Hypertension and nephrology

[Hypertension and menopause]

MASSZI Gabriella

FEBRUARY 20, 2020

Hypertension and nephrology - 2020;24(01)

DOI: https://doi.org/10.33668/hn.24.001

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Hypertension and nephrology

[Heart failure with mid-range ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF)]

NYOLCZAS Noémi

[reduced ejection fraction (HFrEF) is well-known. Physicians are well versed in diagnosing and treating the disease. At the same time, our knowledge is scarce about heart failure with preserved ejection fraction (HFpEF) and heart failure with mid-ranged ejection fraction (HFmrEF). We are diagnosing these cases in a much lower number than the actual ones, and we have no morbidity and mortality-reducing evidence for treating the disease. The summary is intended to provide an overview of the epidemiology, clinical characteristics, morbidity and mortality, treatment options, the importance of the etiological diagnosis and long-term follow- up of HFmrEF and HFpEF based on currently available literature.]

Hypertension and nephrology

[Stevo JULIUS Michigan Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA]

STEVO Julius

Hypertension and nephrology

[Thinking globally - the significance of the joint treatment of risk factors]

BENCZÚR Béla

[Hypercholesterolemia and hypertension - as the key risk factors of ischemic heart disease - are strongly linked to the increasing prevalence of cardiovascular mortality and morbidity. These risk factors are related to each other and half of the hypertensive patients have elevated cholesterol, as well. The recent European hypertension guidelines recommend statin treatment in dyslipidemic and/or subjects at high risk including diabetic or CKD-patients. Reaching blood pressure target if we can hold the patient under 1.8 mmol/l LDL-level results in 60% reduction of the risk of CAD and 17% reduction of stroke. This aim can only be reached if patients regularly take their prescribed medications although statinadherence is the poorest in our country. One of the main tools of improving adherence beyond education is the use of fix-dosed combination.]

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Hypertension and nephrology

[The importance of statin therapy in hypertension]

PARAGH György, PÁLL Dénes

[Hypertension and hypercholesterolaemia often co-occur and promote early cardiovascular disease. Previous studies have shown that antihypertensive treatment may be more effective if LDL cholesterol is also reduced. This may be due to the increased expression of angiotensin-1 receptor in hypercholesterolaemia, which increases peripheral vascular resistance through angiotensin-2, and adversely affects endothelial and smooth muscle cells. Other authors indicate that high cholesterol levels increase the production of angiotensin-2 through the activation of the chymase system. High cholesterol levels increase the amount of circulating oxidized LDL which binds to the transmembrane oxidized LDL receptor (LOX- 1) also activates the angiotensin-1 receptor. In addition, angiotensin-2 has an effect on intracellular cholesterol synthesis by enhancing the key enzyme of the synthesis of intracellular cholesterol, HMG-CoA reductase. The authors present the studies that support cholesterol lowering can contribute to lowering blood pressure and other major meta-analyses in which the beneficial effects of cholesterol lowering and lipid lowering on blood pressure reductions were not proven. In the background, it may well be that these studies are not designed to evaluate the effect of cholesterol-lowering drugs on hypertension in patients with hypercholesterolaemia, and non-statin-treated patients are not randomized.]

Lege Artis Medicinae

[THE IMPORTANCE OF HYPERTENSION IN CEREBROVASCULAR DISEASES]

SZAPÁRY László

[Stroke is a highly prevalent disorder worldwide; it is the third main cause of death and the leading cause of severe disability. Recent data showed that 72-86% of cerebrovascular disorders are of ischaemic type. Arterial hypertension is the most prevalent risk factor for both haemorrhagic and ischaemic stroke, it is present in approximately 70% of cases. All forms of hypertension, isolated systolic or diastolic and combined hypertension increase stroke risk about 3-4 times and the relationship with systolic blood pressure may even be stronger than with diastolic blood pressure. Hypertension is very common after acute stroke. In this phase the cerebral autoregulation is disturbed in the region of focal brain ischaemia or haemorrhage such that cerebral blood flow is directly dependent on systemic blood pressure. It is therefore essential to avoid systemic hypotension in acute stroke patients and the reduction of high blood pressure may lower cerebral blood flow in the ischemic penumbra. Evidence from clinical data shows that control of blood pressure leads to lower risk of first or reccurent stroke and patients have shown beneficial effects especially of ACE inhibitors and diuretics. In the PROGRESS study both hypertensive and non-hypertensive cerebrovascular patients benefited from antihypertensive therapy. Previous results suggests that there may be additional beneficial effects of the ACEinhibitor therapy not related to blood pressure lowering in the prevention of stroke.]

Hypertension and nephrology

[The success of fixed combined amlodipine/atorvastatin (Amlator®) therapy in patients with hypertension and dyslipidemia]

KÉKES Ede

[In total 2606 patients with hypertension and dyslipidemia got combined antihypertensive and antilipid-treatment. The main component of therapy was amlodipine/ atorvastatin fixed combination in different dose variations. The goal of the study was to access optimal target blood pressure and lipid profile. The baseline average blood pressure value was 155.9/90.18 mmHg and it decreased to 132.77/80.04 mmHg during the six months therapy. The lipid profile also changed successfully: the average value of total cholesterol decreased from 5.97 mmol/l to 4.68 mmol/l, LDL cholesteron from 3.45 mmol/l to 2.49 mmol/l and serum triglyceride from 2.1 mmol/l to 1.69 mmol/l. We reached the target values in respect of LDL cholesterol (<2.5 mmol/l) and of triglyceride (<1.7 mmol/l) prescribed in guidelines for subjects with high cardiovascular risk. According to the global cardiovascular risk estimation (European Heart Score) the risk ratio in percent was significantly decreased in each age group, in both genders and in smoking or nonsmoking subjects.]

Lege Artis Medicinae

[Notes on the management of hypertension in chronic kidney disease ]

AMBRUS Csaba

[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]