[Drug treatment strategies, hypertensive urgencies and emergencies]
FARSANG Csaba1
FARSANG Csaba1
Szöveg nagyítása:
[In this paper I summarise the currently valid guidelines for the pharmacotherapy of hypertensive patients, and in separate part, those for hypertensive urgencies and emergencies.]
Lege Artis Medicinae
[The diagnosis of hypertension is important, as high blood pressure is the most frequent and consequently the most important risk factor of cardiovascular diseases leading to mortality. The basis of diagnosis is the correct blood pressure measurement. Recent guidelines underline the importance of out of office (home and ambulatory) blood pressure monitoring besides the traditional office measurements. These methods have not only additive prognostic value, but with the help of these measurements, special hypertension forms (white coat and masked hypertension) can be diagnosed. On top of all these, home monitoring increases the patient’s compliance to the therapy. This short review summarizes the most important information on blood pressure measurement.]
Lege Artis Medicinae
[As the first step in the transformation of primary care, the first communities of practice were set up to seek ways of expanding the competences, the range of equipment and the services provided by primary care. The structure of these no longer resembles the previous model of general practice, with teams of two or three doctors working in isolation from each other. The new form is a network of community practices. The care and management of hypertensive patients is a typical area of community work. In this article, the authors aim to illustrate the role of community practices in the care and management of hypertensive patients.]
Lege Artis Medicinae
[Childhood hypertension was previously regarded as a rare disease, caused primarily by renal or renovascular diseases. However, in the past 10-15 years due to increased prevalence of childhood obesity and the associated metabolic abnormalities, elevated blood pressure has become significantly more common. This highlights the public health significance of high blood pressure, and it also determines the screening protocols, which varies by age groups. The child's development should be taken into account when establishing normal blood pressure in childhood. In addition to the definition of hypertension, the characteristics of blood pressure measurements must also be known. Before adolescence, hypertension is most likely caused by an organic cause. During puberty and postpuberty, hypertension is primarily associated with obesity. The tests and their evaluation should be performed in a centre familiar with the examination of children, and where the childhood normal values are known. The goal of therapy is to prevent the organ-damaging effects of hypertension in a population where the disease is expected to persist for decades. Customized and realistic lifestyle changes are essential during treatment, but it may be necessary to introduce drug therapy as well. The medication should start as a monotherapy with the lowest necessary dose. If this does not achieve an adequate therapeutic effect, the treatment is supplemented with another class of antihypertensive medication.]
Lege Artis Medicinae
[Hypertension, which is the most important independent risk factor of cardiovascular mortality, affects approximately 3.5 million people in Hungary. Among them the rate of the unknown, known, but untreated or uncontrolled hypertensive patients is more, than 50%, a fact, which underlines the importance of screening and proper treatment. Since 2017, there is a difference in the classification of hypertension between Europe and the United States, based mostly on SPRINT study, which was published in 2015. However, in the treatment recommendations more similarities are present. Risk stratification must be the part of hypertension care. In risk communication as an alternative, the concept of vascular age was introduced, which mirrors more suggestively the patients' vascular hazard. In this review the author overviews the novelties in hypertension epidemiology, classification, and risk stratification.]
Lege Artis Medicinae
[Arterial aging is a physiologic process coexisting with general aging of the human body, however arterial age of a given individual can be different from his chronologic age. The underlying causes are determined by genetic factors, cell biologic processes and several risk factors. While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Therefore, it is necessary to refine the risk stratification at an individual level, the tools for this are biomarkers. Biomarkers are surrogate endpoints, which precede, substitute the real, hard endpoint clinical events. It has been proposed that numerous potential vascular biomarkers would have a role in primary and secondary cardiovascular prevention. Most of them fit in the concept of early vascular aging (EVA). Only carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity meet perfectly the strictest criteria against the biomarkers. The process of arterial aging may be decelerated and beneficially influenced with non-pharmacologic and pharmacologic treatment strategies.]
Journal of Nursing Theory and Practice
[The high blood pressure disease is one of the primary risk factors for the development of other cardiovascular diseases. The aim of the present study was to assess the medication habits, sleep quality, and quality of life of patients aged 45 and older living with hypertension.
Our study was a quantitative descriptive cross-sectional survey conducted in 2022 in the form of an online questionnaire among patients aged 45 and older suffering from hypertension (n=143). The data collection tools included the Morisky Medication Adherence Scale (8 items), the Pittsburgh Sleep Quality Index, EQ-5D-5L, and a self-designed questionnaire.
Lower age was associated with higher levels of medication adherence (R=-0.36; p=0.024). Patients who regularly visited their general practitioner showed more consistent medication intake (p=0.048). Adequate sleep quality positively influenced the quality of life (p<0.001).
Regular visits to the general practitioner not only facilitate medication adherence but also provide an excellent opportunity for patient education and health promotion. Therefore, it has paramount importance to draw the attention of hypertensive patients to the role of regular check-ups with their general practitioner, which can contribute to the prevention of complications arising from hypertension.]
Clinical Neuroscience
Posterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema, usually reversible, with the prominent involvement of the parietal and occipital lobes. The exact etiopathogenesis leading to PRES is unknown. Because signs of eclampsia and preeclampsia in neuroimaging often overlap and manifest as PRES, we aimed to evaluate whether demographic, clinical, and laboratory parameters predict PRES in patients with preeclampsia or eclampsia.
Hypertension and nephrology
[Hypertension and hyperlipidemia frequently coexist, and their interaction amplifies overall atherosclerotic cardiovascular disease risk. We aimed to investigate lipid abnormalities and their associations with body mass index (BMI) in a large adult hypertensive patient population with the help of data mining.]
Hypertension and nephrology
[Biological drugs-combined chemotherapy represents a real breakthrough in the effective treatment of locally advanced and metastatic cancer patients. One of the most common and clinically significant side effects of angiogenesis inhibition is the development of high blood pressure. The purpose of this review is to analyze the relationship between inhibitors of the vascular endothelial growth factor signaling pathway and hypertension. We review incidence of VEGF/VEGFR inhibitors induced hypertension, mechanisms of its development, importance of blood pressure values regular monitoring, possible treatment strategies, and effectiveness of prophylactic antihypertensive treatment. We compare the results of clinical studies to clarify the prognostic and predictive significance of blood pressure elevation during antiangiogenic treatment. Further research into the relationship between biological treatment and hypertension may lead to more effective treatment with longer survival and better quality of life in advanced cancer patients.]
Hypertension and nephrology
[Increased sympathetic nervous system activity can be found in all forms of hypertension, but the degree of this may differ depending on the individual accompanying diseases.]
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