Hypertension and nephrology

[The clinical significance of peripheral and central blood pressure form the neurologist’s point of view]

BERECZKI Dániel, VASTAGH Ildikó

FEBRUARY 28, 2011

Hypertension and nephrology - 2011;15(01)

[Hypertension - affecting both the large and the small cerebral vessels - is the most frequent risk factor for cerebrovascular disorders manifesting in stroke, hypertensive encephalopathy or vascular dementia. The central pressure measured at the proximal part of the aorta has more important role in the development of vascular hypertrophy and carotid atherosclerosis than the pressure measured in the brachial artery. Central aortic pressure more accurately reflects the filling conditions of the left ventricle and thus the pressure conditions affecting the cerebral vascular system, than brachial pressure values, therefore possibly predicts more reliably the risk of cardiovascular events than brachial pressure values. Features of the stiffness of large arteries (like pulse wave velocity) more directly reflect the chronic effect of ageing, hypertension and diabetes than brachial or even central aortic pressure. Therefore in upcoming clinical trials arterial stiffness and central aortic pressure should be considered as possible surrogate endpoints. Antihypertensive treatment is an important part of primary and secondary stroke prevention. Decreasing blood pressure in hypertensive subjects significantly decreases the risk of stroke and other vascular events, and the extent of risk reduction primarily depends on the extent of the decrease in blood pressure. Several factors should be considered when choosing from treatment options. The use of traditional β blockers - partly due to their smaller effects on central blood pressure - decreased recently. Further observations will decide on the role of third generation β blockers in the prevention of cardiovascular mortality and morbidity.]

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Hypertension and nephrology

[Importance, prevalence and therapy of vitamin D deficiency]

SZABÓ András

[Annual citations in the PubMed database on vitamin D were approximately 5000, this represents a doubling in the last decade and a 20% increase in the last year. There is renewed interest in vitamin D synthesis, metabolism and action. The two principal reasons for increased interest can be: 1. new knowledge regarding the nonhormonal, autocrine, and paracrine actions of 1,25-dihydroxylated vitamin D metabolites in man, 2. the worsening, worldwide trend to vitamin D insufficiency. Clinical vitamin D research in last years has confirmed the presence of a worldwide problem of vitamin D depletion, a problem that appears to be worsening. Largescale population based studies bear out long-held concerns that low serum 25(OH)D levels are associated with a number of adverse outcomes in the human musculoskeletal, innate immune, and cardiovascular systems. In fact, low vitamin D levels are significantly associated with all-cause mortality in the U.S. population and Hungary respectively. It is hypothesized that the global rise in incidence of obesity contributes to the worsening of the problem of vitamin D deficiency, amplifying adverse impacts on the host skeleton, immunoreactivity to microbes, and metabolic status. Finally, it should be remembered that treatment of vitamin D deficiency has two phases: restoration of 25(OH)D levels up to more than 30 ng/ml; and maintenance of the serum 25(OH)D level in that range. The present upper level (UL) of vitamin D intake that is deemed to be safe (2000 IU/day) must be re-evaluated considering data acquired over the past 15 years.]

Hypertension and nephrology

[Combination of diuretics in resistant hypertension]

RADÓ János

[Resistant hypertension developed in a 60-year-old male patient with chronic renal insufficiency due to untreated high blood pressure for decades despite of the coadministration of furosemide, β-blocker, calcium channel blocker, angiotensin converting enzyme inhibitor and angiotensin receptor blocker. Breakthrough could be achieved by the combination of a tiazide compound and a loop diuretic (furosemide). It seemed to be worthwile publishing the case because the tiazide drug could be successfully administered below 30 ml/min GFR, where it is generally thought to be ineffective, and because both elements of the combination was given in very low doses relative to the kidney disease. The literature of the most important combinations of the tiazide preparations and the loop diuretics are reviewed and some historical aspects are given as well.]

Hypertension and nephrology

[Scylla and Charybdis - the treatment of hypertension]

RADÓ János

Hypertension and nephrology

[Direct renin inhibitors]

FARSANG Csaba

[The mechanisms of action of direct renin inhibitors and the important clinical findings gained by the first, clinically approved drug, aliskiren are discussed. The relative lack of side effects and the very long-lasting antihypertensive action of aliskiren is emphasized. Investigations showing efficacy and protective effects of aliskiren and its combinations with other antihypertensive drugs (diuretics, calcium antagonists, angiotensin converting enzyme inhibitors, angiotensin receptor blockers) against hypertension-induced subclinical organ damage as well as still ongoing clinical trials are also described.]

Hypertension and nephrology

[The importance of epithelial-mesenchymal transition in kidney fibrosis]

NAGY SZAKÁL Dorottya, SZEBENI Beáta, SZIKSZ Erna, HIMER Leonóra, REUSZ György, VÁSÁRHELYI Barna, TULASSAY Tivadar, VANNAY Ádám

[Epithelial-mesenchymal transition (EMT) plays a central role in physiological and pathological processes of embryogenesis, carcinogenesis and tissue fibrosis. During EMT epithelial cells may transform to myofibroblasts, which are the effector cells of fibrosis. In our summary the process of EMT and its medical importance will be reviewed in relation to renal fibrosis. Regardless of the initiating cause the final common mechanism of organ fibrosis is similar in the different chronic renal diseases. It always involves major inflammatory responses, however the molecular mechanisms involved are still elusive. The EMT now takes centre stage as the point of convergence between inflammation and the progression of degenerative fibrotic diseases. Understanding the pathomechanism of EMT and the significance of signalling pathways involved in this process may lead to a new therapeutic approach in the treatment of chronic renal diseases.]

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[Fear of medical care: epidemiology and prevention among 5-6 years old children]

PÓCS Dávid, SIKLÓSI Réka, NYÁRI Tibor, BARABÁS Katalin

[INTRODUCTION - At least 5-10% of the adult population is afraid of medical care. These fears may begin in preschool years. Therefore, the aim of our study was to assess the rates of medical fears among 5-6 year old children, and to prove that medical fears can be reduced by a health promotion program for children called “Teddy Bear Hospital” POPULATION AND METHODS - 248 children participated in the study (average age: 5.5 years, 45% girl, 55% boy). The “Teddy group” (129 children) took part in the Teddy Bear hospital program (Teddy group). The control group (119 children) did not take part in this program (control group). Questionnaires, including a Visual Analog Scale, a picture test, and drawing analyses were completed on two separate occasions three weeks apart difference. RESULTS - Fear of needles was the most frequent fear (59%) among the participating children, followed by the fear of medical environment (33%), the fear because of the lack of information (27%), the fear of doctors (20%), and the fear of pain (15%). On the basis of the picture test the fear of doctors significantly decreased in the Teddy group (from 18% to 7%) compared with the control group (from 10% to 11%, p<0.05). Drawing analyses also showed that children in the Teddy group had significantly lower levels of medical anxiety (29% and from 19.3 point to 17.6 point) than the control group (19% p<0.05 and from 18.8 point to 18,33 point p<0.05). On the drawings of the Teddy group we found significantly more new medical information (38%) compared with the control group (21%, p<0.05). CONCLUSIONS - Medical fears are frequently present among 5-6 year old children, therefore, their prevention is greatly needed. A potential way of the prevention is the “Teddy Bear Hospital” program, which efficiently reduces children's medical fears and anxiety.]

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