Hypertension and nephrology

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


APRIL 10, 2016

Hypertension and nephrology - 2016;20(02)

[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).]



Further articles in this publication

Hypertension and nephrology

[The Hypertension Awareness Day and Programs by the Hungarian Society of Hypertension]

KISS István

Hypertension and nephrology

[Blood pressures of adolescents at screening program in Budapest]


[The Aim of the screening program was to investigate the blood pressure and the association with obesity, hypercholesterinaemia and increased body fluid in adolescents. Methods: A screening program was conducted during the period from April 2010 to May 2011.The screenings consisted of: blood pressure, heart rate, body composition determination, cholesterol, blood glucose, weight, height and BMI. Results: 2226 children fullfied all of the outlined criteria. Their range of age was between 14–18 years. The average systolic blood pressure was 126.34±12.55 Hgmm volt. At boys were higher 131.87±13.59 then at girls 117.49±5.69 Hgmm. The average diastolic blood pressure was 71.86±8.74 Hgmm. There were also higher at boys 72.61±9.17 then at girls 66.69±5.04 Hgmm. High systolic blood pressure (95%<) were 307/1326 cases at girls, and 403/876 cases at boys. High diastolic blood pressure were together with high systolic blood pressure, but less frequency. High diastolic blood pressure occurred at 85 girls and at 90 boys. Overweight and obes were 18.994% of girls and 15.26% of boys. The percentage of pathological high blood pressure was most frequent among boys and girls who are in the overweight group. The pathologically high level of body fat percentage appeared to be 12.98% among girls and 5.9% among boys. In elevated BMI groups the frequency of high body fat was 66% among girls and 81% among boys. The mean cholesterol was significantly higher in the overweight and obese group. Conclusions: Rates of hypertension and overweight and obesity are high in school children in Budapest, and increased bodyweight is a significant risk factor for hypertension. The results of the study will help to design preventive programmers.]

Hypertension and nephrology

[Article Report]

APOR Péter

Hypertension and nephrology

[Rilmenidin - a versatile combination partner in the treatment of high blood pressure]


[The rilmenidin as an imidazoline agonist drug strongly decreases the central sympathetic activity, release of renine and the RAS activity. Because of these advantageous properties the peripheral vascular resistance falls and the blood pressure is decreased. Today it is excellent tool for combination therapy. Useful especially in stress induced hypertension. The antihypertensive effects of ACE inhibitors sor calcium antagonists are increased by rilmenidine. This drug decreases the insuline resistance, it has a positive effect on the carbohydrate and fat metabolism, because it is useful as a complementary therapy in metabolic syndrome and diabetes mellitus of type II. It is useful in stress induced hypertension, and in menopause as well.]

Hypertension and nephrology

[Hyperuricemia and Hypertension]


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Related contents

Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[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 new European ESH/ESC guidelines Part I. Most important changes and cardiovascular risk]


[The most important features of the new European joint hypertension guidelines of the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) became available aslectures at the ESH meeting in Barcelona, in 2018 June, while the publication came out in the Journal of Hypertension and also in the European Heart Journal in August, 2018. Based on the published new guidelines I summarise the most important changes concerning cardiovascular risks and target blood pressures.]

Hypertension and nephrology

[Enjoyable and invisible risk: salt The role of the Hungarian Hypertension Society in the National Salt Intake Lowering Program: STOP-SÓ]

KISS István

[Cardiovascular disease accounts for more than 50% of Hungarian mortality and hypertension accounts for almost 50% of coronary heart disease and for more than 60% of stroke. High salt intake increases blood pressure and major and sustained consumption may cause high blood pressure. In Hungary more than 2.5 million people have hypertension and among them only 44% have their blood pressure under 140/90 mm Hg. Achieving target blood pressure is difficult as salt intake of the Hungarian population is higher than that recommended in every age group. Blood pressure control consists of proper combination of medical treatment and of nonmedical procedures. Among non-medical procedures weight loss, increase of physical activity, Mediterranean diet and decrease of salt intake are of value in blood pressure lowering. A daily salt intake of less than 6 grams is recommended in the Hungarian guideline and in the European one the recommendation is more rigorous. However in Hungary average salt intake is 18 grams among men and 14 grams among women. Responsibility of the individual person is inevitable in preserving health and preventing disease. A perfect example for this is the change of salt intake habits as it is demonstrated that decreasing salt intake results in the decrease of blood pressure. A daily decrease of 5 grams in salt intake results in 23% less stroke and 17% less cardiovascular disease. The Hungarian Society of Hypertension has joined among the first to the Hungarian Salt Intake Decreasing Programme and thus its activity is aimed at strengthening the public health subset of the Hungarian Cardiovascular Programme.]

Clinical Neuroscience

[The effect of angiotensin receptor blockers in cerebrovascular disorders and dementia: Bonus in addition to the antihypertensive effect]


[Hypertension and dementia are frequent disorders or rather syndromes. Their incidence is growing with advancing age and hypertension is increasing the risk of cognitive impairment too, while treating hypertension (i.e. the use of antihypertensive medications) is decreasing it. In addition, hypertension is the most important risk factor for stroke. The renin-angiotensin system (RAS) has a special role in the development of hypertension and also involved in the pathogenesis of the most frequent dementia form, namely Alzheimer’s disease. The effect of angiotensin convertase inhibitors and angiotensin receptor blockers (ARB) is based on the inhibition of the RAS, but the ARBs do not inhibit angiotensin formation, just blocking its harmful effects on the AT1 receptor, while allowing the activation of AT2 receptors with pleiotropic effects. Preclinical, epidemiological and clinical therapeutic studies suggest this additional effect of ARBs and these are summarized in this review.]

Hypertension and nephrology

[The prognostic role of placental growth factor in pregnancies complicated by hypertensive disorders]


[Placental growth factor (PlGF) is a member of the proangiogenic VEGF-family; it is mainly produced by throphoblast cells. During the last years numerous studies have shown that circulating PlGF-level in maternal plasma is decreased and its suluble receptor sFlt-1 shows increased expression. In the present study we examined the prognostic accuracy of Alere Triage® PlGF-Assay in hypertensive disorders of pregnancy and its relation with the length of pregnancy. 130 pregnant women were involved in this case-control study (PE: 23, HELLP-syndrome: 20, superimposed praeeclampsia: 17, chronic hypertension: 25, gestational hypertension: 18 and normal control: 27). Blood draw occured between the 22nd and 34th gestational week. PlGF levels were measured by the Alere Triage® PlGF Assay using samples from the maternal plasma. The plasma PlGF-levels of women whose pregnancies were complicated by hypertensive disorders were significantnormotoly lower compared to those who had uncomplicated pregnancies and the decrease were greater in those patients who delivered before the 35th gestational week. The PlGF-test was positive in 93,7% of those women who delivered before the 35th gestational week and in 90,5% of those who delivered before the 37. gestational week. The vast majority of preeclamptic (PE: 95,7%, SIPE: 82,4%) and HELLP-syndrome (95%) patients had positive PlGF tests, the 60% of the chronic hypertension and the 44,4% of the gestational hypertension patients have also shown positive results. The main conclusion of this study is that the PlGF levels using maternal plasma are lower in those pregnancies which are complicated by hypertension and show strong correlation with the severity of the hypertensive disorder. We perceived high sensitivity values in detecting preeclampsia, HELLP-syndrome and superimposed preeclampsia. In the future we may use this method to separate high risk women for hypertensive disorders and it may improve the perinatal outcome]