Hypertension and nephrology

[Significance of patient adherence in the treatment of hypertension]

SIMONYI Gábor, ALFÖLDI Sándor, BARNA István

AUGUST 20, 2018

Hypertension and nephrology - 2018;22(02 klsz)

[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.]

COMMENTS

0 comments

Further articles in this publication

Hypertension and nephrology

[The role of telemedicine is to help the optimal patient-doctor cooperation in the treatment of hypertension]

KÉKES Ede, SZEGEDI János, †KISS István

[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

[Significance of the ambulatory and home blood pressure monitoring in patients with hypertension: focus on CONADPER-ABPM substudy]

ALFÖLDI Sándor, BARNA István

[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

[Patient-practitioner cooperation - medication adherence and persistence in the CONADPER-HU study]

SZEGEDI János, KÉKES Ede, KISS István

[Hypertension is a common popular disease, it basically determines the health status, morbidity, cardiovascular mortality, rehabilitation and quality of life of the population. Prevention, early detection, effective treatment of the disease, quality of care is an important part of the people’s health program. The success of the therapy, the attainment and long-term maintenance of the target blood pressure - in addition to many other factors - is determined by drug adherence and persistence, one of the crucial elements of which is the optimal cooperation of the physician and patient. The poor persistence causes most of the therapeutic failures. The main objective of the CONADPER-HU study was to optimize practitionerpatient cooperation (increased control, information delivery, home blood pressure measurement, telemedicinal equipements and software use), thus increasing the proportion of patients with target blood pressure and reducing the number of resistant hypertensive patients. The study proved that the complex care system is effective and has a positive impact on persistence. It has also been clarified that the first three months will decide on further sustained therapeutic success.]

Hypertension and nephrology

[Measurement and value of blood pressure variability in increasing the number of patients reaching target blood pressure goal in hypertension]

KÉKES Ede, JÁRAI Zoltán, PAKSY András, KISS István

[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 CONADPER-HU program. Objective and methodology of the program. Patients. Basaline data]

KISS István, ALFÖLDI Sándor, BARNA István, JÁRAI Zoltán, SIMONYI Gábor, SZEGEDI János, PAKSY András, UGRAI Péter, KÉKES Ede

[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.]

All articles in the issue

Related contents

Hungarian Radiology

[Surgical treatment of scoliosis: pre- and postoperative follow-up with whole-body EOS radiography]

LÉVAI Andrea, VÁRADY Edit, SZUKITS Sándor, WENINGER Csaba, BATTYÁNY István, ILLÉS Tamás

[Currently, Cotrel-Dubousset spondylodesis is the treatment of choice in orthopaedics. It allows for correction of deformity in three-dimensions allowing for stable fixation. EOS (Extended Orthopedic System) is an ultra low dose X-ray imaging system, simultaneously acquiring images of the whole body in two planes. Examinations with the EOS system is not only indicated in cases related to orthopaedics but in multiple other conditions owing to its low level of emitted radiation with rapid and cost-effective imaging. The importance of EOS examination is emphasized in systemic skeletal disorders, thus allowing itt o be used in various other clinical fields.]

Lege Artis Medicinae

[SEPSIS AS A NEW DISEASE - PROBLEMS IN HUNGARY]

LUDWIG Endre

[In our current understanding sepsis is a systemic inflammatory response syndrome to infections mediated by cytokines, an uncontrolled progression which may result in multiorgan failure and in the final stage septic shock. There are no pathognomic clinical signs or laboratory parameters in the early stage of sepsis and the diagnosis can be easily missed if the possibility is overlooked. One of the crucial points of therapy is early diagnosis: the mortality rate of severe sepsis is about 20% and that of septic shock is about 40-50%. The cornerstones of the therapy are the eradication of the focus of sepsis (surgical intervention and antimicrobial treatment), standard intensive care and the intervention in the pathophysiological process of sepsis. For successful treatment a multidisciplinary approach is required: only the early diagnosis and the teamwork of different specialists can decrease the mortality rate that is higher in Hungary than the international average.]

Lege Artis Medicinae

[Experiences with rosuvastatine therapy]

MEZŐ Izabella

[A relative cardiovascular risk reduction of 25-35% has been reported in patients with high cardiovascular risk that have started statins directly after the cardiovascular events. A lot of patients fail to consistently take these medications as directed. In order to obtain further success, it is very important to improve the actual routine, especially because in the field of lipid-lowering we have new data and guidelines that strongly support our efforts in the right direc­tion. We report the results of our ten patients treated with rosuvastatin after myocardial infarction from our ALADDIN Study. In the period of six month of treatment with 40 mg rosuvastatin LDL-cholesterol decreased 55% (from 3.55±1.1 to 1.58±0.6 mmol/l, p<0.01), non-HDL-cholesterol decreased 52% (from 4.15±1.23 to 2.0±0.8 mmol/l, p<0.01), triglycerides -26% (from 1.63± 0.41 to 1.2±0.4 mmol/l) and hsCRP level decreased 61% (from 5.47±3.8 to 2.1±1.0 mg/l, p<0.01). The two years persistence in these patients were 100%. Our experience confirms that the daily use of a highly-efficient statin (rosuvastatin) has a beneficial effect on lipid parameters and also facilitates the attainment of target lipid levels and significant cardiovascular risk reduction. ]

Lege Artis Medicinae

[ANTI-TNF-α ANTIBODY THERAPY IN CROHN’S DISEASE]

LAKATOS Péter László, LAKATOS László

[Crohn’s disease is a chronic inflammatory disorder which may affect any part of the gastrointestinal tract. Its pathogenesis is only partially understood; various environmental and host (e.g., genetic, epithelial, immune and nonimmune) factors are involved, together initiating a chronic uncontrolled inflammation, which is partly due to an imbalance between pro- and anti-inflammatory cytokines, and a defective apoptosis of lamina propria T cells. Among proinflammatory cytokines, tumour necrosis factor- α (TNF-α) seems to play a central role in Crohn’s disease. Over the past years, the increasing knowledge on the pathogenesis of Crohn’s disease has led to the development of a number of biological agents targeting specific molecules involved in gut inflammation, including TNF-α and its receptors. This paper reviews the rationale for the use of TNF-α inhibitors in the treatment of Crohn’s disease.]

Clinical Oncology

[Pregnancy and cancer]

NAGY Zsuzsanna, SZILLER István, VALTINYI Dorottya, HORVÁTH Orsolya

[The joint appearance of pregnancy and cancer is rare. It is highly recommended that the tumorous pregnant should be managed by a multidisciplinary team. The early diagnosis is very important, but it is not easy, because the symptoms of pregnancy and cancer are rather similar. Imaging diagnosis has to avoid ionizing radiation (e.g. PET/CT). The same is true for chemotherapy in the fi rst trimester, due to the increased risk of developmental abnormalities. Consequently, radiation therapy is not allowded throughout the pregnancy, and the chemotherapy in the fi rst trimester is a strong indication for the interruption of pregnancy. Surgery, with good practice, usually can be performed without complications. Chemotherapy, given in the second and third trimester generally follows the standard protocols with a low frequency of developmental errors. Early delivery should not be encouraged, except the delay has a hazardous effect on the mother and/or on the child. The pregnant should be informed about all steps to be an active part of the fi nal decision.]