Hypertension and nephrology

[The measurement of blood pressure variability with „visit-to-visit” method in the OPAL study]

KÉKES Ede, KISS István

SEPTEMBER 20, 2014

Hypertension and nephrology - 2014;18(03-04)

[Authors reanalysed the 2 years-data of OPAL study for evaluation of change in blood pressure variability. The visit-to-visit form of long term measurement method was selected for characterization of the variability. The decrease of blood pressure fluctuation due to antihypertensive treatment was measured with the standard deviation of mean values and the variation koefficient. According to our observation the combined ACE inhibitor + amlodipine therapy was effective not only in the respect of systolic and diastolic target pressure, but - with continuous reduction - the BPV indices reached the level of normotensive subjects in the end of first year of treatment.]



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[The Effects of Blood Pressure Reduction on Intracranial and Extracranial Hemorrhages in Antithrombotic Therapy Patients: the PROGRESS Study]


Hypertension and nephrology

[Visualization of glomerular filtration in animals in vivo - significant filtration in afferent arteriola. Regulation of endothelial permeability]


[Recently we have in vivo visualized glomerular filtration and fluid flow from the JGA portion of afferent arteriole into JGA using intravital multiphoton microscopy. Fluorescence of the extracellular fluid marker lucifer yellow appeared in the interstitium around the distal portion of afferent arteriole before the filtration into Bowman's capsule. In isolated microperfused JGA we demonstrated fluid movement from the glomerulus into the MD tubule. All these prove that there is a significant and dynamic fluid flow exists in the JGA. Angiotensin II similar to VEGF plays a role in regulation of permeability/fenestration formation. Angiotensin II acts through AT1 receptor and PV-1 protein synthesis.]

Hypertension and nephrology

[Treatment of high blood pressure in praxis and beyond. Hypertension praxis model]

ÁDÁM Ágnes

[Author presents a hypertension care model in the general praxis. Hypertensive patients and those with diabetes, hyperlipidemia and obesity, OSAS and the therapeutic results with these care model system for three years was analysed. The target blood pressure was achieved in a great rate in all patient’s groups. the elements of therapeutic success was analysed.]

Hypertension and nephrology

[Local importance of Hantavirus infections in mirror of the latest virological, epidemiological and clinical results]

NÉMETH Viktória, OLDAL Miklós, SEBÕK Judit, WITTMANN István, JAKAB Ferenc

[Hantaviruses are widespread infectious agents carried by different rodent species. The majority of them belongs to viral zoonotic pathogens, sometimes causing severe human infections. Hantaviruses inflict hemorrhagic fever with renal syndrome in Eurasia and supposedly in Africa, and hantavirus cardio-pulmonary syndrome in the Americas. The relationship between the virus and its host species is a result of a several million year co-evolution. Although virus replication is most intense in the infected rodents' lungs, these animals do not develop disease, instead they carry and spread the pathogens throughout their lifetime by body fluids. In the majority of infections, the virus gets into the human body by vaporization of rodent body fluids or by direct contact. In Europe, Puumala (PUUV) and Dobrava-Belgrade (DOBV) hantaviruses are the most abundant hantaviral infectious agents. There are numerous studies described the presence of different genotipes of hantaviruses circulating in Hungary. Although the number of clinical and epidemiolgical studies are limited, the medical importance - especially in a high risk population - of these viruses are unqustionable. There are a variety of methods to identify hantaviral infections. Molecular biological methods (RT-PCR) - also enabling genotyping - and virus neutralization tests proved to be the most reliable tools. The latter technique requires virus culturing, which can only be carried out in high-containment laboratories.]

Hypertension and nephrology



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Related contents

Hypertension and nephrology

[The advantages of a fixed combination of lisinopril with amlodipine in patients with primary hypertension]


[Background: The aim of the study was to examine the effect of amlodipine, lisinopril and a fixed low-dose combination of amlodipine + lisinopril on the performance of the daily profile, blood pressure variability and heart rate variability in patients with PH stage I-II, 1-2 degrees. The diagnosis of PH was made in accordance with the classification of JNC USA in 2003, ESH, ESH 2007 on the basis of careful clinical and instrumental investigations. Methods: The study included 75 PH patients who were divided into three groups depending on the medication received. The first group included 23 patients treated with lisinopril, the second included 27 patients treated with amlodipine, and the third included 25 patients receiving a fixed combination of amlodipine + lisinopril. Drugs were administered once daily with dose titration for lisinopril effective for 10 to 20 mg (mean 15.6±2.2 mg), for amlodipine 5 to 10 mg (mean 7.8±1.1 mg), and Lisonorm administered in a standard fixed dose (lisinopril 10 mg, amlodipine 5 mg), once in the morning. Controlled treatment lasted for 12 weeks. The study used daily blood pressure monitoring and ECG Holter monitoring methods. Results: A comparison of side effects found that combined therapy significantly reduced the number of adverse reactions. For all three groups, treatment resulted in a significant decrease in the average daily, daytime and night-time BP values and in the variability of systolic and diastolic BP. With combined therapy, these changes were more significant. Conclusion: These positive changes appear to be due to the fact that combination therapy can affect several parts of the pathogenetic development of hypertension, compared with the effects of monotherapy, with superior results. In the combination therapy, lisinopril levelled the sympathetic stimulation of amlodipine by blocking the activity of the sympathoadrenal and renin-angiotensin-aldosterone system.]

Hypertension and nephrology

[Hypertension and brain function. Correlation of high blood pressure and demencia in aging. Hypertension in young-middle adults - demencia in elderly]


[The cerebral vascular damage caused by hypertension is manifested primarily in cognitive dysfunction, which is caused by hypoperfusion of brain tissue, ischemic, or bleeding stroke, or white matte injury. Hypertension may not only result in cerebral damage to the vascular background - dementia -, but may also contribute to the development and progression of classical gene-related Alzheimer’s disease. Blood pressure gradually increases in the elderly and in the very elderly, and the frequency of hypertension-mostly as isolated systolic hypertension - is 50% to 70%. High blood pressure predominately, or in full, means not only an increase in the circulatory resistance of the small children, but also, as part of the aging of the body, the rigidity (stiffness) of the arteries. At the same time, the incidence of dementia, along with age, rises sharply - up to 20% in those over 65 years of age, and over 40% in 80-90 years of age. The relationship between high blood pressure and dementia from the young age to the very old age may change as a function of current age. In the very old age of life, the varying influence of other pathological factors other than hypertension is becoming more and more important in the deterioration of both the vascular structure and the brain function. In this late stage of life, the very advanced rate of aging and nutritive blood flow often require higher perfusion pressure, and the not enough thought-out blood pressure reduction can be more damaging than a protective effect on brain condition or function. SPRINT MIND - the Intense Blood Pressure Reduction - hasn’t resolved the question, and we can legally assume that the 130-140 Hgmm SBP. Is the most favorable for dementia. The value of DBP 70 Hgmm is definitely unfavorable.]

Hypertension and nephrology

[Cardiovascular risk caused by chronic obstructive pulmonary disease in patients with hypertension]

KISS István

[According to World Health Organization data 250 million people suffer from chronic obstructive pulmonary disease (COPD) worldwide, and the diseases accounts for 5% of total mortality. It is the only cause of death with increasing incidence and is estimated to be the third most prevalent one after stroke and myocardial infarction by 2030. In Hungary the estimated number of patients is 500 000 and projected to the number of habitants the highest number of death is caused by COPD in our country in Europe. Hypertension is a public health problem also in Hungary and it is estimated that 2.5-3.5 million adult are affected. Most of them are not aware of their disease or their treatment is insufficient. Hypertension also accounts for a great percentage of cardiovascular morbidity and mortality. Coincidence of the two diseases is significant in the adult population. According to international data the prevalence of COPD among patients with hypertension is similar to that of the general population, thus the coincidence of the two diseases may affect 2.5% of the adult population. Separate guidelines are available for the diagnosis and the treatment of the diseases, however these issues are not discussed jointly neither in international nor in Hungarian guidelines. In this review epidemiology of coincidence, the raising effect of COPD in cardiovascular risk and the potential therapeutic suggestions are summarized.]

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.]

Hypertension and nephrology

[Therapy of isolated systolic hypertension III.]


[In the elderly and very elderly (˃80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE-inhibitors/ARBs with calcium antagonists, and in special cases diuretics and beta blockers are also suggested by recent European guidelines (ESH, HSH). The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.]