washout period of one month for 12 weeks respectively.

OBSERVATION:
1. By using the divalent cation status as surrogate of rennin activity incidence of low renin, normal renin and high renin essential hypertension was 36%, 44% and 20% respectively.
2. Incidence of low renin essential hypertension (LREH) was 55% in females and high renin essential hypertension (HREH) was 80% in males.
3. Most patients in Group –A (LREH) were in the age group between 56-60 years while in Group –B (HREH) the average age were between 42-45 years.
4. 82.5%(33) cases of Group A responded well to a dose of 5mg of Amoldipine, while 17.5% (7) responded well to 10mg. In comparison with Ramipril 95% (38) cases responded well to 5mg of Ramipril and 5%(2) cases with 2.5 mg of Ramipril.
5. In Group B 90% patients responded to 2.5 mg Ramipril, 10%(1) cases responded to 5 mg Ramipril. In comparison of response to Amlodipine 80% patients required 10 mg dose of Amlodipine.
6. Average SBP, DBP, MAP fall of the end of 12 weeks in Group–A with Amlodipine was 19.8, 13.7 and 15.8 mmHg respectively. While with Ramipril the average falls were 16.45, 7.79 and 10.72 mmHg respectively.
7. The average fall of SBP, DBP, MAP and Ramipril in Group–B were 18, 15.79 and 15.98 mmHg & 14.6, 8.8 and 10.23 mmHg respectively with Amlodipine.

CONCLUSION:
Measurement of serum ionized calcium and serum magnesium levels and according to their level which serve as surrogate marker of plasma renin activity can be classified into low renin, normal renin and high renin status of essential hypertension patients. From the above study, the low renin status patients best responded to calcium channel blocker Amlodipine, while high renin status patients best responded to ACE inhibitor Ramipril. This new innovative approach can help initiate antihypertensive drugs like a physiological antidote in the treatment of essential hypertension and may help to control hypertension and retard or prevent complications in the absence of costly, bothersome and non-availability of plasma renin activity study. SBP- Systolic Blood Pressure, DBP- Diastolic Blood Pressure, MAP- Mean Arterial Pressure, LREH- Low Renin Essential Hypertension, HREH- High Renin Essential Hypertension, NREH- Normal Renin Essential Hypertension.


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