Hypertension and nephrology

[Scientific Program]

OCTOBER 02, 2011

Hypertension and nephrology - 2011;15(01 klsz)



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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

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]


[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Lege Artis Medicinae

[A new era in the treatment of patients with type 2 diabetes - Significance of the incretin analogue liraglutide from an internist’s perspective]


[Therapy of patients with type-2 diabetes has two important features: in addition to the nonpharmacological approach (changes in lifestyle and diet, smoking cessation, physical exercise), pharmacological intervention is needed to reach the target level of blood sugar, and those of other cardiometabolic risk factors (blood pressure, body weight, lipids, uric acid). Unfortunately, it is a worldwide problem that only a small fraction of diabetic patients reach all these goals. This is why it is very important to have drugs which can not only decrease the blood sugar level, but have beneficial effect on several cardiometabolic factors. Antidiabetic drugs affecting incretin system, the GLP-1 analogues or -mimetics, and DPP-4 inhibitors open a new era in the treatment of diabetic patients, because in addition to the reduction of blood glucose level, they may have beneficial effects on blood pressure, blood lipids and body weight. Among these drugs the newly registered liraglutide has an important role, because it stimulates secretion of insulin in a glucose-independent manner, and it also reduces the secretion of glucagon which is a well known endogenous substance that increases blood glucose level. It is important to note that liraglutide decreases appetite, body weight and blood pressure of diabetic patients. Several clinical pharmacological studies has been completed with liraglutide. Of these the LEAD (Liraglutide Effect and Action in Diabetes) program is of outstanding value because it proved that either in monotherapy or in combination with other antidiabetics it effectively decreased blood sugar level, body weight, and had a beneficial effect on systolic blood pressure.]

Hypertension and nephrology

[“Protecting our Vessels”. Continuing the “ÉRV” Program in 2011]

KISS István, KOLOSSVÁRY Endre, JÁRAI Zoltán, LUDÁNYI Andrea, FARKAS Katalin

Lege Artis Medicinae