Hypertension and nephrology

[Metformin as an Antihypertensive?]

SIMONYI Gábor

APRIL 08, 2017

Hypertension and nephrology - 2017;21(02)

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Hypertension and nephrology

[Preferred Drug Groups, Active Substances and Combinations in European and Hungarian Recommendations]

BARABÁS Noémi

Hypertension and nephrology

[Letter to our Readers]

KÉKES Ede, KISS István

Hypertension and nephrology

[The History of Hypertension – Paul Dudley White (1886-1973)]

KÉKES Ede, NAGY Judit

Hypertension and nephrology

[First experiences with percutaneous renal denervation in management of resistant hypertension]

SCHULCZ Domonkos, NAGY Ferenc Tamás, THURY Attila, BAJCSI Dóra, FEJES Imola, LETOHA Annamária, CONSTANTINOU Kypros, UNGI Imre, ÁBRAHÁM György, LÉGRÁDY Péter

[Percutaneous transluminal radiofrequency renal denervation is a promising new therapeutic method for the treatment of primary resistant hypertension. The intervention decreases the systemic sympathetic over activation and thus arterial blood pressure. In the 1st Department of Medicine of the University of Szeged, 9 resistant hypertensive patients (2 male, 7 female; mean age: 55.0±4.0 years) had all the conditions were required for renal denervation at the time of interventions were performed. We measured the blood pressure together with the heart rate of the patients on the day preceding the intervention, right after the intervention, at discharge from hospital, then at months 6, 9 and 15. The mean blood pressure was 178/107±7/5 mmHg before the intervention. After denervation mean blood pressure decreased right after the intervention, at discharge from hospital, as well as at months 6, 9 and 15, respectively -15/-17 mmHg; -36/-16 mmHg; -19/-9 mmHg; -27/-21 mmHg and -15/- 16 mmHg. Besides decreasing of blood pressure, the antihypertensive drug therapy also decreased, however, it was not the primary aim of the intervention. No denervation- related intra- or perivascular complications were detected. The findings of our study proved the efficacy and safety of renal denervation in the treatment of primary resistant hypertension, of course with an appropriate patient selection. Our study was not relevant to determine whether this method is accompanied with a significant decrease of cardiovascular morbidity and mortality. Answers may come only based on randomized sham controlled studies with great case numbers.]

Hypertension and nephrology

[How can we improve the chronic renal patient care?]

KULCSÁR Imre

[The author summarizes on the base of forty year’s experience in the field of Hungarian nephrological care, that which are the main developmental problems and possibilities in the clinical nephrology and in dialysis therapy in Hungary recently. There is a clear claim to change in the training of nephrological nurses and nephrologists, and it is very important the organized education of predialysis patients, improving capacity of outpatient nephrological care in his opinion. He recommends organizing the total nephrological care in every county (except nephropathology and renal transplantation) and changing the relevant health law. He emphasizes the importance of conservative care in chronic kidney diseases and home renal replacement therapies. Highly educated nurses must play much more important role in care of dialyzed patients (with more competencies). It is very important planned start in dialysis, and instead of uniform regimes, the therapy provided individually. He suggests measuring of the health-related quality of life regularly and the survival of patients on renal replacement therapy, also. It would be important to determine the residual renal function in dialysis program, monthly. He is considering the phenomenon of “recovery of renal function” and the problem of withdrawal of dialysis.]

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Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

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

[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.]

LAM Extra for General Practicioners

[ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH COPD - THE SIGNIFICANCE OF NEBIVOLOL]

FARSANG Csaba

[The occurrence of hypertension associated with chronic obstructive pulmonary disease (COPD) is increasing. Recognising COPD is important in order to choose the appropriate antihypertensive drugs. Antihypertensive drugs that can be used to treat patients with hypertension and COPD include diuretics, ACE-inhibitors, angiotensine receptor blockers (AT1 receptor antagonists) and calcium antagonists, as well as cardioselective beta blockers, as these drugs decrease total and cardiovascular mortality. Of these agents, the importance of the most cardioselective one, nebivolol should be stressed, as this drug has no clinically significant effect on parameters of respiratory function, and, through its additional effects (namely by increasing the synthesis of NO), it has a beneficial effect on COPD-related deterioration of respiratory functions, haemodynamic alterations (cor pulmonale) and local factors that participate in the respiratory inflammation and endothelial dysfunction.]

Hypertension and nephrology

[Analysis of the Effects of the Antihypertensive Agent Rilmenidine: One-Year Results from the VERITAS Study]

POÓR Ferenc