Hypertension and nephrology - 2019;23(04)

Hypertension and nephrology

SEPTEMBER 10, 2019

Hypertension and nephrology

SEPTEMBER 10, 2019

[Hungarian Hypertension Registry. Different methods and effects of increasing physician-patient cooperation on target blood pressure]

SZEGEDI János, KÉKES Ede, KISS István

[The life expectancy, the mortality and the development of complications of hypertensive patients are fundamentally influenced by the treatment, the effectiveness of care and physician-patient cooperation, the achievement of target blood pressure. Based on the database of the Hungarian Hypertonia Registry, we present three examples of the effect of different solutions for physician-patient cooperation on increasing the blood pressure target. During the two years between 2005 and 2007, we used a complex, versatile method of increasing the patient’s adherence in treated hypertensive patients (17,114 males and 21,772 women), with information, education, home-blood pressure diary, and continuous, regular physician- patient communication (sms, green phone line, website). The target blood pressure was significantly increased from 38.8% to 43.9%, and the rate of growth was higher in women. The increase was also significant in the elderly (over 70 years). In the first quarter of 2011, we launched a wide-ranging education and patient support campaign for 28,018 hypertensive patients under the ‘Everywhere Good, Best Home!’ subprogram for promoting of home blood pressure measurement and its use in therapy. 81.3% of the patients had completed the diaries under ther observation period, the full completion of the diaries was 91.3%. At the end of the third month, the target blood pressure of 135/85 mmHg for HBPM increased from baseline 21.2% to 48.8%. Growth was significant (P <0.001). In the year 2015-2016 we started a one-year, multicentric, prospective, observational study, in which 7735 patients aged 18-64 years were included from the database of Hungarian Hypertension Registry. In the non-active group (3313 people), treated hypertensive patients were controlled according to the traditional care program so far, while the active group members (4422) participated in an intensive care program with telemedicine (smart phone application) and other helping opportunities. The control was done at the end of 3, 6, 9, and 12 months after the start. In the active group, blood pressure dier was done by smart phone and every month, in the non-active group, paper logging was done every 3 months. In the active group, the blood pressure dieries were filled with smart phone every month and in nonactive group the paper dieries only every 3 months. Patient adherence was high in both groups (around 70%) and in the active group was greater than in the nonactive group. Target blood pressure (<140/90 mmHg) in the active group increased from 53.8% to 73.4% and in the non-active group from 49.9% to 68.1%. Studies have shown that patient interaction is determined by good communication between the care team and the patient, success of home blood pressure monitoring. The communicative ability of the care team (physician-nurse pharmacist) greatly influences the achievement of the therapeutic target. Modern telecommunications is another useful option.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Role of IL-10 family of cytokines in kidney fibrosis]

PAP Domonkos, VERES-SZÉKELY Apor, SZEBENI Beáta, SZIKSZ Erna, KISS József Zoltán, TAKÁCS István Márton, REUSZ György, SZABÓ J. Attila, VANNAY Ádám

[Chronic renal failure is a major health problem, affecting 8 to 16% of the population. Regardless of the etiology the common hallmark of chronic renal failure is inflammation, leading to the activation of renal myofibroblasts. Chronic activation of myofibroblasts lead to abnormal accumulation of extracellular matrix, disruption of the architecture of the kidney and finally to reduced renal function. Although our knowledge is rapidly expanding about the pathomechanism of chronic renal failure, we still have no drug to treat or hinder the progression of the disease. In our present review article, we summarize the role of the cytokines of the IL-10 family in renal scarring.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[The prevalence of therapy resistant hypertension]

FEJES Imola, ÁBRAHÁM György, LÉGRÁDY Péter

[In our country as well as around the world the most common chronic disease is the hypertension, and it is also an important risk factor causing disability and premature death. Within this, getting to know the true prevalence of therapy- resistant hypertension is important also from a public health perspective, since the prognosis of it is worse than that of those who reaches goal blood pressure range. It usually comes with hypertension mediated organ damages and higher (2- 2.5 folder) cardiovascular risk. It is prevalence in the literature is from 5% to 30%. The knowledge of the true prevalence depends on many factors, like: there are many different definitions of resistant hypertension, what is the main profile of the data collecting study site and what level of the health care system it works, or for example a questionnaire of a multicenter trial cannot be used totally in each country and study site.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Serum uric acid level in hypertension. Domestic experience based on the data of the Hungarian Hypertension Registry 2011., 2013. and 2015. Part III. - Relation of uric acid to clinical and laboratory characteristics]

KÉKES Ede, PAKSY András, ALFÖLDI Sándor

[2013. and 2015, we examined the correlation between the serum uric acid level and blood pressure, target blood pressure, prevalence of ISH and other diseases associated to high blood pressure used trend analysis and linear regression in 22,668 hypertensive men (mean age 60.8 years) and 24,684 hypertensive women (mean age 64.1 years). We have extended the correlation analysis to metabolic factors (BMI, abdominal circumference, lipid profile, blood sugar) and kidney function. Significant correlation was found between SH level and systolic and diastolic blood pressure as well as target blood pressure. There was a significant correlation between SH level and metabolic parameters (abdominal circumference, BMI, total cholesterol, HDL cholesterol, triglyceride, fasting blood sugar) and in hyperuricemia the prevalence of metabolic syndrome was higher. As the level of SH increases, the prevalence of hypertension-related KVB, ISZB and diabetes have increased. The closest correlation between uric acid levels and chronic kidney disease was in women and between the uric acid levels and ischemic heart disease in men. ur analysis supports the international declaration that hyperuricemia is an independent cardiovascular, metabolic and renal risk factor.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Hypertension and pregnancy]

JÁRAI Zoltán, VÁRBÍRÓ Szabolcs

[Hypertension complicates approximately 10% of the pregnancies and with this high blood pressure is the most frequent cardiovascular comorbidity during pregnancy. Hypertension during pregnancy accounts for a substantial maternal and perinatal morbidity and mortality risk. In our review we focus on the forms, diagnosis and therapeutic possibilities of gestational hypertension according to the European and domestic guidelines.]

Hypertension and nephrology

SEPTEMBER 10, 2019

[Kidney diet and the patient compliance issue ]

LADÁNYI Erzsébet

[There have been significant developments in the field of nephrology and dialysis as for the science and technology are concerned in the past decades. However, CKD patients still show high mortality and morbidity. From among the several factors determining the long-term outcome of CKD patients metabolic disorder and malnutrition play an important role. Malnutrition is often not diagnosed or is not paid enough attention to in the complex treatment of CKD patients. It is important to make both the patients and clinical staff more aware of proper nutrition and importance of prevention and treatment of malnutrition, respectively. The early diagnosis and treatment of malnutrition is of utmost importance in CKD patients. The long term renal failure and the accompanying malnutrition have a negative impact on their long term outcome and quality of life. Since the malnutrition causes a lot of complications, it is indispensable for dietitians and nephrologists to work closely together. Patient compliance is a determining factor in the successful implementation of renal diet.]

Hypertension and nephrology

SEPTEMBER 10, 2019