Lege Artis Medicinae



APRIL 21, 2006

Lege Artis Medicinae - 2006;16(04)

[Hypertension and hypercholesterolemia are two very important risk factors of cardiovascular diseases. Statins are the most widely used drugs to treat hypercholesterolemia, and they also modify the efficiency of antihypertensive treatment in patients with hypertension. With the use of statins, a significant reduction in blood pressure has been described both in patients previously untreated and in patients already being treated with antihypertensive drugs. The blood pressure lowering effect of statins is partially independent of their effects on the lipid profile, and is probably related to their interaction with endothelial function, angiotensin-II receptor and other biologically important systems. The ability of statins to improve blood pressure control should be more widely considered when thinking of the complex prevention of cardiovascular diseases.]



Further articles in this publication

Lege Artis Medicinae

[Gastrointestinal bleeding in infancy and childhood - Recommendation of the College of Paediatrics]

ARATÓ András, VERES Gábor, DEZSŐFI Antal

Lege Artis Medicinae



[Insulin detemir is a neutral, soluble, long-acting insulin analogue in which the amino acid threonineB30 has been removed and the LysB29 acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to dihexamerisate and reversibly bind to human albumin upon administration. This brand new principle (self association and albumin binding) ensures slow absorption and a prolonged and consistent metabolic effect without a marked peak for up to 24 hours in patients both with type 1 and type 2 diabetes mellitus. Results of large clinical trials have shown that detemir can be efficiently used as basal insulin, supplemented with human regular insulin or aspart insulin taken before the main meals, in both type 1 and type 2 diabetes. Available data clearly demonstrate that the use of this insulin is associated with decreased variability of the fasting blood glucose values. In some of the studies the risk of (mostly nocturnal) hypoglycaemic episodes also dropped. It is important to note that patients using insulin detemir gained less or no weight compared to the group of patients treated with neutral protamine Hagedorn (NPH) insulin. Evaluation of long-term and wide-spread application of detemir needs further observations. Such trials are being conducted worldwide.]

Lege Artis Medicinae

[Snapshot – For a Lifetime...]


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[Secondary causes of bone loss are not often considered in patients, who are diagnosed as having osteoporosis. There are many causes of secondary osteoporosis, including endocrine diseases, renal disorders, transplantation, glucocorticoid therapy, inflammatory rheumatic diseases etc. This article gives an overview on the most frequent and in the everyday practice important forms of secondary osteoporosis. The first principle is the correct diagnosis and the adequate treatment of the underlying disease. In the prevention and treatment of secondary bone loss similar principles are followed as in the primary forms. Calcium, Vitamin D, personalized, well-aimed physical therapy and continuous physical activity are the basic treatment of secondary osteoporosis. Active form of Vitamin D, which does not require calcium combination, has to be applied in advanced age, in impaired renal function, and in case of ineffective therapy with cholecalciferol. Evidence based data suggest that bisphosphonates (alendronate and risedronate) are the most effective antiresorptive agents in the prevention and treatment of glucocorticoid- induced osteoporosis and in osteoporosis associated with rheumatoid arthritis. To prevent secondary hyperthyreoidism during bisphosphonate treatment, a calcium intake of 1000 1500 mg/d and an 800 IU/d of cholecalciferol are recommended. Ibandronate (150 mg once a month), a new bisphosphonate will be available soon. Parathyroid hormone (teriparatide) is an anabolic agent, that enhances bone formation. Its recent introduction offers new options in the treatment of patients with established osteoporosis.]

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[Telmisartan, an angiotensin receptor blocker, is a potent antihypertensive drug. Similarly to other members of the drug family, it has cardio-, vasoand renoprotective properties; in addition, uniquely in the group, it stimulates the peroxisome proliferator activated receptor (PPAR) -γ. This partial agonist activity results in favourable effects mainly in carbohydrate metabolism and, to a lesser extent, in lipid metabolism. Based on this pharmacological profile, telmisartan seems to be especially useful in the treatment of hypertension associated with metabolic syndrome or type 2 diabetes.]

All articles in the issue

Related contents

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).]

Clinical Neuroscience

[Treatment of migraine in hypertension and ischemic heart disease]

FICZERE Andrea, CSIBA László

[Migraine is a common disorder with a prevalence of 9-10% in Hungary. Migraine can be accompanied by hypertension and/or ischemic heart disease sometimes in younger patients, but more frequently in the elderly, which is important for therapeutical considerations. The article reviews the literature with special focus on hypertension and coronary heart disease. In the second part, the authors summarize their experiences on headache patients.]

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.]

Hypertension and nephrology

[Prevalence of overweight and obesity in hypertensive patients]

KISS István, PAKSY András, KÉKES Ede

[Authors had performed an anthropometric analysis using a database of 2011-2013 of Hungarian Hypertension Register. They analyzed overweight and obesity in relation of age. The results were compared with similar analysis conducted in the total population 2015. They analyzed the prevalence of visceral obesity as well using the waist circumference measurement categories and these were also compared with screening data of total population. The prevalence of overweight and obesity was very high in both genders, co-occurrences exceeded 70% between 45-70 years. The prevalence was significantly higher in hypertensives, than in the total population. The prevalence of visceral obesity measured by waist circumference was also high, especially in women whose reached 50% of cases. They observed a significant difference between hypertensive and total populations In category „danger” of visceral obesity]

Hypertension and nephrology

[Risk categories, goals and treatment of hypercholesterolemia in Europe and in the recommendations of the AHA/ACC]


[Hypercholesterolemia is one of the most important major risk factors that can be most influenced. Its treatment is based on guidelines. In 2013 in Hungary the common guideline of 17 societies (MKKK) as well as the recommendations of EAS/ESC and those of IAS are at disposal. These recommendations have established similar risk categories and strict LDL-cholesterol goals (<1.8 mmol/l). On 12 November, 2013, in the USA after a long drawn debate the AHA/ACC - without any lipid association - issued a new cholesterol (Ch) guideline, which drasticly differs from the existing national and European recommendations. According to AHA/ACC each patient with cardiovascular disease or diabetes should be treated with statin, irrespective of the Ch value, All patients with a LDL-Ch level over 4.9 mmol/l should also be treated with statin. In primary prevention those with values between 1.8-4.9 (LDL-Ch), or 3.5-8.0 mmol/l (Ch) would also be given statin, if their risk is more than 7.5%, with the new calculator system (“Statin Benefit Groups”). These recommendations would eliminate the classic risk categories (very-high, high, moderate risk), would abolish the system of treatment goals, as well as the regular Ch test. The non-statin therapy is not supported even in combinations. A big part of the population with low Ch level would also receive statin based on the results with the calculator, meaning that in the USA the number of those treated might double. Not only the European (e.g. EAS/,ESC) but even American societies (National Lipid Association 2013-2014) (e.g. NLA) oppose to the new guideline of AHA/ACC.]