Hypertension and nephrology

[ACEI or ARB: a Debate Refueled?]


JUNE 10, 2018

Hypertension and nephrology - 2018;22(03)



Further articles in this publication

Hypertension and nephrology

[Multifactorial Treatment of Type 2 Diabetes from a Cardiovascular Prevention Perspective ]

SZTANEK Ferenc, PUSKÁS István, DEME Albert, ZÖLD Eszter

Hypertension and nephrology

[Accredited Postgraduate Training]

Hypertension and nephrology

[Antihypertensive effect of rilmenidine focusing on the Hungarian multicenter trial VERITAS]


[Summary in the antihypertensive therapy, in addition to the RAS-blockers (ACE-inhibitors or ARBs), calcium antagonists and thizid-like diuretics, other antihypertensive drugs with different mechanisms of actions, such as the imidazoline I1 receptor agonists, are beneficially used. Several international and Hungarian studies showed the results of the effects of these agents. Authors emphasize the effects of the VERITAS study showing that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hypertrophy (LVH) were also decreased. In a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect. Authors summarise the most important actions of rilmenidine, and the selected publications on the results of the Hungarian and international investigations.]

Hypertension and nephrology

[Cilostazol is an Effective and Safe Option for the Treatment of Intermittent Claudication]

POÓR Ferenc

Hypertension and nephrology

[Remembering Professor István Kiss MD (1952-2018) ]

All articles in the issue

Related contents

Lege Artis Medicinae



[The article deals with the question where and when is it ethically acceptable in a randomized controlled clinical trial to give the investigational drug to one of the groups, while placebo to the other. First, it gives a short overview on the origin of the problem and the history of its reemergence before and after the revision of the Declaration of Helsinki 2000. It examines the various forms of placebo use, the pros and cons of its implementation, the international debate before the revision of the Declaration of Helsinki 2000 and the corrections after its acceptance. Finally it declares some principles in connection with placebo controlled clinical trials and examines when such a trial is acceptable in various psychiatric disorders.]

Hypertension and nephrology

[Results of ATTENTION study]


[In the ATTENTION (Using of ARB and sTaTin basEd iNdividualized Treatments in Hungarian patients In the light Of New CV prevention guidelines) trial’s ARB arm 9996 treated hypertensive patients were enrolled. Based on the results in the medical practice, the choice of the first ARB has a significant impact on the further antihypertensive therapy. Losartan, telmisartan and valsartan are all suitable for reaching the goal blood pressure. If necessary, doctors will not change the composition but the dose or use a diuretic supplement (resistant hypertension, older age etc.). Overall a telmisartan preference was observed in the study.]

Lege Artis Medicinae

[What is worth to know about COVID-19 for (not only) a cardiologist]

HEPP Tamás, CSÉKE Balázs, BENCZÚR Béla

[SARS-CoV-2 virus infection sprang from Wuhan the capital of the Chinese Hubei province, at the end of 2019 and caused a worldwide pandemic with 1.5 million confirmed cases and claimed almost 100 000 victims until the beginning of April, 2020. First analyses of Chinese COVID-patients confirmed that diabetes, hypertension, and cardiovascular diseases were highly prevalent among SARS-CoV2 infected patients, and might be associated with poor outcome. As previously shown for SARS-CoV-1, SARS-CoV-2 similarly utilizes ACE2 as receptor for viral alveolar cell entry. A suspicion has arisen that the widely used ACE-inhibitor/ARB therapy could be potentially harmful for patients suffering from COVID-19 infection as these agents upregulate the ACE2-expressions. From the other point RAAS-blockade might be beneficial due to fact that ACE2 counters the deleterious effects of Angiotensin II. Authors provide a comprehensive over­view of the most recent literature and summarize the link between COVID-19 and car­diovascular disease. It is important to em­phasize that there are no available hu­man evidences confirming if the RAAS-in­hi­bitor therapy were harmful or helpful in pa­tients suffering from COVID-19.]

Clinical Neuroscience

Syndrome of trephined-underestimated and poorly understood complication after decompressive craniectomy


Decompressive craniectomy (DC) is still a matter of debate, with a numerous complications as expansion of haemorrhagic contusions, external cerebral herniation, subdural hygromas, post-traumatic hydrocephalus (HC). The often overlooked “syndrome of the trephined” (ST) as a delayed complication of DC also known as sinking skin flap sy initially described in 1939.ST is characterised by the neurological changes associated with alteration of the pressure/volume relationship between intracranial pressure (ICP), volume of cerebrospinal fluid (CSF), blood, and brain tissue in patients with large bone defects. This review aims at elucidating the mechanisms responsible for the development of ST, and providing useful tips and red-flag signs for healthcare professionals involved with care of post DC patients. Symptoms identified on time could help to develop appropriate treatment strategies for this suddenly deteriorating, but possible reversible condition. Although the treatment strategy is straightforward, calling for a prompt cranioplasty, the correction of HC through CSF diversion devices might require a lengthy optimisation period. Continuous changes in the setting of the shunting systems or spinal tap might lead to dangerous swinging of the midline structures causing further neurological deterioration. Thus, finding the right balance in terms of clinical management often represents a significant challenge.

Lege Artis Medicinae



[Angiotensin-converting enzyme inhibitors are used in broad spectrum of cardiovascular pharmacotherapy as evidence based drugs. Cough, which is the most typical adverse effect of ACEinhibitors occurs in relatively high proportion of patients (20-63%) during therapy. Angioedema is a less frequent and often underdiagnosed but potentially life-threatening adverse effect of ACEI-treatment occurring typically on the face and extremities or rarely in a visceral form. Authors review the pathomechanisms of angioedema and the therapeutic options.]