Hypertension and nephrology

[Unattended automated office blood pressure measurement versus classic office automated blood pressure measurement in a hypertension outpatient clinic]

LÉGRÁDY Péter1, FEJES Imola1, CZOMBOS András1, ÁBRAHÁM György1

NOVEMBER 01, 2021

Hypertension and nephrology - 2021;25(05)

[Accurate measurement of blood pressure is a fundamental prerequisite requirement for an appropriate management of arterial hypertension. In order to eliminate the well-known limitations of classic office blood pressure measurements, the so-called unattended automatic office blood pressure measurement method can be a solution. In 52 patients arriving for regular followup into one of the Hypertension Outpatinet Clinic of the Nephrology-Hypertension Center of the University of Szeged 3-3 blood pressure measurements were made at 1-1 minute intervals first by a doctor with an MIT5 automatic device and then in a separate room unattended, starting alone by the patient with a Hem-907 device. ]

AFFILIATIONS

  1. Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Általános Orvostudományi Kar, Belgyógyászati Klinika, Nephrologia-Hypertonia Centrum

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Hypertension and nephrology

[Subtype diagnosis, treatment, complications and outcomes of primary aldosteronism and future direction of research: a position statement and consensus of the Working Group on Endocrine Hypertension of the European Society of Hypertension – excerpts]

KOVÁTS Viktória, ALFÖLDI Sándor

[Primary aldosteronism is a frequent cause of secondary hypertension requiring a specific pharmacological treatment with mineralocorticoid receptor antagonist or with unilateral adrenalectomy. These treatments have shown to reduce the excess of cardiovascular risk characteristically associated with this disease. In this consensus, we discussed the procedures for the diagnosis of primary aldosteronism, we address the strategies for the differential diagnosis of primary aldosteronism subtypes and therapy. We also discuss the evaluation of outcomes and provide suggestions for follow-up as well as cardiovascular and metabolic complications specifically associated with primary aldosteronism. ]

Hypertension and nephrology

[Effect of beta-blockers with or without vasodilating properties on central blood pressure]

BENCZÚR Béla

[Beta-blockers are more and more excluded as frist-line option in recent hypertension guidelines – they are mainly used in the case of compelling indication. However beta-blockers are not a homogeneous drug-class as several differences exist between them regarding their effect on metabolism or vasoconstriction/vasodilation. The clinical implication of central blood pressure has recently arisen into the focus of interest in the light of the fact that different antihypertensives exert different effect on central blood pressure. The theory of ”stiffness-gradient” may help us to deepen our knowledge regarding the physiology of central blood pressure. Several studies investigated the effects of different beta-blockers on central blood pressure. Based on the unique effect of beta-blockers with vasodilating properties it can be emerged to form this group of drugs as a new antihypertensive class. ]

Hypertension and nephrology

[Beyond the diagnosis – the value of renal biopsy in clinical practice through the example of two glomerular diseases]

DOBI Deján

[In this review, the publications that established the value of renal biopsy in nephrology are referenced, the pathomechanism of lupus nephritis (LN) and IgA glomerulonephritis (IgAGN) is briefly summarized, and a detailed account is given on the previous and currently accepted classification systems of LN and IgAGN and on the prognostic relevance of these systems. ]

Hypertension and nephrology

[Hypertension, cognitive function and dementia – Significance of antihypertensive therapy]

GAJDÁN Nikolett, ÁBRAHÁM György

[The significance of hypertension as one of the major cardiovascular risk factor is unquestionable. By achieving target blood pressure values differentiated by age and comorbidities, the risk of cardiovascular events can be significantly reduced. However, it is essential to the quality of life the patient spends the extra years of life thus gained. This is a really complex issue affecting many co-disciplines, but one of the most important of these is the mental health, maintaining cognitive functions, and avoiding dementia. High blood pressure impairs the blood supply to the target organs, including the brain, by damaging the smooth muscle of the arteries and accelerating atherosclerosis, which increases the risk, the frequency and the severity of mental decline in proportion to the degree of tension. This means serious implications not only for the individual, but for the family and the society, as well. A particular contradiction is that treating blood pressure to the target range does not automatically means preserving cognitive functions and avoiding the risk of dementia. Meta-analyzes of large studies have shown differences between the individual antihypertensive groups have been confirmed in this respect as well. Inhibitors of the renin-angiotensin system and calcium antagonists – mainly dihydropyridines – appear to be a priority in this regard. The authors provide an overview of the relationship between hypertension and mental abilities, with a review of the literature on the effects of antihypertensive therapy, with particular reference to the effects on cognitive function and dementia. ]

Hypertension and nephrology

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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.]

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

TOMCSÁNYI János

[Purpose: Monitoring the effectiveness and safety of the fix combination formulation Egiramlon® therapy containing ramipril and amlodipin in patients, suffering from mild or moderate hypertension despite antihypertensive treatment. Patients and methods: Open, prospective, phase IV clinical observational study, which involved 9169 patients (age >18) with mild or moderate hypertension [TUKEB No: 16927- 1/2012/EKU (294/PI/12.)]. Ramipril/Amlodipin 5/5, 5/10, 10/5, 10/10 mg combinations were administered/ titrated in three visits, during the four months period according to the physician’s decision Blood pressure was measured by validated blood pressure sphygmomanometry and ABPM (Meditech, Hungary). The dosis of the fix combination formulation was determined individually during the visits by the 923 doctors involved in the study. The target blood pressure value was 140/90 mmHg, but in case of high risk patients population (diagnosed cardiovascular disease, diabetes), 130/90 mmHg target value was determined. Results: In 70.1% of the patients had no protocoll deviation. Patients data and examination results were processed according to this 6423 patient population. The average age of the patients were 60.2 year, in 50-50% sex distribution. The average duration of the treated hypertension was 9.8 years and the average blood pressure value was 157/91 mmHg. Till the end of the study, systolic blood pressure has decreased with 26.4 mmHg and diastolic pressure with 11.8 mmHg. An average 5.5 bpm heart rate frequency decreasing was observed at the end of the study. As a result of the treatment 52.4% of the patient population has reached the target blood pressure value.]

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.]

Hypertension and nephrology

[May measurement month: analysis of the Hungarian results of years 2017 and 2019]

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[Cardiovascular (CV) diseases are not only the leading causes of mortality in Hungary, but also the mortality rate is excessively high compared with the average of European Union, so screening programs identifying subjects with elevated blood pressure (BP) is of utmost importance. May Measurement Month (MMM) is an annual global initiative which began in 2017 aimed at raising awareness of high BP. Hungary, through the Hungarian Society of Hypertension has joined the campaign of MMM from the beginning. The results of years 2017 and 2019 are presented in this paper. ]