Hypertension and nephrology

[Telemedicine care for high-risk hypertensive patients with antihypertensive for reaching better blood pressure target ratio and smaller blood pressure variability]

KISS István1, ÁDÁM Ágnes2, HERCZEG Béla3, MATOLTSY András4, POÓR Ferenc5, SZEGEDI János6, VÁRALLYAY Zoltán5, PAKSY András7, KÉKES Ede8

SEPTEMBER 14, 2018

Hypertension and nephrology - 2018;22(03 klsz)

[Telehealth care of high-risk hypertensive patients for a better target blood pressure and smaller size blood pressure fluctuation. Authors conducted a one-year, multicentre, prospective, observational study with no intervention. Their aim was to achieve better targeting and smaller blood pressure fluctuation in patients with high risk hypertensive patients with the new type of doctorpatient co-operation and telemedicinal care than the conventional control method. In the active group, 50 patients, in the non-active group 47 treated hypertensive patients were analysed. During the observation period (1 year) the mean (± SD) of the systolic blood pressure decreased from 143.3 (15.1) mmHg to 134.5 (9.2) mmHg in the active group, but in the non-active group there was no significant decrease. The target blood pressure (< 140/90 mmHg) could be increased from 46% to 62%. The two characteristics of interpersonal visit-to-visit variability index. The standard deviation (SD) and variation coefficient (VC) showed a significant decrease in the active group. There was no change in the inactive group. A method supported by telemedicine-assisted and better patientphysician- assistant co-operation is suitable for increasing target blood pressure rates and reducing blood pressure fluctuation.]


  1. Semmelweis Egyetem, Általános Orvostudományi Kar, II. Sz. Belgyógyászati Klinika, Geriátriai Tanszéki Csoport, Budapest, Szent Imre Oktató Kórház, NephrologiaHypertonia Profil, Budapest
  2. Drádám Egészségügyi Szolgálat – Zugló, Hypertonia Centrum, Budapest
  3. Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház és Rendelôintézet, Kardiológiai Osztály, Szolnok
  4. Kanizsai Dorottya Kórház, Kardiológia, Nagykanizsa
  5. Karolina Kórház, Belgyógyászati Mátrix Osztály, Általános Kardiológiai Részleg/Hypertonia Decentrum, Mosonmagyaróvár
  6. Jósa András Oktatókórház, Nonprofit Kft., I. Sz. Belgyógyászati Osztály, B. Braun Avitum 2. Sz. Dialízisközpont, Nyíregyháza
  7. Aesculap Akadémia Doktorjelöltek Iskolája
  8. ny. egyetemi tanár, Pécs



Further articles in this publication

Hypertension and nephrology

[Letter to our Readers]

JÁRAI Zoltán, REUSZ György

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[Results of the comprehensive health screening of Hungary (MÁESZ) in 2017 and comparative results of 2010-2017 specially to hypertension]

BARNA István, KÉKES Ede, DAIKI Tenno, DANKOVICS Gergely, KISS István, A MÁESZ Programbizottsága nevében

[The year 2017 saw the continuation of Hungary’s greatest and to date most comprehensive health screening program started in 2010. The examinations - among them coronary examinations - covered the fields of cardiology and hypertension, they took place in a specially furnished lorry. In the program we measured blood pressure, pulse rate, calculated cardiovascular risk, plasma cholesterol, glucose and uric acid levels. Whole body analysis started with measuring height, weight, abdominal circumference and waist/hip ratio defining target body weight. Following the measurement of body fat and muscle content we decided the surface volume of the abdominal fat and calculated body mass index. Participants and results of the examinations of the people who have presented themselves for the test since 2017 have been evaluated. In the Program a total (52.2%) women and (47.8%) men were tested at 204 locations. Upon data processing with the help of a query 21.9% of the participants reported suffering from hypertension. The screening truck has been to 1505 places is Hungary, and travelled 183,335 km, 135,879 people have participated in comprehensive screening. The average systolic blood pressure among women was in the normal range up to the age of 55 years. The diastolic blood pressure levels were in the normal range for both sexes (with the exception of the age group 46-55 of men where it exceeded the upper limit of the normal range by a minimal extent). Among men stage 1 hypertension was the most frequent status for all age groups; blood pressures above 140/90 were measured for 39% of subjects from age 18 onwards. Conclusions: Thanks to the vast information obtained through the program a comprehensive picture has been drawn about Hungary’s present health status not only on a regional or cross sectional level but as it was described in the program, too.]

Hypertension and nephrology

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NAGY Judit, KÉKES Ede, KISS István, KOVÁCS Tibor, SZEGEDI János

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[Role of ketoanalogue amino acids and diet in the treatment of patients with chronic kidney disease]

KISS István, HARIS Ágnes, DEÁK György

[Low protein diet is an important component of the non-pharmacological treatment of patients with chronic kidney disease (CKD). Along with the diet it is important to maintain appropriate energy intake to avoid malnutrition. It is recommended to supplement low protein diet (0.6-0.7 g protein/kg body weight/day) with essential amino acids and their ketoanalogues (ketoacids) in a dose of 1 tablet/8-10 kg body weight if there is a threat of protein malnutrition (eg. vegan diet). Very low protein diet (0.3-0.4 g protein/kg body weight/day) should be supplemented with ketoacids in a dose of 1 tablet/5 kg body weight. Low protein diet is recommended for patients with CKD stage 3 and progressively declining renal function, or nephrotic syndrome; in diabetic nephropathy; in CKD stage 4 and non-dialyzed CKD stage 5. Nephroprotective effect of very low protein diet is primarily expected is patients with an eGFR below 20-25 ml/min/1.73 m2 and good compliance. Dietary protein restriction may diminish acidosis and proteinuria, slow the progression of CKD and delay initiation of dialysis. Diets reduced in protein supplemented with appropriate energy intake and ketoacids are nutritionally safe. Dietary education and guidance of patients by qualified dietitians are of great importance in nephrology clinics. We illustrate the main points of our review with case reports.]

Hypertension and nephrology

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[The author presents the classification of current blood pressure measuring devices, the validation procedure, then lists the values of the measuring devices that have passed the international protocol validation procedure.]

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[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]

Hypertension and nephrology

[Therapy of hypertension in mirror of the newest recommendations]


[Hypertension guidelines published by various societies in the previous year follow two distinct trends regarding recommendations about treatment. The European Society of Hypertension and the European Society of Cardiology (ESH/ESC) gives the clinician free hand to select the antihypertensive drug, mentioning the optimal treatment regime for various associated clinical conditions. Guidelines published by the American Society of Hypertension and the International Society of Hypertension (ASH/ISH) or by the Eighth Joint National Committee (JNC8) are far less permissive, recommend the first drug of choice from a narrower circle of antihypertensive agents and describe the initiation and escalation of therapy in algorithms. This article displays some of the corresponding and disparate recommendations of the three guidelines.]

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

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LAM Extra for General Practicioners

[Advantages of fixed Combinations in the treatment of Hypertensive patients ]


[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]