Lege Artis Medicinae

[Pharmacotherapeutic strategies on treatment of patients with high cardiovascular risk based on the 2018 European Hypertension Guidelines]

FARSANG Csaba

AUGUST 30, 2018

Lege Artis Medicinae - 2018;28(06-07)

[The new joint hypertension guidelines of the European Society of Hypertension and European Society of Cardiology will simultaneously be published in August, 2018 in the J. Hypertension and Eur. Heart J. on the diagnostics, evaluation, treatment and follow up of hypertensive patients. This guidelines put emphasis on definition, and therapeutic strategies in patients with high cardiovascular risk. In this paper I summarise the cardiovascular risk factors and put emphasis on possibilities of reduction of cardiovascular risk. ]

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Lege Artis Medicinae

[Feeding and eating in infancy and early childhood part II. - Breastfeeding, complementary feeding and weaning in the Large-sample of the “For Healthy Offspring” project]

NÉMETH Tünde, VÁRADY Erzsébet, DANIS Ildikó, SCHEURING Noémi, SZABÓ László

[INTRODUCTION - Complementary feed-ing is the transitional period from exclusive breastfeeding to family foods, while breastfeeding is continued. It should be started, when breastmilk itself no longer meets the infant’s nutritional requirements, ideally at the age of around 6 months. SUBJECTS AND METHODS - In the Healthy Offspring project self reported questionnaires were received from 1133 parents of 0-3 year old children. Comple­mentary feeding practices and issues of weaning were analyzed. RESULTS - In our sample complementary feeding was started at the age of 5.5±1.8 months. 6% of infants younger than 4 months and about two third of infants at the age between 4 and 6 months were started on complementary feeding. 32% of the 7-12 month old infants were continued on breastfeeding. The proportion of breastfed infants and young children in the 12-24 and 25-36 month age group was 24% and 5.5% respectively. The daily feeding frequency of breastfed infants was 6.7±1.6. The infants and young children, who were breastfed along with complementary feeding were feeding 5.6±1.5 times/day. After completed weaning the range of feeding frequency was limited to 4.9±0.9 occasions/day. 60.4% of mothers regarded their feeding style on demand, while 39.6% on set schedule. 16% of mothers reported that their child had feeding difficulties. CONCLUSIONS - Complementary feeding indicators should be part of infant feeding data collection, such as time of introduction of complementary food, feeding frequency, food consistency, energy density of food and safe preparation. Responsive feeding is part of responsive parenting and should be promoted, along with continuing breastfeeding at least till one year of age, and for as long as mother and infant wish to continue. ]

Lege Artis Medicinae

[Depression, anxiety and suicidal behavior. Recognition and care]

RIHMER Zoltán, BLAZSEK Péter, HARGITTAY Csenge, KALABAY László, TORZSA Péter

[Depression and anxiety disorders are major problems both in psychiatric and in general practice because of their frequency and recurring character. Owing to their common complications (suicide, suicide attempts, secondary alcoholism / drug disease, increased cardiovascular and cerebrovascular morbidity and mortality, loss of work, social isolation, etc.) they are the cause of significant individual, family and social burdens. In our paper we review the clinically revealable suicide risk and protective factors that can be observed in depression and anxiety disorders as well as the main aspects of the recognition and care of suicidal patients. With available medicines and non-pharmacological therapies, the vast majority of depressive and anxiety patients can be successfully treated and in most cases we can prevent suicidal behavior associated with these diseases. Besides psychiatrists general practitioners as well play a significant role in preventing suicidal behavior and in the recognition of suicide risk. ]

Lege Artis Medicinae

[Health economics in Hungary: great potential, missed opportunities?]

NÉMETH Bertalan

Lege Artis Medicinae

[Mobbing and bullying among physicians - when colleagues become enemies]

KAPOCSI Erzsébet

[Workplace mistreatment, mobbing, bully-ing, or psychoterror has become a prioritised field of research in social sciences in the past two-three decades. Mobbing means more than a simple conflict situation between two individuals; it is a complex problem that could and should be investigated in various individual and organisational contexts. In spite of its large-scale theoretical and empirical research, the phenomenon still does not have a uniform definition; it is most commonly de-scribed via its social manifestations. Although the interpersonal constellation of mobbing is diverse, its trigger factors, stages and participants show similar patterns. The description and the evaluation of consequences is also uniform in the literature: workplace mobbing is accompanied by considerable health impairment, and it has severe psychosomatic and mental health effects on both the targeted individuals and the whole community. The latter group has to deal with poor performance, impaired morale and dissatisfaction. All these factors add up and lead to significant financial damage as well. The prevalence of mobbing is especially high in health care. Hierarchy, continuous overload, as well as emotional and physical stress all favour the development of mobbing. In turn, the professional-social culture of medicine that is based on traditions contributes to its acceptance, understatement and denial. The first time medical students have to face psychoterror is typically during their university years. The positive aspects of socialisation and finding their vocation cannot always compensate for the negative experiences. The model role of physicians, their behaviour towards colleagues and students can be protective, but it can also trigger further mobbing. Prevention is essential both at the organisational and individual level, and it requires complex measures whose effect will only be felt in the long term. ]

Lege Artis Medicinae

[Vision or reality? Can Hungary become hepatitis C virus free by 2030?]

GERVAIN Judit

[According to the WHO, there are 71 million people worldwide and 3 million people in the EU who are infected with hepatitis C virus. Most of these infections, however, remain undiagnosed and only 6-7% of them received antiviral therapy. In Hun-gary, there are an estimated 50.000 infections, out of these 20.000 are identified, the remaining 30.000 infections are outside the reach of the health care sector. Early diagnosis and therapy are of utmost importance as late diagnosis leads to se-vere liver insufficiency, hepatocellular carcinoma and multiple other extrahepatic organ impacts. In Hungary, second generation direct acting enzyme inhibitor antiviral medications with a recovery rate of almost 100% are available since 2015. Since 2018, all patients are treated with this type of therapy. Nevertheless, there are several remaining professional, organisational and health policy issues to solve. Firstly, Hungary should join the EU’s HCV elimination programme which aims to eradicate hepatitis C virus from Europe by 2030. Secondly, the frequency and efficiency of national screening should be increased. Furthermore, better information of the general population, inclusion of general practitioners and civil organisations, and introduction of the compulsory screening of high risk groups and health care professionals would be necessary. This review summarises the evolution of hepatitis C virus diagnostics and therapy over the past three decades, current best practice and the still outstanding tasks. ]

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[Association between cyclothymic affective temperament and hypertension]

NEMCSIK János, BATTA Dóra, KŐRÖSI Beáta, RIHMER Zoltán

[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]

VÁLYI Péter

[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.]

Lege Artis Medicinae

[Hypertension, COPD and COVID-19. Focus on antihypertensive therapy]

FARSANG Csaba

[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

[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

[Clinical implication of arterial stiffness in the elderly]

BENCZÚR Béla

[Hypertension prevalence and cardiovascular risk gradually with age. However this aging process seems to take a more rapid course in some individuals, as reflected in the Early Vascular Aging (EVA) syndrome. Age and high blood pressure are the two main determinants of arterial stiffness which is the core of EVA: the impaired elasticity of the media layer of large elastic arteries (mainly the aorta), a process that can be measured by pulse wave velocity. In elderly hyperten­sives, large arteries stiffen and systolic and pulse pressures increase, due to wave reflections. Arterial stiffness has predictive value for future CV e.g. events, coronary artery dis­ease, stroke, and vascular dementia and even all-cause mortality. The concepts of EVA (Early Vascular Aging) and SUPERNOVA (Super­normal Vascular Aging, the opposite phenotype of EVA) help to understand why early target-organ damages develop in some individuals and why others remain much more “younger” than their chronologic age. New drugs are being developed to treat EVA when lifestyle intervention and conven­tional risk factor controlling drugs are not enough.]