Hypertension and nephrology

[The CONADPER-HU program. Objective and methodology of the program. Patients. Basaline data]

KISS István, ALFÖLDI Sándor, BARNA István, JÁRAI Zoltán, SIMONYI Gábor, SZEGEDI János, PAKSY András, UGRAI Péter, KÉKES Ede

AUGUST 20, 2018

Hypertension and nephrology - 2018;22(02 klsz)

[The aim of the study was to increase the rate of target blood pressure and reduce blood pressure variability. This dual objective ensures optimal therapeutic success. In order to reach this goal, we wanted to increase the care of patients with hypertension by increasing patient-physician-assistant cooperation and providing telemedicinal devices.]

COMMENTS

0 comments

Further articles in this publication

Hypertension and nephrology

[Results of the CONADPER-HU program: blood pressure reduction, achieving target blood pressure, factors affecting the target, characteristics of medication]

KISS István, KÉKES Ede, PAKSY András, SZEGEDI János

[The authors analysed in detail the data of 4071 “active” and 2654 “nonactive” groups of patients. In the 18-64 age group, systolic and diastolic blood pressure was significantly reduced during the first three months of the baseline, and maintained for a further year. The largest systolic pressure drop was achieved by members of the active group using the Medigen application. The blood pressure target rate (< of 140/90 mmHg) in the active and non-active group was significantly higher than the baseline at all visit times (above 70%) and this decrease could be maintained throughout the observation period. Here the most favorable results were also found in Medigen software applications. Over the age of 65, reaching the target blood pressure increased significantly in the first three months as well, but due to the significantly uneven number of the two groups, the data received was only considered as approximate value. Main factors of non-achievement of target blood pressure: obesity, alcohol consumption, diabetes mellitus and peripheral vascular disorder, and the fact that the individual is male. Increases the access probabilities of Medigen users by 21% compared to non-users of the active group. Compared to the inactive group, this chance increase is 31%. The difference in target blood pressure reach between the active and non-active group was even more pronounced in diabetic hypertensive patients. The analysis demonstrates that drug treatment in domestic and ESH guidelines is fully consistent with and reflects well on domestic clinical practice.]

Hypertension and nephrology

[The role of telemedicine is to help the optimal patient-doctor cooperation in the treatment of hypertension]

KÉKES Ede, SZEGEDI János, †KISS István

[Telemedicine is now an indispensable part of healthcare and has overtaken the development of hospital information systems. Modern basic and specialized care requires the development of a state-of-the-art communication system between the patient and the physician. One of the main reasons for this is the attempt to raise the level of disease to a higher level, increase the level of prevention and care, involve the patient in the treatment, and care process as an active participant. The latter as a demand is growing ever since the various forms of telecommunication are becoming more and more informed. The technical solutions of telemedicine appear in two forms: In one, the signs and the values of the medical devices (sensors) through the various telecommunication systems are transmitted to the physician. The other solution is using smart phones and other devices (iPad, tablet), where patients send signals, data, and symptoms to your doctor. However, patient information (eg diet, lifestyle, etc.) and instructions from your doctor may arise, a continuous medical consultation can be established in which the patient is a doctor’s partner. This solution is promoted by the rapid spread of telecommunication tools in all layers of society. Authors present the methods of both solutions and details the practical aspects of telemedicine methods in hypertension disease.]

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

[Patient-practitioner cooperation - medication adherence and persistence in the CONADPER-HU study]

SZEGEDI János, KÉKES Ede, KISS István

[Hypertension is a common popular disease, it basically determines the health status, morbidity, cardiovascular mortality, rehabilitation and quality of life of the population. Prevention, early detection, effective treatment of the disease, quality of care is an important part of the people’s health program. The success of the therapy, the attainment and long-term maintenance of the target blood pressure - in addition to many other factors - is determined by drug adherence and persistence, one of the crucial elements of which is the optimal cooperation of the physician and patient. The poor persistence causes most of the therapeutic failures. The main objective of the CONADPER-HU study was to optimize practitionerpatient cooperation (increased control, information delivery, home blood pressure measurement, telemedicinal equipements and software use), thus increasing the proportion of patients with target blood pressure and reducing the number of resistant hypertensive patients. The study proved that the complex care system is effective and has a positive impact on persistence. It has also been clarified that the first three months will decide on further sustained therapeutic success.]

Hypertension and nephrology

[Significance of patient adherence in the treatment of hypertension]

SIMONYI Gábor, ALFÖLDI Sándor, BARNA István

[Hypertension is the one of most frequent chronic disease which a major but modifiable cardiovascular risk factor. In treating of hypertension after life style therapy, drug treatment has an essential role. Patient adherence plays a significant role achieving target blood pressure. One of most important cause of resistant hypertension is the non-adherence. Factors influencing adherence include the number of drugs, their daily dosage frequency, the properties of the drug groups used, age and gender too. According to international and domestic studies, the number of people leaving medication is very high. The disadvantage is clear because these patients lack of benefit from the protective effects of drugs.]

All articles in the issue

Related contents

Hypertension and nephrology

[The importance of assessing subclinical organ damage in risk prediction of hypertensive patients]

GODINA Gabriella, JÁRAI Zoltán

[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]

Hypertension and nephrology

[Treatment of high blood pressure in praxis and beyond. Hypertension praxis model]

ÁDÁM Ágnes

[Author presents a hypertension care model in the general praxis. Hypertensive patients and those with diabetes, hyperlipidemia and obesity, OSAS and the therapeutic results with these care model system for three years was analysed. The target blood pressure was achieved in a great rate in all patient’s groups. the elements of therapeutic success was analysed.]

Hypertension and nephrology

[Place of rilmenidine therapy in reducing of sympathetic overactivity]

FINTA Ervin, KUN Edit, SIMONYI Gábor

[The sympathetic nervous system plays an important and widely investigated role in the pathogenesis of the hypertension and its concomitant diseases. Between the several types of antihypertensive drugs which can influence the sympathetic over activity, centrally acting agents, play an important role. Here some special aspects of the imidazoline I1 receptor agonist rilmenidine are reviewed.]

Lege Artis Medicinae

[The effects of angiotensin receptor blockers on the nervous system in hypertension and dementia]

KOVÁCS Tibor

[The renin-angiotensin system (RAS) is one of the most important mechanisms regarding the pathomechanism and treatment of hyprtension. The most of the elements of the RAS are found in the nervous system too. The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ARBs) is based on the inhibition of the RAS. ARBs might have a special role in the central nervous system because they do not decrease the production of angiotensin but inhibit its harmful effects mediated through the AT1 receptor while allowing the stimulation of AT2 receptors with resulting pleiotrophic actions. Hypertension is the most important risk factor for stroke and has a negative effect on cognitive functions. Antihypertensive treatment has an effect on the nervous system; in addition to the consequences of the reduced blood pressure, ARBs might provide additional advantages in stroke and dementia prevention.]

Lege Artis Medicinae

[Cardiovascular risk factors and risk assessment]

KÉKES Ede

[The author summarises the most important cardiovascular risk factors. Concerning public health, the three most important synergistic factors are smoking, hypertension and abnormal cholesterol. Abnormal total lipid profile, visceral obesity, elevated glucose and uric acid levels and hypertonia all contribute to the global cardiometabolic risk. A number of studies and metaanalyses have confirmed the correlations of the risk factors and cardiovascular events (organ damage, clinical events, mortality). The concomitant occurance of risk factors increases the rate of risk. Risk estimation methods have been designed on the basis of proven correlations and they have been continuously improved and made more reliable owing to the assessment of more and more factors.]