KISS István, KÉKES Ede, PAKSY András, SZEGEDI János
AUGUST 20, 2018
Hypertension and nephrology - 2018;22(02 klsz)
[The authors analysed in detail the data of 4071 “active” and 2654 “nonactive” groups of patients. In the 18-64 age group, systolic and diastolic blood pressure was significantly reduced during the first three months of the baseline, and maintained for a further year. The largest systolic pressure drop was achieved by members of the active group using the Medigen application. The blood pressure target rate (< of 140/90 mmHg) in the active and non-active group was significantly higher than the baseline at all visit times (above 70%) and this decrease could be maintained throughout the observation period. Here the most favorable results were also found in Medigen software applications. Over the age of 65, reaching the target blood pressure increased significantly in the first three months as well, but due to the significantly uneven number of the two groups, the data received was only considered as approximate value. Main factors of non-achievement of target blood pressure: obesity, alcohol consumption, diabetes mellitus and peripheral vascular disorder, and the fact that the individual is male. Increases the access probabilities of Medigen users by 21% compared to non-users of the active group. Compared to the inactive group, this chance increase is 31%. The difference in target blood pressure reach between the active and non-active group was even more pronounced in diabetic hypertensive patients. The analysis demonstrates that drug treatment in domestic and ESH guidelines is fully consistent with and reflects well on domestic clinical practice.]
Hypertension and nephrology
[Telemedicine is now an indispensable part of healthcare and has overtaken the development of hospital information systems. Modern basic and specialized care requires the development of a state-of-the-art communication system between the patient and the physician. One of the main reasons for this is the attempt to raise the level of disease to a higher level, increase the level of prevention and care, involve the patient in the treatment, and care process as an active participant. The latter as a demand is growing ever since the various forms of telecommunication are becoming more and more informed. The technical solutions of telemedicine appear in two forms: In one, the signs and the values of the medical devices (sensors) through the various telecommunication systems are transmitted to the physician. The other solution is using smart phones and other devices (iPad, tablet), where patients send signals, data, and symptoms to your doctor. However, patient information (eg diet, lifestyle, etc.) and instructions from your doctor may arise, a continuous medical consultation can be established in which the patient is a doctor’s partner. This solution is promoted by the rapid spread of telecommunication tools in all layers of society. Authors present the methods of both solutions and details the practical aspects of telemedicine methods in hypertension disease.]
Hypertension and nephrology
[The authors evaluate the indexes and their usefulness of the short term (ABPM), medium and long term measurement of the blood pressure variability in the care phase of the hypertensive population in Hungary by using a one-year multicentre prospective observational study. The population was split into two parts: in the active group, telemedicine tools were used to maximize the patientphysician relationship and patient education, their own activity. In the non-active group, traditional care took place. Among these, 6725, 18-64 years and 1005, 65 + years of hypertensive patients were analysed. At the start of the study, ABPM was performed in 243 cases. 1407 diabetic hypertensive patients were compared to non-diabetic patients. They have analysed previous international and domestic experiences. In the present study, the reduction of systolic and diastolic blood pressure variability was successful and significant in the 18-64 age group during the whole patients’ care phase, but a larger systolic variability reduction in the active group was achieved. In the 65+s, the systolic variability reduction was found to be significant, but the variability indexes in the active group were also smaller. In the 65+s, the diastolic variability did not change significantly in either group. In diabetic hypertension, variability indices were only reduced to 12 months. It could be clearly demonstrated that a high-level physician patient relationship has a beneficial effect on blood pressure fluctuation in hypertensive patients.]
Hypertension and nephrology
[The aim of the study was to increase the rate of target blood pressure and reduce blood pressure variability. This dual objective ensures optimal therapeutic success. In order to reach this goal, we wanted to increase the care of patients with hypertension by increasing patient-physician-assistant cooperation and providing telemedicinal devices.]
Hypertension and nephrology
[Hypertension is the one of most frequent chronic disease which a major but modifiable cardiovascular risk factor. In treating of hypertension after life style therapy, drug treatment has an essential role. Patient adherence plays a significant role achieving target blood pressure. One of most important cause of resistant hypertension is the non-adherence. Factors influencing adherence include the number of drugs, their daily dosage frequency, the properties of the drug groups used, age and gender too. According to international and domestic studies, the number of people leaving medication is very high. The disadvantage is clear because these patients lack of benefit from the protective effects of drugs.]
Hypertension and nephrology
[According to the latest guidelines, ambulatory blood pressure monitoring (ABPM) is both recommended in diagnosing and treating hypertension. The spreading of ABPM is explained by the fact that there are several benefits to the office of blood pressure measurements in the diagnosis, differential diagnosis of hypertension, in the prognostic setting and during therapeutic adjustment. Compared to ABPM, home blood pressure measurement (HBPM) provides information on a substantially longer period of blood pressure, is cheaper, more accessible and more comfortable for the patient. It improves patient-doctor cooperation and therefore the success of setting blood pressure. At the same time, it does not provide information on ABPM over sleep and workplace blood pressure or shortterm blood pressure variability. Thus, the two methods provide complementary information. Finally, we analyse the results of the ABPM subwork of the CONADPER study.]
Hypertension and nephrology
[It is important to achieve the blood pressure targets in the course of antihipertensive therapy. It will be beneficial to increase the proportion of patients on blood pressure target to avoid adverse cardiovascular consequences. In hypertension the main definition the elevation of blood pressure alone, but in hypertension are several abnormalities of cardiac output, systemic vascular resistance, stroke volume and arterial compliance too. Impedance cardiography is a simple highly accurate non-invasive device to assess hemodynamic parameters in hypertension. Hemodynamic assessment may help in the treatment of hypertension. Various authors report the improving rate of blood control rate using impedance cardiography which may decrease the risk of target organ damage.]
Lege Artis Medicinae
[Background and aims - In order to reach target blood pressure values more successfully and to achieve better therapeutic compliance, concomitant use of more antihypertensive agents with different mechanisms of action has gained much attention recently. In the PEARL study we investigated the antihypertensive effect of fixed dose combinations of perindopril and amlodipine (5/5, 5/10, 10/5, 10/10 mg Covercard) by measuring blood pressure values in the doctor’s office and with a 24-hour ambulatory blood pressure monitor (ABPM) in outpatients with primary, grade 1 or 2 hypertension, whose target values could not be reached with prior treatment. We also assessed changes of metabolic parameters and how patients felt themselves throughout the study. Patients and methods - In this open-label, multicentre, non-interventional, observational, 3 month long study we evaluated the data of 10 335 patients (5 483 female, 4 852 male, mean age: 61.0±12.4 years, waist circumference 99.0±13.8 cm). The mean duration of hypertension was 9.5±7.7 years. After signing the informed consent form, patients attended three visits (inclusion, months 1 and 3), and they were asked to fill in the data sheets (visit 1: gender, age, waist circumference, blood pressure and heart rate measured at the doctor’s office, duration of hypertension, risk factors, complications, accompanying diseases, previous antihypertensive treatments, complaints), laboratory blood tests and ABPM were optionally performed; visits 2 and 3: blood pressure and heart rate measured at the doctor’s office, adverse events, patient’s evaluation about the way they felt themselves, treatment, optionally performed laboratory blood tests and ABPM. Patients were asked to take perindopril-amlodipine fixed combination tablets in the mornings; the dose was increased if no normalization of blood pressure was observed. Data were analyzed with a one-sample t-test. The consistency of the different frequency distributions was tested with a Chi-square test. The two-sided level of significance was set at 5%. Results - All the parameters sensitive to treatment efficacy (blood pressure values measured on-site and with ABPM) were significantly improved with perindopril-amlodipine fixed combination treatment. Blood pressure measured at the doctor’s office reduced from 158/93 mmHg to 132/80 mmHg, while 24-hour mean blood pressure reduced from 145/84 mmHg to 128/76 mmHg (p<0.001), the diurnal index sensitive to blood pressure variability did not change and a dipper curve was observed throughout the study. Target blood pressure (<140/90 mmHg) was reached by 75.5 % of the patients. The mean dosage at the end of the study was 8 mg perindopril and 7.3 mg amlodipine. The results were consistent across subgroups of different previously received treatments and cardiovascular risks. Regarding laboratory findings, the reduction of total cholesterol from 5.67 to 5.21 mmol/L and that of LDL cholesterol from 3.18 to 2.83 mmol/L (p<0.001 for both) were of clinical importance. Eighty-five percent of the patients evaluated the way they felt themselves as excellent or improved. No serious adverse events were reported. Conclusion - Perindopril-amlodipine fixed combination can be administered effectively and safely to a large population of hypertensive patients who do not reach target blood pressure values.]
Hypertension and nephrology
[Telehealth care of high-risk hypertensive patients for a better target blood pressure and smaller size blood pressure fluctuation. Authors conducted a one-year, multicentre, prospective, observational study with no intervention. Their aim was to achieve better targeting and smaller blood pressure fluctuation in patients with high risk hypertensive patients with the new type of doctorpatient co-operation and telemedicinal care than the conventional control method. In the active group, 50 patients, in the non-active group 47 treated hypertensive patients were analysed. During the observation period (1 year) the mean (± SD) of the systolic blood pressure decreased from 143.3 (15.1) mmHg to 134.5 (9.2) mmHg in the active group, but in the non-active group there was no significant decrease. The target blood pressure (< 140/90 mmHg) could be increased from 46% to 62%. The two characteristics of interpersonal visit-to-visit variability index. The standard deviation (SD) and variation coefficient (VC) showed a significant decrease in the active group. There was no change in the inactive group. A method supported by telemedicine-assisted and better patientphysician- assistant co-operation is suitable for increasing target blood pressure rates and reducing blood pressure fluctuation.]
Hypertension and nephrology
[The authors summarize the facilities of the telemedicine and telemonitoring system. The methods of telemedicine and their combination with home blood pressure measurement or the help of a nurse or pharmacist are reviewed. In the light of the latest results the authors are led to the conclusion that the intensive spread of using the facilities of telemedicine is necessary in the present-day Hungarian healthcare system. At the same time it is also determined that the methodical and technical potential is not enough to further enhance the efficiency in itself. The personal contact and the possibility of interactive monitoring from distance are definitely crucial for the continuous maintenance of the reached target blood pressure in patients suffering from hypertension and also for the augmentation of patient adherence regarding applying medicine.]
Hypertension and nephrology
[Authors had found diabetes mellitus type 2 in 30% of 38 886 hypertensive patients (stadium I-III). Diabetes was more frequent in case of women under 30 years. Subsequently all age groups (from 40 to 80 years) incidence was more frequently (p<0.01-0.001) in men, above 80 years again a higher ratio was in women. Presence of diabetes was correlated to rate of BMI value and systolic, diastolic pressure as well. In women - above 140 mmHg systolic pressure - the elevation was exponential. We have found a significant correlation between fasting glucose and waist. Reaching the target blood pressure is not a simply task in hypertensive patients with diabetes. The 140/90 mmHg was reached in 34.2%, 90 mmHg diastolic blood pressure in 62.3%, but the required 80 mmHg only in 16.4% of cases. Achieve the target value was quite different in the different region of our country. The major cardiovascular complications (stroke, renal disease, myocardial infarction, peripheral artery disease) have suffered a higher rate in the hypertensives with diabetes compered to hypertensives without diabetes.]
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