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

[The uremic toxin indoxyl sulfate reflects cardio-renal risk and intestinalrenal relationship]

KISS István

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

[Salt consumption and hypertension]

KISS István, MARTOS Éva

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.]

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.]

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[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

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[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

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]

FARSANG Csaba

[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

Hypertension and nephrology

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]

TOMCSÁNYI János

[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

Lege Artis Medicinae

[Clinical implication of arterial stiffness in the elderly]

BENCZÚR Béla

[Hypertension prevalence and cardiovascular risk gradually with age. However this aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome. Age and high blood pressure are the two main determinants of arterial stiffness which is the core of EVA: the impaired elasticity of the media layer of large elastic arteries (mainly the aorta), a process that can be measured by pulse wave velocity. In elderly hyperten­sives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. Arterial stiffness has predictive value for future CV e.g. events, coronary artery dis­ease, stroke, and vascular dementia and even all-cause mortality. The concepts of EVA (Early Vascular Aging) and SUPERNOVA (Super­normal Vascular Aging, the opposite phenotype of EVA) help to understand why early target-organ damages develop in some individuals and why others remain much more “younger” than their chronologic age. New drugs are being developed to treat EVA when lifestyle intervention and conven­tional risk factor controlling drugs are not enough.]