Hypertension and nephrology

[The improvement of the rate of reaching the target blood pressure and the quality of care of hypertensive patients with applying telemedicine facilities]

KISS István, KÉLES Ede

DECEMBER 30, 2012

Hypertension and nephrology - 2012;16(06)

[The authors summarize the facilities of the telemedicine and telemonitoring system. The methods of telemedicine and their combination with home blood pressure measurement or the help of a nurse or pharmacist are reviewed. In the light of the latest results the authors are led to the conclusion that the intensive spread of using the facilities of telemedicine is necessary in the present-day Hungarian healthcare system. At the same time it is also determined that the methodical and technical potential is not enough to further enhance the efficiency in itself. The personal contact and the possibility of interactive monitoring from distance are definitely crucial for the continuous maintenance of the reached target blood pressure in patients suffering from hypertension and also for the augmentation of patient adherence regarding applying medicine.]



Further articles in this publication

Hypertension and nephrology

[The apparatus which controls our kidney too. Part 2 - Structure and function of the juxtaglomerular apparatus]


[The juxtaglomerular apparatus is comprised of the macula densa (a specialregion of the distal tubule), the renin producing granular or epithelioid-cells of the afferent arteriole, the extraglomerular mesengial cells, and the efferent arteriole’s section bordering this region. Somewhat more general definitions also exist. Recently, distinctive morphological and functional associations have been identified between the components of the JGA and some common mediators (e.g. adenosine, angiotensin, NO, prostaglandins, etc.). Current data suggest that each cell of the macula densa also contain few cilia that may have a role in sensing fluid flow. The distal section of the afferent arteriole (possessing the same structure as the glomerular capillaries) is covered by fenestrated endothelium. Trace dose of ferritin particles can pass through the afferent arteriole’s fenestrae into the interstitium of the JGA due to the considerable hydrostatic pressure gradient. The parietal lamina of Bowman’s capsule, which covers the renin granulated cells of the afferent arteriole behaves much like the visceral lamina in that the epithelial cells of the parietal lamina exhibit foot processes and filtration slits. The urinary space is regularly bulging into the extraglomerular mesangium. Therefore, the notion has been refuted that the JGA, which contains neither blood nor lymph capillaries, is a closed system engaging in only slow fluid exchange. Furthermore it is affirmed that the afferent arteriole consists of two morphologically and functionally disparate segments, the ratio of which is considerably modified by the activity of the renin-angiotensin system.]

Hypertension and nephrology

[Acute heart failure and acute renal injury: pathophysiology and management of cardiorenal syndrome type 1]

LÁSZLÓ Ágnes, ÁCS Tamás, JÁRAI Zoltán

[The functional connection between heart and kidney is well known. Several types of this relationship have been recently characterized as cardiorenal syndromes. The relevance of this relationship in clinical practice is supported by the fact, that the consequences of the primary dysfunction are profoundly influenced by the magnitude and the treatment possibilities of the secondary dysfunction. Moreover, the administered therapy for heart failure can deteriorate renal hemodinamics, or side effects of the treatment can lead to the worsening of the clinical picture. Loop diuretics decrease venous congestion, but also induce neurohormonal activation and a decrease in glomerular filtration rate. The body of positive evidence with the use of mineralocorticoid receptor antagonists in acute settings is limited. Inotropic agents on the one hand improve hemodinamics, on the other hand increase the danger of arrhythmia and mortality (levosimendan seems to be an exception). Aquaretics decrease symptoms without influencing mortality. The natriuretic peptide neseritid improved clinical symptoms, but did not improve endpoints in clinical trials. Vasodilators improve hemodinamics, but their usefulness is limited because of their profound hypotensive effect. The effectiveness and benefits of ultrafiltration has to be tested in more clinical trials. Because of such treatment difficulties the management of these patients is a complex task that needs the involvement of intensive therapeutic specialists, nephrologists and cardiologists. This review focuses on the pathophysiology and possible management of the patients with acute heart failure with acute kidney injury, called type 1 cardiorenal syndrome from the cardiologist’s point of view.]

Hypertension and nephrology

[Professor István Vas MD, Who Changed the Outcome of Peritoneal Dialysis]


Hypertension and nephrology

[News of the Hungarian Society of Hypertension]

Hypertension and nephrology

[Blood pressure self-measurement with telemonitoring technology]

KÉKES Ede, KISS István, SAMU Antal, SZEGEDI János, MEZEI Rudolf

[Authors present the guidelines, indications and utility value of home selfmeasurements of blood pressure. They report the results of the most important clinical studies. They analyze the methodology of the measurements within telemedicinal solutions and describe the consultative scopes associated with the measurement methods already applied in clinical practice. Their own telemonitoring system - called Medistance - is then presented. They have created three modules for the long term registration of blood pressure in hypertensive patients: 1. an individual module for the hypertensive patients, the elderly, the family, for patients with high cardiovascular risk and for the physicians. 2. a module for the pharmaceutical care, 3. a module for the communities (social homes, club for the elderly, etc.). The Medistance system is functioning for two years in our count]

All articles in the issue

Related contents

Lege Artis Medicinae

[PErindopril-Amlodipine Reducing Blood Pressure Level Trial - The PEARL Study]

NAGY Viktor, LANTOS Éva, HABONY Norbert

[Background and aims - In order to reach target blood pressure values more successfully and to achieve better therapeutic compliance, concomitant use of more antihypertensive agents with different mechanisms of action has gained much attention recently. In the PEARL study we investigated the antihypertensive effect of fixed dose combinations of perindopril and amlodipine (5/5, 5/10, 10/5, 10/10 mg Covercard) by measuring blood pressure values in the doctor’s office and with a 24-hour ambulatory blood pressure monitor (ABPM) in outpatients with primary, grade 1 or 2 hypertension, whose target values could not be reached with prior treatment. We also assessed changes of metabolic parameters and how patients felt themselves throughout the study. Patients and methods - In this open-label, multicentre, non-interventional, observational, 3 month long study we evaluated the data of 10 335 patients (5 483 female, 4 852 male, mean age: 61.0±12.4 years, waist circumference 99.0±13.8 cm). The mean duration of hypertension was 9.5±7.7 years. After signing the informed consent form, patients attended three visits (inclusion, months 1 and 3), and they were asked to fill in the data sheets (visit 1: gender, age, waist circumference, blood pressure and heart rate measured at the doctor’s office, duration of hypertension, risk factors, complications, accompanying diseases, previous antihypertensive treatments, complaints), laboratory blood tests and ABPM were optionally performed; visits 2 and 3: blood pressure and heart rate measured at the doctor’s office, adverse events, patient’s evaluation about the way they felt themselves, treatment, optionally performed laboratory blood tests and ABPM. Patients were asked to take perindopril-amlodipine fixed combination tablets in the mornings; the dose was increased if no normalization of blood pressure was observed. Data were analyzed with a one-sample t-test. The consistency of the different frequency distributions was tested with a Chi-square test. The two-sided level of significance was set at 5%. Results - All the parameters sensitive to treatment efficacy (blood pressure values measured on-site and with ABPM) were significantly improved with perindopril-amlodipine fixed combination treatment. Blood pressure measured at the doctor’s office reduced from 158/93 mmHg to 132/80 mmHg, while 24-hour mean blood pressure reduced from 145/84 mmHg to 128/76 mmHg (p<0.001), the diurnal index sensitive to blood pressure variability did not change and a dipper curve was observed throughout the study. Target blood pressure (<140/90 mmHg) was reached by 75.5 % of the patients. The mean dosage at the end of the study was 8 mg perindopril and 7.3 mg amlodipine. The results were consistent across subgroups of different previously received treatments and cardiovascular risks. Regarding laboratory findings, the reduction of total cholesterol from 5.67 to 5.21 mmol/L and that of LDL cholesterol from 3.18 to 2.83 mmol/L (p<0.001 for both) were of clinical importance. Eighty-five percent of the patients evaluated the way they felt themselves as excellent or improved. No serious adverse events were reported. Conclusion - Perindopril-amlodipine fixed combination can be administered effectively and safely to a large population of hypertensive patients who do not reach target blood pressure values.]

Hypertension and nephrology

[Hypertension and atrial fibrillation. Part 3. Screening of atrial fibrillation with active involvement of patients. New telemedicine devices]


[In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regaining increasing role. The author provides a detailed description of a number of reliable, validated - working on smart phones or without her solutions - equipment with pulse or ECG recording and the irvalue in every day clinical practice. They promote closer physician - patient cooperation and signal the future of prevention and care of atrial fibrillation. In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regain in gin creasing role.]

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

[Diagnosis of hypertension and target levels in mirror of the newest recommendations]


[In the past year, many societies published new recommendations in the field of hypertension. The European Society of Hypertension and the European Society of Cardiology (ESH/ESC) published a comprehensive guideline in July 2013, providing an elaborate description of the diagnosis of hypertension. The clinical practice guideline of the American Society of Hypertension and the International Society of Hy per - tension (ASH/ISH) contains a brief set of recommendations, and explains the diagnostic approach to hypertension in a less detailed manner. The Eighth Joint National Committee (JNC8) focuses on certain aspects of hypertension using rigorous evidence- based methodology. This article displays some of the corresponding and disparate recommendations of the three guidelines.]

Lege Artis Medicinae

[The impact of telemedicine on the development of doctor-patient relationship based on interviews conducted among physicians]

BÁN Attila

[Introduction - The doctor-patient relationship has always been an essential part of health care, however, in parallel with the integration infocommunication technologies in health care the doctor-patient communication is also transforming. Therefore, the aim of the study is to examine the effect of telemedicine on this relationship. Methods - During the study, we applied qualitative research methods and a total number of 58 semi-structured interviews (45 men, 13 women) were conducted among physicians having experience in telemedicine. The majority of the interviewees were radiologist, general practitioners, and internists. The interview questions concerned that what characterises the doctor-patient relationship in telemedicine. Results - The interviews pointed out that in teleradiology the doctor-patient relationship depersonalises and almost terminates. In this respect, the problem is often the incomplete clinical information about the patient. In turn, telemonitoring can bring a quality change in the doctor-patient communication and through remote contact the patients’ satisfaction, the sense of security, and the doctor-patient relationship will be further enhanced. Conclusions - In accordance with the academic literature - based on the research results - there is no clear evidence that telemedicine would affect doctor-patient communication only positively or only negatively. In some areas of telemedicine, this relationship is reducing (e.g. teleradiology) while in other areas it could be fur-ther strengthened (e.g. telemonitoring).]