Hypertension and nephrology

[Therapy resistant hypertension in clinical practice]

FEJES Imola1, ÁBRAHÁM György1, LÉGRÁDY Péter1

SEPTEMBER 10, 2016

Hypertension and nephrology - 2016;20(04)

[Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to a paper in 2011, the prevalence of resistant hypertension is 2.9-43%. Analyzing only the therapy of hypertensive patients of an Hypertension Outpatient Clinic of the University of Szeged authors wanted to answer these main questions. How many patients were therapeutically resistant by definition? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached the goal systolis blood pressure values? How many fold drug combinations were used generally? Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analyzed, of all cases only one visit. If someone returned more times during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140/ mm Hg. By the definition 234/310 (76%) patients had resistant hypertension in this population (158±17/97±8 mm Hg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136±20 mm Hg) and 134 of them (52% of 257 patients) reached the goal. A fourfold combination of antihypertensive agents was the most frequent in this population. It is advised to use multiple drug combinations to reach the goal blood pressure and it is recommended to spend enough but not longer than necessary time to find the most effective combination in every case. In resistant cases it is always necessary to investigate the background of it.]


  1. Szegedi Tudományegyetem, Általános Orvostudományi Kar, I. sz. Belgyógyászati Klinika, Nephrológia-Hypertonia Centrum, Szeged



Further articles in this publication

Hypertension and nephrology

[The CARDI-COG Study]

POÓR Ferenc

Hypertension and nephrology

[Celebrating the 90th Birthday of Professor Edit Gláz]

KÉKES Ede, KISS István

Hypertension and nephrology

[Letter to our Readers]

KÉKES Ede, KISS István

Hypertension and nephrology

[A new, effective tool in the treatment of hypertension in light of the available evidence]

MASSZI Gabrilella

[Hypertension is important even in the group of common diseases. Cardiovascular mortality could be significantly reduced if high blood pressure could not only be treated, but controlled as well. The newly introduced fixed combination perindopril-amlodipin-indapamide medication could be a good tool for genereal practitioners, specialists in internal medicine and cardiologists. Combined treatment with the ACE inhibitor perindopril, the new vasorelaxant type diuretic indapamide and the third generation type Ca-chanel blocker amlodipin is effective in reducing blood pressure. Besides effectivity the organ protective pleiotrop qualities (cardioprotective, plakk stabilising, antiatherosclerotic, antithrombotic, stroke preventive, endothel dysfunction reducing, renal protetcion granting) provide a long lasting beneficial impact on life expectancy and a better quality of life to the patients. If we choose the right dosage, we could raise the compliance level of patients resulting in excellent degrees of compliance. In our article we wanted to draw attention to the major evidencies which are the best acknowledgements of this triple combination although we didn’t explore all avenues.]

Hypertension and nephrology

[Prevalence of overweight and obesity in hypertensive patients]

KISS István, PAKSY András, KÉKES Ede

[Authors had performed an anthropometric analysis using a database of 2011-2013 of Hungarian Hypertension Register. They analyzed overweight and obesity in relation of age. The results were compared with similar analysis conducted in the total population 2015. They analyzed the prevalence of visceral obesity as well using the waist circumference measurement categories and these were also compared with screening data of total population. The prevalence of overweight and obesity was very high in both genders, co-occurrences exceeded 70% between 45-70 years. The prevalence was significantly higher in hypertensives, than in the total population. The prevalence of visceral obesity measured by waist circumference was also high, especially in women whose reached 50% of cases. They observed a significant difference between hypertensive and total populations In category „danger” of visceral obesity]

All articles in the issue

Related contents

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

[The new European ESH/ESC guidelines - Part II. Therapy]


[The most important features of the new European joint hypertension guidelines of the European Society of Hypertension (ESH) and European Society of Cardiology became available as lectures 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 its most important therapeutic suggestions.]

Lege Artis Medicinae


NAGY Viktor

[The benefit of blood pressure lowering to high risk cardiovascular patients is proven. Thiazides are first line agents of blood pressure lowering treatment. Indapamide has both thiazide-like and vasodilator effects. Randomized controlled trials have shown that slow release indapamide of 1.5 mg efficiently lowers blood pressure, as well as the risk of various cardiovascular events (left ventricular hypertrophy, secondary stroke, progression of nephropathy etc.). Due to the low dose, the drug is well tolerated. Slow release indapamide is therefore an ideal choice as monotherapy for the beginning of blood pressure lowering treatment, and it is also a base drug of combination treatments.]

Hypertension and nephrology

[Hypertension and left ventricular hypertrophy]


[Left ventricular hypertrophy (LVH) is defined as an increase in the mass of the left ventricle. In addition to the absolute increase in mass, the geometric pattern of LVH also may be important. LVH can be secondary to an increase in wall thickness, an increase in cavity size, or both. LVH as a consequence of hypertension usually presents with an increase in wall thickness. This increase in mass predominantly results from a chronic increase in afterload of LV caused by the hypertension, although there is also a genetic component. A significant increase in the number and/or size of sarcomeres is the main pathologic mechanism, but hypertension may also result in interstitial fibrosis. The estimation of mass is commonly derived from measurements obtained by echocardiography. LVH is associated with increased incidence of systolic and/or diastolic dysfunction, heart failure, myocardial infarction, ventricular arrhythmias, sudden cardiac death, aortic root dilatation, and a cerebrovascular event. The cardiovascular risk is directly related to the degree of mass. The regression of LVH is associated with a reduction in cardiovascular risk and improved cardiac function. Regression of LVH is associated with weight loss, dietary sodium restriction, and use of ACE inhibitors, ARBs, some calcium channel blockers, and some sympatholytic agents.]

Clinical Neuroscience

[The effect of angiotensin receptor blockers in cerebrovascular disorders and dementia: Bonus in addition to the antihypertensive effect]


[Hypertension and dementia are frequent disorders or rather syndromes. Their incidence is growing with advancing age and hypertension is increasing the risk of cognitive impairment too, while treating hypertension (i.e. the use of antihypertensive medications) is decreasing it. In addition, hypertension is the most important risk factor for stroke. The renin-angiotensin system (RAS) has a special role in the development of hypertension and also involved in the pathogenesis of the most frequent dementia form, namely Alzheimer’s disease. The effect of angiotensin convertase inhibitors and angiotensin receptor blockers (ARB) is based on the inhibition of the RAS, but the ARBs do not inhibit angiotensin formation, just blocking its harmful effects on the AT1 receptor, while allowing the activation of AT2 receptors with pleiotropic effects. Preclinical, epidemiological and clinical therapeutic studies suggest this additional effect of ARBs and these are summarized in this review.]