Hypertension and nephrology

[Novelties in treatment of hypertension in pregnancy]


DECEMBER 10, 2017

Hypertension and nephrology - 2017;21(06)

[Hypertensive disorders represent the most common and dangerous medical disorder in pregnancy. Furthermore, its prevalence is rising. According the recent studies the initiation of antihypertensive treatment should be withhold in mild chronic hypertension (140-159/90-109 mmHg) in pregnancy, excepting associated subclinical hypertensive organ damage or hypertensive complications because of risk of compromising uteroplacental perfusion and fatal circulation. In preeclampsia, however, early antihypertensive treatment is necessary for the prevention of maternal cerebrovascular events.]



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[The present healthcare system is mainly disease-centered. There is an increased need in a health model, that considerates the human being, his or her health, health status, their effects on every day life activities, on filling of his or her social tasks, takes into account the influential role of physical, social, economical factors and personal characteristics as well. A such of kind health model should be developed, that considerates the whole human being, the completness of his or her health affairs, and simultaneously is a part of a „whole-ness” affair-, human-centered system, taking into account physical, social, economical and political factors at the same time.]

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[Strategies for increasing physical activity in chronic kidney insufficiency. Why to train in CKD?]

APOR Péter

[Chronic kidney patients are prone to lose their muscles, strength, their physical functioning and parallel to this the life expectancies are diminish. Physical training is a natural way to delaying these devastating processes in every grade of the illness. Centre-based or home, ambulant or dialysis-bound forms of programs are published – some of that recent information are summarized in this paper.]

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[Gout, hyperuricaemia and cardiovascular risk - Effects of allopurinol]


[Hyperuricemia has an increasing clinical relevance due to its pathomechanism and its presence and adverse effects on cardiovascular, metabolic and renal diseases today. Its presence is a world phenomenon and in our country, we have seen increasing incidence rates during the screening surveys in recent years. Convincing evidence suggests that the high uric acid values in cardiovascular and renal diseases is an independent risk factor for CV mortality and their clinical manifestations. Experimental and clinical evidences indicates that in addition to gout, all high uric acid levels should be considered to initiate the XO inhibitor allopurinol treatment. Recently, in some diseases, in the treatment of the underlying disease (especially elderly hypertension, ischemic heart disease, chronic heart failure, chronic kidney failure) is also considered as an adjunct therapy.]

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Hypertension and nephrology

[The prognostic role of placental growth factor in pregnancies complicated by hypertensive disorders]


[Placental growth factor (PlGF) is a member of the proangiogenic VEGF-family; it is mainly produced by throphoblast cells. During the last years numerous studies have shown that circulating PlGF-level in maternal plasma is decreased and its suluble receptor sFlt-1 shows increased expression. In the present study we examined the prognostic accuracy of Alere Triage® PlGF-Assay in hypertensive disorders of pregnancy and its relation with the length of pregnancy. 130 pregnant women were involved in this case-control study (PE: 23, HELLP-syndrome: 20, superimposed praeeclampsia: 17, chronic hypertension: 25, gestational hypertension: 18 and normal control: 27). Blood draw occured between the 22nd and 34th gestational week. PlGF levels were measured by the Alere Triage® PlGF Assay using samples from the maternal plasma. The plasma PlGF-levels of women whose pregnancies were complicated by hypertensive disorders were significantnormotoly lower compared to those who had uncomplicated pregnancies and the decrease were greater in those patients who delivered before the 35th gestational week. The PlGF-test was positive in 93,7% of those women who delivered before the 35th gestational week and in 90,5% of those who delivered before the 37. gestational week. The vast majority of preeclamptic (PE: 95,7%, SIPE: 82,4%) and HELLP-syndrome (95%) patients had positive PlGF tests, the 60% of the chronic hypertension and the 44,4% of the gestational hypertension patients have also shown positive results. The main conclusion of this study is that the PlGF levels using maternal plasma are lower in those pregnancies which are complicated by hypertension and show strong correlation with the severity of the hypertensive disorder. We perceived high sensitivity values in detecting preeclampsia, HELLP-syndrome and superimposed preeclampsia. In the future we may use this method to separate high risk women for hypertensive disorders and it may improve the perinatal outcome]

Lege Artis Medicinae

[Praeeclampsia - 2019]

TAMÁS Péter, KOPPÁN Miklós

[Preeclampsia remains one of the most serious gestational diseases. Accumulating data support the opinion that the pathogenesis of preeclampsia (gestational hypertension + organ dysfunction) is not homogenous. The early-onset (onset of clinical phase before the 34th gestational week) type is a placental disease in which hypertension and organ dysfunctions are due to vasoconstriction and microthrombosis. The late-onset form is a maternal disease in which water retention - in connection with obesity - beyond the given vascular capacity may be an important progenitor of the clinical signs. These considerations should also influence the strategy of the treatment. ]

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[Association between cyclothymic affective temperament and hypertension]


[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.]