Hypertension and nephrology

[The Editors Ask, the Expert Responds]

CSÁSZÁR Albert

APRIL 20, 2018

Hypertension and nephrology - 2018;22(02)

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Further articles in this publication

Hypertension and nephrology

[Role of β-blockers, especially carvedilol in the treatment of hypertension]

PÁLL Dénes, MARODA László, ZRÍNYI Miklós

[Changes in hypertension guidelines in the past years have affected the clinical thinking about β-blockers. Authors reviewed the development of β-blockers emphasizing the differences across various active pharmaceutical agents. Different hemodynamic and metabolic effects are being discussed in details for the third ge - neration vasodilatator carvedilol. Carvedilol has no effect on cardiac output but decreases peripheral vascular resistance which results in lower blood pressure values. However, carvedilol, opposite to unfavorable effects of traditional β-blockers, has a neutral impact on both carbohydrate and lipid metabolisms. Its more advanced cardiac effects include decreased left ventricular hypertrophy and increased coronary flow reserve. Vasodilatator type β-blockers (carvedilol, nebivolol) are indicated in the combi - nation treatment of hypertension, especially when the patient has heart failure, coronary disease or suffered from a previous heart attack.]

Hypertension and nephrology

[A Letter to Our Readers]

KÉKES Ede, KISS István

Hypertension and nephrology

[Alberto Zanchetti]

FARSANG Csaba, JÁRAI Zoltán, KÉKES Ede, KISS István

Hypertension and nephrology

[Cholesterol-lowering is not the Holy Grail, but neither is the work of the devil]

BAJNOK László

[Cholesterol-lowering statins are the most tested medications in respect of the effects and side-effects. Based on these, we can safely claim that most of the negative opinions about cholesterol-lowering are not realistic. It is not a panacea, but it is proven that around a 30% of cardio- and cerebrovascular risk reducation can be achieved by their regular taking, while the incidence of side effects and risks are at least one order of magnitude lower in each patient groups. For cholesterol, there is no “normal” lab threshold or low level, only “target values”, since the mean value in the general population is high in regard of atherosclerosis (the values measured at birth and among natural people can be considered normal). Let us appreciate the cholesterol- lowering medications because we do not have a large armamentarium!]

Hypertension and nephrology

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

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[The revolutionary progress of research in neuroimmu­nology has led to the introduction of disease modifying therapies in multiple sclerosis at the end of the last century. The International Panel on Diagnosis of Multiple Sclerosis originally proposed the 2001 McDonald criteria to facilitate the diagnosis of MS in patients with the first objective neurological symptom(s) suggesting demyelinating event, when magnetic resonance imaging is integrated with clinical and other paraclinical diagnostic methods. New terms have been introduced to substitute clinical information by MRI: dissemination in space - indicating a multifocal central demyelinating process and dissemination in time - indicating the development of new CNS lesions over time. The criteria for diagnosis of Multiple Sclerosis have continuously evolved, they were modified in 2005 and 2010 allowing for an earlier and more accurate diagnosis of MS over time, and they provided the most up-to-date guidance for clinicians and researchers. The last recommended revisions relied entirely on available evidence, and not on expert opinion thereby reducing the risk of the misdiagnosis. The 2017 McDonald criteria continue to apply primarily to patients experiencing a typical, clinically isolated syndrome. In this review, we provide an overview of the recent 2017 revisions to the criteria of dissemination in space and time with the importance of the presence of CSF-specific oligoclonal bands; keeping fully in mind that there is no better explanation for symptoms than diagnosis of MS. In the future, validation of the 2017 McDonald criteria will be needed in diverse populations. Further investigations are required on the value of new MRI approaches, on optic nerve involvement, on evoked potential and optical coherence tomography, in order to assess their possible contribution to diagnostic criteria.]

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[Main features of cardiovascular rehabilitation in post-acute Covid-19]

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[The COVID-19 pandemic caused by SARS-CoV-2 is a significant challenge worldwide. Cornerstones of in-patient management of this pandemic which harms predominantly the respiratory system are the acute and intensive care. However, the rehabilitation plays a key role in improving the functional status and quality of life of survivors and reducing the impact of complications. As estimated, 40-50% of discharged patients require some form of medical support and 4-5% of them require inpatient rehabilitation. In addition to the respiratory system involvement, cardiovascular effects caused by COVID-19 (heart failure and myocarditis, acute coronary syndrome, arrhythmia, venous thromboembolism) are part of the ongoing systemic inflammatory processes and may affect 7-28% of hospitalized patients and lead to long-term deterioration in quality of life and loss of work capacity. Based on available scientific databases, expert consensus and the recommendations of European professional societies, this summary presents the recommended method, conditions and intensity of post-Covid cardiac rehabilitation including physical training exercises. The summary concerns also the recommended conditions for re­turn to work and sporting activities. Struc­tured exercise training is a very important and low-risk component of cardiac rehabilitation, reducing cardiovascular complications, thromboembolic complications, sys­temic inflammation and mortality, improving functional recovery and endothelial function. The planning of physical training should be preceded by a complex assessment of patients. Assessments of risk, capacity and function are needed to select the intensity, frequency and mode of indivi­dualized training. This should be combined with appropriate secondary preventive medication, monitoring, diet therapy and psychotherapy in accordance with respected principle of gradual progression. Finally, the consensus recommendations suggest that home-based and tele-rehabilitation should play a prominent role, considering the epidemiological and capacity constraints that also affect rehabilitation. ]

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[Telephone based supporting program to quit tobacco smoking in Hungary]

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[The National Korányi Institute of Pulmonology, Methodology Centre for Tobacco Smoking Cessation Support has been operating a free quitline since 2013. The aim of the program is to provide professional advice on how to quit smoking, to spread information about supporting services and to refer interested smokers to specialized health care providers. Proactive calls following a specific protocol are available once a week for a six week period. This study presents the activities of our service in the last six years. Data of our retrospective longitudinal study were analysed by descrip­tive statistical methods. Between 2015 and 2020, there were received 24 286 messages received on the answering machine of the quit-line service. We were able to initiate conversation with approximately 55% of the interested callers. The free of charge quit-line is used predominantly by lower educated and indigent people. Program participants had a serious nicotine addiction. The program is particularly useful for smokers who are otherwise less likely to receive expert support. Between 2015 and 2020, the average abstinence rate of program participants was 16% after their proactive calls. The initial abstinence rate was 19% in 2015, which dropped to 6% in 2020. In this period the average quit rate was 13% at the six-month and 9% at the one-year follow-up. One possible reason for the low cessation rate is that the telephone counselling program can focus only on changing the patients’ behaviour without the in-person help of pharmacological support. Thus healthcare workers play a key role in encouraging of quit smoking and managing the nicotine withdrawal.]