[Hypertensive urgencies and emergencies]
FARSANG Csaba
FEBRUARY 10, 2016
Hypertension and nephrology - 2016;20(01)
FARSANG Csaba
FEBRUARY 10, 2016
Hypertension and nephrology - 2016;20(01)
[Prompt recognition and evaluation of hypertensive urgencies and emergencies can substantially decrease definitive target organ damage and mortality. Most frequent cause of sudden increase in blood pressure is stopping antihypertensive treatment. In hypertensive crises quickly acting parenteral drugs are of choice, while in urgencies orally administered ones might be sufficient. Cerebral and coronary hypoperfusion should be avoided therefore blood pressure must be decreased gradually.]
Hypertension and nephrology
[Introduction: Erythropoietin (EPO) is a glycoprotein hormone, which is responsible for the proliferation and differentiation of erythroid cell lines. Since it is widely used as the treatment of renal anaemia, EPO-resistance is a common concern. Aims: We aimed to perform in vitro experiments to investigate a possible mechanism of EPO-hyporesponsiveness. Methods: We used a factor dependent erythroblast cell line (TF-1). Two independent observers calculated cell counts simultaneously on day 1; 2 and 3 in Bürker cell counting chambers. Colorimetric method was used to measure protein concentrations. Measurement of protein-bound para-, ortho- and meta-tyrosine was performed with reverse phase high performance liquid chromatography with fluorescence detection. We determined ERK and STAT5 activation using Western blot method. Results: In case of ortho- and meta-tyrosine pretreated cells time-dependent, EPOinduced proliferative activity was decreased compared to the 1.7 fold elevation of cell counts seen in para-tyrosine cultured cells. Protein concentration of ortho- and metatyrosine treated samples was significantly lower than control cells on the third day. Addition of para-tyrosine reclaimed EPO-sensitivity. Erythroblasts treated with orthoor meta-tyrosine contained lower concentrations of protein-bound para-tyrosine with higher ortho- and meta-tyrosine content. EPO dependent activation of ERK and STAT5 could be inhibited by ortho- or meta-tyrosine treatment. Conclusions: Elevated level of protein-bound ortho- and meta-tyrosine in erythroblasts can result in the pathological modification of intracellular signaling, leading to EPOhyporesponsiveness.]
Hypertension and nephrology
[Authors studies the incidence of hypertensive patients with prediabetes - according to the IFG criteria - based on the 2005 Hungarian Hypertension registry (38849 subject) and on the „Live under 140/90” sub-program („Prevent it”) (23670 subject) database. The presences of diabetes patients were excluded. IFG incidence (from 5,6 to 7,1 mmol/l) was found between 13-18% of the adult population over 40 years. In men, the incidence was significantly higher. In individuals with IFG the BMI, waist circumference values were significantly higher than the average normal values and exceeded the danger zone. For women significantly higher values were found. These patients had higher total cholesterol and blood pressure values. After three months of intensive supervision, counseling, care over every 40 years age group - without medication - significantly decrease the fasting blood glucose values. They presented the international experiences of prediabetes.]
Hypertension and nephrology
Hypertension and nephrology
Hypertension and nephrology
[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.]
Lege Artis Medicinae
[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothiazide and indapamide, and their combination drugs in Hungary.]
Lege Artis Medicinae
[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.]
Hypertension and nephrology
[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]
Lege Artis Medicinae
[The renin-angiotensin system (RAS) is one of the most important mechanisms regarding the pathomechanism and treatment of hyprtension. The most of the elements of the RAS are found in the nervous system too. The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ARBs) is based on the inhibition of the RAS. ARBs might have a special role in the central nervous system because they do not decrease the production of angiotensin but inhibit its harmful effects mediated through the AT1 receptor while allowing the stimulation of AT2 receptors with resulting pleiotrophic actions. Hypertension is the most important risk factor for stroke and has a negative effect on cognitive functions. Antihypertensive treatment has an effect on the nervous system; in addition to the consequences of the reduced blood pressure, ARBs might provide additional advantages in stroke and dementia prevention.]
1.
2.
Clinical Neuroscience
Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease3.
4.
5.
1.
Journal of Nursing Theory and Practice
[Examination of the Strength of Core- and Perineal Muscles in Case of Different Movements]2.
Journal of Nursing Theory and Practice
[Examination of Parental Treatment among Outgoing Ambulance Workers]3.
Journal of Nursing Theory and Practice
[BLS Quality Assessment – The Effectiveness of Telephone Cardiopulmonary Resuscitation Instruction]4.
Journal of Nursing Theory and Practice
[The History of the Founding of the first State School of Nursing ]5.
COMMENTS
0 comments