Hypertension and nephrology

[A turning point in the approach to primary aldosteronism?]


APRIL 29, 2021

Hypertension and nephrology - 2021;25(2)

[In László Bajnok 's warning summary statement a secondary hypertension with the most common endocrine disease, the primary related to aldosteronism, recently published two important studies (1, 2) show that it is a paradigm shift began in the assessment of the disease, and so far professional guidelines (3, 4) have been questioned]


  1. Szent Imre Oktatókórház, Anyagcsere Központ, Budapest



Further articles in this publication

Hypertension and nephrology

[Current evidence on the accuracy and precision of non-invasive cardiac output monitoring]

VÉGH Anna, REUSZ S György

[Purpose of review: Assessing cardiac output (CO) is an important part of monitoring the hemodynamically unstable patients. Different non-invasive CO measurement devices are currently available, that can be useful in various clinical situations. The purpose of this article is to review current literature on commonly employed methods especially regarding their accuracy and precision. Results: Most of the devices, especially the non-invasive ones have the disadvantage of questionable accuracy and precision. Generally speaking, the more a method is based on assumptions and mathematical models, the less precise it will be. There is also significant heterogeneity between individual studies. Clinically it is important to consider the purpose of the measurement before choosing a method. In terms of accuracy the most reliable ones are, the ones that are based on simple physical principles and minimal assumptions, for example transthoracic echocardiography, and thermodilution. Conclusions: To have better comparability between individual studies it would be imperative to have standardized study protocols regarding the number of cardiac cycles assessed, the used method, the clinical environment, the age and clinical condition of the study population.]

Hypertension and nephrology

[At the doorstep of an attitude change: our novel knowledge on renal fibrosis in chronic kidney disease]


[In spite of the diverse etiology, chronic kidney disease is finally leading to end-stage renal disease uniformly by the fibrotic transformation of the kidneys. In recent years – mainly due to experimental data – the explanation of this transformation changed profoundly: it has been revealed, that renal fibrosis is a dynamic, actively ongoing process involving many keyfactors. Influencing these factors, give us hope to prevent the progression of chronic kidney disease. This review summarizes the connection of renal fibrosis and chronic kidney disease, the results of the widely used different methods and the recently discovered mechanisms, which caused paradigm change in this topic]

Hypertension and nephrology

[When should antihypertensive be taken: in the morning and/or evening? Chronopharmacotherapy of hypertension in practice]


[The circadian (24-hour) variability of blood pressure (BP) is influenced by constant and variable (external and internal) factors. With this in mind and by determining the type of hypertension with a 24-hour blood pressure monitoring (ABPM), individual chronopharmacological (chronopharmacotherapy) treatment can be planned. There are significant differences in the chronokinetics of antihypertensive drugs administered at different times. Their therapeutic range and efficacy depend significantly on their circadian timing. Although the most modern antihypertensives have a 24-hour effect, they are not able to lower blood pressure at all times. Morning intake of ACE inhibitors, ARB-s, alpha-blockers mainly affect the afternoon and early evening rise, while evening intake reduces nocturnal and morning rise. Calcium channel blockers, beta-blockers (except carvedilol and labetolol), do not affect the circadian blood pressure profile. Therefore, in nondipper hypertension or in the case of morning rise, the twice daily morning and evening administration is more effective than the single morning administration. (Usually a lower dose is sufficient in the evening.) Adequate control of nocturnal or morning blood pressure elevations can be achieved with medication taken in the evening. According to the relevant studies the conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events, so evening intake only is not recommended. In particular the administration of antihypertensive drugs at bedtime, especially in the case of elderly patients may cause excessive BP fall at night with increased risk of silent cerebral infarct and the myocardial ischemia in patients with coronary heart disease.]

Hypertension and nephrology

[Primary aldosteronism, the mysterious object of desire – in the context of a study]


[The aldosterone-producing adenoma, aldosteronoma, the actual Conn syndrome, is a relatively well-defined entity, while the separability of idiopathic hyperaldosteronism and low-renin primary hypertension appears to be inherently uncertain according to our current knowledge. In this way, the diagnosis of primary aldosteronism (PA) is in fact more or less probabilistic and this also contributes fundamentally to the uncertainty of prevalence data. These are confirmed by a recent study in which PA was evaluated in the form of 24- hour urinary aldosterone excretion measured with oral salt loading instead of the standard technique. The paper has contributed to the change of paradigm by which the chair of the most widely accepted PA guideline, renewed in 2016, called to be jettisoned much of it.]

Hypertension and nephrology

[Covid-19 and peripheral arterial disease]

FARKAS Katalin

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

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