Hypertension and nephrology

[Practical aspects of therapy by erythropoiesis stimulating agents in renal anaemia]

DEÁK György, HERSZÉNYI Eszter, AMBRUS Csaba, KISS István

JULY 20, 2013

Hypertension and nephrology - 2013;17(02)

[Prevalence of renal anaemia due to insufficient production of erythropoietin increases progressively in the course of renal function deterioration. Renal anaemia is treated by erythropoesis stimulating agents (ESA). Outcomes of randomized clinical trials have taught us to avoid the strategy of normalization of hemoglobin (HGB) levels by ESA therapy as it may increase the risk of cardiovascular events and mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anaemia published in 2012 recommends to start ESA therapy in the 90-100 g/l HGB range and suggests to keep HGB concentrations below 115 g/l. It is an inappropriate strategy to aim at normalizing hemoglobin (HGB) levels by ESA therapy because it may lead to progressive escalation of ESA doses even in the presence of diminished ESA responsiveness. High ESA doses and diseases causing ESA hyporesponsiveness eg. infections, chronic inflammation, malnutrition, insufficient dose of dialysis, severe hyperparathyroidism, iron deficiency are related to increased risk of mortality. KDIGO Clinical Practice Guideline for Anaemia emphasizes the importance of assessing and treating causes of ESA hyporesponsiveness, limits ESA dose escalation and recommends gradually changing ESA doses to avoid high amplitude HGB oscillation.]



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Hypertension and nephrology

[Report on the 50th Jubilee Congress of the European Renal Association – European Dialysis and Transplant Association]

BÁNKI N. Fanni

Hypertension and nephrology

[Hypertension and diabetes mellitus]

SZEGEDI János, KISS István

[Hypertension and diabetes mellitus are endemics which affect large crowds; they play an important role in the morbidity and mortality of the population. Both diseases are cardiovascular risk factors, their co-occurrence increases the coronary risk. According to forecasts, there will be 60% increase in the number of hypertensive patients by 2025; it will affect 29% of the world’s adult population, 1.56 billion people. The number of patients with diabetes increases in all countries; 552 million diabetic patients should be expected by 2030. The simultaneous occurrence of both diseases may be a coincidence, but there is also causal relationship between the two diseases (diabetic nephropathy, metabolic syndrome). The two diseases often occur in endocrine diseases, and in connection with medicinal therapy (steroids, etc.). The simultaneous occurrence of these two diseases determines the therapeutic strategy. During the prevention and treatment of both diseases, the change in lifestyle has an important role (obesity, salt intake, physical activity).]

Hypertension and nephrology

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]


[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

Hypertension and nephrology

[Managing hypertension using a fixed combination of an angiotensin converting enzyme inhibitor and a calcium channel blocker]

E. Chazova, G. Ratova, V. Nedogoda, M. Lopatin, B. Perepech, V. Tsoma

[The objective of the study was to compare the efficacy of a low-dose combination of an angiotensin-converting enzyme (lisinopril 10 mg) and a dihydropyridine calcium channel blocker (amlodipine 5 mg) (Ekvator, Gedeon Richter) (Group 1) and enalapril with or without hydrochlorothiazide (Group 2) in hypertension. Materials and methods: The study included 93 patients with hypertension (36% of men and 64% of women). The mean age was 52.6±12 years and the mean duration of hypertension was 7.5±6.1 years. The initial office blood pressure (BP) was 149.2±13.8/91.4±81 mmHg. Patients were randomized into two groups (Group 1, n=51 and Group 2, n=36). Results: The fixed-dose combination of amlodipine/lisinopril offered the potential to reduce the office BP by -28.9±11.3/-16.0±8.7 mmHg; p<0.0001. In Group 2 the office BP dropped by -22.9±17.9/-11.5±10.7 mmHg; p<0.0001. Patients in Group 1 achieved goal blood pressure more frequently than patients in Group 2 (94.1% versus 72.2% patients respectively; p=0.008). There were no significant changes in the heart rate in either group. The reduction of microalbuminuria (the reduction in urinary albumin excretion (UAE)) by -13.8±24.4 mg/24h (p<0.001) was observed only in patients from Group 1. The quality of life of patients from Group 2 improved. However, the quality of life improvements were more significant in Group 1 than in Group 2 (p=0.002). Conclusion: The fixed-dose combination of amlodipine/lisinopril offers the potential to achieve a target blood pressure in 94% of patients with hypertension, produces a nephroprotective effect and improves patients’ quality of life.]

Hypertension and nephrology

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Clinical Neuroscience

Risk factors for ischemic stroke and stroke subtypes in patients with chronic kidney disease

GÜLER Siber, NAKUS Engin, UTKU Ufuk

Background - The aim of this study was to compare ischemic stroke subtypes with the effects of risk factors, the relationship between grades of kidney disease and the severity of stroke subtypes. Methods - The current study was designed retrospectively and performed with data of patients who were hospitalised due to ischemic stroke. We included 198 subjects who were diagnosed with ischemic stroke of Grade 3 and above with chronic kidney disease. Results - In our study were reported advanced age, coronary artery disease, moderate kidney disease as the most frequent risk factors for cardioembolic etiology. Hypertension, hyperlipidemia, smoking and alcohol consumption were the most frequent risk factors for large-artery disease. Female sex and anaemia were the most frequent risk factors for small-vessel disease. Dialysis and severe kidney disease were the most frequent risk factors in unknown etiologies, while male sex, diabetes mellitus, prior stroke and mild kidney disease were the most frequent risk factors for other etiologies. National Institute of Health Stroke Scale (NIHSS) scores were lower for small-vessel disease compared with other etiologies. This relation was statistically significant (p=0.002). Conclusion - In order to improve the prognosis in ischemic stroke with chronic kidney disease, the risk factors have to be recognised and the treatment options must be modified according to those risk factors.

LAM Extra for General Practicioners



[Natural mineral waters in their "natural form" are meant for public consumption and are officially recognized waters by a certain definition which states that they possess beneficial qualities in medical respects due to their mineral and trace element contents. Our subsurface mineral waters are being bottled without manipulation from about five hundred wells and springs. Nowadays we drink mineral waters to satisfy our biological needs. Hopefully in place of the "germanic type" mineral waters containing traditionally higher level of minerals, the "mediterran type" mineral waters containing less salt will come to the front in the future. We consume above 15 grams pro day of salt in place of the suggested under 6 grams pro day. Reducing the salt content of the foods and consuming less salt can prevent the rising of blood pressure and tone down the risks of developing cardiovascular diseases. The Hungarian Society of Hypertension therefore announces the serious reduction of sodium chlorid consumption for the year 2010 as part of the STOP-SALT Program and the Hungarian National Cardiovascular Program possibly including the desire to consume less mineral water with high sodium levels.]

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Hypertension and nephrology

[Update on diagnostics and therapy of the renal artery stenosis in 2010]


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