Hypertension and nephrology

[Our clinical practice with perindopril/indapamide/amlodipine triple fixed-dose combination]

BATTYÁNYI Bertalan

FEBRUARY 10, 2017

Hypertension and nephrology - 2017;21(01)

[Notwithstanding the abundance of pharmacotherapeutic options available, the rate of optimal blood pressure control may be estimated as low as 20 to 40 per cent throughout Europe. The underlying causes of this include, among others, the substantial impact of using free combinations of several antihypertensive - this practice results in rather poor patient adherence. Fixed-dose dual combinations have been introduced just about two decades ago, and their popularity has been increasing progressively since then. Nevertheless, in a considerable proportion (>30%) of patients, achieving optimal blood pressure control requires treatment with at least three antihypertensive acting on different targets. Accordingly, a rational demand has grown for triple-fixed combinations. In Hungary, the fixed combination of perindopril (an ACEI), indapamide (a thiazide-like diuretic), and amlodipine (a calcium channel-blocker) has been available since last year. Our experience with this product shows, as confirmed by ABPM studies, that its routine use in hypertensive patients with cardiological comorbidities improves patient compliance, thereby enhancing also long-term blood pressure control.]

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[Letter to our Readers]

KÉKES Ede, KISS István

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[The importance and techniques of fluid status assessment in patients with heart and kidney disease]

LEDÓ Nóra, HORVÁTH Viktor József, TISLÉR András

[Managing the fluid balance in patients with chronic heart and kidney disease is critical, it exceptionally affects the success of the therapy. Therefore, it is crucial to recognize and treat the fluid overload or depletion as soon as possible. Plenty of methods are available to assess fluid status, which can help us to find the right diagnosis, plan and follow the therapy of the patients. The aim of our review article is to present the current techniques of estimating fluid status. Beside the widely used methods (e.g. physical examination, laboratory testing) we describe other techniques which are less common in the Hungarian clinical practice but easy to use, such as chest sonography and bioimpedance spectroscopy. To choose the right approach for assessing fluid status, we have to examine the advantages and disadvantages of the methods in consideration of the patient’s individual needs.]

Hypertension and nephrology

[Effects of ketodiet in fourth-stage chronic renal failure]

KÓSA Dezider, GELENCSÉR Éva, PALOTAI Ágota, GASZTONYI Beáta

[The well-known progressive nature of chronic renal failure can be slowed by low protein diet of various degrees. We applied standard 0.6g/kg body weight diet with supplement of essential amino acids and keto acids, 1 tablet/10 kg body weight Ketosteril was administered to 100 patient with IV. stage chronic renal failure for 31.5 months in average (10-63 month). During observational period 11% of the patients started hemodialysis program, 4 patients died. At the end of the observational period on basis of laboratory value of renal function 31% of patients had III, 50% IV, 19% V. stage chronic renal failure. We applied calculated glomerular filtration rate (ml/min/1.73 m2) for following the renal function. Average GFR value reduced from 24.9 to 23.63 ml/min/1.73 m2 (not significant). In case of female patients, we found a milder loss in renal function, average GFR was reduced from 24.8 to 24.6 ml/min/1.73 m2. We observed that women hold on the prescribed diet in greater ratio. On basis of the BMI value calculated at end of our examination no patient was undernourished. 25.8% of the patients had normal body weight, 54.3% had overweight, 17.5% was obese and 2.4% severely obese. We followed the changes in state of nourishment by serum albumin value, average serum albumin was 42.92 g/l at beginning and did not change significantly (42.81 g/l at the end of our examination). Applying keto diet is safe and efficient in slowing the progression of severe chronic renal failure and improves the state of nourishment. Good state of nourishment achieved in predialytic stage is associated with low mortality ratio and gives opportunity to lower the mortality of patients starting dialysis program.]

Hypertension and nephrology

[Stroke incidence and prevalence in the world]

KÉKES Ede

[The incidence and prevalence of ischaemic and haemorrhagic stroke declined continuously from 1970 to 2010. The rate of incidence was the lowest in North America, within Europe in the Mediterranean countries, France and in Asian developed countries. The incidence and prevalence the progress of age have in - creased respectively. The outcome of haemorrhagic stroke is worse everywhere, than that of ischaemic form, rate of mortality/incidence is greater.]

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