Hypertension and nephrology

[Measurement and value of blood pressure variability in increasing the number of patients reaching target blood pressure goal in hypertension]

KÉKES Ede, JÁRAI Zoltán, PAKSY András, KISS István

AUGUST 20, 2018

Hypertension and nephrology - 2018;22(02 klsz)

[The authors evaluate the indexes and their usefulness of the short term (ABPM), medium and long term measurement of the blood pressure variability in the care phase of the hypertensive population in Hungary by using a one-year multicentre prospective observational study. The population was split into two parts: in the active group, telemedicine tools were used to maximize the patientphysician relationship and patient education, their own activity. In the non-active group, traditional care took place. Among these, 6725, 18-64 years and 1005, 65 + years of hypertensive patients were analysed. At the start of the study, ABPM was performed in 243 cases. 1407 diabetic hypertensive patients were compared to non-diabetic patients. They have analysed previous international and domestic experiences. In the present study, the reduction of systolic and diastolic blood pressure variability was successful and significant in the 18-64 age group during the whole patients’ care phase, but a larger systolic variability reduction in the active group was achieved. In the 65+s, the systolic variability reduction was found to be significant, but the variability indexes in the active group were also smaller. In the 65+s, the diastolic variability did not change significantly in either group. In diabetic hypertension, variability indices were only reduced to 12 months. It could be clearly demonstrated that a high-level physician patient relationship has a beneficial effect on blood pressure fluctuation in hypertensive patients.]

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Hypertension and nephrology

[The role of telemedicine is to help the optimal patient-doctor cooperation in the treatment of hypertension]

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[Telemedicine is now an indispensable part of healthcare and has overtaken the development of hospital information systems. Modern basic and specialized care requires the development of a state-of-the-art communication system between the patient and the physician. One of the main reasons for this is the attempt to raise the level of disease to a higher level, increase the level of prevention and care, involve the patient in the treatment, and care process as an active participant. The latter as a demand is growing ever since the various forms of telecommunication are becoming more and more informed. The technical solutions of telemedicine appear in two forms: In one, the signs and the values of the medical devices (sensors) through the various telecommunication systems are transmitted to the physician. The other solution is using smart phones and other devices (iPad, tablet), where patients send signals, data, and symptoms to your doctor. However, patient information (eg diet, lifestyle, etc.) and instructions from your doctor may arise, a continuous medical consultation can be established in which the patient is a doctor’s partner. This solution is promoted by the rapid spread of telecommunication tools in all layers of society. Authors present the methods of both solutions and details the practical aspects of telemedicine methods in hypertension disease.]

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[Significance of the ambulatory and home blood pressure monitoring in patients with hypertension: focus on CONADPER-ABPM substudy]

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[According to the latest guidelines, ambulatory blood pressure monitoring (ABPM) is both recommended in diagnosing and treating hypertension. The spreading of ABPM is explained by the fact that there are several benefits to the office of blood pressure measurements in the diagnosis, differential diagnosis of hypertension, in the prognostic setting and during therapeutic adjustment. Compared to ABPM, home blood pressure measurement (HBPM) provides information on a substantially longer period of blood pressure, is cheaper, more accessible and more comfortable for the patient. It improves patient-doctor cooperation and therefore the success of setting blood pressure. At the same time, it does not provide information on ABPM over sleep and workplace blood pressure or shortterm blood pressure variability. Thus, the two methods provide complementary information. Finally, we analyse the results of the ABPM subwork of the CONADPER study.]

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[Patient-practitioner cooperation - medication adherence and persistence in the CONADPER-HU study]

SZEGEDI János, KÉKES Ede, KISS István

[Hypertension is a common popular disease, it basically determines the health status, morbidity, cardiovascular mortality, rehabilitation and quality of life of the population. Prevention, early detection, effective treatment of the disease, quality of care is an important part of the people’s health program. The success of the therapy, the attainment and long-term maintenance of the target blood pressure - in addition to many other factors - is determined by drug adherence and persistence, one of the crucial elements of which is the optimal cooperation of the physician and patient. The poor persistence causes most of the therapeutic failures. The main objective of the CONADPER-HU study was to optimize practitionerpatient cooperation (increased control, information delivery, home blood pressure measurement, telemedicinal equipements and software use), thus increasing the proportion of patients with target blood pressure and reducing the number of resistant hypertensive patients. The study proved that the complex care system is effective and has a positive impact on persistence. It has also been clarified that the first three months will decide on further sustained therapeutic success.]

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[Hypertension is the one of most frequent chronic disease which a major but modifiable cardiovascular risk factor. In treating of hypertension after life style therapy, drug treatment has an essential role. Patient adherence plays a significant role achieving target blood pressure. One of most important cause of resistant hypertension is the non-adherence. Factors influencing adherence include the number of drugs, their daily dosage frequency, the properties of the drug groups used, age and gender too. According to international and domestic studies, the number of people leaving medication is very high. The disadvantage is clear because these patients lack of benefit from the protective effects of drugs.]

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[The CONADPER-HU program. Objective and methodology of the program. Patients. Basaline data]

KISS István, ALFÖLDI Sándor, BARNA István, JÁRAI Zoltán, SIMONYI Gábor, SZEGEDI János, PAKSY András, UGRAI Péter, KÉKES Ede

[The aim of the study was to increase the rate of target blood pressure and reduce blood pressure variability. This dual objective ensures optimal therapeutic success. In order to reach this goal, we wanted to increase the care of patients with hypertension by increasing patient-physician-assistant cooperation and providing telemedicinal devices.]

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