Hypertension and nephrology

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MARCH 22, 2013

Hypertension and nephrology - 2013;17(01)

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Hypertension and nephrology

[Paradigmal changes in renal replacement therapy. Dialysis and drug therapy of quality in chronic renal patients - Optimal and adequate opportunities of dialysis therapy]

KISS István, SZEGEDI János, FODOR Erzsébet, BARABÁS Noémi, REMPORT Ádám, AMBRUS Csaba, KULCSÁR Imre

[Researches over the past thirty years, many results have been related to acute and chronic renal failure pathophysiology, clinical characteristics and therapy. Can be more than just the uremic toxins and their characteristics of the regulation of salt and water balance, renal anemia treatment, uremic metabolic disorders, calcium phosphate and lipid metabolism dysfunction. Improve the quality of treatment and reduce mortality and options can be influenced by factors come to, therefore, execution and technique of dialysis therapy. We know the primary concern of the treatment period for reducing mortality. This is best for intermittent treatments increased (4.5-6 hours) treatment will help. Narrow scope is optional for the treatment several times a week treatment, the daily 8-hour long nightly therapy. The mortality of the patient significantly influenced by age, gender, co-morbidities, fluid balance and the CaxPO4. The technical side is the key factor influencing the dialysis fluid purity and membrane properties. The use of high-flux membranes is clearly improving the quality of treatment, the additional benefit of hemodiafiltration therapy, the mortality for those still controversial. For optimal dialysis adequacy, complexity may result in reducing mortality and improving the quality of life in chronic dialysis patients.]

Hypertension and nephrology

[Obstructive sleep apnea, hypertension and cardiovascular risk]

ALFÖLDI Sándor

[Obstructive sleep apnea (OSA) is a surprisingly frequent disease worsening the quality of life of the patients, associated with serious complications, however, largely underdiagnosed and undertreated. OSA, hypertension and other symptoms of the metabolic syndrome are closely and independently correlated. OSA has been substantially emphasized as a new (emerging) cardiometabolic risk factor, not only a risk marker. The severe form of OSA (apnea-hypnea index>20/hour) has been accepted as a component of high cardiovascular risk on the Hungarian Cardiovascular Consensus Conference in 2008. Greater attention both to the identification and to the treatment of blood pressure increase associated with OSA as well as to the detection of OSA in patients with the diagnosis of hypertension has been suggested by the new European OSA and Hypertension Position Papers, because hypertension associated with OSA is frequently resistant and the proper management of OSA and hypertension could decrease the cardiovascular risk in patients followed up either in sleep or in hypertension centres.]

Hypertension and nephrology

[Causes of and therapeutic opportunities in resistant hypertension]

SIMONYI Gábor, GENCSI Kristína

[Hypertension is an independent cardiovascular risk factor and one of the most frequent diseases in Hungary. In the treatment of hypertensive patients usually more than two drugs are needed for the appropriate blood pressure control. Resistant hypertension (RH) is defined when blood pressure remains above target value despite full doses of antihypertensive medications, which consist of at least three different classes of drugs including a diuretic administered in maximal doses. The frequency of RH can reach 20-30% among hypertensive patients. RH increases the cardiovascular risk because of the lack of target blood pressure. RH is multifactorial and it is important to exclude pseudo-resistant hypertension (e.g. poor compliance, white coat effect). In the background of RH we can find lifestyle factors (e.g. obesity, excessive salt intake, alcoholism, etc.) and a variety of drugs (e.g. non-steroids, corticosteroids, sympathomimetics). In the pathogenesis of RH the increased activity of the sympathetic nervous system has an important role. In the treatment of RH we should manage lifestyle factors and it is important to assess the drugs and diseases (e.g. sleep apnea, chronic kidney disease, diabetes mellitus) which may cause increased blood pressure. It is no exact recommendations for the treatment of RH. Therapy often consists of 4-5 various drugs in combination. An important role has the device therapy of RH in recent years (e.g. stimulation of the carotid baroreceptors and renal denervation) as well.]

Hypertension and nephrology

[The success of fixed combined amlodipine/atorvastatin (Amlator®) therapy in patients with hypertension and dyslipidemia]

KÉKES Ede

[In total 2606 patients with hypertension and dyslipidemia got combined antihypertensive and antilipid-treatment. The main component of therapy was amlodipine/ atorvastatin fixed combination in different dose variations. The goal of the study was to access optimal target blood pressure and lipid profile. The baseline average blood pressure value was 155.9/90.18 mmHg and it decreased to 132.77/80.04 mmHg during the six months therapy. The lipid profile also changed successfully: the average value of total cholesterol decreased from 5.97 mmol/l to 4.68 mmol/l, LDL cholesteron from 3.45 mmol/l to 2.49 mmol/l and serum triglyceride from 2.1 mmol/l to 1.69 mmol/l. We reached the target values in respect of LDL cholesterol (<2.5 mmol/l) and of triglyceride (<1.7 mmol/l) prescribed in guidelines for subjects with high cardiovascular risk. According to the global cardiovascular risk estimation (European Heart Score) the risk ratio in percent was significantly decreased in each age group, in both genders and in smoking or nonsmoking subjects.]

Hypertension and nephrology

[Population based study of hypertension in Hungary - 2012 Comprehensive Health Protection Screening Program of Hungary 201-2020]

BARNA István, DAIKI Tenno, DANKOVICS Gergely, KÉKES Ede, KISS István

[Background: The year 2011 saw the continuation of Hungary’s greatest and to date most comprehensive health screening programme started in 2010. The aim of the screening programme established according to the directives of the European Union with the cooperation of more than forty professional organisations is the preservation of the health of the population, the prevention of illnesses and the improvement of the general health status. The programme contributes to the prevention of coronary diseases by passing on knowledge concerning healthy nutrition and guidelines to help the establishment of a health-conscious lifestyle. Partecipants and methods: In the Comprehensive Health Tests Programme of Hungary, the examinations, among them coronary examinations covering the fields of cardiology and hypertension, take place in a specially furnished lorry. The results of the examinations of the people who have presented themselves for the tests (n=19,814) have been evaluated. In the Comprehensive Health Tests Programme of Hungary a total of 10,444 (52.7%) women and 9,370 (47.3%) men were tested at 332 locations. Although the tests were free for all adults, predominantly persons between the ages of 26 and 55 presented themselves. The average age of women was 42 years and that of the men was 40 years. Results: Upon data processing with the help of a query, 28% of the participants reported suffering from hypertension disease. Measurement of the blood pressure was carried out in each case with validated equipment and by qualified medical staff. Based on the data, it can be observed that while among men hypertension tends to occur in larger numbers at a younger age, the tendency is reversed at ages above 45 years, where hypertension is more frequent among women. Among women, the state of normotonia was most frequent up to the age of 45 and stage 1 hypertension became most frequent from the age of 46 onwards. It must be noted, however, that stage 3 hypertension was already present in 1.7% of women of 26 years of age, and the frequency of this category increased to 6% from the age of 46 onwards. The average systolic blood pressure measured among men exceeded the upper limit of the normal range for all age groups. The average systolic blood pressure measured among women was in the normal range up to the age of 55 years and only moved to the pathological range from the age of 56 onwards. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of the men, where it exceeded the upper limit of the normal range by a minimal extent). Among the men, stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of the subjects from the age of 18 onwards. The distribution of this did not vary significantly with the increase of age. It must be mentioned here too, that stage 3 hypertension became more frequent with age, and that it was observed in more than 11% of the patients above 56 years of age. The correlation between abdominal circumference, total cholesterol, blood sugar level and the measured blood pressure values was unambiguously ascertainable. In case of simultaneous presence of diabetes and hypertension (women, n=344 and men, n=303), blood pressures above 140/90Hgmm were 2-3 times more frequent for both sexes than without the presence of diabetes. Discussion: Thanks to the vast information obtained through the programme, a comprehensive picture has been drawn up about Hungary’s present health status not only on a regional or cross sectional level, but as it was described in the programme, too. ]

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TORNAI István

[The outcome of chronic hepatitis C (CHC) therapy has been improved significantly. If sustained virologic response (SVR) is achieved, then it may prevent the occurrence of liver failure and hepatocellular carcinoma. With the currently used double combination therapy (peginterferon and ribavirin) SVR can be achieved in 40-50% of patients with genotype 1. In treatment naive patients, triple combination with protease inhibitors can result in 70-75% SVR. In treatment experienced patients, however, the result of the previous therapy, which mostly depends on the reaction to interferon (IFN), has a significant influence on the outcome of triple combination. INF sensitivity is the highest in relapsers, triple combination can achieve about 85% SVR, while in null responders this is only 30%. Viral resistance is a new phenomenon during triple combination therapy of CHC. In poorly IFN responsive patients the virus is effectively exposed to protease inhibitor functional monotherapy, leading to the rapid emergence of resistant virus. IFN sensitivity is well represented by the on-treatment viral response, therefore the knowledge of the previous viral response, relapse, a partial response or a null response is absolutely important. Optimization of triple therapy is crucial, since for a lot of patients with advanced liver disease it might be the last chance to achieve an SVR. The selection of the patients seems very important. Relapsers are the best candidates, there is no doubt with the indication. However, there are many debates for cirrhotic nullresponders, since the most virological failures are expected in this group. Prevention of viral resistance is crucial. PegIFN and ribavirin suppress both wild-type and resistant virus. PegIFN α-2a based treatment proved to be the most effective backbone for triple combination. This combination should be preferred especially for treatment experienced patients. Adherence to therapy is also critically important to prevent resistance. If resistant mutants appear, treatment should be stopped promptly.]

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[Empirical examination of the persistence value among the students studying health-care at the beginning of student professionalization]

DINYÁNÉ Szabó Mariann, PUSZTAI Gabriella

[INTRODUCTION – Students in healthcare studies can help maintain the mental base and maintain their health if the lecturers know the degree of student persistence. When entering higher education, it is possible to measure the pre-university experience. Persistence determines the student's relationship to learning and can be a predictor of learning success. PARTICIPANTS AND METHODS – A questionnaire study (N = 200) of the 1st year student (N = 200) of the Health Care Organization (BSc) of the University of Debrecen and Semmelweis University. For the continuous Persistence Variable a descriptive statistical method was used, an independent two-sample t-test was used for comparison between groups, and Hedges-g was used to express the effect size. We used the GLM (General Linear Model) model for fitting the persistence model. By means of factor analysis, we constructed factors from the significant predictor variables of the GLM model, which helped us assessing students' chances of learning. To quantify the strength of evidence against null hypothesis P < 0.05 (5% significance) was chosen as a standard level for concluding that there is evidence against the hypothesis tested. Statistical analysis was performed with IBM SPSS Statistics 24.0 (SPSS, Chicago, IL). RESULTS – The persistence factor loadings can be divided into three types: high, medium and low. High persistence rearranges student preferences, low interest persistence, minimal interest in academic engagement. In the case of middle-ranking people, the importance of volunteering (life-experience) and friendship is paramount. CONCLUSIONS – The results indicate that at the beginning of the student life there is a willingness, diligence, acceptance of academic values, interest or lack of interest in future success studies. During the stu­dies, these features can be monitored and the necessary interventions can be made in time.]