Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

MAY 20, 2010

Hypertension and nephrology - 2010;14(02)

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Hypertension and nephrology

[Attracted by science III. - My scientific life product of 55 years: what have I achieved?]

RADÓ János

[Author analyses the scientific results of his own clinical research work by evaluating his product in a „traditional way”, and only after then supplemented by scientometric data (citedness). From the 148 articles which has been published in foreign language (mostly in English) in abroad, 10 was grouped into the category of “new procedure/ recognition”, 40 into “original data/significant new statement”, and 98 into “new observation (statement) in a detailed question”. He has found close correlation between the values of the publications grouped by the traditional evaluation and the corresponding numbers of citations. Author discusses in the light of his own data the evaluating role of citedness with the hope to help by this motivated young scholars to plan their own future.]

Hypertension and nephrology

[Cerebrovascular diseases in patients with chronic kidney disease]

KISS István, NAGY Judit

[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]

Hypertension and nephrology

[Practical questions of early diagnosis and prevention of cerebrovascular disease are highly important for all internists]

NAGY Judit, SZAPÁRY László, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, VAS Tibor, KOLLER Ákos, WITTMANN István, KISS István, KOMOLY Sámuel

[Stroke is the third most frequent cause of death and the most important cause of disability and dependency worldwide. There are marked differences in the incidence, prevalence and mortality between the populations of Eastern and Western Europe. In Hungary, between 1998-2003, the incidence of stroke was 1,5-2 times higher than in the Western part of the continent. The early recognition of signs and symptoms of TIA and stroke and the urgent transportation of the patient to neurology, preferably to the nearest stroke-center are the key points of successful treatment, reduction of consequences and increased survival. The “time is brain” concept means that the management of TIA/stroke patients should be considered as emergency. This review briefly summarizes the epidemiology, key elements of the etiology, risk factors, up-to-dated diagnosis, primary and secondary prevention and treatment of TIA/stroke to provide information regarding the development of this field targeting the optimal management of TIA/stroke patients.]

Hypertension and nephrology

[Stroke is a common, severe, but preventable cardiovascular disease in chronic kidney disease]

NAGY Judit, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, SZAPÁRY László, VAS Tibor, KOMOLY Sámuel, KOLLER Ákos, WITTMANN István, BERECZKI Dániel, KISS István

[In chronic kidney disease (CKD) patients the high risk for cardiovascular events represents the major cause for morbidity and mortality. Stroke is the third most common manifestation of cardiovascular diseases and cause of death. The risk of cerebrovascular diseases persists in CKD patient in predialysis increases by 1.5-3 times whereas in patients on dialysis is increases by 4-10 times. The combination of classical cardiovascular risk factors and the pathomechanisms present in CKD and activated by dialysis treatment may explain the increased risk. The outcome of stroke is more severe in CKD, than in other populations. There are only a few data regarding early identification, primary and secondary prevention. and proper treatment of stroke in CKD patients with and without dialysis. In this review we summarize the diagnostic and treatment strategies that are based on the existing state of knowledge. However, additional studies are needed to address the poor prognosis through early identification of risk developing potential preventions and treatments of stroke in CKD.]

Hypertension and nephrology

[Cardiovascular risk caused by chronic obstructive pulmonary disease in patients with hypertension]

KISS István

[According to World Health Organization data 250 million people suffer from chronic obstructive pulmonary disease (COPD) worldwide, and the diseases accounts for 5% of total mortality. It is the only cause of death with increasing incidence and is estimated to be the third most prevalent one after stroke and myocardial infarction by 2030. In Hungary the estimated number of patients is 500 000 and projected to the number of habitants the highest number of death is caused by COPD in our country in Europe. Hypertension is a public health problem also in Hungary and it is estimated that 2.5-3.5 million adult are affected. Most of them are not aware of their disease or their treatment is insufficient. Hypertension also accounts for a great percentage of cardiovascular morbidity and mortality. Coincidence of the two diseases is significant in the adult population. According to international data the prevalence of COPD among patients with hypertension is similar to that of the general population, thus the coincidence of the two diseases may affect 2.5% of the adult population. Separate guidelines are available for the diagnosis and the treatment of the diseases, however these issues are not discussed jointly neither in international nor in Hungarian guidelines. In this review epidemiology of coincidence, the raising effect of COPD in cardiovascular risk and the potential therapeutic suggestions are summarized.]

All articles in the issue

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Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]

Clinical Neuroscience

[The Comprehensive Aphasia Test in Hungarian]

ZAKARIÁS Lilla, RÓZSA Sándor, LUKÁCS Ágnes

[In this paper we present the Comprehensive Aphasia Test-Hungarian (CAT-H; Zakariás and Lukács, in preparation), an assessment tool newly adapted to Hungarian, currently under standardisation. The test is suitable for the assessment of an acquired language disorder, post-stroke aphasia. The aims of this paper are to present 1) the main characteristics of the test, its areas of application, and the process of the Hungarian adaptation and standardisation, 2) the first results from a sample of Hungarian people with aphasia and healthy controls. Ninety-nine people with aphasia, mostly with unilateral, left hemisphere stroke, and 19 neurologically intact control participants were administered the CAT-H. In addition, we developed a questionnaire assessing demographic and clinical information. The CAT-H consists of two parts, a Cognitive Screening Test and a Language Test. People with aphasia performed significantly worse than the control group in all language and almost all cognitive subtests of the CAT-H. Consistent with our expectations, the control group performed close to ceiling in all subtests, whereas people with aphasia exhibited great individual variability both in the language and the cognitive subtests. In addition, we found that age, time post-onset, and type of stroke were associated with cognitive and linguistic abilities measured by the CAT-H. Our results and our experiences clearly show that the CAT-H provides a comprehensive profile of a person’s impaired and intact language abilities and can be used to monitor language recovery as well as to screen for basic cognitive deficits in aphasia. We hope that the CAT-H will be a unique resource for rehabilitation professionals and aphasia researchers in aphasia assessment and diagnostics in Hungary. ]

Hypertension and nephrology

[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.]

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