Hypertension and nephrology

[Covid-19 and peripheral arterial disease]

FARKAS Katalin1,2

APRIL 29, 2021

Hypertension and nephrology - 2021;25(2)

DOI: https://doi.org/10.33668/hn.25.009

[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.]


  1. Szent Imre Egyetemi Oktatókórház, Angiológia Profil, Budapest
  2. Semmelweis Egyetem, Angiológiai Tanszéki Csoport, Budapest



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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.]

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[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

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Hypertension and nephrology

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[Supine hypertension, a consequence of autonomic neuropathy, is a rarely recognized pathological condition. Reported diseases in the background are pure autonomic failure, multiple system atrophy, Parkinson’s disease, diabetes and different autoimmune disorders. In our case report we present a case of supine hypertension which developed in a patient decades after kidney transplantation. The patient was followed for 25 months and we demonstrate the effect of the modification of antihypertensive medications. At the time of the diagnosis supine hypertension appeared immediately after laying down (office sitting blood pressure (BP): 143/101 mmHg; office supine BP: 171/113 mmHg) and on ambulatory blood pressure monitoring (ABPM) extreme reverse dipping was registered (daytime BP: 130/86 mmHg, nighttime BP: 175/114 mmHg). After the modification of the antihypertensive medications in multiple times, both office supine BP (office sitting BP: 127/92 mmHg; office supine BP: 138/100 mmHg) and on ABPM nighttime BP improved markedly (daytime BP: 135/92 mmHg, nighttime BP: 134/90 mmHg). In conclusions, our case report points out that autonomic neuropathy-caused supine hypertension and extreme reverse dipping can develop in chronic kidney disease, after kidney transplantation. The modification of the antihypertensive medications can slowly restore this pathological condition.]

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