Hypertension and nephrology

[The Double-Faced Thiazides]

KEMPLER Péter1, HORVÁTH Viktor József1

DECEMBER 10, 2015

Hypertension and nephrology - 2015;19(06)


  1. Semmelweis Egyetem, I. Sz. Belgyógyászati Klinika, Budapest



Further articles in this publication

Hypertension and nephrology

[Role of nephroclinicopathology in the nephrological diagnosis]


[In cases where a definitive diagnosis of a renal disease cannot be established on the basis of the clinical and laboratory data as well as imaging techniques the histological examination of the renal biopsy can be useful for establishing a pathological diagnosis, assessing the prognosis and can give etiopathogenetic information to guide the further management. The description and the degree of the active and chronic changes may influence the rationale treatment and the likelihood of the response. However, discussion between the nephrologist and the nephropathologist is indispensable at the decision to take the biopsy and at the evaluation of the result of the histological examination.]

Hypertension and nephrology

[Diagnostic of genetic factors affecting blood pressure and the genetic risk factorsof hypertension]


[Hypertension is a risk factor of cardiovascular and renal diseases. Although high blood pressure usually does not show symptoms, it can lead to serious health problems such as stroke or cardio and renal insufficiency. Globally 40% of adults over the age of 24 suffer from hypertension, and the risk increases with age. The incidence is more than 70% over 65 years of age. Environmental and genetic effects are jointly responsible for the onset of hypertension, thereby determining predisposing genes is extremely difficult. Genetic variations of several genes have been identified to increase the risk of hypertension. The most common hypertension susceptibility polymorphisms occur in AGT, AGTR1, ACE, NOS3 and CYP4A11 genes. Learning about polymorphisms has clinical importance both in prevention and therapeutic processes. Therapeutic and lifestyle recommendations can be individualized by using molecular genetic tests such us PCR, microarrays, real-time PCR.]

Hypertension and nephrology

[Application of central sympatholytic agents and vasodilators between 2007-2014 based on OEP’s database]


[Due to the a large number of antihypertensive drugs on the Hungarian market, in the light of the constantly updated recommendations for therapy, seemed to be worth to consider the traffic data provided by the National Health Insurance. We analysed the turnover of the centrally-acting and direct vasodilator antihypertensive, using the data of The National Health Insurance Fund (NHIF) between 2007 and 2014. Every year the December data were comparesed, the turnover of the month did not substantially different from other month, an average of 5-6 million boxes of cardiovascular products are prescribed. Over the past seven years it was fluctuating, but overall there was almost 19% increase in the turnover of centrally acting medicinal products. The prescription number of guanfacine decreased almost one-third, moxonidine orders fell 37%, while the turnover of rilmenidine doubled during that same period. A significant expansion of the centrally acting rilmenidine became clear in the domestic market. The minimal side effects, the favourable profile of applications, the number of international and domestic studies make it an excellent second-third additional agent. The use of vasodilators overall increased of a small degree (15%), mainly due to a 53% increase of doxazosin. Considering the domestic prescribing habits they follow very well the international and domestic recommendations. The observed differences in each group are the effects of the positive results of recent studies.]

Hypertension and nephrology

[The Worldwide and Hungarian Prevalence of Hypertension According to the 2014 WHO Database]


Hypertension and nephrology

[Measurement Options of Overweight and Obesity and their Levels of Usefulness]

KISS István, KÉKES Ede

All articles in the issue

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Atypical presentation of late-onset Sandhoff disease: a case report

SALAMON András , SZPISJAK László , ZÁDORI Dénes, LÉNÁRT István, MARÓTI Zoltán, KALMÁR Tibor , BRIERLEY M. H. Charlotte, DEEGAN B. Patrick , KLIVÉNYI Péter

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Clinical Neuroscience

[Tension type headache and its treatment possibilities]

ERTSEY Csaba, MAGYAR Máté, GYÜRE Tamás, BALOGH Eszter, BOZSIK György

[Tension type headache, the most common type of primary headaches, affects approximately 80% of the population. Mainly because of its high prevalence, the socio-economic consequences of tension type headache are significant. The pain in tension type headache is usually bilateral, mild to moderate, is of a pressing or tightening quality, and is not accompanied by other symptoms. Patients with frequent or daily occurrence of tension type headache may experience significant distress because of the condition. The two main therapeutic avenues of tension type headache are acute and prophylactic treatment. Simple or combined analgesics are the mainstay of acute treatment. Prophylactic treatment is needed in case of attacks that are frequent and/or difficult to treat. The first drugs of choice as preventatives of tension type headache are tricyclic antidepressants, with a special focus on amitriptyline, the efficacy of which having been documented in multiple double-blind, placebo-controlled studies. Among other antidepressants, the efficacy of mirtazapine and venlafaxine has been documented. There is weaker evidence about the efficacy of gabapentine, topiramate, and tizanidin. Non-pharmacological prophylactic methods of tension type headache with a documented efficacy include certain types of psychotherapy and acupuncture. ]

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[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]


[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

Clinical Neuroscience

[Role of peginterferon-β-1a in the therapy of multiplex sclerosis]

SIMÓ Magdolna, ILJICSOV Anna

[The subcutaneous peginterferon-b-1a is recently introduced in the therapy of relapsing-remitting multiplex sclerosis (RRMS) patients. Pegylation of IFN b-1a improved pharmacodynamic and pharmacokinetic properties, resulting in, increased biologic activity and a longer half-life. The efficacy of peginterferon-b-1a was proved by the ADVANCE study - a 2-year Phase 3, multicenter, randomized, double-blind study with a 1-year placebocontrolled period evaluating the efficacy and safety of subcutaneous peginterferon-b-1a administered every 2 or 4 weeks in patients with RRMS. Peginterferon-b-1a efficacy was maintained during the two years, with greater effects observed with every 2 week versus every 4 week dosing. Annualized relapse rate and confirmed disability progression was reduced comparing with patients on delayed treatment. Patients treated with continuous peginterferon-b-1a had fewer new or newly enlarging T2 lesions over 2 years than patients in the delayed treatment group. Adverse events were consistent with the known profiles of IFN b therapies in MS. The most commonly reported adverse events were injection site erythema, influenza-like illness. The less frequent administration is associated with fewer flu-like adverse events, which may improve patients’ compliance and adherence. Peginter-feron-b-1a could be an effective and safe treatment option for RRMS patients.]

Lege Artis Medicinae

[Lipid lowering therapy during COVID-19 pandemic]

MÁRK László

[The COVID-19 pandemic posed significant challenges to all healthcare systems of the world as created a new situations above the large number of people infected, solutions of which were lacking any previous patterns. Former experiences were specifically needed among physicians who practised usually with therapies supported by evidence based clinical experiences thus they were working along the principles of Evidence-Based Medicine. The new observations and recommendations for treating infected patients increased gradually, however they were not always well-founded by the general urgency. In this situation, physicians faced often problems of the patient’s former medications since they had to focus on the therapy of the prevalent life-threatening condition. In such cases, therapy as lipid lowering, which is inherently inimically and lightly taken, may be omitted even more often. Basic drugs of lipid lowering are statins. They are used to reduce cholesterol levels and the risk of cardiovascular events, but they have also been described as having beneficial effect on the new viral infection. In this effect, the statins beyond the well-known anti-inflammatory impact and increasing the expression of angiotensin-converting enzyme-2 further mechanisms can take part as well. These may include among others the promoted breakdown of lipid rafts, which directly inhibits the entry of coronavirus into the cell through the S protein by decreasing the level of cholesterol required for this proceeding. In a group of more than 1200 statin treated and SARS-COV-2 infected patients the overall mortality rate by the 28th day was 48% lower than among the non-statin-users. According to a meta-analysis of nearly nine thousand COVID-19-infected statin users, they had 30% lower mortality rate or serious complications. Up to date observational studies suggest that statin therapy and the administration of other lipid lowering drugs should be continued or initiated according to the guidelines also during the COVID-19 infection.]