Hypertension and nephrology

[Stroke incidence and prevalence in the world]


FEBRUARY 10, 2017

Hypertension and nephrology - 2017;21(01)

[The incidence and prevalence of ischaemic and haemorrhagic stroke declined continuously from 1970 to 2010. The rate of incidence was the lowest in North America, within Europe in the Mediterranean countries, France and in Asian developed countries. The incidence and prevalence the progress of age have in - creased respectively. The outcome of haemorrhagic stroke is worse everywhere, than that of ischaemic form, rate of mortality/incidence is greater.]



Further articles in this publication

Hypertension and nephrology

[Letter to our Readers]

KÉKES Ede, KISS István

Hypertension and nephrology

[The importance and techniques of fluid status assessment in patients with heart and kidney disease]

LEDÓ Nóra, HORVÁTH Viktor József, TISLÉR András

[Managing the fluid balance in patients with chronic heart and kidney disease is critical, it exceptionally affects the success of the therapy. Therefore, it is crucial to recognize and treat the fluid overload or depletion as soon as possible. Plenty of methods are available to assess fluid status, which can help us to find the right diagnosis, plan and follow the therapy of the patients. The aim of our review article is to present the current techniques of estimating fluid status. Beside the widely used methods (e.g. physical examination, laboratory testing) we describe other techniques which are less common in the Hungarian clinical practice but easy to use, such as chest sonography and bioimpedance spectroscopy. To choose the right approach for assessing fluid status, we have to examine the advantages and disadvantages of the methods in consideration of the patient’s individual needs.]

Hypertension and nephrology

[Our clinical practice with perindopril/indapamide/amlodipine triple fixed-dose combination]


[Notwithstanding the abundance of pharmacotherapeutic options available, the rate of optimal blood pressure control may be estimated as low as 20 to 40 per cent throughout Europe. The underlying causes of this include, among others, the substantial impact of using free combinations of several antihypertensive - this practice results in rather poor patient adherence. Fixed-dose dual combinations have been introduced just about two decades ago, and their popularity has been increasing progressively since then. Nevertheless, in a considerable proportion (>30%) of patients, achieving optimal blood pressure control requires treatment with at least three antihypertensive acting on different targets. Accordingly, a rational demand has grown for triple-fixed combinations. In Hungary, the fixed combination of perindopril (an ACEI), indapamide (a thiazide-like diuretic), and amlodipine (a calcium channel-blocker) has been available since last year. Our experience with this product shows, as confirmed by ABPM studies, that its routine use in hypertensive patients with cardiological comorbidities improves patient compliance, thereby enhancing also long-term blood pressure control.]

Hypertension and nephrology

[Effects of ketodiet in fourth-stage chronic renal failure]


[The well-known progressive nature of chronic renal failure can be slowed by low protein diet of various degrees. We applied standard 0.6g/kg body weight diet with supplement of essential amino acids and keto acids, 1 tablet/10 kg body weight Ketosteril was administered to 100 patient with IV. stage chronic renal failure for 31.5 months in average (10-63 month). During observational period 11% of the patients started hemodialysis program, 4 patients died. At the end of the observational period on basis of laboratory value of renal function 31% of patients had III, 50% IV, 19% V. stage chronic renal failure. We applied calculated glomerular filtration rate (ml/min/1.73 m2) for following the renal function. Average GFR value reduced from 24.9 to 23.63 ml/min/1.73 m2 (not significant). In case of female patients, we found a milder loss in renal function, average GFR was reduced from 24.8 to 24.6 ml/min/1.73 m2. We observed that women hold on the prescribed diet in greater ratio. On basis of the BMI value calculated at end of our examination no patient was undernourished. 25.8% of the patients had normal body weight, 54.3% had overweight, 17.5% was obese and 2.4% severely obese. We followed the changes in state of nourishment by serum albumin value, average serum albumin was 42.92 g/l at beginning and did not change significantly (42.81 g/l at the end of our examination). Applying keto diet is safe and efficient in slowing the progression of severe chronic renal failure and improves the state of nourishment. Good state of nourishment achieved in predialytic stage is associated with low mortality ratio and gives opportunity to lower the mortality of patients starting dialysis program.]

Hypertension and nephrology

[Effects of Baseline Blood Pressure and Blood Pressure Changes on the Progression of Arterial Stiffness]


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Clinical Neuroscience

The applications of transcranial Doppler in ischemic stroke


Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in­crea­sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro­em­boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en­chan­ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt.

Clinical Neuroscience

[Systemic thrombolysis and endovascular intervention in postpartum stroke]


[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]

Clinical Neuroscience

Comparison of hospitalized acute stroke patients’ characteristics using two large central-eastern european databases

ORBÁN-KIS Károly, SZŐCS Ildikó, FEKETE Klára, MIHÁLKA László, CSIBA László, BERECZKI Dániel, SZATMÁRI Szabolcs

Objectives – Stroke is the third leading cause of death in the European region. In spite of a decreasing trend, stroke related mortality remains higher in Hungary and Romania when compared to the EU average. This might be due to higher incidence, increased severity or even less effective care. Methods – In this study we used two large, hospital based databases from Targu Mures (Romania) and Debrecen (Hungary) to compare not only the demographic characteristics of stroke patients from these countries but also the risk factors, as well as stroke severity and short term outcome. Results – The gender related distribution of patients was similar to those found in the European Survey, whereas the mean age of patients at stroke onset was similar in the two countries but lower by four years. Although the length of hospital stay was significantly different in the two countries it was still much shorter (about half) than in most reports from western European countries. The overall fatality rate in both databases, regardless of gender was comparable to averages from Europe and other countries. In both countries we found a high number of risk factors, frequently overlapping. The prevalence of risk factors (hypertension, smoking, hyperlipidaemia) was higher than those reported in other countries, which can explain the high ratio of recurring stroke. Discussion – In summary, the comparatively analyzed data from the two large databases showed several similarities, especially regarding the high number of modifiable risk factors, and as such further effort is needed regarding primary prevention.

Clinical Neuroscience

[Epidemiology, cost and economic impact of cerebral palsy in Hungary]

FEJES Melinda, VARGA Beatrix, HOLLÓDY Katalin

[Objective - The purpose of our communication was to determine the total cost of cerebral paretic patients in Hungary between 0 and 18 years and to assess their impact on the national budget. Methods - Based on the data of Borsod county we calculated the CP characteristics. The cost of CP was determined by routine care of individuals. Lost Parental Income and Tax were calculated on the basis of average earnings. The ratio of GDP, Health and Social Budget and Health Budget to CP is based on CP annual average cost and frequency. We have developed a repeatable computational model. Results - Of the risk groups, premature birth (30.97%), low birth weight (29.64%), perinatal asphyxia (19.47%) were the most common. Source is unknown of 37.61% of the cases. CP prevalence was 2.1‰. The two-sided (59.7%) and the one-sided (19.0%) spastic pareses dominated. The most serious form is the two-sided spastic paresis (42.5% GMFCS 3-5 degrees). Epilepsy was 22.0%, incontinence was 27%, mental involvement was 46%. Care for one child up to 18 years of age costs an average of 73 million HUF (€ 251,724). The lost family income was 27.36 million HUF (€ 94,345), and lost tax and health care contributions were 14.46 million HUF (€ 49,862). Additionally, 0.525% of the GDP, 0.88% of the full health and social budget and 1.83% of direct medical costs were spent for CP families. Conclusion - The cost of CP disease is significant. Costs can be reduced by improving primary prevention. From the perspective of the family and government, it is better to care for families so they can take care of their disabled children.]

Hypertension and nephrology

[Cerebrovascular diseases in patients with chronic kidney disease]

KISS István, NAGY Judit

[The reason of the unfavourable life expectancy of patients with chronic kidney disease (CKD) is not only the development of end-stage renal failure but the frequent appearance of cardiovascular diseases (CVD). Chronic kidney damage itself is a cardiovascular risk state and the occurrence of CVD/associated diseases is significantly higher in chronic kidney failure. Beside risk stratification and valid treatment of CVD (hypertension, diabetes mellitus, ischemic heart disease e.g.) we and the international nephrological community have left the cerebrovascular diseases of CKD patients out of consideration. However, up to 50% of patients suffering a stroke will die immediately, only 10% of stroke survivors can continue his/her profession, but the others will be permanently disabled. High blood pressure is a strong predictor of stroke and of other CVD in most of the patients. In stroke risk reduction it is particularly important to reach the target blood pressure values. The main object of the “Live under 140/90 mmHg” programme of the Hungarian Society of Hypertension is to familiarize with target blood pressure itself and how to reach target blood pressure. In 2010, prevention, early diagnosis and management of stroke are the most important challenges of this programme (The Brain Control Programme). We think it is advisable to prepare and publish a clinical practice guideline in collaboration with stroke societies which is similar to the guidelines of international societies and of the Hungarian Society of Stroke but specific for CKD patients. This guideline would help to give a uniform, up-to-date treatment for the cerebrovascular diseases of CKD patients.]