Hypertension and nephrology

[What you need to know about the influence of abnormal lipid profiles. - New experiences]

CSÁSZÁR Albert

JULY 20, 2013

Hypertension and nephrology - 2013;17(02)

[Statins represent the most important drug among antilipidemic therapy modalities playing dominant roles against atherosclerotic burden. Statin’s outstanding importance is due partly to cholesterol lowering capacity, however their anti-inflammatoric, antiproliferative, antioxidant and vasodilatative efficacies as a pleiotropic potential indicates much more impact on prompt retardation of atherosclerotic progression. The results concerning statin pleiotropic influence are reviewed which are in association with their new indication in ACS management. The second part of this review delineates suspected side effects of statin use. Only one concern brings safety information: it is a fact that patients being treated with statins may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus, but the cardiovascular and mortality benefits of statin therapy exceed the diabetes hazard.]

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Hypertension and nephrology

[Practical aspects of therapy by erythropoiesis stimulating agents in renal anaemia]

DEÁK György, HERSZÉNYI Eszter, AMBRUS Csaba, KISS István

[Prevalence of renal anaemia due to insufficient production of erythropoietin increases progressively in the course of renal function deterioration. Renal anaemia is treated by erythropoesis stimulating agents (ESA). Outcomes of randomized clinical trials have taught us to avoid the strategy of normalization of hemoglobin (HGB) levels by ESA therapy as it may increase the risk of cardiovascular events and mortality. The Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anaemia published in 2012 recommends to start ESA therapy in the 90-100 g/l HGB range and suggests to keep HGB concentrations below 115 g/l. It is an inappropriate strategy to aim at normalizing hemoglobin (HGB) levels by ESA therapy because it may lead to progressive escalation of ESA doses even in the presence of diminished ESA responsiveness. High ESA doses and diseases causing ESA hyporesponsiveness eg. infections, chronic inflammation, malnutrition, insufficient dose of dialysis, severe hyperparathyroidism, iron deficiency are related to increased risk of mortality. KDIGO Clinical Practice Guideline for Anaemia emphasizes the importance of assessing and treating causes of ESA hyporesponsiveness, limits ESA dose escalation and recommends gradually changing ESA doses to avoid high amplitude HGB oscillation.]

Hypertension and nephrology

[Health Protective Screening Program of Hungary 2010-2020. Metabolic syndrome - Results in 2010-2012]

KÉKES Ede, BARNA István, DAIKI Tenno, DANKOVICS Gergely, KISS István

[1 597 163 health assessments were performed on 65267 persons as a part of screening program. 132 964 participants were participated in our lifestyle advice program. The number of questionnaire responses for health statue were 3 717 480 during three years. This publication presents the results of metabolic disorders explored by screening. The metabolic syndrome was characterized by visceral obesity, abnormal glucose level and elevated blood pressure. Reasonable suspicion of metabolic syndrome was occured in 33-38% of subjects. Where the positive criteria was present, there were higher values of investigated parameters (waist, glucose, cholesterol, systolic blood pressure, uric acide level) compared with those of negative criteria.]

Hypertension and nephrology

[HYVET: A Milestone Drug Study – The Clinical Study of the Year in 2008]

VÁRALLYAI Péter

Hypertension and nephrology

[Report on the Meeting of Young Hungarian Scientists in Hypertonology and Nephrology]

KIS Éva

Hypertension and nephrology

[Goals, doubts and confidences in treatment of renal anemia]

KISS István, SZEGEDI János, KULCSÁR Imre, DEÁK György, KISS Zoltán, REMPORT Ádám, AMBRUS Csaba

[The authors sum up the physiology of erythropoiesis, the history of the erythropoietin’s discovery and the steps through which it became applicable to clinical adaptation. The biologically similar erythropoietin medicines and their application are reviewed. The setting of the target hemoglobin value and the weekly amount of erythropoietin needed for successful therapy are briefly surveyed. The authors draw attention to the fact that by increasing the dose the risk of mortality rises. Considering the other side effects they conclude based on international data and studies that “less is more” in this case namely the lower target value and erythropoietin dose can mean bigger therapeutic success. The erythropoietin treatment’s practice in Hungary is expressly efficient in the authors’ view.]

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[Experiences with fix combination of amlodipin-atorvastatin according to the ESH/ESC hypertension recommendation 2013]

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[BACKGROUND - Hypertension is a widespread disease in Hungary and worldwide as well. Combination products containing more effective agents in one pill have an increasing role in the treatment strategy. One of the most often used products is Amlator, in which the advantageous features of amlodipine and atorvastatin are combined. METHOD - During my investigation I treated a patient with just diagnosed hypertension, prescribing Amlator 20/5 pill once a day. Blood pressure measurements were registered at home in a blood pressure diary. After two months laboratory and ABPM measurements were administered again. Gathered data was compared and changes were analysed. RESULTS - During the first ABPM measurement the mean blood pressure was 150/90 mmHg. Laboratory measurements showed a moderate increase in cholesterol level (6.1 mmol/l), lipid values were in the normal range (LDL 3.0 mmol/l, HDL 2.61 mmol/l) and hypertriglyceridemia wasn’t observed either (0.97 mmol/l). The blood pressures measured at home showed a significant decrease using the prescribed medication. During the first month the average blood pressure was 133/80 mmHg. This shows an 11.3% decrease of the systolic value. At the second monthly inspection a decrease in the cholesterol level was noted (cholesterol 5.0 mmol/l, LDL 2.31 mmol/l, HDL 2.2 mmol/l, triglyceride 0.96 mmol/l). This is a 14.7% decrease. The second ABPM measurement showed a significant decrease in both the systolic and diastolic blood pressure values. The average blood pressure was 124/78 mmHg, which means a 17.3% decrease of the systolic value. CONCLUSION - Amlator proved to be an effective treatment of both hypertension and hypercholesterolemia.]

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