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

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[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.]

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[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.]

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[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.]

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