Hypertension and nephrology

[Hyperuricemia and cardiovascular risk: new treat to target principle in focus]

ALFÖLDI Sándor

SEPTEMBER 12, 2018

Hypertension and nephrology - 2018;22(04)

[Hyperuricemia is frequent and its prevalence is increasing as it correlates with obesity and metabolic syndrome by several different mechanisms. Furthermore, recently several data are available for the cardiovascular and renal protective effect of allopurinol in the treatment of hyperuricemia and gout. The new European EULAR guidelines suggested treat to target principle in urat lowering therapy of gout. The uric acid target is below 360 µmol/l in mild to moderate gout. The guidelines unequivocally stated, that allopurinol is the first line uric acid lowering drug. Allopurinol treatment should be started immediately at the diagnosis and should be continued lifelong.]

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Further articles in this publication

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[Physical training in dialysis population]

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[The impaired physical activity and the related increased cardiovascular risk is caracteristic in all stages of chronic kidney diseases. The regular physical activity has a beneficial effect on the metabolic risks associated with chronic kidney disease, dialysis and poor activity lifestyle, it also has favorable effect on the inflammatory state, poor physical performance, muscle loss and can improve the quality of life and life expectancy. Accordingly, the international and Hungarian guidelines suggest at least 150 minutes physical activity with moderate intensity per week - at least five days, 30 minutes each day. But there are no particular guidelines for dialysated patients. This article, without being exhaustive, in part using our own experiences, present suggestions for the physical activity of dialysated patients.]

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[Treatment of hypertension in kidney transplant patients]

KOVÁCS Tibor, WAGNER László

[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

Hypertension and nephrology

[ESH Satellite Symposium Budapest, 26-27 May 2018]

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