Hypertension and nephrology

[Is there a connection between neuropathy and hypertension?]

ISTENES Ildikó, KERESZTES Katalin, KEMPLER Péter

NOVEMBER 20, 2010

Hypertension and nephrology - 2010;14(06)

[Neuropathy is usually not an independent entity, its symptoms usually occur as part of other underlying diseases. Diabetes, chronic alcoholism, chronic liver diseases and chronic kidney diseases belong to the most important pathogenetic factors of neuropathy. It is less well known that neural damage may occur among patients with hypertension as well. Autonomic and sensory nerve dysfunction are considered as progressive forms of neuropathy. Both of them are associated with poor prognosis while quality of life is also significantly impaired among these patients. Key clinical characteristics of sensory and autonomic neuropathy are reviewed. There is a relationship between autonomic neuropathy and hypertension in patients with diabetes. Parasympathetic neuropathy and as a consequence relative sympathetic overactivity seems to have a pathogenetic role in this respect. The prevalence of previously unknown hypertension is doubled in diabetic patients with autonomic neuropathy - ambulatory blood pressure monitoring is suggested to be performed among these patients. The authors provided evidence that autonomic and sensory nerve dysfunctions are frequent complications of essential hypertension as well, which are closely related to traditional cardiovascular risk factors. Their observations may confirm the role of vascular factors in the pathogenesis of neuropathy.]

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[Hypovitaminosis D has emerged as a risk factor for multiple adverse outcomes, including cardiovascular and cancer related morbidity and mortality. Observational studies along with laboratory investigations have lead to the discovery of the pleiotropic effects of vitamin D which affect a variety of physiologic processes such as blood pressure regulation, cell proliferation or the modulation of inflammation, and may account for the many negative clinical outcomes associated with hypovitaminosis D. Our article reviews studies that describe the incidence and prevalence of hypovitaminosis D, and the various adverse outcomes that low serum vitamin D has been linked with. This review will provide the reader with a better understanding of why vitamin D is currently regarded as a very promising area of research to try and lower adverse outcomes in a variety of patient groups and in the general population, with the main emphasis on patients with chronic kidney disease (CKD). Most of our discussion on the harmful effects of hypovitaminosis D will concentrate on conditions related to cardiovascular disease morbidity and mortality due to the significance of these in patients with CKD, with less mention of other deleterious effects related to low vitamin D levels such as malignancies.]

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[Erythropoiesis-stimulating agents and oxidative stress in hemodialysis patients]

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[Oxidative stress plays an important role in the elevation of the cardiovascular risk of patients with chronic kidney insufficiency. The oxidative stress becomes more severe together with the deterioration of the renal function, and the hemodialysis sessions may also induce repetitive oxidative insults. Erythropoesis-stimulating agents (ESAs) may alter the level of oxidative stress via their effects on hematopoiesis, resulting in indirect effects on changes of iron metabolism and the levels of antioxidants. We review the current knowledge about the administration of ESAs as concerns effects on oxidative parameters in hemodialysis patients. We discuss the relationship between the characteristics of the ESA therapy (type, administration frequency and dosage of ESA, length of the therapy, administration withdrawal) and the oxidative stress in view of earlier and recent research.]

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[Focus on central arterial pressure. Beta blockers - one group of agents with different efficacy]

BARNA István

[Not only have beta blockers excellent antihypertensive effect but both in monotherapy and in combination they exert antiarrhythmic and antiischemic efficacy, as well. They are recommended on A level of evidence in the treatment of patients with primary hypertension. Certain beta blockers differ from each other considering their lipid solubility, membrane stabilizing effect and in many other characteristics which difference can be exploited in the treatment. Nebivolol increases the release of nitrogen oxide, it is metabolically neutral and has vasodilating and antioxidant effect. The consequence of the stiffness of the arterial wall is the rise of systolic blood pressure, the diminshed diastolic circulation in the coronary vessels, the increase of the central pulse pressure and the frequent occurrence of cardiovascular diseases. Various antihypertensive agents have different mode of action on central blood pressure and arterial stiffness. Comparing nebivolol/atenolol and nebivolol/bisoprolol, respectively, nebivolol decreased aortic pulse pressure with greater efficacy than other beta blockers. The extent of the reduction of blood pressure was the same in the nebivolol and atenolol group while the augmentation index decreased significantly among the patients receiving nebivolol. In addition to the well known beneficial effects of nebivolol recent studies proved another, yet still unknown and unique characteristic of this agent, i.e. favourable influence on arterial stiffness. It not only improves endothelial dysfunction which has emphasized role on development of atherosclerosis but - independently of its antihypertensive effect - it has favourable action on arterial stiffness, too. These features guarantee a decisive position in the treatment of arterial hypertension.]

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[Summary – Considering the pathomechanism, the risk factors, as well as the environmental and toxic effects, some associated illnesses, unhealthy life-style habits in the background of hypertension and infertility, significant overlapping can be found. The question arises; does play any role the hypertension in the development of infertility? In this article the author review the connection between the hypertension and infertility. ]