Hypertension and nephrology

[Gender differences in blood pressure values throughout the life course]

VÁRALLYAY Zoltán1

JUNE 24, 2020

Hypertension and nephrology - 2020;24(3)

AFFILIATIONS

  1. Karolina Kórház, Összevont Belgyógyászati Osztály, Kardiopulmonológiai Egység, Mosonmagyaróvár

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Hypertension and nephrology

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Hypertension and nephrology

[Treatment of hypertension in patients with chronic renal failure]

SZLOVÁK Edina, SZILVESZTER Dolgos

[The prevalence of chronic renal failure and hypertension is steadily increasing worldwide. The risk of possible cardiovascular death in patient with advanced renal failure is greater than the risk of progression to end-stage renal failure. Therefore treating and achieving target blood pressure is important in order to slow renal function decline in parallel with cardiovascular risk reduction. However, guidelines do not specify a single blood pressure target to be achieved in patients with renal failure, but suggest evidence based, reno- and cardioprotective therapy. This paper summarizes the clinical practice of treating hypertension (drug and nondrug treatment, therapeutic algorithm, target value, effectiveness of therapy) in patients with chronic renal failure.]

Hypertension and nephrology

[Covid-19 and the kidney]

PATÓ Éva, DEÁK György

[Covid-19 pandemy has emerged from Wuhan, China in December 2019. The infection affects not only the lung but other organs such as the kidney, as well. The relation between Covid-19 infection and the kidney is bidirectional. On one hand, Covid-19 infection may cause kidney damage in 50-75% of the cases resulting in proteinuria, haematuria and acute kidney injury (AKI). The etiology of AKI is multifactorial. Main pathogenic mechanisms are direct proximal tubular cell damage, sepsis-related haemodinamic derangement, citokine storm and hypercoagulability. The virus enters proximal tubular cells and podocytes via the ACE2 receptor followed by multiplication in the lysomes and consequential cell lesion. Histopathology shows acute tubular necrosis and acute tubulointerstitial nephritis. AKI is a strong predictor of mortality in critically ill patients. On the other hand, the risk of Covid-19 infection and mortality is substantially increased in patients with chronic kidney disease – especially in those with a kidney transplant or on dialysis – due to their immunocompromised status. Among haemodialysis patients, infection may spread very easily due to the possibility of getting contacted in the ambulance car or at the dialysis unit. The mortality rate of patients on renal replacement therapy with Covid-19 infection is 20-35%. In order to avoid mass infection it is obligatory to employ preventive measures and implement restricions along with (cohors) isolation of infected patients. In Hungary, every dialysis or kidney transplant patient with Covid-19 infection should be admitted to dedicated Covid-19 wards.]

Hypertension and nephrology

[Hypertension and Covid-19 – Part I. Significance of age, underlying diseases, and ACEI/ARB therapy in hypertension and co-morbidities during SARS-Cov2 infection]

KÉKES Ede, SZÉKÁCS Béla, NAGY Judit, KOVÁCS Tibor

[The appearance of the Covid-19 epidemic in different continents shows specific clinical features. Confirmed infected patients are detectable from approximately 30 years, with a maximum between 40 and 70 years of age. At the same time, however, a significant proportion of those who die from the infection come from patients over 65 years. The prevalence and mortality rates of the hypertensive population show a very similar formation. Based on the data collected, it is not surprising that hypertension as the underlying disease in the Covid- 19 epidemic is the first in all analysis. A more precise analysis clarified that it is not hypertension per se, but co-morbidities and complications of hypertension that play a primary role behind large-scale mortality in old age, such as diabetes, coronary heart disease, stroke, heart failure, and chronic kidney disease. Data from China, North America, and Italy suggest that hypertension and diabetes – and in North America, pathological obesity – in infected patients actually only reflect the prevalence of these diseases in a given population. The presence of comorbidities (coronary artery disease, stroke, heart failure, arrhythmia, chronic kidney disease) – based on multivariate logistic regression analysis – presents a more risk for severe clinical course and mortality. Some recent analyses have provided strong evidence that ACEI/ARB treatment does not pose a higher risk for the course or outcome of infection. Their administration is constantly needed in hypertension and comorbidities due to their organ protective and slowing the progression of diseases.]

Hypertension and nephrology

[Systolic and diastolic blood pressure by height, BMI, gender and age between 14 and 18 years of age]

SZABÓ László, SCHEURING Noémi, GÁCSI Erika, KORMOS-TASI Judit

[The aim of the screening program was to investigate blood pressure levels in different ages according to obesity. Blood pressure, heart rate, body composition, bodyweight, height and BMI were assessed. 2202 adolescent (1326 girls, 876 boys) participated in the screening program. The mean systolic blood pressure of all screened adolescents was 126.34 ± 12.55 mmHg. Boy/girl values were 131.87 ± 13.59/117.49 ± 5.69 mmHg, p < 0.001. The mean diastolic blood pressure of all screened adolescents was 71.86 ± 8.74 mmHg. Boy/girl values were 72.61 ± 9.17/66.69 ± 5.04 mmHg, p < 0.001. The 50%, 90%, 95%, and 99% thresholds and cases for systolic, diastolic blood pressure, and the BMI and BodyFluid thresholds, detailed for 14–18 year olds, girls and boys, are tabulated. Systolic blood pressure (SBP) was over 99% in 12 girls (14- year-olds), 39 (15), 42 (16), 33 (17), 5 (18) to height. SBP was over 99% in 17 boys (14-year-olds), 73 (15), 100 (16), 33 (17), 5 (18) to height. It is emphasized that systolic blood pressure (SBP) is > 99% in 12 girls (14 years), 39 (15), 42 (16), 33 (17), 5 (18) to body height. SBP > 99% for 17 boys (14 years), 73 (15), 100 (16), 33 (17), 5 (18) to body height. Elevated diastolic values were associated with elevated systolic values, but less occurred. The percentage of high blood pressure was more frequent among boys and girls who were in the overweight group (58.6% and 18.6%). Normal blood pressure is higher in overweight and obese adolescents and is a significant risk factor for developing high blood pressure in young adulthood.]

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[Population based study of hypertension in Hungary - 2012 Comprehensive Health Protection Screening Program of Hungary 201-2020]

BARNA István, DAIKI Tenno, DANKOVICS Gergely, KÉKES Ede, KISS István

[Background: The year 2011 saw the continuation of Hungary’s greatest and to date most comprehensive health screening programme started in 2010. The aim of the screening programme established according to the directives of the European Union with the cooperation of more than forty professional organisations is the preservation of the health of the population, the prevention of illnesses and the improvement of the general health status. The programme contributes to the prevention of coronary diseases by passing on knowledge concerning healthy nutrition and guidelines to help the establishment of a health-conscious lifestyle. Partecipants and methods: In the Comprehensive Health Tests Programme of Hungary, the examinations, among them coronary examinations covering the fields of cardiology and hypertension, take place in a specially furnished lorry. The results of the examinations of the people who have presented themselves for the tests (n=19,814) have been evaluated. In the Comprehensive Health Tests Programme of Hungary a total of 10,444 (52.7%) women and 9,370 (47.3%) men were tested at 332 locations. Although the tests were free for all adults, predominantly persons between the ages of 26 and 55 presented themselves. The average age of women was 42 years and that of the men was 40 years. Results: Upon data processing with the help of a query, 28% of the participants reported suffering from hypertension disease. Measurement of the blood pressure was carried out in each case with validated equipment and by qualified medical staff. Based on the data, it can be observed that while among men hypertension tends to occur in larger numbers at a younger age, the tendency is reversed at ages above 45 years, where hypertension is more frequent among women. Among women, the state of normotonia was most frequent up to the age of 45 and stage 1 hypertension became most frequent from the age of 46 onwards. It must be noted, however, that stage 3 hypertension was already present in 1.7% of women of 26 years of age, and the frequency of this category increased to 6% from the age of 46 onwards. The average systolic blood pressure measured among men exceeded the upper limit of the normal range for all age groups. The average systolic blood pressure measured among women was in the normal range up to the age of 55 years and only moved to the pathological range from the age of 56 onwards. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of the men, where it exceeded the upper limit of the normal range by a minimal extent). Among the men, stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of the subjects from the age of 18 onwards. The distribution of this did not vary significantly with the increase of age. It must be mentioned here too, that stage 3 hypertension became more frequent with age, and that it was observed in more than 11% of the patients above 56 years of age. The correlation between abdominal circumference, total cholesterol, blood sugar level and the measured blood pressure values was unambiguously ascertainable. In case of simultaneous presence of diabetes and hypertension (women, n=344 and men, n=303), blood pressures above 140/90Hgmm were 2-3 times more frequent for both sexes than without the presence of diabetes. Discussion: Thanks to the vast information obtained through the programme, a comprehensive picture has been drawn up about Hungary’s present health status not only on a regional or cross sectional level, but as it was described in the programme, too. ]

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[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.]

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[The regulation of the homeostasis of sodium and water is one of the oldest fields in medical research. Our article exhibits a new aspect of sodium balance: the concept of the regulated sodium storage taking place in the interstitium of the skin. We summarize the history of the research carried out in this area, beginning with the discovery of osmotically inactive sodium reservoirs to the localization of these buffers and the elucidation of the role of a regulating cutaneous cascade, which has an effect on blood pressure. Glycosaminoglycan (GAG) macromolecules present in the skin interstitium, come into reversible contact with the excess of dietary sodium intake. Thus in addition to the known role of the kidney, the above system may contribute to the regulation of sodium- and water balance and thereby to the regulation of blood pressure.]

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[Cardiovascular diseases are the leading causes of morbidity and mortality worldwide. Before the appearance of overt symptoms of various diseases, a silent, progressive condition exists. The main goal of prevention guidelines is to reduce the incidence of first and recurrent clinical events, which include coronary heart disease, ischaemic stroke and peripheral artery disease. Modification of risk factors has been proved to reduce cardiovascular mortality and morbidity, especially in patients with a high risk. By reducing the risk of substantial cardiovascular events it is possible to ameliorate premature disability, prolong survival and improve quality of life. We would like to emphasize the importance of lifestyle changes, the management of major cardiovascular risk factors and the use of various prophylactic drug therapies in the prevention of cardiovascular diseases. Medical intervention strategies for high-risk patients include the use of acetilsalycilic acid, statin, beta-blocker, ACE-inhibitor and anticoagulant for the treatment of any disease where the use of such drugs has been supported by evidence. The specific preventive effect of a drug is considered to be verified if the drug significantly reduced the incidence of pirmary vascular outcomes, beyond its primary pharmacodynamic effect, or if it is likely to have such an effect according to adequately powered metaanalyses.]