Lege Artis Medicinae

[The hypertensive, non-diabetic nephropathy]


NOVEMBER 15, 2019

Lege Artis Medicinae - 2019;29(11)

DOI: https://doi.org/10.33616/lam.29.048

[According to the increase of the number of the hypertensive patients the prevalence of hypertensive nephropathy will increase also. According to the data in the Registry of Hungarian Society of Hypertension, in 2015 the proportion of hypertension patients with chronic kidney disease was 12.3% of the males, 39.1% of the females and generally 26.1% of all the hypertensives. In Hungary the hypertensive nephropathy was the 2nd most common condition led to chronic dialysis in 2010 and 2015 (21% and 22%). According to the Hungarian Society of Hypertension 2018 Guideline the classic inhibitors of the renin-angiotensin system can decrease significantly the progression of renal function decline and the proteinuria. ]


  1. Szegedi Tudományegyetem, I. Sz. Belgyógyászati Klinika, Nephrológia és Hypertónia Centrum



Further articles in this publication

Lege Artis Medicinae

[Ezetimibe-statin combination therapy]


Lege Artis Medicinae

[The association between advanced age and peripheral arterial disease]


[The high-income countries are characterized by the aging of the residents (epidemiological transition) and the change of the disease patterns that are recognized in the population (epidemiological transition). In that sense, considering the cardiovascular diseases in the last few decades, a decline of mortality of acute, fatal conditions (stroke, myocardial infarction) is notable. All these factors contributed to the recognition of the importance of peripheral arterial disease and related problems in the aging popula­tion of the affected people. The high prevalence, the decline of quality of life associated with compromised lower limb circula­tion, the risk of the limb loss, the challenge of rehabilitation and the high mortality represent a significant and increasing burden to the healthcare. The review aims to analyse the relation of the aging population and peripheral arterial disease, addressing the aspects of epidemiology, diagnostics, and therapy. ]

Lege Artis Medicinae

[White-coat and masked hypertension]


[White-coat hypertension is a heterogenous clinical entity, that includes patients with lower and higher cardivascular risk. Its prognosis is relatively benign, when it is not associated with other cardiovascular risk factors. Therefore, cardiovascular risk evaluation has utmost importance in patients with white-coat hypertension for the determina­tion of appropriate treatment. Masked hy­per­tension, however, is not a benign pheno­type, as it has been proven. Its early recognition, regular follow-up and effective anti­hypertensive drug treatment are mandatory. ]

Lege Artis Medicinae

[Hypertensive emergency conditions in Family practice]


[Family doctors play an important role in the treatment of high blood pressure emergencies. There are two forms of these: hypertensive, non-life-threatening states (urgency) and the hypertensive crisis (emergency) with life-threatening complications. The boundary between these two forms is not sharp, and a non-life-threatening urgency can turn into a hypertensive crisis. Hypertensive emergency is defined as an acute, marked increase of blood pressure with concomitant life-threatening target organ dysfunction. Treatment always requires hospitalization and parenteral administration of antihypertensive agents. In the case of hypertensive urgency, the acute increase of blood pressure is not complicated with organ damage. In these cases treatment can be performed in primary care with oral drugs. ]

Lege Artis Medicinae

[“There is no Other such Place in the World” – The Life of Objects in the Art Collection of the Hungarian Academy of Sciences]


All articles in the issue

Related contents

Hypertension and nephrology

[Therapy of isolated systolic hypertension III.]


[In the elderly and very elderly (˃80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence/persistence to therapy. Using diuretics, ACE-inhibitors/ARBs with calcium antagonists, and in special cases diuretics and beta blockers are also suggested by recent European guidelines (ESH, HSH). The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages/disadvantages, so the optimal SBP may be around 130 mmHg.]

Hypertension and nephrology

[Isolated systolic hypertension in children and young adults I.]


[Prevalence of the isolated increase in systolic blood pressure ≥140 mmHg with normal or low diastolic blood pressure ≤80 mmHg, is defined as isolated systolic hypertension. Its prevalence increases with age up to >90% in patients aged >90 years. Isolated systolic hypertension is also found in the young and the clinical significance of it is still debated. For the therapy, those drugs should be used which have a license for use in children: angiotensin converting enzyme inhibitors, angiotensin AT-1 receptor antagonists, calcium channel blockers beta-blockers and diuretics and their combinations. The young adults with isolated systolic hypertension had a much higher risk of dying from coronary heart disease or cardiovascular disease, then the normotensive individuals, and should be treated to normalise their blood pressure. In the elderly and very elderly (>80 yrs), a wealth of data from large clinical trials are available, showing the necessity of treatment mostly with drug combinations - fix-combinations are preferred for increasing the adherence / persistence to therapy. Using diuretics, ACE-inhibitors / ARBs with calcium antagonists, and when needed diuretics and beta-blockers are suggested by recent European guidelines. The target is <140 mmHg, but in octogenarians <150 mmHg. Some studies are pressing for even lower SBP (to around 120 mm Hg), but it seems to be wise to balance advantages / disadvantages, so the optimal SBP may be around 130 mmHg.]

Hypertension and nephrology

[Epidemiology of hypertension in Hungary]


[The most important aspects of Hungarian hypertension epidemiology are demonstrated. The prevalence of hypertension is continuously increasing and in 2011 from the nearly 10 million population exceeded 3 million. Its occurrence rises in parallel with the increase in of systolic blood pressure and the progression of age, and exceeds 60% in those aged over 65 years. The average blood pressure is increasing in children and adolescents, and isolated systolic hypertension is often observed in those over 65-70 years. The situation is closely related to overweight in the young, while in elderly the atherosclerotic process results in low diastolic blood pressure. The prevalence is significantly different in some regions with the highest incidence in South-Transdanubia and North- Hungary. Overall, there is a higher incidence in women. Among known hypertensive patients, the ratio of men is greater till 40-45 years; thereafter, there will be an equilibration and in elderly women the incidence will be higher. It is interesting, that the morbidity and mortality have significantly increased in hypertension and diabetes since 2004, while the incidence of myocardial infarction and stroke has significantly decreased. As concerns organ damage, an increase in occurrence of left ventricular hypertrophy and microalbuminuria has been observed. Metabolic syndrome, diabetes mellitus and ischemic heart disease were the most frequent comorbidities.]

Hypertension and nephrology

[Dialysis treatment in Hungary: 2010–2015]


[The authors show the data of Hungarian dialysis statistics from 2010 to 2015. The questionnaire - based data collection was made by Dialysis Registry Committee of the Hungarian Society of Nephrology. The number of all patients entered in the dialysis program increased by 8.4% over six years (an average of 1.4/ per year) and the number of new ones increased by 10.5% (1.75% per year). Between 2003 and 2009 the mean annual increasing of new patients was 7.5%! The incidence of new dialyzed patients was 440/1 million population in 2010 and 486/1 million) in 2015. The population point prevalence at the end of the year was 621/1 million in 2010 and 643/1 million in 2015. The penetrance of peritoneal dialysis was 13.5% in 2010, and 13.6% in 2015. The proportion of incident patients with diabetic or hypertensive nephropathies (conditions which lead to end stage renal disease) was about the same in 2010 (27 and 21%) than in 2016 (27 and 22%). The mean age of incident patients entered into dialysis program decreased from 66.9 years (2010) to 62.8 years (2015), surprisingly. The rate of patients on waiting list for renal transplantation was 10.7% in 2009 and increased to 15,8% in 2015. There is also a significant increase in the number of the annual renal transplantations (268 in 2010 and 356 in 2015). The mortality rate of chronically dialyzed patients shows little decrease (14.4-13.1%).]

Hypertension and nephrology

[Hypertension and diabetes mellitus]

SZEGEDI János, KISS István

[Hypertension and diabetes mellitus are endemics which affect large crowds; they play an important role in the morbidity and mortality of the population. Both diseases are cardiovascular risk factors, their co-occurrence increases the coronary risk. According to forecasts, there will be 60% increase in the number of hypertensive patients by 2025; it will affect 29% of the world’s adult population, 1.56 billion people. The number of patients with diabetes increases in all countries; 552 million diabetic patients should be expected by 2030. The simultaneous occurrence of both diseases may be a coincidence, but there is also causal relationship between the two diseases (diabetic nephropathy, metabolic syndrome). The two diseases often occur in endocrine diseases, and in connection with medicinal therapy (steroids, etc.). The simultaneous occurrence of these two diseases determines the therapeutic strategy. During the prevention and treatment of both diseases, the change in lifestyle has an important role (obesity, salt intake, physical activity).]