Hypertension and nephrology

[Management of hypertensive crises]

JÁRAI Zoltán, ÁCS Tamás, FARSANG Csaba

DECEMBER 22, 2011

Hypertension and nephrology - 2011;15(06)

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Hypertension and nephrology

[Salt consumption and hypertension]

KISS István, MARTOS Éva

Hypertension and nephrology

[The advantages of a fixed combination of lisinopril with amlodipine in patients with primary hypertension]

GAHRAMANOVA SM, BAKHSHALIYEV AB

[Background: The aim of the study was to examine the effect of amlodipine, lisinopril and a fixed low-dose combination of amlodipine + lisinopril on the performance of the daily profile, blood pressure variability and heart rate variability in patients with PH stage I-II, 1-2 degrees. The diagnosis of PH was made in accordance with the classification of JNC USA in 2003, ESH, ESH 2007 on the basis of careful clinical and instrumental investigations. Methods: The study included 75 PH patients who were divided into three groups depending on the medication received. The first group included 23 patients treated with lisinopril, the second included 27 patients treated with amlodipine, and the third included 25 patients receiving a fixed combination of amlodipine + lisinopril. Drugs were administered once daily with dose titration for lisinopril effective for 10 to 20 mg (mean 15.6±2.2 mg), for amlodipine 5 to 10 mg (mean 7.8±1.1 mg), and Lisonorm administered in a standard fixed dose (lisinopril 10 mg, amlodipine 5 mg), once in the morning. Controlled treatment lasted for 12 weeks. The study used daily blood pressure monitoring and ECG Holter monitoring methods. Results: A comparison of side effects found that combined therapy significantly reduced the number of adverse reactions. For all three groups, treatment resulted in a significant decrease in the average daily, daytime and night-time BP values and in the variability of systolic and diastolic BP. With combined therapy, these changes were more significant. Conclusion: These positive changes appear to be due to the fact that combination therapy can affect several parts of the pathogenetic development of hypertension, compared with the effects of monotherapy, with superior results. In the combination therapy, lisinopril levelled the sympathetic stimulation of amlodipine by blocking the activity of the sympathoadrenal and renin-angiotensin-aldosterone system.]

Hypertension and nephrology

[Ede Kékes and István Kiss (Editors): Hyperuricemia. – Cardiovascular-Renal Risk of Elevated Uric Acid Levels and Options for Therapeutic Intervention]

BUDA Béla, KIS János Tibor

Hypertension and nephrology

[The importance of white-coat hypertension in adolescents]

LENGYEL Szabolcs, SZÁNTÓ Ildikó, KATONA Éva, PARAGH György, FÜLESDI Béla, PÁLL Dénes

[The importance of adolescent hypertension is that there is tight correlation between blood pressure data in adolescents and in adulthood. In case of sustained adolescent hypertension increase of the left ventricular mass and the intima-media thickness of the carotid artery is also detected. The prevalence of adolescent hypertension is about 1-4%. Among them 1-41% is the frequency of white-coat hypertension. Diagnosis can be set up with repeated measurements at home, or with ambulatory blood pressure monitoring. In the background of adolescent white-coat hypertension the increased sympathetic activity has outstanding importance, which causes endothel dysfunction and increased arterial stiffness. There are growing evidence, that adolescent white coat hypertension is not a harmless condition, because sustained hypertension can develop in the future. In its case risk survey, start of non-pharmacological treatment, and follow-up has major importance.]

Hypertension and nephrology

[Association between sleep disorders and inflammation among kidney transplant recipients]

FORNÁDI Katalin, LINDNER Anett, CZIRA Mária Eszter, SZENTKIRÁLYI András, LÁZÁR S. Alpár, ZOLLER Rezső, TURÁNYI Csilla, VÉBER Orsolya, NOVÁK Márta, MUCSI István, MOLNÁR Miklós Zsolt

[In patients on dialysis, the results of studies examining the association of sleep disorders and inflammation are controversial. We assessed the association between inflammatory markers and different sleep disorders in a large sample of kidney transplant recipients. In the cross-sectional study 100 randomly selected kidney transplanted patients underwent one-night polysomnography [“SLeep disorders Evaluation in Patients after kidney Transplantation (SLEPT) Study”] to diagnose obstructive sleep apnea (OSA) and periodic limb movement is sleep (PLMS). Athens Insomnia Scale (AIS) was used to assess the prevalence of insomnia. Socio-demographic information, data on medication, comorbidity and laboratory parameters were collected. Inflammatory markers such as Creactive protein (CRP), serum albumin, white blood cell count, interleukine-6 (IL-6) and tumor necrosis factor-α (TNF-α) levels were measured. The mean age was 51±13 years (43% female) and the prevalence of diabetes 19%. We found no significant difference in the levels of inflammatory markers between patients with OSA and PLMS versus (vs) patients without such disorders. Apnea-hypopnea index showed a significant association with white blood cell count (rho=0.23), and weak, non significant correlations with the other inflammatory markers (rho<|0.15|). PLM index showed weak, non significant correlations with all markers of inflammation (rho<|0.15|). The serum IL-6 level was significantly higher in patients with insomnia (AIS≥10) than in non-insomniacs [median (IQR): 3.2 (2.6-5.1) vs. 1.7 (1.2- 2.9) ng/l; p=0.009]. The levels of other inflammatory markers were similar between insomniacs and non-insomniacs. We did not find any association between the presence of objectively assessed sleep disorders and inflammatory markers in kidney transplant patients.]

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[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

[THE IMPORTANCE OF HYPERTENSION IN CEREBROVASCULAR DISEASES]

SZAPÁRY László

[Stroke is a highly prevalent disorder worldwide; it is the third main cause of death and the leading cause of severe disability. Recent data showed that 72-86% of cerebrovascular disorders are of ischaemic type. Arterial hypertension is the most prevalent risk factor for both haemorrhagic and ischaemic stroke, it is present in approximately 70% of cases. All forms of hypertension, isolated systolic or diastolic and combined hypertension increase stroke risk about 3-4 times and the relationship with systolic blood pressure may even be stronger than with diastolic blood pressure. Hypertension is very common after acute stroke. In this phase the cerebral autoregulation is disturbed in the region of focal brain ischaemia or haemorrhage such that cerebral blood flow is directly dependent on systemic blood pressure. It is therefore essential to avoid systemic hypotension in acute stroke patients and the reduction of high blood pressure may lower cerebral blood flow in the ischemic penumbra. Evidence from clinical data shows that control of blood pressure leads to lower risk of first or reccurent stroke and patients have shown beneficial effects especially of ACE inhibitors and diuretics. In the PROGRESS study both hypertensive and non-hypertensive cerebrovascular patients benefited from antihypertensive therapy. Previous results suggests that there may be additional beneficial effects of the ACEinhibitor therapy not related to blood pressure lowering in the prevention of stroke.]

Hypertension and nephrology

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]

Lege Artis Medicinae

[Notes on the management of hypertension in chronic kidney disease ]

AMBRUS Csaba

[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.]

Lege Artis Medicinae

[Hypertension and twenty years of LAM]

FARSANG Csaba

[The author reviews significant results related to hypertension with special emphasis on papers published in the LAM during the past twenty years. The history of hypertensiology, important aspects of hypertension research, therapeutic guidelines, antihypertensive agents and their combinations are also discussed. A brief section is dedicated to the expected future development of hypertension research and new directions of antihypertensive therapy.]