Hypertension and nephrology

[Society News]

APRIL 10, 2016

Hypertension and nephrology - 2016;20(02)

COMMENTS

0 comments

Further articles in this publication

Hypertension and nephrology

[A Letter to Our Readers]

A szerkesztôség

Hypertension and nephrology

[Blood pressures of adolescents at screening program in Budapest]

KORMOS-TASI Judit, GÁCSI Erika, SCHEURING Noémi, TÓTH Fanni, CZINNER Antal, SZABÓ László

[The Aim of the screening program was to investigate the blood pressure and the association with obesity, hypercholesterinaemia and increased body fluid in adolescents. Methods: A screening program was conducted during the period from April 2010 to May 2011.The screenings consisted of: blood pressure, heart rate, body composition determination, cholesterol, blood glucose, weight, height and BMI. Results: 2226 children fullfied all of the outlined criteria. Their range of age was between 14–18 years. The average systolic blood pressure was 126.34±12.55 Hgmm volt. At boys were higher 131.87±13.59 then at girls 117.49±5.69 Hgmm. The average diastolic blood pressure was 71.86±8.74 Hgmm. There were also higher at boys 72.61±9.17 then at girls 66.69±5.04 Hgmm. High systolic blood pressure (95%<) were 307/1326 cases at girls, and 403/876 cases at boys. High diastolic blood pressure were together with high systolic blood pressure, but less frequency. High diastolic blood pressure occurred at 85 girls and at 90 boys. Overweight and obes were 18.994% of girls and 15.26% of boys. The percentage of pathological high blood pressure was most frequent among boys and girls who are in the overweight group. The pathologically high level of body fat percentage appeared to be 12.98% among girls and 5.9% among boys. In elevated BMI groups the frequency of high body fat was 66% among girls and 81% among boys. The mean cholesterol was significantly higher in the overweight and obese group. Conclusions: Rates of hypertension and overweight and obesity are high in school children in Budapest, and increased bodyweight is a significant risk factor for hypertension. The results of the study will help to design preventive programmers.]

Hypertension and nephrology

[Plasma ortho-tyrosine/para-tyrosine ratio predicts hyporesponsiveness to erythropoiesis-stimulating agents in dialyzed patients]

KUN Szilárd, MIKOLÁS Esztella, MOLNÁR Gergő Attila, SÉLLEY Eszter, LACZY Boglárka, CSIKY Botond, KOVÁCS Tibor, WITTMANN István

[Objectives: Patients suffering from end-stage renal failure (ESRF) are mostly treated with erythropoiesis-stimulating agents (ESAs). They often show hyporesponsiveness to ESA, which condition is associated with elevated production of free radicals. Phenylalnine (Phe) is converted into para- and ortho-tyrosine (p- and o- Tyr) by hydroxyl free radical. o-Tyr is produced exclusively in this way. However, physiological isomer p-Tyr is formed in significantly higher amounts by phenylalaninehydroxylase, mainly in the kidney. It has been shown that p-Tyr production is decreased in ESRF. As a result, p-Tyr can be replaced by o-Tyr in proteins, e.g. in proteins playing part in signal transduction of erythropoietin. We aimed to study the association of different Tyr isoforms with ESA-responsiveness. Methods: Four groups of volunteers were involved in our cross-sectional study: healthy volunteers (CONTR; n=16), patients on hemodialysis without ESA-treatment (non-ESA-HD; n=8), hemodialyzed patients with ESA-treatment (ESA-HD; n=40) and patients on continuous peritoneal dialysis (CAPD; n=21). Plasma p-, o-Tyr and Phe levels were detected using a high performance liquid chromatography (HPLC)-method, with fluorescence detection. ESA-demand was expressed as ESA-dose, ESAdose/ body weight and erythropoietin resistance index1 (ERI1, weekly ESA-dose/body weight/hemoglobin). Multivariate regression models were used to examine predictors of ESA-demand. In these models, most of the known predictors of ESA-hyporesponsiveness were included. Results: Lower p-Tyr levels were found in dialyzed patients compared with control subjects. In contrast, o-Tyr levels and o-Tyr/p-Tyr ratios were higher in dialyzed patients. Regarding dialyzed patients, o-Tyr level and o-Tyr/p-Tyr ratio were higher in ESA-HD than in non-ESA-HD and CAPD groups. Weekly ESA-dose/body weight and ERI1 correlated with o-Tyr/p-Tyr ratio (r=0.441, p=0.001; r=0.434, p=0.001, respectively). Finally, o-Tyr/p-Tyr ratio proved to be an independent predictor of ERI1 (β=0.330, p=0.016). Discussion: Our results suggest that elevation of o-Tyr/p-Tyr ratio could be responsible for ESA-hyporesponsiveness in dialyzed patients.]

Hypertension and nephrology

[Initiation of antihipertensive therapy with fix combinations, focusing on perindopril, amlodipine and indapamide]

FARSANG Csaba

[Early clinical studies proved that most hypertensive patients (>70%) need drug combinations to reach the target blood pressure. We should combine two or three - sometimes more - drugs from different antihypertensive classes for quicker normalisation of blood pressure and to reduce incidence and severity of hypertensive complications. Several international and Hungarian (MHT 2015) guidelines emphasize the advantages of fix combinations against free combinations. Most frequently used combinations contain ACEi + calcium antagonist, or ACEi + diuretic. From them I will focus on the perindopril + amlodipine or perindopril + indapamide combinations. If we do not reach target blood pressure, triple fix combinations (e.g. perindopril + amlodipine + indapamide) can also be used. Now there are fix combinations of different strengths, therefore we may start the therapy with these fix combinations according to patients’ characteristics (e.g. age, complications, concomitant diseases).]

Hypertension and nephrology

[Rilmenidin - a versatile combination partner in the treatment of high blood pressure]

KÉKES Ede

[The rilmenidin as an imidazoline agonist drug strongly decreases the central sympathetic activity, release of renine and the RAS activity. Because of these advantageous properties the peripheral vascular resistance falls and the blood pressure is decreased. Today it is excellent tool for combination therapy. Useful especially in stress induced hypertension. The antihypertensive effects of ACE inhibitors sor calcium antagonists are increased by rilmenidine. This drug decreases the insuline resistance, it has a positive effect on the carbohydrate and fat metabolism, because it is useful as a complementary therapy in metabolic syndrome and diabetes mellitus of type II. It is useful in stress induced hypertension, and in menopause as well.]

All articles in the issue

Related contents

Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias

BALÁZS Nóra , BERECZKI Dániel, KOVÁCS Tibor

In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

Clinical Neuroscience

[Rehabilitation results after severe traumatic brain injury ]

DÉNES Zoltán, MASÁT Orsolya

[To assess the rehabilitation outcome after severe traumatic brain injury. Retrospective evaluation of the rehabilitation process and prospective follow-up five years after discharge. Patients – Patients treated in 2013 at the Traumatic Brain Injury Unit, National Institute for Medical Rehabilitation were included in the study (n = 232). Ninety-nine of 232 patients were treated with severe traumatic brain injury. Data were available for 66/99 patients (67%). Fifty patients (13 women and 37 men) were successfully contacted for follow-up (51%), three patients deceased. The mean age of the patients was 42 years (range: 22-72). The majority of them (36/50) was injured in traffic accidents. The mean duration of coma and post-traumatic amnesia were 19 (1-90) and 45 days (5-150), respectively. Patients were admitted for rehabilitation on the 44th (11-111) day after the injury and were rehabilitated for 95 days (10-335). Thirty-eight patients became independent at daily living activity during the rehabilitation period, and none during the follow-up. Two patients needed moderate and one a little help for the daily life. After successful rehabilitation 4 patients continued their higher education, 24 patients worked (six in sheltered, six in the original, 12 in other workplaces). Twenty-two patients did not have permanent jobs, two of whom were retired. The majority of the patients were successfully reintegrated into society. More than half of the patients returned to work or continued their studies. These successes were greatly facilitated by the 40 years of experience and the multidisciplinary team working in the National Institute for Medical Rehabilitation. ]

Lege Artis Medicinae

[Mental and physical health in light of health behaviours among sexual and gender minorities]

GUBÁN Zsuzsanna, CSEKÔ Csilla, SZÉL Zsuzsanna

[In a large proportion the reason behind enlisting both primary and secondary care are psychophysiologic disorders or symp­toms. In this current study we reviewed the literature regarding the physical and mental health of a subpopulation (sexual and gender minorities) and their patterns of health behavior. The literature examined in our study contains publications from January of 2009 to March of 2019. Based on the minority stress theory and the biopsychosocial model, the people from sexual and gender minorities face increased level of stress which affects their health and health behaviour in a negative way. Because of the factors mentioned above this group is more exposed to certain illnesses than the majority society – such conditions are cardiovascular diseases, lung diseases and several types of tumors and cancer. Furthermore the excess stress affects their psychological wellbeing and mental health. Summarizing the literature regarding the health and health behavior of people belonging to sexual and gender minorities our aim was to create an inventory of information for health care workers to help enhance the quality of care the members of these minorities receive. It could also support developement of cultural competence for the circle of professionals in education, law enforcement agencies, social care and health care system, in additional it might decreas health inequity.]

Clinical Neuroscience

[Guidelines for the treatment of traumatic brain injury - 2017]

BÜKI András, BARZÓ Pál, DEMETER Béla, KANIZSAI Péter, EZER Erzsébet, TÓTH Péter, HORVÁTH Péter, VARGA Csaba

[Traumatic brain injury (TBI) is recognized to be the main cause of death and disability in the first four decades representing a major socio-economical problem worldwide. Recent communications revealed a particularly worrying image about the quality of care for TBI in Hungary. For any improvement a systematic approach characterized by utilization of scientific evidence based guidelines forming the basis for close monitoring of the actual care are considered a prerequisite. In Hungary the first evidence based guidelines in the field of TBI have been issued by the National Society for Anesthesiology and Intensive Care more than two decades ago followed by joint guidelines of the Hungarian Neurosurgical Society and the Hungarian College of Neurosurgeons. These publications were primarily based on the work of the European Brain Injury Consortium as well as guidelines issued by the Brain Trauma Foundation. Recent renewal of the latter and a need to refresh the outdated national guidelines was met by a call from regulatory authorities to issue the updated version of the Hungarian TBI-guidelines. The present review is aimed to briefly summarize the most fundamental elements of the national head injury guidelines that would hopefully be officially issued in a far more detailed format soon.]