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Hypertension and nephrology

AUGUST 20, 2018

[Significance of the ambulatory and home blood pressure monitoring in patients with hypertension: focus on CONADPER-ABPM substudy]

ALFÖLDI Sándor, BARNA István

[According to the latest guidelines, ambulatory blood pressure monitoring (ABPM) is both recommended in diagnosing and treating hypertension. The spreading of ABPM is explained by the fact that there are several benefits to the office of blood pressure measurements in the diagnosis, differential diagnosis of hypertension, in the prognostic setting and during therapeutic adjustment. Compared to ABPM, home blood pressure measurement (HBPM) provides information on a substantially longer period of blood pressure, is cheaper, more accessible and more comfortable for the patient. It improves patient-doctor cooperation and therefore the success of setting blood pressure. At the same time, it does not provide information on ABPM over sleep and workplace blood pressure or shortterm blood pressure variability. Thus, the two methods provide complementary information. Finally, we analyse the results of the ABPM subwork of the CONADPER study.]

Hypertension and nephrology

AUGUST 20, 2018

[Measurement and value of blood pressure variability in increasing the number of patients reaching target blood pressure goal in hypertension]

KÉKES Ede, JÁRAI Zoltán, PAKSY András, KISS István

[The authors evaluate the indexes and their usefulness of the short term (ABPM), medium and long term measurement of the blood pressure variability in the care phase of the hypertensive population in Hungary by using a one-year multicentre prospective observational study. The population was split into two parts: in the active group, telemedicine tools were used to maximize the patientphysician relationship and patient education, their own activity. In the non-active group, traditional care took place. Among these, 6725, 18-64 years and 1005, 65 + years of hypertensive patients were analysed. At the start of the study, ABPM was performed in 243 cases. 1407 diabetic hypertensive patients were compared to non-diabetic patients. They have analysed previous international and domestic experiences. In the present study, the reduction of systolic and diastolic blood pressure variability was successful and significant in the 18-64 age group during the whole patients’ care phase, but a larger systolic variability reduction in the active group was achieved. In the 65+s, the systolic variability reduction was found to be significant, but the variability indexes in the active group were also smaller. In the 65+s, the diastolic variability did not change significantly in either group. In diabetic hypertension, variability indices were only reduced to 12 months. It could be clearly demonstrated that a high-level physician patient relationship has a beneficial effect on blood pressure fluctuation in hypertensive patients.]

Hypertension and nephrology

JUNE 10, 2018

[Antihypertensive effect of rilmenidine focusing on the Hungarian multicenter trial VERITAS]

FARSANG Csaba, FINTA Ervin

[Summary in the antihypertensive therapy, in addition to the RAS-blockers (ACE-inhibitors or ARBs), calcium antagonists and thizid-like diuretics, other antihypertensive drugs with different mechanisms of actions, such as the imidazoline I1 receptor agonists, are beneficially used. Several international and Hungarian studies showed the results of the effects of these agents. Authors emphasize the effects of the VERITAS study showing that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hypertrophy (LVH) were also decreased. In a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect. Authors summarise the most important actions of rilmenidine, and the selected publications on the results of the Hungarian and international investigations.]

JUNE 20, 2017

Antihypertenive effect of rilmenidine. Evaluation of the Hungarian multicenter VERITAS study

FARSANG Csaba

The VERITAS study showed that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hyperthrophy (LVH) were also decreased. Ain a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect.

Hypertension and nephrology

MAY 20, 2017

[Antihypertenive effect of rilmenidine. Evaluation of the Hungarian multicenter VERITAS study]

FARSANG Csaba

[The VERITAS study showed that in hypertensive patients the imidazoline I1 receptor agonist, rilmenidine significantly decreased the office blood pressure as well as the blood pressure measured by ambulatory blood pressure monitoring (ABPM). The white-coat reaction and left ventricular hyperthrophy (LVH) were also decreased. Ain a separate study involving hypertensive subjects rilmenidine significantly increased baroreflex sensitivity. This effect may contribute - mainly during daytime - to the antihypertensive effect.]

Hypertension and nephrology

APRIL 08, 2017

[Efficacy of a fixed-dose association of amlodipine and lisinopril in grade II and III hypertensive patients]

JOÃO Maldonado, TEIMO Pereira, MARGARIDA Carvalho

[We conducted an observational study, with ambulatory blood pressure monitoring (ABPM), to evaluate the efficacy of a fixed-dose combination of Amlodipine (5 mg) and Lisinopril (20 mg) in grade II and III hypertensive patients, over an 8 week intervention period. Thirty non-medicated hypertensive patients were enrolled, 36% female, with a mean age of 52.44±11.54 years, a body mass index of 28.73±4.54 kg/m2, and brachial office systolic (SBP) and diastolic (DBP) blood pressure of 174.43±15.06 mmHg and 102.83±10.67 mmHg, respectively. All patients performed a 24 hours ABPM at baseline and after a treatment period of 8 weeks with the fixed-dose association. Brachial office blood pressure and routine blood and urine samples were also obtained in both moments. A significant reduction in blood pressure was observed after the treatment with the fixed-dose association. The proportion of patients with controlled ambulatory blood pressure after the treatment was 69%, considering the normalization of the systolic and diastolic ambulatory pressures over the daytime, nighttime and 24 hours. Considering the brachial office blood pressures, the proportion of controlled hypertensive patients reached 79%. A significant improvement was also seen in microalbuminuria (reduction of 37.40 mg/24h; IC: 2.82-71.97; p=0.035) and fasting glycaemia (reduction of 11.53 mg/dl; IC: 3.46-19.61; p=0.007). No side effects were reported during the 8 week treatment period. The treatment of grade II and III hypertensive patients with a fixed-dose association of Amlodipine (5 mg) and Lisinopril (20 mg) during 8 weeks is effective controlling blood pressure. Furthermore, evidences indicate that the efficacy of the association is achieved quickly, safely and with good tolerability.]

Hypertension and nephrology

FEBRUARY 10, 2017

[Our clinical practice with perindopril/indapamide/amlodipine triple fixed-dose combination]

BATTYÁNYI Bertalan

[Notwithstanding the abundance of pharmacotherapeutic options available, the rate of optimal blood pressure control may be estimated as low as 20 to 40 per cent throughout Europe. The underlying causes of this include, among others, the substantial impact of using free combinations of several antihypertensive - this practice results in rather poor patient adherence. Fixed-dose dual combinations have been introduced just about two decades ago, and their popularity has been increasing progressively since then. Nevertheless, in a considerable proportion (>30%) of patients, achieving optimal blood pressure control requires treatment with at least three antihypertensive acting on different targets. Accordingly, a rational demand has grown for triple-fixed combinations. In Hungary, the fixed combination of perindopril (an ACEI), indapamide (a thiazide-like diuretic), and amlodipine (a calcium channel-blocker) has been available since last year. Our experience with this product shows, as confirmed by ABPM studies, that its routine use in hypertensive patients with cardiological comorbidities improves patient compliance, thereby enhancing also long-term blood pressure control.]

Hypertension and nephrology

SEPTEMBER 20, 2015

[Case report of resistent hypertension with failed renal denervation]

ALFÖLDI Sándor, KOVÁTS Viktória, SIMONYI Gábor, MERKELY Béla, FARSANG Csaba

[A 48 year old male patient with hypertension, resistant to the combined administration of seven antihypertensive drugs had an associated hypertrophic nonobstructive cardiomyopathy. Bilateral renal denervation has been performed with the Symplicity catether of Medtronic after the exclusion of possible secondary forms of hypertension, but his blood pressure did not decrease. Preventive intracardiac cardioverter defibrillator implantation has also been performed because of progressive congestive heart failure. We planned a witnessed intake of antihypertensive medication before qualifying ABPM study but without success because of noncompliance of the patient. According to the database of the Hungarian National Health Insurance Fund (OEP) on request of his general practitioner, the patient payed for prescripted medicine only once in the previous year, on the day before his planned witnessed intake of antihypertensive medication. The witnessed intake of medication before qualifying ABPM study was finally successful two years after the renal denervation and both his office and ambulatory blood pressure decreased substantially. The witnessed intake of antihypertensive medication for the exclusion of nonadherence as a cause of therapy resistant hypertension is warranted, especially before device or operative interventions for the treatment of hypertension.]

Lege Artis Medicinae

MARCH 20, 2015

[Experiences with fix combination of amlodipin-atorvastatin according to the ESH/ESC hypertension recommendation 2013]

NAGY Gergő

[BACKGROUND - Hypertension is a widespread disease in Hungary and worldwide as well. Combination products containing more effective agents in one pill have an increasing role in the treatment strategy. One of the most often used products is Amlator, in which the advantageous features of amlodipine and atorvastatin are combined. METHOD - During my investigation I treated a patient with just diagnosed hypertension, prescribing Amlator 20/5 pill once a day. Blood pressure measurements were registered at home in a blood pressure diary. After two months laboratory and ABPM measurements were administered again. Gathered data was compared and changes were analysed. RESULTS - During the first ABPM measurement the mean blood pressure was 150/90 mmHg. Laboratory measurements showed a moderate increase in cholesterol level (6.1 mmol/l), lipid values were in the normal range (LDL 3.0 mmol/l, HDL 2.61 mmol/l) and hypertriglyceridemia wasn’t observed either (0.97 mmol/l). The blood pressures measured at home showed a significant decrease using the prescribed medication. During the first month the average blood pressure was 133/80 mmHg. This shows an 11.3% decrease of the systolic value. At the second monthly inspection a decrease in the cholesterol level was noted (cholesterol 5.0 mmol/l, LDL 2.31 mmol/l, HDL 2.2 mmol/l, triglyceride 0.96 mmol/l). This is a 14.7% decrease. The second ABPM measurement showed a significant decrease in both the systolic and diastolic blood pressure values. The average blood pressure was 124/78 mmHg, which means a 17.3% decrease of the systolic value. CONCLUSION - Amlator proved to be an effective treatment of both hypertension and hypercholesterolemia.]

Lege Artis Medicinae

FEBRUARY 15, 2015

[Amlodipine/atorvastatin fix combination in type 2 diabetes mellitus]

BÓTYIK Balázs

[INTRODUCTION - Type 2 diabetes mellitus is known to represent a major cardiovascular risk. In type 2 diabetes, hypertension and dislipidemy are often also present, increasing the vascular risk. In this case the use of both antihypertensive and lipid lowering therapies is needed. In our CASE REPORT, we discuss the data of a 43 years old diabetic man with BMI: 29.4 kg/m2, waist circumference of 101 cm, who had recently diagnosed hypertension and was given single pill amlodipine/ atorvastatine in addition to his original ACEI therapy. At the initiation of the therapy the mean blood pressure - measured during ABPM was 149/91 ± 14.99 Hgmm, his total cholesterol: 4.18 mmol/l, HDL cholesterol: 0.82 mmol/l, LDL cholesterol: 2.41 mmol/l, and triglicerid: 4.09 mmol/l. Three months later the results were the following: mean blood pressure: 121.66/ 82.79 ± 8.21 Hgmm, total cholesterol: 3.47 mmol/l, HDL cholesterol: 1.08 mmol/l, LDL cholesterol: 1.98 mmol/l, triglicerid: 1.44 mmol/l. There were no side effects. Using the therapy among several other diabetic patients we observed similar efficacy and tolerability, and the adherence of the patients was perfect. DISCUSSION - In type 2 diabetes the use of the fix combination of amlodipin/atorvastatin in addition to previous ACEI therapy is effective, well tolerated, and the long term compliance proves to be good.]