LAM Extra for General Practicioners

[About vitamin D - let’s combine!]

HONTVÁRI Lívia

FEBRUARY 18, 2014

LAM Extra for General Practicioners - 2014;6(01)

[Vitamin D deficiency is a worldwide health problem. On the basis of the recommendations of the latest vitamin D consensus conference, we would like to draw attention to the significance of prevention as well as the recognition and treatment of vitamin D deficiency. We mention that some antipo-rotics designated “prefix” or “combi” are available that may ensure adequate calcium and vitamin D intake, thus improving patient’s adherence.]

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Further articles in this publication

LAM Extra for General Practicioners

[SECONDARY OSTEOPOROSIS IN GASTROINTESTINAL DISEASES]

FUSZEK Péter

[Gastrointestinal disease is often overlooked or simply forgotten as a cause of osteoporosis. In a number of gastrointestinal diseases, sometimes because of the medicines used for their treatment, malabsorption syndrome may occur. Malabsorption might lead to insufficient absorption of calcium, phosphate, magnesium, vitamin D, vitamin K and proteins, which can cause osteopenia, osteoporosis and osteomalacia. In this paper, we aim to review the gastroenterological diseases that can lead to osteoporosis and treatment strategies.]

LAM Extra for General Practicioners

[How to detect it? Dementia screening in primary care]

KÁLMÁN János, PAPP Edina, PÁKÁSKI Magdolna

[The early stage of dementia, the diagnostic and clinical importance of prodromal stages of dementia have been increasingly recognised in the past few years. Nowa­days, simple, rapid, easy to use cognitive screening tests are available, such as the recently developed Early Mental Test and the standardised Mini-Mental State Exami­nation, Clock Drawing Test, which could help general practicioners in the recommended regular dementia screening. The aim of this review is to help general practicioners understand the nature and importance of prodromal and manifest stages of dementia syndromes, and to summarise the characteristics, advantages and disadvantages of dementia screening tests that can be used in primary care. In addition, practical hints are also integrated regarding the diagnosis, screening and referral of persons with high risk for dementia. ]

LAM Extra for General Practicioners

[Contact lens wear ]

TAPASZTÓ Beáta

[The improvement of contact lens materials and types have made it possible to use contact lenses for visual rehabilitation besides optical and cosmetic use, The high oxygen permeability of contact lenses have extended the age limits for contact lens wear and encouraged clinicians to use them for therapeutic purposes, especially for pain relief and aiding cornea epithelialisation. Con­tact lenses can be worn safely for years if rules of hygiene are followed. Their use is most frequently abandoned because of contact lens related dry eye. Despite the high oxigen permeability, their prolonged wear increases the risk of inflammation.]

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Hypertension and nephrology

[Is there a role of triple combination in the therapy of hypertension? - Antihypertensive efficiency of perindopril-amlodipine-indapamide]

PÁLL Dénes, SZÁNTÓ Ildikó, PARAGH György, KATONA Éva

[Blood pressure reduction to target level decreases cardiovascular morbidity and mortality. However, in the vast majority of cases, this can be achieved only with a (multiple) combination regimen. The primary objective of the PAINT (Perindopril- Amlodipine plus Indapamide Combination for Controlled Hypertension Non-intervention Trial) study was to evaluate the efficacy of combination therapy with perindopril, amlodipine, and indapamide in patients who had not reached target blood pressure with their pre-existing therapy. Secondary objectives included the monitoring of metabolic parameters and the number of antihypertensive tablets taken by the subjects. In this subgroup-analysis we involved 126 patients (74 females and 52 males, mean age 59.8±12.5 years) who had a valid 24-hour ambulatory blood pressure monitoring both at baseline and at the end of the 4-months follow-up. At the beginning of the study none of the subjects reached blood pressure target despite taking on average 2.4±1.4 antihypertensive drugs. During the study, the subjects received the combination of amlodipine, perindopril, and indapamide instead of their pre-existing antihypertensive regimen. 24-hour mean systolic blood pressure decreased from 139.2±13.4 mmHg to 126.5±12.9 mmHg (p<0.01), as well as mean diastolic blood pressure from 77.3±11.3 mmHg to 71.1±8.7 mmHg (p<0.01). Heart rate remained unchanged. Blood pressure reduction was statistically significant both during the day and the night. We found significant blood pressure reduction in all hours (10.1-15.4/5.1-7.8 mmHg; p<0.001). Hyperbaric impact decreased from 366.9±251.1 mmHg × hour to 166.2±185.4 mmHg × hour (p<0.01) for systolic blood pressure, and from 112±130.6 mmHg × hour to 41.6±65.6 mmHg × hour (p<0.01) for diastolic blood pressure. We also could observe favourable changes in metabolic parameters, not only in lipids, but also in blood sugar level. The mean number of tablets taken by the subjects increased from 2.4 to 2.9, but this led to a significantly improved control of blood pressure. Triple combinations of state-of-the-art antihypertensive agents - such as of perindopril, amlodipine and indapamide - ensure effective blood pressure control in sufficiently compliant patients.]

LAM Extra for General Practicioners

[Advantages of fixed Combinations in the treatment of Hypertensive patients ]

FARSANG Csaba

[In 60-70% of patients with hypertension, a significant decrease in blood pressure can only be achieved by a combination of antihypertensive drugs. International as well as national guidelines emphasise the numerous advantages and the importance of combination treatment. Fixed combinations are particularly advantageous, as their use improves patients’ compliance. This paper summarises the available information on the possible combinations of the nine major antihypertensive drug groups distributed in Hungary, and for details the results published on the recently approved and introduced fixed combination of telmisartan and amlodipine.]

Hypertension and nephrology

[Cardiovascular prevention in hypertensive patients - use an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker?]

BARNA István

[The primary aim of cardiovascular prevention is to reach adequate blood pressure control. To prevent the development of target organ lesion it is essential to use long-acting, well tolerable drugs without significant side effects. Angiotensin-converting enzyme (ACE) inhibitors are popular and excellent preparations but their side effects reduce life long patient compliance. Angiotensin II receptor blockers (ARBs) are effective drugs having unique tolerability and a capability to reduce cardiovascular morbidity and mortality to the same extent as the ACE inhibitors. Especially high risk patients benefit from their combination with thiazide diuretics or with calcium channel blockers. Clinical trials proved that telmisartan can be safely given and well tolerable alone or in combination to high risk cardiovascular patients, in heart and renal, peripheral vascular and cerebrovascular diseases combined or not with diabetes.]

LAM KID

[About vitamin D - let’s combine!]

HONTVÁRI Lívia

[Vitamin D deficiency is a worldwide health problem. On the basis of the recommendations of the latest vitamin D consensus conference, we would like to draw attention to the significance of prevention as well as the recognition and treatment of vitamin D deficiency. We mention that some antiporotics designated “prefix” or “combi” are available that may ensure adequate calcium and vitamin D intake, thus improving patient’s adherence.]

LAM KID

[„HOPE for people with fracture”: Results of the HOPE (Hungarian Osteoporosis Project for Elderly) study]

SPEER Gábor, NÁDAS Katalin, FERENCZ VIKTÓRIA, MÉSZÁROS SZILVIA, HORVÁTH CSABA, BORS Katalin

[We conducted a multicentre, prospective, single cross-sectional, 12-month, open-label study for the assessment of treatment satisfaction using TSQM (Treatment Satisfaction Questionnaire for Medication) for zoledronic acid therapy used in patients with osteoporosis, who suffered minor traumatic fractures. PATIENTS AND METHODS - In total 1736 patients from 94 centers completed the study and filled in the TSQM questionnaire at both visit 1 and visit 2. TSQM is suitable for measuring the patient’s satisfaction with a treatment, by evaluating side-effects, efficacy and convenience of the treatment and the patient’s overall satisfaction rated on a scale of 0 to 100. RESULTS - Patients included in the study previously received a mean of 1.58 other therapies for osteoporosis and their case history included a mean of 1.24 fractures. This real-life study demonstrated that even one year of zoledronate treatment significantly (p<0.0001) improved the satisfaction of patients regarding efficacy (a mean change from a score of 56.15 to 70.89) as well as the occurrence of side-effects on a TSQM score. Regarding the convenience of treatment, the mean score increased from 62.96 to 79.34 (p<0.0001), whereas the overall treatment satisfaction changed from 59.3 to 75.48 by visit 2 (p<0.0001). CONCLUSIONS - Our study demonstrated beneficial TSQM results associated with zoledronic acid treatment, which is a basic requirement for appropriate adherence as well. ]