Hypertension and nephrology

[More than bodyguard? The ramipril/amlodipine FDC effect on their whole blood pressure spectrum]

SIMONYI Gábor, ZSUZSA Pál, GENCSIOVA Kristína, FINTA Ervin

SEPTEMBER 12, 2018

Hypertension and nephrology - 2018;22(04)

[Hypertension is a significant cardiovascular risk factor. Effective treatment of hypertension contributes to avoiding the risk of later cardiovascular complications. Rapid access to blood pressure targets is also important in new untreated hypertensive patients. In the new ESH/ESC Hypertension Recommendation - during the initiation of antihypertensive therapy - the immediate introduction of drug combinations is explicitly recommended. In our retrospective data collection study we studied the effect of the ramipril/amlodipine fixed combination on the 24-hour brachial and central blood pressure parameters of the fresh hypertensives.]

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Hypertension and nephrology

[Physical training in dialysis population]

SCHNEIDER Károly

[The impaired physical activity and the related increased cardiovascular risk is caracteristic in all stages of chronic kidney diseases. The regular physical activity has a beneficial effect on the metabolic risks associated with chronic kidney disease, dialysis and poor activity lifestyle, it also has favorable effect on the inflammatory state, poor physical performance, muscle loss and can improve the quality of life and life expectancy. Accordingly, the international and Hungarian guidelines suggest at least 150 minutes physical activity with moderate intensity per week - at least five days, 30 minutes each day. But there are no particular guidelines for dialysated patients. This article, without being exhaustive, in part using our own experiences, present suggestions for the physical activity of dialysated patients.]

Hypertension and nephrology

[Comparison between Intensive (Clopidogrel + Aspirin + Dipyridamol) and Guideline-Prescribed (Aspirin + Dipyridamol or Clopidogrel) Antiplatelet Therapy in Patients with Acute Cerebral, Non-Cardioembolic Ischemia]

VÁRALLYAY Zoltán

Hypertension and nephrology

[Accredited Postgraduate Training]

Hypertension and nephrology

[Treatment of hypertension in kidney transplant patients]

KOVÁCS Tibor, WAGNER László

[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

Hypertension and nephrology

[ESH Satellite Symposium Budapest, 26-27 May 2018]

FARSANG Csaba

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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.]

Hypertension and nephrology

[The importance of health-centered approach in the management of hypertensive patients]

VÁLYI Péter

[In the everyday clinical practice the main objectives are the accurate establishment of the diagnosis and evidence based treatment of diagnosed disease. Besides the accustomed, rigorously medical, simplifying aspect, the bio-psycho- social approach is gaining an increasing importance. The objective of the article is, taking modern definition of health into account, emphasizing the importance of a new approach in the complex management of patients, having primary hypertension, a disease, impairing not only target organs, as well as the whole person, seriously influencing the health status of the affected person. In the management of a hypertensive patient, besides decreasing blood pressure, preventing and treating target organ complications and coexisting diseases, we should assess the whole person impairment, the effects of environmental and personal factors, and their influence on activities of daily living and participation in the life of the society, consequently, the changes in health status. This complex approach permits alone the more complete restoration of health of an affected person.]

Hypertension and nephrology

[Telemedicine care for high-risk hypertensive patients with antihypertensive for reaching better blood pressure target ratio and smaller blood pressure variability]

KISS István, ÁDÁM Ágnes, HERCZEG Béla, MATOLTSY András, POÓR Ferenc, SZEGEDI János, VÁRALLYAY Zoltán, PAKSY András, KÉKES Ede

[Telehealth care of high-risk hypertensive patients for a better target blood pressure and smaller size blood pressure fluctuation. Authors conducted a one-year, multicentre, prospective, observational study with no intervention. Their aim was to achieve better targeting and smaller blood pressure fluctuation in patients with high risk hypertensive patients with the new type of doctorpatient co-operation and telemedicinal care than the conventional control method. In the active group, 50 patients, in the non-active group 47 treated hypertensive patients were analysed. During the observation period (1 year) the mean (± SD) of the systolic blood pressure decreased from 143.3 (15.1) mmHg to 134.5 (9.2) mmHg in the active group, but in the non-active group there was no significant decrease. The target blood pressure (< 140/90 mmHg) could be increased from 46% to 62%. The two characteristics of interpersonal visit-to-visit variability index. The standard deviation (SD) and variation coefficient (VC) showed a significant decrease in the active group. There was no change in the inactive group. A method supported by telemedicine-assisted and better patientphysician- assistant co-operation is suitable for increasing target blood pressure rates and reducing blood pressure fluctuation.]

Hypertension and nephrology

[Treatment and care of hypertensive patients during and after the Covid-19 pandemic. Possibilities and effectiveness of telemedicine]

KÉKES Ede, SZEGEDI János, VÁLYI Péter

[The course and outcome of an pandemic caused by coronaviruses are determined by many factors, such as the strength and dose of the infectious virus, the immune system of the affected individual, the underlying diseases, the speed of virus spread, age and environmental factors and methods of control. In old age, there is a significantly higher risk of developing severe cases and fatalities. The rate of loss of life is particularly high in social care and nursing homes. Hypertension as the underlying disease is the most common cause of death, but hypertension alone is not an independence risk factor, but the main reason is the co-morbidities and complications associated with viral infection. In the epidemic situation, the treatment and care of hypertensive patients poses special challenges for health and active primary and specialist care workers and, of course, for hypertonologists. The Hungarian Society of Hypertension expressed its opinions and recommendations to patients living at home and to doctors performing treatment and care during the Covid-19 virus epidemic and summarized the decision-making possibilities derived from the data obtained during the telemedicine consultation. We would like to present the details of the possibilities provided by telemedicine, the practical possibilities and advantages of the different methods of teleconsultation, and the models that can be implemented in a domestic environment. We have taken into account international experience to date, the new e-health strategy for chronic, non-communicable diseases and the WHO concept. Telemedicine, continuous teleconsultation ensures an optimal relationship between the patient and the doctor, increases the patient’s sense of security, improves drug adherence. The doctor receives reliable data about the patient’s condition and can send him instructions as well as information. The development of a harmonious balance between personal contact and telecommunications already shows the future, and the application of these methods must be developed in the epidemic-free period as well. Previous international (TASMINH-4, HOMED-BP etc.) and domestic (CONADPER-HU) studies have proved that telemonitoring of hypertensive patients can be successfully solved, improves patients’ drug adherence, increases the target blood pressure achievement rate and at the same time the patient will be the active part of the treatment. The method is especially useful in rural settlements without a doctor. Telemedicine monitoring of elderly and multimorbid patients is especially useful in social institutions and nursing homes. It is solved the continuous control of vital functions, ensures continuity of contact with the supervising physician and in urgent cases, allows for rapid intervention. Telemedicine is also of great importance due to the lack of human resources, as many things can be solved with such technology, there are no need so many personal encounters. In addition to influencing the course of this pandemic, it also plays an important role in efficiency, headcount, management and “convenience” in general practice and in all formes of medicine. The proposed models can not only be applied in an epidemic situation, but should continue to be part of everyday health work in future.]

Lege Artis Medicinae

[TREATMENT OF HYPERTENSION - RECOMMENDATIONS FOR THE PRACTICE]

PÁLL Dénes

[Hypertension is one of the most common diseases with a prevalence of over 25%. Despite of the availability of modern therapeutic options, the proportion of well-controlled patients is low. Before starting the treatment of patients with hypertension, it is essential to assess cardiovascular risk factors, co-morbidities and damages to target organs, in addition to repeated blood pressure measurements. The author first reviews the non-pharmacological treatment options of hypertension, then summarizes the most important characteristics of first-line antihypertensive agents (diuretics, beta-receptor blockers, calcium channel antagonists, angiotensin converting enzyme inhibitors, angiotensin receptor blockers). Considering the complex pathomechanism of essential hypertension, the author details the advantages and options of combined antihypertensive therapy, touching on the combinations recommended in special conditions. The metabolic effects and side-effects of antihypertensive agents, which have recently gained increased significance, are also discussed. Modern hypertension care is aimed at maximally decreasing cardiovascular morbidity and mortality, and improving the patient's quality of life. Maximum decrease of cardiovascular risk not only involves proper blood pressure control, but also aggressive fight against other risk factors (e.g., diabetes, dyslipidaemia, smoking) and treatment of target organ damages and comorbidities.]