Hypertension and nephrology

[The importance of health-centered approach in the management of hypertensive patients]


DECEMBER 08, 2012

Hypertension and nephrology - 2012;16(05)

[In the everyday clinical practice the main objectives are the accurate establishment of the diagnosis and evidence based treatment of diagnosed disease. Besides the accustomed, rigorously medical, simplifying aspect, the bio-psycho- social approach is gaining an increasing importance. The objective of the article is, taking modern definition of health into account, emphasizing the importance of a new approach in the complex management of patients, having primary hypertension, a disease, impairing not only target organs, as well as the whole person, seriously influencing the health status of the affected person. In the management of a hypertensive patient, besides decreasing blood pressure, preventing and treating target organ complications and coexisting diseases, we should assess the whole person impairment, the effects of environmental and personal factors, and their influence on activities of daily living and participation in the life of the society, consequently, the changes in health status. This complex approach permits alone the more complete restoration of health of an affected person.]



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Hypertension and nephrology

[The interpretation of metabolic syndrome]

KÉKES Ede, KISS István

[The significant increase of the splanchnic ectopic fat, the disturbance of carbohidrate metabolism, atherogenic dyslipidemia and high blood pressure creates the syndrome so called deadly quartet. These components promote the early appearance of cardiovascular diseases (ischemic heart disease, stroke, peripheral artery disease, etc.) as well as the enormous growth of type 2 diabetes mellitus. It was thought, that the ectopic fat is the only background of the syndrome and the insulin resistance with hyperinsulinemia as well as the disruption of associated endocrine regulatory balance system and elevated sympathetic drive explain jointly the clinical events. We now know that cytokines released by ectopic fat issue (CRP, TNF-α, IL-6 etc.) launch processes in our organism, which contribute to the development of vascular remodelling, endothelial dysfunction and in the end to that of atherothrombotic processes. The diagnostic criteria of the syndrome were changed continuously parallel growing theoretical knowledge till 2009, when on the Harmony Conference the important components of the syndrome were accepted, but some laboratory and other parameters do not enter into everyday praxis.]

Hypertension and nephrology

[Association between the genetic polymorphism of heat-shock protein 72 and pediatric kidney diseases]

BÁNKI Nóra Fanni, RUSAI Krisztina, KÁROLY Éva, SZEBENI Bea, VANNAY Ádám, SALLAY Péter, REUSZ György, TULASSAY Tivadar, SZABÓ J. Attila, FEKETE Andrea

[Recurring urinary tract infections (UTI) in childhood may result in chronic- and end-stage-renal-disease (ESRD), which leads to the initiation of dialysis and renal transplantation (NTx). Heat shock protein (HSP) 72 protects the kidney, whereas it refolds destroyed proteins and cells, and helps regenerating the renal tissue. The HSPA1B (1267)G allele is associated with lower HSP72 expression. This study assesses the role of HSPA1B A(1267)G polymorphism using PCR-RFLP in 103 children treated because of recurrent UTI, 26 children after NTx and 235 healthy controls. Clinical data were also evaluated. HSPA1B (1267)GG genotype and HSPA1B (1267)G allele occurred more frequently in the UTI (p=0.0001; CI: 1.378-2.68) and in the NTx (p=0.014; CI: 2.29-187.7) patient group than in the controls group, and were associated with a higher risk for scarring (p=0.012; CI: 0.33-1.00) and renal malformation (p=0.0072; CI: 1.623- 140.6). Our data indicate a relationship between the carrier status of HSPA1B (1267)G allele and the development of recurrent UTI and ESRD, raising further questions about the clinical and therapeutic relevance of these polymorphism.]

Hypertension and nephrology

[The history of diuretic treatment in Hungary. Part I. Imre Fodor]

RADÓ János

[The diuretic effect of mercurial compounds was discovered in 1920. However, the term of “mercurial diuresis” was created 36 years earlier by Ernő Jendrassik. Imre Fodor published his experiences with the mercurial diuretic, which has been cited by several authors worldwide. The Hungarian pharmaceutical industry also took its part from the production of the mercurial diuretic with Novurit that proved to be an excellent and worldwide well known preparation in the next 40 years. Even Imre Fodor required the repeated administration of mercurial diuresis because of his severe cardiac oedema in the last period of his life. When the drug became ineffective, i.e. developed refractory oedema, he made a “self-experiment” with the administration of ACTH to restore the sensitiveness to the mercurial diuretic on the basis of most recent American literature at that time. His experience has been published by his colleagues just before his death. Imre Fodor was an eminent clinician, a school creating internist who entered his name into the science dealing with the use of diuretics.]

Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

Hypertension and nephrology

[Treatment of hypertension in chronic kidney disease and in renal failure]

KISS István

[The number of patients with chronic renal disease is growing steadily over the past decade. The reason for this is the increasing number of patients developing diabetes mellitus and hypertension, diseases that have common complication of chronic kidney disease. There is evidence that in chronic kidney disease or end-stage renal disease high blood pressure is more common which has a very complex management. Renal patients were able to participate in a small number of clinical studies, so the evidence base of antihypertensive therapy from these studies is limited. Therefore professional guidelines made with thumbnail analysis are very important, which now appeared as the KDIGO recommendations in November 2012. The author of this quick presentation of the practice undertook to summarize the important messages of this paper.]

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Lege Artis Medicinae



[Stroke is a highly prevalent disorder worldwide; it is the third main cause of death and the leading cause of severe disability. Recent data showed that 72-86% of cerebrovascular disorders are of ischaemic type. Arterial hypertension is the most prevalent risk factor for both haemorrhagic and ischaemic stroke, it is present in approximately 70% of cases. All forms of hypertension, isolated systolic or diastolic and combined hypertension increase stroke risk about 3-4 times and the relationship with systolic blood pressure may even be stronger than with diastolic blood pressure. Hypertension is very common after acute stroke. In this phase the cerebral autoregulation is disturbed in the region of focal brain ischaemia or haemorrhage such that cerebral blood flow is directly dependent on systemic blood pressure. It is therefore essential to avoid systemic hypotension in acute stroke patients and the reduction of high blood pressure may lower cerebral blood flow in the ischemic penumbra. Evidence from clinical data shows that control of blood pressure leads to lower risk of first or reccurent stroke and patients have shown beneficial effects especially of ACE inhibitors and diuretics. In the PROGRESS study both hypertensive and non-hypertensive cerebrovascular patients benefited from antihypertensive therapy. Previous results suggests that there may be additional beneficial effects of the ACEinhibitor therapy not related to blood pressure lowering in the prevention of stroke.]

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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 István, ÁDÁM Ágnes, HERCZEG Béla, MATOLTSY András, POÓR Ferenc, SZEGEDI János, VÁRALLYAY Zoltán, PAKSY András, KÉKES Ede

[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.]