Lege Artis Medicinae



JULY 20, 2004

Lege Artis Medicinae - 2004;14(07)

[The author presents a review about the fundamental principles of normal endothelial function and the main causes for the development of endothelial dysfunction. First of all, endothelial dysfunction results in structural alterations in the wall of the vessel - the „vascular remodelling” in hypertension - and that is the base of hypertensive microangiopathy and target organ damage. In patients with high blood pressure the reactivity of vessels is impaired by the endothelial dysfunction. The members of the main drug groups can influence the vasoactive factors produced in endothelium differently. This different effects of drugs create different clinical benefits. Especially, the ACE inhibitors, the calcium antagonists (mostly the new generation of dihydropyridines) have endothelial protective effects, but some β-blockers, α-1 adrenergic blockers and - in a totally different way of action - the statins are capable of influencing the endothelial dysfunction.]



Further articles in this publication

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[Report on the 1st Debrecen Medical Days]

BRÚGÓS Boglárka, JUHÁSZ Mária

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GYŐRFFY Zsuzsa, LŐRINCZ Jenő, ÁDÁM Szilvia, KOPP Mária

[INTRODUCTION - In Hungary the number of induced abortions is three times higher than in European Union countries. The exploration of the bio-psycho-social factors in the background of abortions may serve as an instrument to develop effective prevention. METHODS - The Hungarostudy 2002 national representative study included 12,634 interviewed subjects. The sample represents the Hungarian population above the age of 18, according to gender, age and geographical location. The aim of the health survey was to analyse the physical and psychological status of the Hungarian population as well as the psychosocial risk factors. The prevalence of abortion in the female sub-sample was 22%. We analysed the background factors of abortion with the help of a statistical analysis. RESULTS - The risk factors behind abortions can be grouped as: physical abuse on behalf of partners and/or parents, attachment disorder and early traumatisation, lack of social support, low financial status and inadequate social environment. These factors have all shown significant connection to abortions. Suicide attempts and suicidal thoughts, high Beck Depression (BDI) scores, smoking and alcohol consumption are also significant among those who had abortions. CONCLUSION - An important aim of the Hungarostudy 2002 survey and the follow-ups is to serve a more extensive and effective prevention by exploring the background factors of induced abortions.]

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[The number of diabetic patients will be doubled in the coming decades reaching 300 million for year 2025. The number of type 1 diabetics will also be increased but the majority of it will result from the increased number of type 2 diabetics. All types of diabetes are the consequence of a combination of genetic susceptibility and environmental factors, meaning that the prevention of diabetes epidemic cannot be done without the clarification of the genetic background. Significant progression has happened in the discovery of the genetic background of type 1 diabetes mellitus. It was helped by the etiologic classification of the disease: with the new classification the patient groups became more homogeneous. The HLA system is responsible for about 50-70% of the genetic risk while the effects of other genetic factors contribute 1-2% of the genetic susceptibility, respectively. Presently 25 gene regions are known as the different genetic factors of type 1 diabetes mellitus. Regarding the HLA system, the genes and pathomechanism causing the disease are not known. The classification of diabetes mellitus can be based on the HLA type while the predictability of type 1 diabetes mellitus is helped by the HLA type and the INS-VNTR. Much less is known about the genetic background of the polygenic type 2 diabetes mellitus. Its manifestation is now happening at younger age before. The best-fit genetic model consists of only a few genes with moderate effect superimposed on a polygenic background. Several „candidate” genes participating in the impaired insulin secretion and insulin action have already been investigated as the genes responsible for type 2 diabetes. These data showed the specificity in the population and most showed mild or modest association with the disease. Genomewide scans have resulted a number of significant diabetes susceptibility genes specific for a variety of populations, but these investigations have only resulted in the isolation of one gene (calpain 10) that is thought to contribute to type 2 diabetes. Most recent genomewide scans found loci on chromosome 20 in two different populations with significant segregation of type 2 diabetes. These loci are near to the region harboring the transcription factor hepatocyte nuclear factor genes. The transcription regulator HNF family is responsible for the regulation of the expression of several genes participating in the function of liver and pancreatic islet becoming a strong candidate for being a diabetes gene.]

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[Hormonal contraception above the age of 40]


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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.]

Lege Artis Medicinae

[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]


[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[Notes on the management of hypertension in chronic kidney disease ]


[The prevalence of hypertension among pa­tients with chronic kidney disease is high, reaching more than 80%. Hypertension is both one of the main causes and also the most common consequence of chronic kidney disease. It is also a main factor responsible for the high cardiovascular morbidity and mortality in this patient population. Blood pressure control can improve patient outcomes, lower cardiovascular risk and slow down the progression of kidney dis­ease, irrespective of the underlying cause. The optimal therapy should therefore focus not only on blood pressure reduction but also on renoprotection. Basic understanding of the renal pathophysiology in hypertension and renal effects of various medications is of paramount importance. In this review, we summarized cornerstones of the antihypertensive therapy in patients with chronic kidney disease. The management of patients receiving kidney replacement therapies, such as hemodialysis, peritoneal dialysis or transplanta­tion requires special knowledge and expe­rience, therefore it is not discussed here. The aim of this review was to allow non-nephrologist physicians to take care of their kidney patients with more confidence and effectiveness.]

Hypertension and nephrology

[The importance of assessing subclinical organ damage in risk prediction of hypertensive patients]

GODINA Gabriella, JÁRAI Zoltán

[As the cardiovascular risk influences the quality and intensity of blood pressure lowering therapy, the goal blood pressure values and the frequency of medical control of hypertensive patients, as well as global risk assessment has an important role in the management of hypertension. In the last couple of years many data have been accumulated showing the poor prognostic value of traditional cardiovascular risk factors. This is the reason why recent Hungarian and international guidelines on the management of hypertension advise the screening for subclinical organ damage. Our goal was to summarize the importance of subclinical organ damage by discussing recently published literature on this topic. An overview has been made on the markers of vascular subclinical damage, like carotid atherosclerosis proved with carotid ultrasonography, peripheral arterial disease assessed with ankle-brachial pressure index measurements and vascular rigidity defined with pulse wave velocity measurements. The prognostic values of myocardial hypertrophy assessed with ECG and/or echocardiography and renal damage proved with decreased estimated glomerular filtration rate and proteinuria are also discussed. Summing up what has been said so far, the assessment of subclinical organ damage has a role in cardiovascular risk prediction, however more randomized and prospective studies have to be performed to define the most suitable (i.e. the most reliable and the most cost-effective) markers for this purpose.]

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[The effects of angiotensin receptor blockers on the nervous system in hypertension and dementia]


[The renin-angiotensin system (RAS) is one of the most important mechanisms regarding the pathomechanism and treatment of hyprtension. The most of the elements of the RAS are found in the nervous system too. The effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ARBs) is based on the inhibition of the RAS. ARBs might have a special role in the central nervous system because they do not decrease the production of angiotensin but inhibit its harmful effects mediated through the AT1 receptor while allowing the stimulation of AT2 receptors with resulting pleiotrophic actions. Hypertension is the most important risk factor for stroke and has a negative effect on cognitive functions. Antihypertensive treatment has an effect on the nervous system; in addition to the consequences of the reduced blood pressure, ARBs might provide additional advantages in stroke and dementia prevention.]