Hypertension and nephrology

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


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.]



Further articles in this publication

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.]

Hypertension and nephrology

[Physical training in dialysis population]


[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.]

Hypertension and nephrology

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


[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.]

Hypertension and nephrology

[Accredited Postgraduate Training]

Hypertension and nephrology

[Treatment of hypertension in kidney transplant patients]


[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.]

All articles in the issue

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Hypertension and nephrology

[Association between cyclothymic affective temperament and hypertension]


[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]

Hypertension and nephrology

[Gout, hyperuricaemia and cardiovascular risk - Effects of allopurinol]


[Hyperuricemia has an increasing clinical relevance due to its pathomechanism and its presence and adverse effects on cardiovascular, metabolic and renal diseases today. Its presence is a world phenomenon and in our country, we have seen increasing incidence rates during the screening surveys in recent years. Convincing evidence suggests that the high uric acid values in cardiovascular and renal diseases is an independent risk factor for CV mortality and their clinical manifestations. Experimental and clinical evidences indicates that in addition to gout, all high uric acid levels should be considered to initiate the XO inhibitor allopurinol treatment. Recently, in some diseases, in the treatment of the underlying disease (especially elderly hypertension, ischemic heart disease, chronic heart failure, chronic kidney failure) is also considered as an adjunct therapy.]

Hypertension and nephrology

[Focus on central arterial pressure. Beta blockers - one group of agents with different efficacy]

BARNA István

[Not only have beta blockers excellent antihypertensive effect but both in monotherapy and in combination they exert antiarrhythmic and antiischemic efficacy, as well. They are recommended on A level of evidence in the treatment of patients with primary hypertension. Certain beta blockers differ from each other considering their lipid solubility, membrane stabilizing effect and in many other characteristics which difference can be exploited in the treatment. Nebivolol increases the release of nitrogen oxide, it is metabolically neutral and has vasodilating and antioxidant effect. The consequence of the stiffness of the arterial wall is the rise of systolic blood pressure, the diminshed diastolic circulation in the coronary vessels, the increase of the central pulse pressure and the frequent occurrence of cardiovascular diseases. Various antihypertensive agents have different mode of action on central blood pressure and arterial stiffness. Comparing nebivolol/atenolol and nebivolol/bisoprolol, respectively, nebivolol decreased aortic pulse pressure with greater efficacy than other beta blockers. The extent of the reduction of blood pressure was the same in the nebivolol and atenolol group while the augmentation index decreased significantly among the patients receiving nebivolol. In addition to the well known beneficial effects of nebivolol recent studies proved another, yet still unknown and unique characteristic of this agent, i.e. favourable influence on arterial stiffness. It not only improves endothelial dysfunction which has emphasized role on development of atherosclerosis but - independently of its antihypertensive effect - it has favourable action on arterial stiffness, too. These features guarantee a decisive position in the treatment of arterial hypertension.]

Hypertension and nephrology

[The importance of statin therapy in hypertension]

PARAGH György, PÁLL Dénes

[Hypertension and hypercholesterolaemia often co-occur and promote early cardiovascular disease. Previous studies have shown that antihypertensive treatment may be more effective if LDL cholesterol is also reduced. This may be due to the increased expression of angiotensin-1 receptor in hypercholesterolaemia, which increases peripheral vascular resistance through angiotensin-2, and adversely affects endothelial and smooth muscle cells. Other authors indicate that high cholesterol levels increase the production of angiotensin-2 through the activation of the chymase system. High cholesterol levels increase the amount of circulating oxidized LDL which binds to the transmembrane oxidized LDL receptor (LOX- 1) also activates the angiotensin-1 receptor. In addition, angiotensin-2 has an effect on intracellular cholesterol synthesis by enhancing the key enzyme of the synthesis of intracellular cholesterol, HMG-CoA reductase. The authors present the studies that support cholesterol lowering can contribute to lowering blood pressure and other major meta-analyses in which the beneficial effects of cholesterol lowering and lipid lowering on blood pressure reductions were not proven. In the background, it may well be that these studies are not designed to evaluate the effect of cholesterol-lowering drugs on hypertension in patients with hypercholesterolaemia, and non-statin-treated patients are not randomized.]

LAM Extra for General Practicioners



[Administration of the alpha-glucosidase enzyme inhibitor acarbose leads to a prolonged absorption of carbohydrates, which has a smoothing effect on blood glucose excursions, and results in a more even daily blood glucose profile. The glucose lowering effect is mainly due to the reduction of postprandial blood glucose levels. Non-glycaemic effects of acarbose, including those on blood pressure, lipids and the coagulation system are also clearly beneficial. According to the available data, the preparation also reduces cardiovascular risk. If used as a monotherapy, acarbose does not cause hypoglycaemia. Flatulence and diaorrhea represent the main side effects. From a professional point of view, acarbose should be given if postprandial blood glucose excursions exceed 2.2 mmol/l.]