Hypertension and nephrology

[The importance of the increase in the use of fix dosage combination of calcium channel blockers in the domestic medical practice between 2007 and 2013]

BARNA István, GYURCSÁNYI András

MARCH 20, 2015

Hypertension and nephrology - 2015;19(01)

[Antihipertensive therapy in the complex treatment of diabetes mellitus, obesity and lipid metabolism disorder was discussed, which also means the fight against the emergence of cardiometabolic syndrome and chronic renal failure as well. Angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), calcium channel blockers (CCB), b-blockers and thiazid diuretics with “A” level of evidence reduce cardiovascular morbidity and mortality. The main effect of CCBs is effective antihipertensive vasodilatation, which is the basis of anti-ischaemic, anti-anginal and antihipertensive agents for use in everyday practice. Based on the database of the National Health Insurance, we analyzed changes in the turnover of CCBs between 2007 and 2013 the examined period among CCBs ordered with TB support amlodipin is the most frequently used active ingredient. In December 2007 almost 75% of the prescriptions was amlodipin. That increased to 87,12% by December 2013. CCBs ordered in monotherapy not changed in the examined period, while combinations increased continuously Among CCBs between 2007 and 2013 the fix dosage combinations available with TB support are: statins (atorvastatin + amlodipin), ACE inhibitors (ramipril + felodipin, lisinopril + amlodipin, perindopril + amlodipin, ramipril + amlodipin, verapamil + trandolapril) and b-blockers (metoprolol + felodipin). Using the assigned CCB monotherapy decreased steadily during the study period, while the use of combination formulations induced gradually increased. At the end of the examined seven year period more than 40% of the prescribed boxes were CCB in fix combination. Use of the combination of amlodipin + perindopril increased while amlodipin + lisinopril continuously reduced. The use of the combination of felodipin + ramipril also decreased.]

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Hypertension and nephrology

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[In the past decades an increasing attention has been paid regarding the possible role of the immune system in the development of hypertension. In vitro and in vivo animal experiments, as well as human studies provided evidence for the role of the innate and adaptive immune systems in the development of hypertension, especially in connection with the perivascular adipose tissue, heart and kidney. Inflammatory mediators, cytokines, reactive oxygen metabolites have not only local pro-hypertensive effecting the vasculature, but also influence the development of hypertension through other regulatory mechanisms, such as the central nervous system. These findings provide a new understanding of the development of hypertension, as well as offer new potential mechanisms that can be targeted with novel the - rapies.]

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[Hypertension is a cardiovascular risk factor. The 6th Cardiovascular Consensus Conference has recommended metabolic syndrome in high-risk category. In diabetic patients hypertension is observed in most cases. Aims: Monitoring the effectiveness and safety of the fix combination of ra - mipril/amlodipine therapy in patients with metabolic syndrome suffering from mild or moderate hypertension despite current antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved known metabolic syndrome patients (age over 18 years) with mild or mode - rate hypertension. Ramipril/amlodipine fixed combination (5/5, 5/10, 10/5 or, 10/10 mg) were administered or titrated in 3 visits, during the 6 months of trial period. The doses of the fixed combination drugs were determined individually during the visits by physicians involved in the study. The target blood pressure value was 140/90 mmHg and <140/85 mmHg in diabetic patients. Results: 63% of total patient (9,052) have fulfilled the protocol during the four month of trial (5,707 patients). The age of patients was 61.3±11.97 (mean±SD) years, 2.736 (47.9%) men and 2,971 (52.1%) women. 74.0% of total metabolic patients has reached target blood pressure at the end of 6th month (primary end point). The blood pressure has decreased significantly from 158.7±8.97/91.9±7.30 mmHg (1. visit) to 131.6±7.73/79.8±12.20 mmHg (-27.1±10.43 /12.1±13.38 mmHg) to the 6th month (3. visit) (p<0.0001). Patients with hypertension in metabolic syndrome have tolerated the various fixed combination of ramipril/amlodipine well. ]

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[Effects of peripheral resistance lowering and elevating beta-blockers on central blood pressure - nebivolol in focus]

BENCZÚR Béla

[Central blood pressure, that is, blood pressure (BP) in the ascending aorta, is considered an important physiologic parameter as it reflects the hemodynamic relationship between the heart and the aorta, both in systole and in diastole. In the systolic phase, central BP represents the pressure against which the left ventricle has to eject blood during systolic contraction. Thus, central arterial pressure reflects both left ventricular stroke volume and afterload, defines cardiac work, and contributes to the development of left ventricular hypertrophy in hypertensive individuals. In the diastolic phase, central BP is a key determinant of the blood flow delivery to the myocardium. Despite the increasing knowledge regarding the importance of central blood pressure and the availability of non-invasive measurement technics it couldn’t spread in everyday clinical practice and rarely or not mentioned in the therapeutic guidelines. The different antihypertensiv drugs significantly differs based on their effects on central blood pressure particularly β-blockers. The so-called ’classical’ β-blockers have un - favourable effect on central blood pressure due to increasing peripherial vascular resistance. In the opposit the vasodilating β-blockers including nebivolol markedly decrease central blood pressure which could explain their beneficial effects.]

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[The rilmenidin as a imidazoline agonist drug strongly decreases the central simpathetic activity, renine release and the RAS activity. Because of these advantageous properties the peripheral vascular resistance falls and the blood pressure decreases. It is very useful especially in stress induced hypertension. The antihypertensive effects of ACE inhibitors and calciumantagonists are increased by rilmenidine. This drug decreases the inzuline resistance, it has a positive effect on the carbohydrate and fat metabolism, because it is useful as a complementary therapy in metabolic syndrome and of type II diabetes mellitus.]

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