Hypertension and nephrology

[The new European ESH/ESC guidelines Part I. Most important changes and cardiovascular risk]

FARSANG Csaba

SEPTEMBER 12, 2018

Hypertension and nephrology - 2018;22(04)

[The most important features of the new European joint hypertension guidelines of the European Society of Hypertension (ESH) and European Society of Cardiology (ESC) became available aslectures at the ESH meeting in Barcelona, in 2018 June, while the publication came out in the Journal of Hypertension and also in the European Heart Journal in August, 2018. Based on the published new guidelines I summarise the most important changes concerning cardiovascular risks and target blood pressures.]

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Hypertension and nephrology

[Hungary’s anthropometric position based on national public health screening (2010-2017). Data and correlation analysis - Part I.]

KÉKES Ede, BARNA István, DAIKI Tenno, Dankovics Gergely, †KISS István

[The aim of the study is to present a Hungarian anthropometric profile on a full-scale basis (body mass, BMI, waist circumference, waist/hip ratio, percentage of body fat, abdominal fat mass) based on the data of the “Nationwide Comprehensive Health Screening Program in Hungary 2010-2020” collected over 8 years. In the analysis we processed 70,094 women and 67,549 men. We found, that in the Hungarian society, overweight and obesity was on the rise between 2010 and 2017, and beyond 2014 its rate was ever higher. Growth of body fat and abdominal fat is characteristic for both sexes, but abdominal obesity in relative terms of waist size, waist/hip ratio and percentage of body fat is significantly higher in morbid obese women. The fact is particularly worrying that these growth trends are already present in age groups of 18-26. These signs warn us definitely that we need to take a greater part in influencing the lifestyle, eating habits of individuals and in the promotion of physical activity.]

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[The impaired physical activity and the related increased cardiovascular risk is caracteristic in all stages of chronic kidney diseases. The regular physical activity has a beneficial effect on the metabolic risks associated with chronic kidney disease, dialysis and poor activity lifestyle, it also has favorable effect on the inflammatory state, poor physical performance, muscle loss and can improve the quality of life and life expectancy. Accordingly, the international and Hungarian guidelines suggest at least 150 minutes physical activity with moderate intensity per week - at least five days, 30 minutes each day. But there are no particular guidelines for dialysated patients. This article, without being exhaustive, in part using our own experiences, present suggestions for the physical activity of dialysated patients.]

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[More than bodyguard? The ramipril/amlodipine FDC effect on their whole blood pressure spectrum]

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[Hypertension is a significant cardiovascular risk factor. Effective treatment of hypertension contributes to avoiding the risk of later cardiovascular complications. Rapid access to blood pressure targets is also important in new untreated hypertensive patients. In the new ESH/ESC Hypertension Recommendation - during the initiation of antihypertensive therapy - the immediate introduction of drug combinations is explicitly recommended. In our retrospective data collection study we studied the effect of the ramipril/amlodipine fixed combination on the 24-hour brachial and central blood pressure parameters of the fresh hypertensives.]

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[Accredited Postgraduate Training]

Hypertension and nephrology

[Treatment of hypertension in kidney transplant patients]

KOVÁCS Tibor, WAGNER László

[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

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LAM Extra for General Practicioners

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