Hypertension and nephrology

[Sex-specific clinical and exercise based risk assessment of the total mortality risk]

KÉKES Ede

SEPTEMBER 10, 2017

Hypertension and nephrology - 2017;21(04)

[In both sexes combining different types clinical questionnaire and results of exercise test in a point system can more reliably predict 10 years mortality or survival. The method in both sexes is reliably suitable for the screening of highly endangered individuals in everyday practice.]

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Hypertension and nephrology

[Systemic ANCA-associated vasculitis. Induction immunosuppression therapy, complications and outcome. Part 2]

HARIS Ágnes, POLNER Kálmán

[The present review is compiled of two parts, the first part aims to summarize the induction immunosuppressive therapy, the second part delineates the outcome and complications of ANCA-associated vasculitis. ANCA-associated vasculitis is a systemic disease, accompanied with rapidly progressive glomerulonephritis and severe, often life-threatening extrarenal complications. By early diagnosis and immediate initiation of immunosuppressive therapy both patient and renal outcome have been substantially improved. The major aims of modern therapeutic protocols are, besides improving survival, to decrease immunosuppressive drug toxicity and avoid infections. Immunosuppression is based on the combination of large dose of corticosteroid and cyclophosphamide, which is advisable to supplement by plasma exchange. The B-cell depleting anti-CD20 monoclonal antibody rituximab, which has already been available in Hungary, has been proved to be similarly effective in newly diagnosed ANCA-vasculitis, and even more effective in a relapsing disease, compared to cyclophosphamide. Amongst rituximab’s further indications in this disease is the preservation of young women’s fertility, and it also has priority in some other special cases. Early diagnosis and prompt immunosuppressive treatment have resulted that ANCAvasculitis became a treatable disease with reasonably good clinical outcome, yet both the disease and the immunosuppressive medications frequently cause complications, which necessitate continuous alertness of the attending nephrologists.]

Hypertension and nephrology

[A Letter to Our Readers]

Hypertension and nephrology

[Isolated systolic hypertension in the elderly and very elderly]

FARSANG Csaba

[In the elderly (˃65 yrs) and very elderly (˃80 yrs) large clinical investigations showed that isolated systolic hypertension is the most frequent form of hypertension. In the background, several cardiovascular, neural and hormonal changes have been proved. One of the most important pathogenetic factor is the increase of arterial stiffness. This leads to the increase of pulse wave velocity and systolic blood pressure, and also to the decrease of diastolic blood pressure. Consequently, pulse pressure increases. All these factors contribute to the increase in incidence and prevalence of cardiovascular consequences of hypertension, which are more frequent than in younger ages.]

Hypertension and nephrology

[The Frequency of Isolated Systolic Hypertension in the Elderly among the Hungarian Hypertension Population ]

KISS István, PAKSY András, KÉKES Ede

Hypertension and nephrology

[Where Does Fat Go During a Weight Loss Diet?]

VÁLYI Péter

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[Efficient, cardiovascular risk-dependent therapy of patients with hypertension according to the data from database of the Hungarian Hypertension Registry]

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[Over 3.5 million people have hypertension in Hungary, although with only 40-45% of them have the target blood pressure of under 140/90 been reached thanks to the non-medication and medication therapies. The reason of this can be several folds as an improperly chosen blood pressure lowering therapy, not sufficient care, insufficient doctor-patient cooperation and the incompetent information of the patients. According to the Hungarian Hypertension Register’s database of 2015 it is confirmed that the reaching of target blood pressure significantly differs and in the case of the hypertension disease coincide with the morbidity and mortality differences of the regions. These regional differences can be explained with not only the social, cultural and economic dissimilarities, but with the diversity of the quality of the healthcare and the professional work. Analyzation of the biggest risk factors of hypertension as the diabetes, ischemic heart failure and chronic kidney disease showed that when all of them are extant, the reaching of the target blood pressure is only successful in the case of 26% of the male and 33% of the female’s patients. According to the Register it turned out that the leading cause of the unsuccessful reaching of the target blood pressure is the peripheral vascular disease in the case of female patients which is followed by in turn with the disorder of lipid metabolism, the disorder of uric acid metabolism and obesity. The leading cause in the case of male patients is lipid metabolism which is followed by in turn with smoking, alcohol abuse and peripheral vascular disease. According to the summed-up results, 88% of the patients received combined treatment with the medication suggested by the professional guidelines. The proportion responsible for the unsuccessful reaching of the target blood pressure can be explained by the insufficient patient concordance and adherence. Both patient information and the care involved in the doctor-patient relationship have to be corrected and improved. One possible solution is the transmission of some competence of the doctors to the well-trained assistants and nurses who have a decisive role in the risk assessment and the base medical examination. It is also important to draw the pharmacists in too to the care of patients with applying more telemedicinal methods. It can be concluded from the results that came from the processing of the Register’s database that the population-level knowledge is important and the continuation of the data entry into the Register is necessary.]