Hypertension and nephrology

[Chronic stress in the development of essential hypertension. Role of rilmenidine in the treatment of stress induced hypertension]

SIMONYI Gábor1

APRIL 22, 2022

Hypertension and nephrology - 2022;26(02)

DOI: https://doi.org/10.33668/hn.26.014

[Hypertension is an independent risk factor of cardiovascular diseases. Several factors contribute to its development, including chronic stress, which may induce hypertension by increasing sympathetic activity. The signs of increasing sympathetic activity can be primarily detected in the initial phase of hypertension, which is characterized by the increase in cardiac output. In addition to the hemodynamic consequences (increase in cardiac output, tachycardia, coronary vasoconstriction, proarrhythmia), the increase in sympathetic activity has many harmful effects. Numerous metabolic (insulin resistance, dyslipidemia), structural and trophic effects (endothelial dysfunction, vascular hypertrophy, myocardial hypertrophy), as well as thrombotic and humoral processes (procoagulation, enhancement of thrombocyte aggregation, sodium retention, activation of the renin-angiotensin-aldosterone axis) may develop and consequently damage body functions at many targets. Several different antihypertensive drug classes are available for reducing increased sympathetic activity, including peripheral alpha and beta blockers and centrally acting drugs. First generation antihypertensive drugs with central mechanisms of action (e.g. clonidine, guanfacine, alpha-methyldopa) is currently rarely administered and only for a few indications as they have a significant adverse events profile. Among centrally acting, second generation drugs, rilmenidine stimulates imidazoline-I1 receptors and thus beneficially influences mild or moderate hypertension that involves enhanced sympathetic nervous system activity.]

AFFILIATIONS

  1. Dél-budai Centrumkórház-Szent Imre Egyetemi Oktatókórház, Anyagcsere Központ, Hypertonia Centrum

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Hypertension and nephrology

[Novelties in the diagnosis and treatment of X-linked hypophosphatemia]

RUESZ György Sándor, MIKES Bálint, CSIZEK Zsófia, HORVÁTH Orsolya

[X-linked hypophosphataemia (XLH) is the most common inherited cause of phosphate wasting. Its pathogenesis is complex, determined by the dysregulation of phosphate homeostasis and bone metabolism. We review herein the pathophysiology of XLH leading to multiple manifestations, stages of diagnosis and the treatment strategies. XLH is now in the scientific interest of pediatric nephrology, because a new treatment modality, burosumab became available in Hungary. Burosumab is a monoclonal antibody against fibroblast growth factor 23 (FGF-23). XLH is caused by the loss of function mutations in ”phosphate regulating endopeptidase homolog, X-linked” (PHEX) gene, which results enhanced secretion of the phosphaturic hormone FGF-23. The diagnosis of XLH is based on signs of rickets and/or osteomalacia and decreased growth velocity in association with hypophosphataemia and renal phosphate wasting in the absence of vitamin D or calcium deficiency. Conventional treatment with oral phosphate supplementation together with active vitamin D (calcitriol or alfadiol) can improve bone metabolism, but only partial results can be achieved, and can promote side effects (nephrocalcinosis). The better understanding of the role of PHEX gene and FGF-23 levels in the pathomechanism helped to identify therapeutic options more properly. With monoclonal antibody therapy against FGF-23 the disease process can be interrupted, and complications can be prevented if the therapy is initiated in time. However, deformities already leading to disability cannot regress completely during burosumab therapy, highlighting the need of early diagnosis and the start of the biological treatment before complications.]

Hypertension and nephrology

[Cilostazol improves quality of life and lower limb functional capacity in lower extremity arterial disease regardless of age and gender – new results of the SHort-tERm cIlostazol eFFicacy and quality of life (SHERIFF) study]

FARKAS Katalin, KOLOSSVÁRY Endre , JÁRAI Zoltán

[Intermittent claudication has a significant negative impact on the patients’ quality of life. Revascularization procedures and noninvasive medical therapie scan improve walking capacity. Cilostazol has IA recommendation for the treatment of intermittent claudication (IC). The aim of this study was to evaluate the effect of three-month cilostazol treatment on the health related quality of life and on the lower limb functional capacity in women (F) and men (M), in patients under 65 years of age (Y) and among patients 65 years of age or older (O) with intermittent claudication in the clinical practice. The study was a multicenter, non-interventional trial, 812 lower extremity arterial disease (LEAD) patients (Fontaine II stage, mean age: 67.17 years, male/female: 58.25/41.75%, 506 patients aged ≥65 years) were enrolled, who received cilostazol (50 or 100 mg b.i.d.) for three months. Quality of life was evaluated with the EQ- 5D-3L questionnaire, functional capacity with the WELCH questionnaire. Walking distances, ankle-brachial index were measured at baseline and after 3-month. Upon conclusion of the study, the EQ-5D index improved (baseline: F [female] –0.49±0.23, M (male –0.44±0.22, Y (age <65 years) –0.45±0.21, O (age ≥65 years) –0.47±0.23; 3rd month: –0.27±0.18, –0.25±0.18, –0.25±0.18, –0.26±0.18; respectively, p<0.0001) and there was a significant increase in the WELCH score as well (baseline: F 18±13, M 20±14, Y 21±14, O 18±13; 3rd month: 31±18, 32±18, 32±19, 31±17; respectively, p<0.0001). Both pain-free and maximal walking distance increased: F 60.94%, (median: +50.26%), 49.57%, (median: + 42.86%), M 50.22%, (median: +50%), 37.7%, (median: + 33,33 %), Y 54,35 %, (median: + 56,2%), 36.78%, (median: +42.86%), O 54.62%, (median: +50%), 46.29% (median: +33.33%); respectively (p<0.001). Three months of cilostazol treatment improved quality of life and lower limb functional capacity in claudicant patients regardless of age and gender. The WELCH questionnaire is a useful tool in clinical practice for the evaluation of intermittent claudication treatment.]

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[The efficiency of angiotensin receptor blocker/neprilysin inhibitor (ARNI) treatment in heart failure 2021 ARNI, VIDI, VICI…]

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