Lege Artis Medicinae

[The importance of differences between diuretics in the treatment of hypertension - Metabolic neutrality in focus]

ALFÖLDI Sándor

FEBRUARY 20, 2010

Lege Artis Medicinae - 2010;20(02)

[Indapamide is a “second-generation” vasodilatatory thiazide diuretic. Its antihypertensive efficacy when used at a low dose is equivalent to those of the other first-line antihypertensive drugs. Unlike other thiazide diuretics, low-dose indapamide was not found to have any adverse glucose or lipid effects in previous studies, moreover, it decreased insulin resistance in patients with hypertension. The risks of hypokalemia and hyperuricemia were also substantially lower. In the large, randomized, placebo-controlled HYVET-study, low-dose, indapamide-based antihypertensive therapy significantly decreased the risks of cardiovascular diseases and mortality in elderly (age >80 years) patients with hypertension. According to new guidelines, indapamide is preferred to other thiazide diuretics for patients with hypertension associated with metabolic syndrome or diabetes mellitus.]

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Lege Artis Medicinae

[Heart surgery among octogenerians - fiction or reality?]

SZÉKELY László, GYÖRGY Margit, JUHÁSZ Boglárka, SZABÓ J. Zoltán, SZUDI László, PAULOVICH Erzsébet, LONKAY Eszter, HORKAY Ferenc

[OBJECTIVE - Aging of the society results in important demographic changes in cardiac surgical practice. Controversy exists as to whether heart surgery in elderly patients improves their life expectancy and the severe functional restraint caused by their heart diseases. PATIENTS AND METHODS - We discuss a retrospective study of octogenarian patients who underwent cardiac surgical procedures in our institutions between 01.01.2000. and 30.06.2006. The mean age of the 105 participants was 81.5 years (80-87). 67% (70) of patients had coronary artery disease (CAD). 31% (33) of the patients had aortic valve stenosis (AVR), of whom 16 had isolated AVR and 17 had AVR combined with CAD. One patient had surgery because of mitral valve insufficiency (MVR) only, and one was treated for combined AVR and MVR. The average surgical euroscore was 9.7 (5-18) and the predictive mortalities were 18%. 9.5% of the procedures were acute, 42.9% were urgent and 47.6% were chronic surgeries. RESULTS - The average operating time was 149±23 min, duration of the aortic cross clamp was 65±11 min. OPCAB procedures were performed in 82.9% of patients treated for CAD. In the postoperative period, the occurrence of renal failure was 2.9%, blood transfusions were needed in 37.4% of patients, and neurological deficits occurred in 2.9% of patients. The incidence of perioperative myocardial infarction was 5.6%. The rate of early mortality was 4.8%, the rate of late (>30 days) mortality was 14.3%. At the last follow-up examination, 67 (79%) of the surviving 85 patients were free of cardiac symptoms, physically active and able to take care of themselves. 14 patients (17%) needed some help and only 4 patients (5%) were unable of taking care of themselves. CONCLUSIONS - The mortality of cardiac diseases can be reduced by cardiac surgeries in octagenerians. Improvement of cardiac symptoms improves the patients’ functional status and their quality of life can be similar to that of healthy people of the same age.]

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KISS Nóra, KISS Róbert Gábor

[Acetylsalicylic acid effectively blocks the activation of platelets, and becomes a basic element of antithrombotic therapy of patients with high cardiovascular risk. Decrease of platelet reactivity is due to the irreversible inhibition of COX- 1 isoenzime in platelets during treatment. Choosing the right dose is still not an easy task. Bleeding side effects are frequently seen in patients treated with this drug worldwide. Clinical benefit does not improves with escalated doses (300 mg), however the risk of haemorrhagic events increases. Therefore acetylsalicylic acid dose should be reduced to the effective minimal dose (75-150 mg daily) after the acute phase of atherothrombosis in order to prevent side effects. Effect of acetylsalicylic acid differs individually, it might be important screening out those patients who respond less to the drug. Resistance is still an evolving field, proper methodology is to be determined. Right indications of acetylsalicylic acid needs balance between reaching clinical benefit and avoiding side effects. The Hungarian Cardiovascular Therapeutic Consensus Conference 2009 suggested acetylsalicylic acid in primary prevention for those males only, who have overt cardiovascular risk, and SCORE result is more than 10%, with no gastrointestinal haemorrhage in medical history, and with a well-controlled hypertension. Lifelong aspirin prevention should be used after all diagnosed cardiovascular atherothrombotic event as a cornerstone of secondary prevention with low dose (75-150 mg daily) in both genders.]

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