Hypertension and nephrology

[Obstructive sleep apnea, hypertension and cardiovascular risk]

ALFÖLDI Sándor

MARCH 22, 2013

Hypertension and nephrology - 2013;17(01)

[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.]

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

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[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

[The beginning and difficulties of peritoneal dialysis at the end of the last century - Part I. International experiences]

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[The theoretical background of peritoneal dialysis dates back to the 18th and 19th century. It was in 1923 when the first experimental and clinical experiences were summarised by Ganter from Munich. Of the Hungarian researchers Stephen Rosenak’s name can be mentioned, who was working in this field in Bonn in 1926 and later in London and New York. Obstacles to the spread of this treatment method was the lack of appropriate abdominal catheters, biocompatible solutions and equipment. The intermittent technique of the method was time consuming and, due to the conditions of that time, peritonitis frequently developed. The spread of the method was facilitated by the catheter constructed by Tenchkoff towards the end of the 1960s, the automatization of the treatment and later continuous ambulatory peritoneal dialysis (CAPD) described by Popovich and Moncrief. Further development of the method became possible by the use of the two-litre plastic bags instead of the bottled solution and later a twin-bag system employing the “flush before fill” technique. The occurrence of peritonitis developing during the treatment gradually decreased, in which Stephen I. Vas of Hungarian origin, working in Toronto as a professor of microbiology played an important role by constantly improving and modifying the principles of the therapy. Besides the infection in the abdominal cavity the bioincompatibility of the dialysis fluid presented another problem, which was solved by the use of essential amino acids, icodextrin instead of glucose and bicarbonate instead of lactate. By the turn of the century it became clear that the survival rate of peritoneal dialysis is very similar to that of hemodialysis in the second and third years following the treatment, while in relation to the quality of life it proved to be better. This observation has been proved in numerous clinical studies in the past decade and has been refined with regard to patients’ age, their primary and accompanying diseases. It is my intention to give account of the Hungarian experiences with peritoneal dialysis in the second part.]

Hypertension and nephrology

[Scientific Programs of the Hungarian Society of Hypertension Characteristics of Hungarian Hypertensive Patients According to the Hungarian Society of Hypertension Registry and the Program “Live Below 140/90” ]

KÉKES Ede, KERKOVITS Lóránt, BÖDÖR Anikó, KISS István

Hypertension and nephrology

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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.]

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