Hypertension and nephrology

[Overview of changes in the use of the cardiovascular system (ATC code based) products based on National Health Insurance data]


JUNE 20, 2016

Hypertension and nephrology - 2016;20(03)

[Use of cardiovascular products supported by the National Health Insurance in December 2015 exceeded more than 5% the data of December 2007. This is a significant change, because simultaneously the amount paid as a support decreased by 41.1%. Change in the categories of support resulted in an increase in the use of generics. In addition, the expansion of fixed combinations also brought a significant change in drug consumption. The role of products effecting on the reninangiotensin system, lowering serum lipid modifying agents, diuretics, β-receptor blockers, centrally acting agents and vasodilators in the treatment of cardiovascular diseases has increased as well.]



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[Sclerosis tuberculosa. Newer aspects of therapy and care]


[Tuberous sclerosis (TSC) is an autosomal dominant disease characterized by the development of hamartomas in various organs with variable frequency. The major organs involved are the skin (70%), the brain (75%), the heart (50%) and the kidney (80%). Life threatening acute and chronic events are due initially to cardiac involvement, later neurologic complications and after the second and third decade nephrological and pulmonological involvement may predominate. Skin and osteo - skeletal disease may lead to disfiguring appearance causing additional psychological burden to the patient. Uninhibited activation of the mTOR signaling pathway is at the center of the disease process. The discovery of the pathomechanism established the base of the up-to-date medical therapy presenting a real alternative to the classical supportive and surgical treatment. Due to the progressive nature of the disease early recognition, best standard care and treatment according to the disease stage is of crucial importance. Optimal therapy is based on internationally recognized guide-lines and should be controlled through specialized, multidisciplinary centers.]

Hypertension and nephrology

[The prevalence of type 2 diabetes mellitus in the Hungarian population with hypertension]

KÉKES Ede, PÁL László, SCHANBERG Zsolt, KISS István

[Authors had found diabetes mellitus type 2 in 30% of 38 886 hypertensive patients (stadium I-III). Diabetes was more frequent in case of women under 30 years. Subsequently all age groups (from 40 to 80 years) incidence was more frequently (p<0.01-0.001) in men, above 80 years again a higher ratio was in women. Presence of diabetes was correlated to rate of BMI value and systolic, diastolic pressure as well. In women - above 140 mmHg systolic pressure - the elevation was exponential. We have found a significant correlation between fasting glucose and waist. Reaching the target blood pressure is not a simply task in hypertensive patients with diabetes. The 140/90 mmHg was reached in 34.2%, 90 mmHg diastolic blood pressure in 62.3%, but the required 80 mmHg only in 16.4% of cases. Achieve the target value was quite different in the different region of our country. The major cardiovascular complications (stroke, renal disease, myocardial infarction, peripheral artery disease) have suffered a higher rate in the hypertensives with diabetes compered to hypertensives without diabetes.]

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Hypertension and nephrology

[Therapy of isolated systolic hypertension III.]


[In the elderly and very elderly (˃80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE-inhibitors/ARBs with calcium antagonists, and in special cases diuretics and beta blockers are also suggested by recent European guidelines (ESH, HSH). The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.]

Clinical Neuroscience


CSAPÓ Krisztina, BAJKÓ Zoltán, MOLNÁR Sándor, MAGYAR Tünde, CSIBA László

[The vascular diseases (myocardial infarct, stroke, peripheral occlusive disease) have a common pathophysiological background, the arteriosclerosis, that impairs the autoregulation of cerebral vessels, decreases the endothel mediated flow in the peripheral vessels. Therefore the assessment of the vascular damage or the follow-up of therapy need a complex and simultaneous approach. Currently the morphological and functional changes in the vascular system can be investigated with separated measuring systems, focusing either to cardiac or cerebral parameters (intermittent blood pressure measurement, ECG, cerebral blood flow by transcranial Doppler e.g.). Our purpose is to establish a complex non-invasive system for the simultaneous measurement and comparison of cardiac/cerebral/periheral hemodynamics. The hemodynamic parameters in hypertensive patients are examined with transcranial Doppler and cardiac monitoring during tilt-table test. Intima-media thickness, flow-mediated dilatation in brachial artery, augmentation index and pulse wave velocity are also measured. The measurement will be repeated after 6 and 12 months follow-up. Our preliminary results are similar to those found in the literature, that proves the reliability of our complex noninvasive hemodynamic system. It is assumed, that 12 months antihypertensive therapies with ACE inhibitors, calciumantagonist etc. might result in different effects on different vascular parameters. Our system enables the individualization of antihypertensive therapy.]

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.]

Hypertension and nephrology

[Isolated systolic hypertension in children and young adults I.]


[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]

Hypertension and nephrology

[Application of central sympatholytic agents and vasodilators between 2007-2014 based on OEP’s database]


[Due to the a large number of antihypertensive drugs on the Hungarian market, in the light of the constantly updated recommendations for therapy, seemed to be worth to consider the traffic data provided by the National Health Insurance. We analysed the turnover of the centrally-acting and direct vasodilator antihypertensive, using the data of The National Health Insurance Fund (NHIF) between 2007 and 2014. Every year the December data were comparesed, the turnover of the month did not substantially different from other month, an average of 5-6 million boxes of cardiovascular products are prescribed. Over the past seven years it was fluctuating, but overall there was almost 19% increase in the turnover of centrally acting medicinal products. The prescription number of guanfacine decreased almost one-third, moxonidine orders fell 37%, while the turnover of rilmenidine doubled during that same period. A significant expansion of the centrally acting rilmenidine became clear in the domestic market. The minimal side effects, the favourable profile of applications, the number of international and domestic studies make it an excellent second-third additional agent. The use of vasodilators overall increased of a small degree (15%), mainly due to a 53% increase of doxazosin. Considering the domestic prescribing habits they follow very well the international and domestic recommendations. The observed differences in each group are the effects of the positive results of recent studies.]