Hypertension and nephrology

[The selective imidazoline I agonist rilmenidine in the combined antihypertensive therapy]

KÉKES Ede

MARCH 20, 2015

Hypertension and nephrology - 2015;19(01)

[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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Hypertension and nephrology

[Role of activated cells and local inflammatory mechanisms in the development of hypertension]

LELBACH Ádám, KOLLER Ákos

[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.]

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

[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.]

Hypertension and nephrology

[Monitoring of effectiveness of ramipril-amlodipine fixed combination in metabolic syndrome, a non-interventional trial (The RAMSES Study)]

TOMCSÁNYI János, SIMONYI Gábor

[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. ]

Hypertension and nephrology

[Antihypertensives: Should They be Taken in the Morning or in the Evening? ]

KISS István, KÉKES Ede

Hypertension and nephrology

[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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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

VÁLYI Péter

[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[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

[Monitoring of the blood pressure lowering effectiveness of ramipril-amlodipine fix combination – a non-interventional trial (RAMONA study)]

TOMCSÁNYI János

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Lege Artis Medicinae

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]

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[Chronic obstructive pulmonary disease is a very common comorbidity of hypertension and it is often unrecognised by physicians. The factors involved in the pathomechanism of both diseases should be realised when choosing treatment. Among factors, hypoxia, increased tone of sympathetic nervous system and activation of renin-angiotensin-aldosterone system should primarily be considered. Vascular wall damage and endothelial dysfunction has an important role in both conditions. The goals of treatment are elimination of risk factors, optimizing the blood pressure, the consequential prevention of cardio-cerebrovascular, renal and pulmonary damage; finally prolonging the patients’ life and improving their quality of life as well. Both hypertension and COPD significantly worsen the condition of COVID-19 patients since they increase the severity of the disease and the rate of in-patients’ and their mortality. In the treatment of hypertension among COPD and COVID-19 patients there must be emphasized the medication inhibiting of renin-angiotensin-aldosterone system, such as angiotensin-converting en­zyme inhibitors or angiotensin-II AT1 re­cep­tor antagonists. Special attention concerned the beneficial effect of mineralocorticoid receptor antagonist spironolactone. Other antihypertensive drugs (calcium channel blockers, thiazide-like diu­retics, high selectivity β1 receptor antagonists) may supplement the treatment if necessary. Long-acting β2 receptor agonists, muscarinic receptor antagonists and inhalation corticosteroids may be administered in double or triple combination also in hypertension and COPD as well. It is important to note, that statin therapy and also vitamin D3 improve the condition of COVID-19 patients.]

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