Hypertension and nephrology

[Practical questions of early diagnosis and prevention of cerebrovascular disease are highly important for all internists]

NAGY Judit, SZAPÁRY László, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, VAS Tibor, KOLLER Ákos, WITTMANN István, KISS István, KOMOLY Sámuel

MAY 20, 2010

Hypertension and nephrology - 2010;14(02)

[Stroke is the third most frequent cause of death and the most important cause of disability and dependency worldwide. There are marked differences in the incidence, prevalence and mortality between the populations of Eastern and Western Europe. In Hungary, between 1998-2003, the incidence of stroke was 1,5-2 times higher than in the Western part of the continent. The early recognition of signs and symptoms of TIA and stroke and the urgent transportation of the patient to neurology, preferably to the nearest stroke-center are the key points of successful treatment, reduction of consequences and increased survival. The “time is brain” concept means that the management of TIA/stroke patients should be considered as emergency. This review briefly summarizes the epidemiology, key elements of the etiology, risk factors, up-to-dated diagnosis, primary and secondary prevention and treatment of TIA/stroke to provide information regarding the development of this field targeting the optimal management of TIA/stroke patients.]

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Hypertension and nephrology

[Cerebrovascular diseases in patients with chronic kidney disease]

KISS István, NAGY Judit

[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]

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

[News of the Hungarian Society of Hypertension]

Hypertension and nephrology

[Attracted by science III. - My scientific life product of 55 years: what have I achieved?]

RADÓ János

[Author analyses the scientific results of his own clinical research work by evaluating his product in a „traditional way”, and only after then supplemented by scientometric data (citedness). From the 148 articles which has been published in foreign language (mostly in English) in abroad, 10 was grouped into the category of “new procedure/ recognition”, 40 into “original data/significant new statement”, and 98 into “new observation (statement) in a detailed question”. He has found close correlation between the values of the publications grouped by the traditional evaluation and the corresponding numbers of citations. Author discusses in the light of his own data the evaluating role of citedness with the hope to help by this motivated young scholars to plan their own future.]

Hypertension and nephrology

[Stroke is a common, severe, but preventable cardiovascular disease in chronic kidney disease]

NAGY Judit, KOVÁCS Tibor, KÉSŐI István, TÓTH Péter, SÁGI Balázs, SZAPÁRY László, VAS Tibor, KOMOLY Sámuel, KOLLER Ákos, WITTMANN István, BERECZKI Dániel, KISS István

[In chronic kidney disease (CKD) patients the high risk for cardiovascular events represents the major cause for morbidity and mortality. Stroke is the third most common manifestation of cardiovascular diseases and cause of death. The risk of cerebrovascular diseases persists in CKD patient in predialysis increases by 1.5-3 times whereas in patients on dialysis is increases by 4-10 times. The combination of classical cardiovascular risk factors and the pathomechanisms present in CKD and activated by dialysis treatment may explain the increased risk. The outcome of stroke is more severe in CKD, than in other populations. There are only a few data regarding early identification, primary and secondary prevention. and proper treatment of stroke in CKD patients with and without dialysis. In this review we summarize the diagnostic and treatment strategies that are based on the existing state of knowledge. However, additional studies are needed to address the poor prognosis through early identification of risk developing potential preventions and treatments of stroke in CKD.]

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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.

Clinical Neuroscience

Hyperhomocysteinemia in female migraineurs of childbearing ages

ALEMDAR Murat, SELEKLER Macit Hamit

Background and purpose - Migraine is a risk factor for ischemic stroke in women of childbearing ages. Previous researches revealed a higher prevalence of hyperhomocysteinemia in migraineurs. Possible differences on the frequencies of hyperhomocysteinemia between migraine with aura and migraine without aura could contribute the established variances in stroke risk between these migraine types. Therefore, we aimed to search if the frequency of hyperhomocysteinemia was different between these subtypes of migraine or not. Methods - We analyzed the findings of serum homocysteine levels in female migraineurs of 16-49 years old who admitted to our outpatient clinic. Results - Homocysteine level was elevated in 13.3% of study population. There were not any significant differences on median serum homocysteine levels between migraine with aura (8.0 mikromol/L) and without aura (8.5 mikromol/L). (p=0.426) The frequencies of hyperhomocysteinemia were also similar (9.1% versus 16.7%, respectively; p=0.373). Correlation analyses did not reveal any linear correlation between ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura (p=0.417 and p=0.647, respectively). Similarly, any linear correlation between disease ages and homocysteine levels either in group of migraine with aura or in group of migraine without aura was not detected (p=0.359 and p=0.849, respectively). Conclusion - The median serum homocysteine levels and the frequencies of hyperhomocysteinemia are similar between migraine with aura and without aura in women of childbearing ages. Therefore, the variances on stroke risk ratios between these types of migraine are probably not originated from the differences of serum homocysteine status.

Lege Artis Medicinae

[Suicide endangering elderly people: risk factors, prevention and care]

BARACZKA Krisztina

[According to the data of the Hungarian Central Statistical Office (HCSO), the Hungarian citizens aged over 65 represented in 2001 11.8%, 2011 13.2% and 2019 19.3% of the total population. Providing services for aging (>60 years), aged (>75 years), very old (>90 years) and Matusalem (>100 years) individuals burdens heavily the health system and the socio-economic sector. Maintaining these people’s physical and mental health and self-perceived well-being is a pre-eminently important task. According to the World Health Organization (WHO) statistics based on data providing countries, the number of suicides committed in the population aged 60-79 has risen approximately by 21% between 1987 and 2006. The suicide rate in Hungary has decreased steadily and significantly since 1980 (4809 in 1980, 1656 in 2018, i.e. a decrease of 66%). Thus since 2018, Hungary is not among the top three countries in Europe and the top 15 in the world. However, the number of completed suicides and suicide attempts remains high and shows rising tendency in the elderly. Preventing suicide, exploring the risk factors and caring patients after attempted suicide we need to analyse thoroughly and disseminate widely the results of the recent researches. In this study, we re­viewed international and domestic literature data to find answers primarily to prevention issues. ]

Clinical Neuroscience

[ELECTROPHYSIOLOGICAL SIGNS OF STRUCTURAL CHANGES IN MOTOR UNITS AFTER ISCHAEMIC STROKE]

LUKÁCS Miklós

[Introduction - While it is several decades ago that electrophysiological studies in the early stages after an ischaemic stroke revealed spontaneous activity in the affected muscles, today few data are available on the peripheral changes in later stages after a cerebrovascular event. The aim of this study was to detect electrophysiological signs that could indicate changes at the motor unit level occurring within a longer post-stroke period. Patients and methods - Forty-four patients who had developed hemiparesis after an ischaemic stroke in the area of the middle cerebral artery were involved in the study. Motor and sensory nerve conduction studies and electromyography were carried out on each side on six nerves and in five muscles respectively. Values between the affected and unaffected side were compared by statistical methods. Results - In patients with hemiparesis present for less then nine months, low M wave amplitudes, fibrillation potentials and an increased number of complex motor unit potentials were found on the affected side; in patients with symptoms present for more then nine months the mean duration and size index of the motor unit potentials in the paretic abductor digiti minimi muscle were increased. These data suggest a process of neurogenic type. The signs of distal axonal damage observed in the early period after stroke have been replaced later by chronic neurogenic changes. These changes could be the consequence of spinal motor neuron damage and axonal transport disturbance due to the loss of supraspinal trophic inputs. Conclusion - The correlation between the extent of electrophysiological changes and of the central motor deficit of the patient indicates the importance of delaying this process by appropriate rehabilitation procedures.]

Lege Artis Medicinae

[Examination of the efficacy of clopidogrel-hydrogen-sulphate in patients with cerebrovascular disease]

SZAPÁRY László, FEHÉR Gergely

[INTRODUCTION - On the basis of current guidelines, acetylsalicylic acid plus dipyridamole or clopidogrel monotherapy should be used for the long-term treatment of patients with cerebrovascular disease, whereas acetylsalicylic acid monotherapy is not recommended. The efficiency of recently introduced generic clopidogrels has not been assessed in patients with a history of acute stroke. PATIENTS AND METHODS - 100 patients with a history of acute stroke or transient ischaemic attack were involved in our study. The patients received acetylsalicylic acid monotherapy in the first 48 hours, followed by clopidogrel-hydrogen sulphate (Egitromb®) monotherapy. The efficiency of the therapy was assessed on day 7 and 28 of medical therapy. RESULTS - At the first measurement (day 7) after clopidrogel-hydrogen sulphate treatment, the therapy seemed to be inefficient in 11 patients (11%). A strong, clinically significant correlation was found between blood pressure values, blood glucose and lipid parameters, hsCRP levels and platelet aggregation values. At the second measurement (day 28), an aggressive secondary preventive threapy resulted in the normalisation of the above mentioned parameters, and the efficiency of platelet aggregation inhibtion therapy was also improed, whereas no patients proved to be resistant. No unwanted events or haemorrhagic complications were registered. CONCLUSIONS - On the basis of the result of our study, treatment with clopidogrel- hydrogen sulphate is safe and efficient both clinically and on the basis of optical aggregometry. The significance of an aggressive secondary preventive therapy should be considered as a factor that might influence the efficiency of thrombocyte aggregation inhibitory therapy.]