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.]

AFFILIATIONS

  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

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[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.]

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[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.]

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