Hypertension and nephrology

[Role of ramipril/amlodipine fixed combination in treatment hypertension of patients with chronic kidney disease]


DECEMBER 08, 2012

Hypertension and nephrology - 2012;16(05)

[Hypertension is an important risk factor of chronic kidney disease (CKD) however CKD can cause hypertension. Untreated CKD may result in renal failure. Hypertension and CKD are important cardiovascular risk factors. Several mechanisms play role in the worsening of renal function. The main pathogenetic factor is the increased activity of the renin-angiotensin-aldosteron system (RAAS) that can result in glomerulosclerosis, destroy of nephrons and proteinuria. In the treatment of hypertension in CKD patients inhibiting RAAS is very important because ACE-inhibitors and angiotensin-receptor blockers provide efficient control not only of blood pressure, but also of proteinuria, an effect associated with improved long-term nephroprotection. Between ACE-inhibitors ramipril has proved nephro- and cardiovascular protection effect. Fix combination therapy of ramipril with amlodipine has a very pronounced blood pressure lowering effect and can improve patient compliance too.]



Further articles in this publication

Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

Hypertension and nephrology

[Treatment of hypertension in chronic kidney disease and in renal failure]

KISS István

[The number of patients with chronic renal disease is growing steadily over the past decade. The reason for this is the increasing number of patients developing diabetes mellitus and hypertension, diseases that have common complication of chronic kidney disease. There is evidence that in chronic kidney disease or end-stage renal disease high blood pressure is more common which has a very complex management. Renal patients were able to participate in a small number of clinical studies, so the evidence base of antihypertensive therapy from these studies is limited. Therefore professional guidelines made with thumbnail analysis are very important, which now appeared as the KDIGO recommendations in November 2012. The author of this quick presentation of the practice undertook to summarize the important messages of this paper.]

Hypertension and nephrology

[The importance of health-centered approach in the management of hypertensive patients]


[In the everyday clinical practice the main objectives are the accurate establishment of the diagnosis and evidence based treatment of diagnosed disease. Besides the accustomed, rigorously medical, simplifying aspect, the bio-psycho- social approach is gaining an increasing importance. The objective of the article is, taking modern definition of health into account, emphasizing the importance of a new approach in the complex management of patients, having primary hypertension, a disease, impairing not only target organs, as well as the whole person, seriously influencing the health status of the affected person. In the management of a hypertensive patient, besides decreasing blood pressure, preventing and treating target organ complications and coexisting diseases, we should assess the whole person impairment, the effects of environmental and personal factors, and their influence on activities of daily living and participation in the life of the society, consequently, the changes in health status. This complex approach permits alone the more complete restoration of health of an affected person.]

Hypertension and nephrology

[Terciary hyperparathyreosis or not? ? You cannot solve it alone: combined treatment in severe osteitis fibrosa cystica]

HERSZÉNYI Eszter, PATÓ Éva, SZALAY László, BÍRÓ Zsolt, György Andrea, DEÁK György

[Phosphate retention, consequential rise of the phosphaturic fibroblast growth factor-23 that decreases the level of calcitriol resulting in hypocalcemia facilitates the development of secondary hyperparathyroidism (sHPT) in chronic kidney disease (CKD). Hyperphosphatemia, hypocalcemia and low calcitriol level result in increasing secretion of parathormone (PTH). While sHPT occures frequently in CKD, the development of therapy-resistant and hypercalcemic tertiary hyperparathyroidism is rare due to current therapeutic approaches. We present the case of a 41 year old, treated schizophrenic, hemodialized male patient with severe osteitis fibrosa cystica, severe hyperparathyroidism (PTH 2500 pg/ml) - considered to be tertiary - and with repeated pathologic fractures. While hospitalized, the patient was under supervised, combined therapy with the vitamin D receptor activator paricalcitol and the calcimimetic cinacalcet that resulted in marked decrease of PTH level to 1589 pg/ml. However, after discharge from the hospital due to the lack of compliance he failed to take his medications and PTH had risen to the initial level. This case demonstrates that severe hyperparathyroidism thought to be therapy resistant responds well to a combination of paricalcitol and cinacalcet however, patient compliance is essential to therapeutic success.]

Hypertension and nephrology

[The Hungarian “ÉRV” Program. Program of the Hungarian Society of Hypertension]


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Hypertension and nephrology

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

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