Hypertension and nephrology

[Hypertension and pregnancy]

JÁRAI Zoltán, VÁRBÍRÓ Szabolcs

SEPTEMBER 10, 2019

Hypertension and nephrology - 2019;23(04)

DOI: https://doi.org/10.33668/hn.23.020

[Hypertension complicates approximately 10% of the pregnancies and with this high blood pressure is the most frequent cardiovascular comorbidity during pregnancy. Hypertension during pregnancy accounts for a substantial maternal and perinatal morbidity and mortality risk. In our review we focus on the forms, diagnosis and therapeutic possibilities of gestational hypertension according to the European and domestic guidelines.]



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Hypertension and nephrology

[Accredited Postgraduate Training]

Hypertension and nephrology

[Role of IL-10 family of cytokines in kidney fibrosis]

PAP Domonkos, VERES-SZÉKELY Apor, SZEBENI Beáta, SZIKSZ Erna, KISS József Zoltán, TAKÁCS István Márton, REUSZ György, SZABÓ J. Attila, VANNAY Ádám

[Chronic renal failure is a major health problem, affecting 8 to 16% of the population. Regardless of the etiology the common hallmark of chronic renal failure is inflammation, leading to the activation of renal myofibroblasts. Chronic activation of myofibroblasts lead to abnormal accumulation of extracellular matrix, disruption of the architecture of the kidney and finally to reduced renal function. Although our knowledge is rapidly expanding about the pathomechanism of chronic renal failure, we still have no drug to treat or hinder the progression of the disease. In our present review article, we summarize the role of the cytokines of the IL-10 family in renal scarring.]

Hypertension and nephrology

[Serum uric acid level in hypertension. Domestic experience based on the data of the Hungarian Hypertension Registry 2011., 2013. and 2015. Part III. - Relation of uric acid to clinical and laboratory characteristics]


[2013. and 2015, we examined the correlation between the serum uric acid level and blood pressure, target blood pressure, prevalence of ISH and other diseases associated to high blood pressure used trend analysis and linear regression in 22,668 hypertensive men (mean age 60.8 years) and 24,684 hypertensive women (mean age 64.1 years). We have extended the correlation analysis to metabolic factors (BMI, abdominal circumference, lipid profile, blood sugar) and kidney function. Significant correlation was found between SH level and systolic and diastolic blood pressure as well as target blood pressure. There was a significant correlation between SH level and metabolic parameters (abdominal circumference, BMI, total cholesterol, HDL cholesterol, triglyceride, fasting blood sugar) and in hyperuricemia the prevalence of metabolic syndrome was higher. As the level of SH increases, the prevalence of hypertension-related KVB, ISZB and diabetes have increased. The closest correlation between uric acid levels and chronic kidney disease was in women and between the uric acid levels and ischemic heart disease in men. ur analysis supports the international declaration that hyperuricemia is an independent cardiovascular, metabolic and renal risk factor.]

Hypertension and nephrology

[Kidney diet and the patient compliance issue ]

LADÁNYI Erzsébet

[There have been significant developments in the field of nephrology and dialysis as for the science and technology are concerned in the past decades. However, CKD patients still show high mortality and morbidity. From among the several factors determining the long-term outcome of CKD patients metabolic disorder and malnutrition play an important role. Malnutrition is often not diagnosed or is not paid enough attention to in the complex treatment of CKD patients. It is important to make both the patients and clinical staff more aware of proper nutrition and importance of prevention and treatment of malnutrition, respectively. The early diagnosis and treatment of malnutrition is of utmost importance in CKD patients. The long term renal failure and the accompanying malnutrition have a negative impact on their long term outcome and quality of life. Since the malnutrition causes a lot of complications, it is indispensable for dietitians and nephrologists to work closely together. Patient compliance is a determining factor in the successful implementation of renal diet.]

Hypertension and nephrology

[Is the “Prophecy of the Wise Men” True that Systolic Blood Pressure Target Levels will Soon be Below 130 mmHg? – Commentary to the 11th Professional Guideline of the Hungarian Society of Hypertension]


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[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

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[Estimation of serum uric acid in the Hungarian population]

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

[The clinical significance of serum uric acid markedly increased in the last years, especially in the civilized countries, but the abnormal serum uric acid level shows a significantly strong increasing tendency worldwide. The high level of uric acid is an integral part of metabolic syndrome. Today we recognized the important role of xanthine oxidase in the clinical practice for developing of oxidative stress in some tissues and organs. In 2011 during the Hungarian Health Care Screening Program we analyzed the prevalence of metabolic factors in 18 886 subjects. In the present publication we have dealt with uric acid and calculated the occurrence of abnormal values in percentage of the observed population. We found abnormal values in 12.3% of women (over 350 µmol/l) and 16.5% of men (over 400 µmol/l). The average values were higher in hypertensive subjects against normotensive ones in both gender. There was a close correlation among the metabolic components and the elevated uric acid level. The screening had given a possibility for detecting hidden gout and some other diseases, where the elevated uric acid level is specific of the clinical entity.]

Hypertension and nephrology

[Initiation of antihipertensive therapy with fix combinations, focusing on perindopril, amlodipine and indapamide]


[Early clinical studies proved that most hypertensive patients (>70%) need drug combinations to reach the target blood pressure. We should combine two or three - sometimes more - drugs from different antihypertensive classes for quicker normalisation of blood pressure and to reduce incidence and severity of hypertensive complications. Several international and Hungarian (MHT 2015) guidelines emphasize the advantages of fix combinations against free combinations. Most frequently used combinations contain ACEi + calcium antagonist, or ACEi + diuretic. From them I will focus on the perindopril + amlodipine or perindopril + indapamide combinations. If we do not reach target blood pressure, triple fix combinations (e.g. perindopril + amlodipine + indapamide) can also be used. Now there are fix combinations of different strengths, therefore we may start the therapy with these fix combinations according to patients’ characteristics (e.g. age, complications, concomitant diseases).]

Clinical Neuroscience


CSAPÓ Krisztina, BAJKÓ Zoltán, MOLNÁR Sándor, MAGYAR Tünde, CSIBA László

[The vascular diseases (myocardial infarct, stroke, peripheral occlusive disease) have a common pathophysiological background, the arteriosclerosis, that impairs the autoregulation of cerebral vessels, decreases the endothel mediated flow in the peripheral vessels. Therefore the assessment of the vascular damage or the follow-up of therapy need a complex and simultaneous approach. Currently the morphological and functional changes in the vascular system can be investigated with separated measuring systems, focusing either to cardiac or cerebral parameters (intermittent blood pressure measurement, ECG, cerebral blood flow by transcranial Doppler e.g.). Our purpose is to establish a complex non-invasive system for the simultaneous measurement and comparison of cardiac/cerebral/periheral hemodynamics. The hemodynamic parameters in hypertensive patients are examined with transcranial Doppler and cardiac monitoring during tilt-table test. Intima-media thickness, flow-mediated dilatation in brachial artery, augmentation index and pulse wave velocity are also measured. The measurement will be repeated after 6 and 12 months follow-up. Our preliminary results are similar to those found in the literature, that proves the reliability of our complex noninvasive hemodynamic system. It is assumed, that 12 months antihypertensive therapies with ACE inhibitors, calciumantagonist etc. might result in different effects on different vascular parameters. Our system enables the individualization of antihypertensive therapy.]

Hypertension and nephrology

[Change in the approach of the treatment of hypertension in Hungary. Five years results of the „Live below 140/90!” Program]

KISS István, PÁL László, SCHANBERG Zsolt, BARNA István, ALFÖLDI Sándor, FARSANG Csaba, DE Châtel Rudolf

[One of the potentials of the effective fight against endemic diseases is their exposition and the recognition of their dangers and risk factors. The other possibility is to increase the professional knowledge of the medical and healthcare employees along with the patients’ co-operation. For the prevention of complications and the adequate treatment of hypertension an extensive compliance program, called „Live below 140/90!” was initiated by the Hungarian Society of Hypertension in 2005. The mission was to give knowledge to the non-professional public about the symptoms of the disease and how to get information about it while helping patients’ relatives. The first message was the “Hit the target blood pressure value!”. With careful planning, treatment and taking of medicines the next phase could begin. The ratio of the patients who reached the target blood pressure increased by 5% during the two years of the Program between 2005 and 2007 therefore the message changed to “Hold the blood pressure there!”. The next step in the Program was to prevent the forming of complications and to treat the co-morbidities effectively among patients with pre-diabetes or diabetes and hypertension in 2008. The slogan was “Prevent the complications!”. As part of the Program we organized a roadshow named the “Day of caring!” and we announced the “Conscious Care” substudy focused on the public summoning about the stroke which is the most dangerous complication of hypertension. The year of 2011 is an absolutely new beginning in the communication of the Program since we started to use some very modern tools of the 21st century including YouTube, Facebook and others for the better education of the people. Based on the results of the initial Program we got to know the risks, co-morbidities, complications and the characteristics of the Hungarian hypertensive patients. We have recognized that most of the patients belong to the high and very high risk hypertensive category. Also more than 30 percent of them have a pre-diabetes condition. We have found that increased caring helps to build up the patients’ co-operation which in return improves the decrease of their blood pressure significantly. The Program therefore continues in 2011! Our intention is to enlarge the Hungarian Hypertension Register database and to get to know more and more epidemiologic and therapeutic features of the hypertension disease.]