[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)
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.]
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Lege Artis Medicinae
Hypertension and nephrology
[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
[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
[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
[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
[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.]
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