KISS István, PAKSY András, KÉKES Ede, KERKOVITS Lóránt
APRIL 10, 2017
Hypertension and nephrology - 2017;21(01 klsz)
[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.]
Hypertension and nephrology
[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
[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.]
Lege Artis Medicinae
[Guidelines of diagnosing and treating hypertension play pre-eminent role in maintaining health in our World. Based on reliable estimates we have to take in account more than 1.6 billion individuals suffering from hypertension by 2025. Adherence to the guidelines is a vital issue for all high blood pressure patients, however, also the economically developed countries have a disappointing share of well-controlled hypertension. Unfortunately, on the 5 continents of the world, the guidelines provide different or very different recommendations for measuring blood pressure, making diagnosis, estimating cardiovascular risk, and setting a target value, although an attempt has been made in the recent years for developing “consensus” in specific issues. This study presents the different opinions and resolutions by analysing the ACC/AHA, ESC/ESH, NICE, Canadian and Australian guidelines. WHO and ISH resolutions were also concerned. We describe the mutual adjustment in theoretical and practical terms of the guidelines and the consensus that have already been established.]
Lege Artis Medicinae
[The molecular and predictive epidemiology plays more and more important role in the prevention of cancer. With the help of early biomarkers, high risk population could be identified for primary preventive intervention modalities. It uses both molecular biological methods and elements of risk assessment plus a testing system based on animal experiments. Its specificity is not high enough to establish the diagnosis but it can be used to monitor the disease and to follow the effectivity of the therapy (e.g. "minimal residual disease") and the preventive interventions. It is also suitable for risk assessment with the markers of individual susceptibility. As to everyday practice there are many problems because of limited therapeutic possibilities, but we hope that the molecular and predictive epidemiology becomes an important part of medicine in the near future.]
Lege Artis Medicinae
[INTRODUCTION - Affective disorders are widely prevalent causing a common health problem. They appear frequently as comorbid disorders in connection with somatic illnesses. In the Hungarian literature there are very little data available related to his topic. In this study the prevalence of depression was analyzed in different departments of general hospitals. PATIENTS AND METHODS - A questionnaire screening was performed in nine Hungarian hospitals among 2423 patients treated in general medical departments. The prevalence of depression and the use of antidepressants was measured. The Beck Depression Inventory was applied for the detection of depression. RESULTS - In the studied sample the mean score of depression was 12.9 on the Beck Depression Inventory. 46.4% of the patients reached a pathological score. The most prevalent depression was screened in the rheumatological, neurological and rehabilitation departments. The use of antidepressants was very low among the depressed patients (0-11.9%). CONCLUSION - Based on the data of the study it seems that screening and treatment of depression in general medical departments is of great importance, which stresses the practical significance of the consultation-liaison psychiatry.]
Hypertension and nephrology
[In both sexes combining different types clinical questionnaire and results of exercise test in a point system can more reliably predict 10 years mortality or survival. The method in both sexes is reliably suitable for the screening of highly endangered individuals in everyday practice.]
Lege Artis Medicinae
[Psychiatric problems are a common comorbid condition in patients with cardiovascular disease. Depression is a well-known risk factor for the development of cardiovascular disease and mortality too. Psychiatric and cardiovascular diseases are prevalent public health problems in the western world. Depression is associated with endothelial dysfunction and increased platelet aggregation, which may explain the consequent cardiovascular complications. Specific affective temperaments may be associated with special cardiovascular diseases. Antidepressant therapy does not only reduce depression but also cardiac mortality.]
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Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease2.
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Lege Artis Medicinae
[We do not know that the phenotype of the coronavirus would have changed]5.
Lege Artis Medicinae
[Teleconsultations in general practice during coronavirus epidemiological emergency]
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