Hypertension and nephrology

[Accredited Postgraduate Training 17HNAT]

APRIL 10, 2017

Hypertension and nephrology - 2017;21(01 klsz)

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Hypertension and nephrology

[Poor medication adherence - Whose responsibility? the physician and/or the patients?]

SIMONYI Gábor

[Hypertension is one of the most frequent disease in Hungary and one of the most important cardiovascular risk factor. Treating to target, significantly lower the risk of coronary artery disease, stroke chronic renal disease and mortality too. In treating of hypertension after life style therapy drug treatment has an essential role. In essential hypertension patients need to treat to the end of their life. Therefore patient adherence plays a significant role in the success of the treatment. The complexity of medication regimen and characteristic of drug class, age and gender all have influence the patient adherence. In Hungary the one year persistence of ramipril/amlodipine fixed dose combination was 20 percent higher than ramipril amlodipine free combination and ramipril/amlodipine fixed dose combination was 25 percent higher than ramipril/hydrochlorothiazide fixed dose combination.]

Hypertension and nephrology

[Angiotensin-converting enyzme inhibitors before and after myocardial infarction]

TOMCSÁNYI János

[In this review current knowledge related to the coronary atherosclerosis and angiotensin-enzym inhibitor is discussed. The earlier recognition to the effect of ACE inhibitors and ARBs to slow or reverse left ventricular remodelling is well known and accepted but the effect of these drugs on the atherosclerotic process itself may be aqual important. The focus should be now how to treat the early phase of coronary atherosclerosis, how to treat safety the hypertensive patient in the setting of coronary stenosis, how to treat the acute myocardial infarction’s patient with renal failure, and at least how to improve the long-time adherence in the primer and secunder prevention too.]

Hypertension and nephrology

[Efficient, cardiovascular risk-dependent therapy of patients with hypertension according to the data from database of the Hungarian Hypertension Registry]

KISS István, PAKSY András, KÉKES Ede, KERKOVITS Lóránt

[Over 3.5 million people have hypertension in Hungary, although with only 40-45% of them have the target blood pressure of under 140/90 been reached thanks to the non-medication and medication therapies. The reason of this can be several folds as an improperly chosen blood pressure lowering therapy, not sufficient care, insufficient doctor-patient cooperation and the incompetent information of the patients. According to the Hungarian Hypertension Register’s database of 2015 it is confirmed that the reaching of target blood pressure significantly differs and in the case of the hypertension disease coincide with the morbidity and mortality differences of the regions. These regional differences can be explained with not only the social, cultural and economic dissimilarities, but with the diversity of the quality of the healthcare and the professional work. Analyzation of the biggest risk factors of hypertension as the diabetes, ischemic heart failure and chronic kidney disease showed that when all of them are extant, the reaching of the target blood pressure is only successful in the case of 26% of the male and 33% of the female’s patients. According to the Register it turned out that the leading cause of the unsuccessful reaching of the target blood pressure is the peripheral vascular disease in the case of female patients which is followed by in turn with the disorder of lipid metabolism, the disorder of uric acid metabolism and obesity. The leading cause in the case of male patients is lipid metabolism which is followed by in turn with smoking, alcohol abuse and peripheral vascular disease. According to the summed-up results, 88% of the patients received combined treatment with the medication suggested by the professional guidelines. The proportion responsible for the unsuccessful reaching of the target blood pressure can be explained by the insufficient patient concordance and adherence. Both patient information and the care involved in the doctor-patient relationship have to be corrected and improved. One possible solution is the transmission of some competence of the doctors to the well-trained assistants and nurses who have a decisive role in the risk assessment and the base medical examination. It is also important to draw the pharmacists in too to the care of patients with applying more telemedicinal methods. It can be concluded from the results that came from the processing of the Register’s database that the population-level knowledge is important and the continuation of the data entry into the Register is necessary.]

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Relationship between Status Epilepticus Severity Score and etiology in adult NCSE patients

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Purpose - Nonconvulsive status epilepticus (NCSE) is a heterogeneous, severe neurological disorder of different etiologies. In this study, the outcomes of NCSE episodes was assessed in a large series of adult patients. Our objective was to evaluate relationship between Status Epilepticus Severity Score (STESS) and etiology and the role of etiological factors on predicting the outcomes. Method - In this retrospective study, the medical records of 95 patients over 18 years of age who were diagnosed with NCSE between June 2011 and December 2015 were reviewed. Their treatment and follow-up for NCSE was performed at the Epilepsy Unit in Department of Neurology, Antalya Research and Training Hospital. Etiological factors thought to be responsible for NCSE episodes as well as the prognostic data were retrieved. The etiological factors were classified into three groups as those with a known history of epilepsy (Group 1), primary neurological disorder (Group 2), or systemic/unknown etiology (Group 3). STESS was retrospectively applied to patients. Results - There were 95 participants, 59 of whom were female. Group 1, Group 2, and Group 3 consisted of 11 (7 female), 54 (33 female), and 30 (19 female) patients, respectively. Of the 18 total deaths, 12 occurred in Group 2, and 6 in Group 3. The negative predictive value for a STESS score of ≤ 2 was 93.88% (+LR 2.05 95% CI: 1.44-2.9 and -LR 0.3 95% CI 0.10-0.84 ) in the overall study group. While the corresponding values for Group 1 (patients with epilepsy), Group 2 (patients with primary neurological disorder), and group 3 (patients with systemic or unknown etiology) were 100%, 92.59% (+LR 2.06 95%CI: 1.32-3.21 and -LR 0.28 95% CI 0.08-1.02 ) 83.33% (+LR 1.14 95%CI: 0.59-2.9 and -LR 0.80 95% CI 0.23-2.73). Conclusions - This study included the one of the largest patients series ever reported in whom STESS, a clinical scoring system proposed for use in patients with status epilepticus, has been implemented. Although STESS appeared to be quite useful for predicting a favorable outcome in NCSE patients with epilepsy and primary neurological disorders, its predictive value in patients with systemic or unknown etiology was lower. Further prospective studies including larger NCSE samples are warranted.

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Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy

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