Hypertension and nephrology

[Pathophysiology, measurement methods and prognostic role of arterial stiffness]


FEBRUARY 20, 2010

Hypertension and nephrology - 2010;14(01)

[In the past decade, a novel property of circulation, arterial stiffness (or decreased arterial distensibility) began to recieve special attention. Three years ago, Hypertonia and Nephrologia has already reviewed the gathered information on the clinical significance of arterial stiffness, described two commonly used stiffness parameters, pulse wave velocity (PWV) and augmentation index (AIx), and assessed the relationship of arterial stiffness and the traditional risk factors. Recently, more and more clinical epidemiological studies provided evidence that the parameters quantifying arterial stiffness are more than innocent side effects of cardiovascular changes, as they can be linked to target organ damage and increased mortality. In the present study, we review the pathomechanism and current methods of measurement of decreased arterial compliance, we summarize the results of recently closed epidemiologic studies and finally, we will briefly discuss possible measures of arterial stiffness treatment.]



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Hypertension and nephrology

[Hypertension and sexuality]

BARNA István

[Atherosclerosis is a phenomenon of natural aging and as part of it erectile dysfunction (ED) occurs. ED is further aggraveted by smoking, diabetes, atherogen dyslipidemia, obesity, systolic hypertension and vascular disesases (carotid, coronary and peripheral). The average incidence of ED is 19.2% but depending on age (between 30 and 80 years) the relative frequency is fairly different (from 2.3% to 53.5%). Appearence of ED might be the first warning sign of cardiovascular disease. The basis of the treatment of hypertensive males suffering from ED might be the cessation of smoking and quitting alcohol consumption. Optimalization of body weight includes low dietary fat and carbohydrate consumption. Concerning the antihypertensive treatment of males suffering from ED centrally acting agents, diuretics (except indapamide) and beta blockers (except carvedilol and nebivolol) should be omitted. Because of the neutral effect of calcium channel blockers and ACE inhibitors they can be safely administered. There is increasing evidence about ARBs that they have beneficial effect on erectile function and libido, too. If, testosterone production decreases hormone substitution - controlled by an urologist - can be recommended. Oral phosphodiesterase inhibitors (PDE5) can be safely administered even in hypertension. The incidence of sexual dysfunction (SD) among women between ages 40 and 80 is 47%. The most frequent cause in the background of decreased sexual desire among women are psychological, emotional and hormonal reasons or side effect of medication. Several studies proved the association of hypertension, high plasma cholesterol levels, smoking, vascular diseases and sexual dysfunction among women. Disturbance of local blood supply (clitoral, vaginal) is an early prognostic sign, too, like in males. Estrogen hormon replacement might alleviate these symptoms. In recent years sildenafil proved to be effective in several studies and ARBs improve libido, as well.]

Hypertension and nephrology

[Symptomes and genetics of nephronophthisis]

TORY Kálmán, VÁRKONYI Ildikó, BERNÁTH Mária, RÉMI Salomon, SOPHIE Saunier, MARIE-CLAIRE Gubler, CORINNE Antignac, TULASSAY Tivadar, REUSZ György

[Nephronophthisis is an autosomal recessive, chronic tubulointerstitial nephropathy, responsible for 6-10% of childhood chronic renal failure cases. Its first symptoms, polyuria-polydipsia, anaemia and failure to thrive precede the development of end-stage renal disease by years. Increased echogenicity with loss of corticomedullary differentiation are the key findings on ultrasound, the lack of cysts does not rule out the diagnosis. Histologically, it is characterized by interstitial fibrosis and irregularities of the tubular basal membrane. Genetically, it is highly heterogeneous. Ten nephronophthisis genes have already been identified in 60% of the patients. The encoded proteins - similarly to other proteins mutated in cystic kidney diseases - are localized to primary cilium-basal body-centrosomal complex.]

Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

Hypertension and nephrology

[Enjoyable and invisible risk: salt The role of the Hungarian Hypertension Society in the National Salt Intake Lowering Program: STOP-SÓ]

KISS István

[Cardiovascular disease accounts for more than 50% of Hungarian mortality and hypertension accounts for almost 50% of coronary heart disease and for more than 60% of stroke. High salt intake increases blood pressure and major and sustained consumption may cause high blood pressure. In Hungary more than 2.5 million people have hypertension and among them only 44% have their blood pressure under 140/90 mm Hg. Achieving target blood pressure is difficult as salt intake of the Hungarian population is higher than that recommended in every age group. Blood pressure control consists of proper combination of medical treatment and of nonmedical procedures. Among non-medical procedures weight loss, increase of physical activity, Mediterranean diet and decrease of salt intake are of value in blood pressure lowering. A daily salt intake of less than 6 grams is recommended in the Hungarian guideline and in the European one the recommendation is more rigorous. However in Hungary average salt intake is 18 grams among men and 14 grams among women. Responsibility of the individual person is inevitable in preserving health and preventing disease. A perfect example for this is the change of salt intake habits as it is demonstrated that decreasing salt intake results in the decrease of blood pressure. A daily decrease of 5 grams in salt intake results in 23% less stroke and 17% less cardiovascular disease. The Hungarian Society of Hypertension has joined among the first to the Hungarian Salt Intake Decreasing Programme and thus its activity is aimed at strengthening the public health subset of the Hungarian Cardiovascular Programme.]

Hypertension and nephrology

[New data about adolescent hypertension]


[The new recommendation of management of high blood pressure in children and adolescents was published at Journal of Hypertension, September 2009. The aim of this review is - based on this guideline - to summarize the newest knowledge of epidemiology, pathomechanism, diagnosis and treatment of adolescent hypertension.]

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Journal of Nursing Theory and Practice

[Healthcare and social aspects of nursing in relation to the rare Pompe disease]

TÓTH Mónika, VÁRDI Katalin Borbála

[Aim of the study: Pompe disease is a rare mitochondrial disease, which is treated with enzyme replacement therapy. The authors examined the lifestyles of patients diagnosed with Pompe disease, and their knowledge regarding the illness. They compared this with the results of the regular checkups performed during the care process, in order to assess the patients’ compliance. Sample and methods: The research was conducted among patients suffering from Pompe disease, treated at the Rehabilitation Department of the Törökbálint Institute of Pulmonary Medicine (N=14). The survey of the patients’ knowledge took place in the form of personal interviews. The findings related to the regular enzyme replacement therapy were recorded and collated in the course of interviews conducted by telephone with the nurses of the centres administering the treatment. The data was processed using Microsoft Excel software. Results: In 2012 in Hungary the number of patients diagnosed with Pompe disease was 14 (12 adults, 2 children). The time elapsed from emergence of the first symptoms to the precise diagnosis in the case of all known patients (except in the case of one screened child) was an average of 13.4 years. Ten of the patients were receiving enzyme replacement therapy. The survey revealed that the conditions of the patients receiving the enzyme replacement therapy did not deteriorate. In the case of the female child, the decrease in CK levels was accompanied by growth and movement consistent with her age, and an improvement in vocalisation. Conclusions: For patients diagnosed with the once fatal Pompe disease, enzyme replacement therapy now offers the opportunity of a full life; and complementary treatments not only boost the effectiveness of the enzyme replacement, but also improve the patients’ subjective quality of life.]


[MOOT-COMP study - Compliance of patients with antiporotic treatment]

BORS Katalin, BOROS Erzsébet

[INTRODUCTION - Several studies prove the importance of the lack of compliance in the ineffectiveness of drugs which have been tested by clinical studies. In our study we finded the reasons of leaving off the antiporotic treatment. PATIENTS AND METHODS - 1067 osteoporotic patients (91% women, 9% men) were enrolled to examine compliance and to find explanation of non-compliance. We asked the patients about medications, exercises, electrotherapy and medical aids. RESULTS - Medications were recommended for most patients and exercise was the secondary most common therapeutic method. Electrotherapy was prescribed for one third and medical aids were recommended for one fifth of the recruited patients. Two third of patients reported to take all pills, most of them suffered from bone fracture. More than one fifth of patients sometimes or often forgot to take the treatment. 10% more patients did exercises than it was recommended by the practitioner. However, only 25% of all patients did exercises appropriate frequency and at least 20 minutes per day. Electrotherapy was not prescribed by the doctors for more than half of patients on this treatment. Medical aids were not used by 10% of patients despite the recommendations. Almost one third of the enrolled patients reported a fact which disturbed keeping recommendations of the doctors. These facts were financial problems, long waiting lists and low motivation of patients for keeping recommendations. The compliance did not correlate with education and social status. The patients with multiple fractures were more comply with medications and exercises. CONCLUSION - Drawing the informed patient into decision making and knowing the therapeutic outcome are important factors for keeping therapeutic recommendations. The high fracture rate in Hungary attracts our attention for enhance patient compliance.]

Hungarian Immunology

[Autoimmunity as a result of escape from RNA surveillance]


[The pathomechanisms of autoimmune diseases are still unknown. Numerous factors are thought to play a role in the formation of the diseases (genetic arrangement, hormonal factors, exogen and endogen viruses, etc.) and many hypotheses have been formulated to explain the role of these factors. Most of the theories suspect that disturbance of the immune system is the clue but according to other researchers the immune system performs properly and one has to find other alterations that could be blamed for the formation of the autoimmune diseases. The aim of our present work is to show that certain genetic alterations together with the mistake of the RNA surveillance system could lead to autoimmune reactions. Results of immune research conducted in the past two decades revealed that there are mutations in the hot spot region of exon 7 of the La gene in the peripheral lymphocytes of patients suffering from certain autoimmune diseases (Sjögren's syndrome, SLE). RNAs originated from the mutant gene contain premature termination codon and therefore the RNA surveillance mechanism should get rid of these RNAs in order to prevent the formation of mutant proteins. However, because of the mistake of the surveillance system mutant proteins are formed that could finally lead to the autoimmune reactions.]

Hypertension and nephrology

[Measurement of ambulatory arterial stiffness index in kidney transplant children]

DÉGI Arianna Amália, KERTI Andrea, KIS Éva, CSEPREKÁL Orsolya, REUSZ György

[Background: Cardiovascular (CV) diseases are the leading cause of death among renal transplant patients (TX). Ambulatory arterial stiffness index (AASI) has been suggested to individually predict the cardiovascular morbidity and mortality. Our aim was to evaluate the relationship between traditional and nontraditional risk factors and AASI in renal transplant children. Patients and methods: In our cross-sectional study, 35 TX patients (15.6±4.3 years of age) were investigated with 24-h ambulatory blood pressure monitoring and AASI was defined. Anthropometric data, metabolic parameters and body composition values were also assessed. Results: By univariate regression analysis, BMI, volume excess, systolic blood pressure SD score, mean pulse pressure, diastolic diurnal index, nocturnal diastolic blood pressure fall, and the presence of hypertension showed positive correlation with AASI (respectively r=0.53, 0.39, 0.34, 0.33, 0.41, –0.42; p<0.05). Hypertensive patients had higher AASI values (0.47±0.13 vs. 0.36±0.18; p=0.04), which may be due to the longer duration of dialysis and longer time since transplantation (p<0.05). BMI SDS and nocturnal diastolic blood pressure fall remained to be the main predictors of AASI in the whole (R2=0.44, SE=0.14, β=0.34 and –0.30, p=0.03) and in the hypertensive group (R2=0.48, SE=0.10, β=0.47 and –0.41, p=0.01 and 0.02). Conclusion: Early transplantation then the early treatment of obesity and hypertension may be essential in the prevention of target organ damage and CV mortality in children after kidney TX.]

Hypertension and nephrology

[The clinical significance of peripheral and central blood pressure form the neurologist’s point of view]


[Hypertension - affecting both the large and the small cerebral vessels - is the most frequent risk factor for cerebrovascular disorders manifesting in stroke, hypertensive encephalopathy or vascular dementia. The central pressure measured at the proximal part of the aorta has more important role in the development of vascular hypertrophy and carotid atherosclerosis than the pressure measured in the brachial artery. Central aortic pressure more accurately reflects the filling conditions of the left ventricle and thus the pressure conditions affecting the cerebral vascular system, than brachial pressure values, therefore possibly predicts more reliably the risk of cardiovascular events than brachial pressure values. Features of the stiffness of large arteries (like pulse wave velocity) more directly reflect the chronic effect of ageing, hypertension and diabetes than brachial or even central aortic pressure. Therefore in upcoming clinical trials arterial stiffness and central aortic pressure should be considered as possible surrogate endpoints. Antihypertensive treatment is an important part of primary and secondary stroke prevention. Decreasing blood pressure in hypertensive subjects significantly decreases the risk of stroke and other vascular events, and the extent of risk reduction primarily depends on the extent of the decrease in blood pressure. Several factors should be considered when choosing from treatment options. The use of traditional β blockers - partly due to their smaller effects on central blood pressure - decreased recently. Further observations will decide on the role of third generation β blockers in the prevention of cardiovascular mortality and morbidity.]