Hypertension and nephrology

[Nebivolol’s unique molecule structure and its effect onthe quality of life]

KERKOVITS Gábor

MARCH 20, 2018

Hypertension and nephrology - 2018;22(01 klsz)

[The β receptor blockers have very different effects depending on their receptor selectivity, ISA effect, which gives a wide opportunity of beneficial therapeutic choice. Resulting from its unique molecule structure nebivolol has its unique effects. It consists two isomers in 1:1 ratio. D-nebivolol is a highly β1 receptor blocker, while l-nebivolol causes NO release resulting vasodilatation. As a result of this dual effect, nebivolol more strongly reduces the blood pressure. The pressure reducing effect of nebivolol is stronger than 25 mg of atenolol, and is equal with the effect of 100 mg of atenolol. Nebivolol has a significantly higher responders’ rate than bisoprolol, and significantly fewer adverse effect. Comparing to losartan nebivolol produces significantly higher reduction in systolic and in diastolic blood pressure as well. Nebivolol has beneficial haemodynamic effects. It raises the stroke volume by 20.6 percent, the cardias output by 7.1 per cent, the ejection fraction by 7.8 per cent while reduces the peripheral resistance by 13.2 per cent. Both at rest and during exercise nebivolol cases significantly higher reduction in pulmonary wedge pressure than atenolol. Nebivolol has a better profile of adverse effects. The following adverse effects were observed: fatigue in 1.3 per cent, cold extremities in 0.8 per cent, impotence in 0.08 per cent and dyspnea in 0.05 per cent. It has also a beneficial effect on erectile dysfunction. It cases a significant elevation in erectile dysfunction score from 17.22 to 22.09. The number of sexual activity also raised from 3.41 to 6.38 during nebivolol treatment. The prevalence of erectile dysfunction is also significantly lower as compared to any β receptor blocker. Nebivolol has a synergic effect on PDE5 blockers, raises the cGMP concentration in the erectile tissue. There is also a significant difference among the β receptor blockers in the reduction of exercise tolerance. The nonselective β receptor blocker cause 40 per cent, carvedilol 35 per cent, the β1 selective receptor blocker 25 per cent while nebivolol 6 per cent reduction in the duration time.]

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Hypertension and nephrology

[Trends in the treatment of hypertension]

BARNA István, GYURCSÁNYI András

[Use of drugs treating hypertension (and its associated diseases) supported by the National Health Insurance has changed spectacularly during the last 10 years. In December 2016 the turnover of drugs exceeds almost 2% the data of December 2007. Simultaneously the amount paid as a support decreased by 42.5%. Change in the categories of support resulted in an increase in the use of generics. In addition, the expansion in use of fixed combinations also brought a significant change in drug consumption. During the examined period the role of drugs used in the treatment of hypertension in most the groups has changed.]

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[THE SAFETY OF TREATMENT WITH PEGYLATED INTERFERON-ALPHA-2A AND RIBAVIRIN IN PATIENTS WITH CHRONIC HEPATITIS C INFECTION, BASED ON HUNGARIAN EXPERIENCE]

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[INTRODUCTION - Adverse effects of treatment for chronic C virus hepatitis present an important problem both for the patient and the clinician. The reduction of drug doses or the suspension of therapy lessen the likelihood of recovery. PATIENTS, METHODS - Between 2001 and 2004, 66 patients with chronic hepatitis C received 180 μg pegylated interferon-alpha-2a per week and 800-1200 mg ribavirin per day, 6 of whom for 24 weeks and 60 patients for 48 weeks. During treatment, patients were closely followed in order to recognize any adverse effects early. RESULTS - Of the patients treated for 48 weeks, 48.3% developed adverse effects, with changes in the differential in 41.7%, and anaemia, low platelet count, neutropenia in similar rates. Further side effects included cardiac complications, skin symptoms, persisting high fever, autoimmune thyroiditis and liver failure, altogether in 9 cases. Dose reduction or temporary suspension of pegylated interferon-alpha-2a was necessary in 21 cases (31.7%), while complete cessation of this treatment was decided in 7 cases, most of them because of blood count changes. The 1000 to 1200 mg per day ribavirin had to be reduced in 30.8% of patients, while treatment was stopped in 3 cases. Long-term virological remission occurred in 48% of patients who received treatment for 48 weeks, whereas no such result was observed among any of those treated for 24 weeks. CONCLUSION - Adverse effects of variable severity developed in nearly half of the patients with chronic hepatitis C infection who received antiviral treatment for 48 weeks, but treatment had to be stopped in only a small proportion of this group. Early treatment of adverse effects can prevent the need to cease therapy and may improve its efficiency.]

Hypertension and nephrology

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Hypertension and nephrology

[Antihypertensive therapy in patients with COPD - the significance of nebivolol]

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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

[Hypertension and sexuality]

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[Atherosclerosis is a phenomenon of natural aging and as part of it erectile dysfunction (ED) occurs. ED is further aggraveted by smoking, diabetes, atherogen dyslipidemia, obesity, systolic hypertension and vascular disesases (carotid, coronary and peripheral). The average incidence of ED is 19.2% but depending on age (between 30 and 80 years) the relative frequency is fairly different (from 2.3% to 53.5%). Appearence of ED might be the first warning sign of cardiovascular disease. The basis of the treatment of hypertensive males suffering from ED might be the cessation of smoking and quitting alcohol consumption. Optimalization of body weight includes low dietary fat and carbohydrate consumption. Concerning the antihypertensive treatment of males suffering from ED centrally acting agents, diuretics (except indapamide) and beta blockers (except carvedilol and nebivolol) should be omitted. Because of the neutral effect of calcium channel blockers and ACE inhibitors they can be safely administered. There is increasing evidence about ARBs that they have beneficial effect on erectile function and libido, too. If, testosterone production decreases hormone substitution - controlled by an urologist - can be recommended. Oral phosphodiesterase inhibitors (PDE5) can be safely administered even in hypertension. The incidence of sexual dysfunction (SD) among women between ages 40 and 80 is 47%. The most frequent cause in the background of decreased sexual desire among women are psychological, emotional and hormonal reasons or side effect of medication. Several studies proved the association of hypertension, high plasma cholesterol levels, smoking, vascular diseases and sexual dysfunction among women. Disturbance of local blood supply (clitoral, vaginal) is an early prognostic sign, too, like in males. Estrogen hormon replacement might alleviate these symptoms. In recent years sildenafil proved to be effective in several studies and ARBs improve libido, as well.]