[Renal Denervation: an Invasive Treatment Option in the Treatment of Resistant Hypertension]
SCHMIEDER E. Roland1, REDON Josep2, TSIOUFIS Costas3
DECEMBER 20, 2014
Hypertension and nephrology - 2014;18(05-06)
SCHMIEDER E. Roland1, REDON Josep2, TSIOUFIS Costas3
DECEMBER 20, 2014
Hypertension and nephrology - 2014;18(05-06)
Hypertension and nephrology
Hypertension and nephrology
[The most important aspects of Hungarian hypertension epidemiology are demonstrated. The prevalence of hypertension is continuously increasing and in 2011 from the nearly 10 million population exceeded 3 million. Its occurrence rises in parallel with the increase in of systolic blood pressure and the progression of age, and exceeds 60% in those aged over 65 years. The average blood pressure is increasing in children and adolescents, and isolated systolic hypertension is often observed in those over 65-70 years. The situation is closely related to overweight in the young, while in elderly the atherosclerotic process results in low diastolic blood pressure. The prevalence is significantly different in some regions with the highest incidence in South-Transdanubia and North- Hungary. Overall, there is a higher incidence in women. Among known hypertensive patients, the ratio of men is greater till 40-45 years; thereafter, there will be an equilibration and in elderly women the incidence will be higher. It is interesting, that the morbidity and mortality have significantly increased in hypertension and diabetes since 2004, while the incidence of myocardial infarction and stroke has significantly decreased. As concerns organ damage, an increase in occurrence of left ventricular hypertrophy and microalbuminuria has been observed. Metabolic syndrome, diabetes mellitus and ischemic heart disease were the most frequent comorbidities.]
Hypertension and nephrology
[Author analyzes the most frequently used, reliable cardiovascular risk estimation methods. Only those methods are useful that meet to the american and european prevention guidelines and were edited by processing of the great databases. The best known risk estimation methods are continuously is expanding by growing body of knowledge and by another iseful risk factors, because the only way in order to successfully prevent the cardiovascular diseases. Two types of method-groups are known: 1. Traditional narrowed form for the general practisers and for the large section of population, 2. Methods with a broader analysis and more risk factors for the specialists and scientists. In Europe PROCAM and Heart Score and their variations are most useful for the practical medical work, but it is possible to use the american ASCVD and Reynolds risk estimation methods as well using the help of the national correction factors. The methods with wider analysis and much more risk factors as the Mayo Clinic mode, Qrisk2 and IHMRS are suitable in assisting of the epidemiologic studies or scientific work.]
Hypertension and nephrology
Hypertension and nephrology
[This consensus document is intended to provide guidance for the effective and efficient treatment of asymptomatic individuals with high uric acid levels and gout patients.]
Clinical Neuroscience
[The well-known gap between stroke mortality of Eastern and Western European countries may reflect the effect of socioeconomic differences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomically deprived neighborhoods. ]
Hypertension and nephrology
[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.]
Lege Artis Medicinae
[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothiazide and indapamide, and their combination drugs in Hungary.]
Lege Artis Medicinae
[Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most frequently used pharmaceuticals. Nevertheless, a number of studies emphasized that NSAIDs were damaging not only the gastrointestinal (GI), but also the cardiovascular (CV) system, could increase the blood pressure, the frequency of coronary events (angina, myocardial infarction) and stroke incidence, as well as they might deteriorate renal functions. The National Institute for Health and Care Excellence (NICE) did not find evidence that administering NSAIDs could increase the risk of developing COVID-19 or worsened the condition of COVID-19 patients. However, unwanted effects of specific drugs differ substantially in their occurrence and seriousness as well. It seemed to be for a long time that the NSAIDs provoked higher GI-risk was closely related to the COX1/COX2 selectivity, like the cardiovascular (CV) risk to the COX2/COX1 selectivity, however, the recent data did not prove it clearly. Based on the available literature while pondering the gastrointestinal and cardiovascular adverse events, among all NSAIDs the aceclofenac profile seemed to be the most favourable.]
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Clinical Neuroscience
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