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Hypertension and nephrology

SEPTEMBER 12, 2018

[Treatment of hypertension in kidney transplant patients]

KOVÁCS Tibor, WAGNER László

[Most of the renal transplant recipients suffer from hypertension. Hypertension substantially contributes to the high cardiovascular mortality in this population. The recommendation of the Hungarian Society of Hypertension and the international guidelines suggest to achieve less than 130/80 mmHg as target blood pressure in these patients. Several factors may be in the background of hypertension after kidney transplantation, which can be summarized as factors from the recipient-side, the donorside and factors provoked by transplantation itself. In most of the cases early after transplantation high doses of immunosuppressive drugs (especially calcineurin inhibitors and steroids) are responsible for the increased blood pressure. There are some further special methods apart from the general recommendations which are needed during the examination of hypertension of kidney transplant patients: e.g. measurement of blood trough-level of immunosuppressive drugs, investigation of bone-mineral disorder, screening for the level and causes of anaemia, check-up of the renal graft circulation. Kidney transplant patients suffering from hypertension usually need more than two antihypertensive drugs beyond the use of non-pharmaceutical antihypertensive methods. In the early posttransplantation period calcium channel blockers are preferred antihypertensive medications, because they counterbalance the vasoconstrictive effect of calcineurin inhibitors. The administration of renin-angiotensin-aldosterone inhibitors are rather suggested after the stabilization of renal function (from the 1-3 months posttransplantation). When designing antihypertensive strategy, comorbidities and special factors should be regarded as well, especially volume overload, proteinuria, allograft function (GFR), diabetes, other cardiovascular risk factors, previous cardiovascular events. The setup of an individual therapeutical strategy is advised in view of all these factors, which is different according to the timing after transplantation: the perioperative, the early postoperative phases and from 1-3 months after transplantation have special focuses.]

Clinical Neuroscience

JULY 30, 2018

Can high uric acid levels be an independent risk factor for acute ischemic stroke due to large-artery atherosclerosis?

ACAR Türkan, ARAS Guzey Yesim, GÜL Sinem Sidika, ACAR Atılgan Bilgehan

Introduction - Uric acid is a molecule that is known to act as a natural antioxidant in acute oxidative stress conditions such as acute ischemic stroke (AIS). Although there are several studies on the prognostic value of serum uric acid (UA) level, especially the AIS, its importance in ischemic stroke is still controversial. Our aim in this study is to investigate whether the serum UA level is an indicative biomarker in the large-artery atherosclerosis in the AIS etiology. Material and method - Of the patients admitted to Sakarya University Training and Research Hospital Depart-ment of Neurology between January 2017 and November 2017, 91 hospitalized patients, who had AIS diagnosis and had their uric acid levels measured, were analyzed retrospectively. Patients with diabetes mellitus (DM), hypertension (HT), smoking habit, obesity, gout, hyperlipidemia (HL) and renal failure were excluded from the study. Patients were classified as anterior system and posterior system infarct. Then, patients were divided into two groups, one with internal carotid artery (ICA) > 50% stenosis and the other with ICA < 50% stenosis according to carotid-vertebral artery doppler USG examination performed for etiology. Serum UA, total bilirubin, direct bilirubin and indirect bilirubin levels of both groups were statistically compared. Results - In the comparison of serum UA values of ICA>50% stenosis and ICA<50% stenosis group of AIS patients, a statistically significant difference was found between the UA levels (p<0.000), but there was no difference between total bilirubin, direct bilirubin and indirect bilirubin values (p>0.05). Conclusion - High uric acid levels can be considered an independent, indicative risk factor for large-artery disease in AIS.

Lege Artis Medicinae

JUNE 20, 2018

[Why is it important and ethical to treat anxiety patients?]

RADICS Judit

[The identification of anxious patiens is not always an easy task. The diagnose is clear in that case, when the symptoms (psychic or somatic) are evident or/and patients complain about anxiety. Anxiety itself is not a pathological symptom if it is adequate in strength and duration. Anxiety reactions have large individual variety -, they are pathological if inadequate and irrelevante and don’t match with the actual situation. According to epidemilogical data one third of patients of family doctors suffer from anxiety but somatic symptoms come to the front, so the patients participate in a great number of medical examinations. It is important to emphasise that medical examinations are necessary to preclude the possibility of any somatic disease. The di­ag­nostic criteria of DSM-5. are an excellent assistance for a good diagnosis. Anxiety is a risk factor for cardiological diseases and diabetes mellitus. The prevalence of anxiety disorders are 12.6-17.2%. Anxiety di­sorders are well-manageable, they need complex therapy: benzodiazepines, antidepressants, hypnotics and psychotherapy. They frequently co-exist with depression and insomnia so they have to be treated together. ]

Hypertension and nephrology

JUNE 10, 2018

Journal of Nursing Theory and Practice

FEBRUARY 28, 2018

[Factors influencing Lifestyle Changes following Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ]

HALÁSZ Henrietta, MEIXNER Istvánné

[The aim of the study: In addition, it seeks those methods which might help in keeping the patients motivated so that they participate in regular health education programs, and in calling their attention to the importance of their own responsibility for their health. Material and Methods: Out of the patients who took part in early rehabilitation after a heart attack, a simple random sample of 127 patients was involved (n=127). The survey was conducted by questionnaire and retrospective data analysis. For the analysis, khi2 test, correlation analysis was performed, where p was considered significant if <0.05. Results: 71% of the patients were over the age of 60, 87% were overweight or obese, 39% were smokers at the beginning of the rehabilitation, 85% suffered from hypertension and 39% had diabetes mellitus. As opposed to male patients, females tend to recognise the impact of lifestyle on health (p=0.004). Patients under the age of 60 were more knowledgeable with regards to medicine than patients above the age of 60 (p=0.000). Positive family anamnesis impacts views on lifestyle changes (p=0.01). Conclusion: In order to increase the effectiveness of health education, different methods are needed when teaching patients above the age of 60. Written materials need to supplement verbal information sharing. Patients with positive family anamnesis have already gained some knowledge, which needs to be corrected or extended as required. Nutrition consulting should be made more practical for better feasibility.]

Lege Artis Medicinae

MAY 02, 2018

[Everyday practice of atrial fibrillation treatment]

KISS István, BENCZÚR Béla

[The clinical importance of atrial fibrillation - the most frequent arrhythmia - is derived from the fact that it means a 5-fold risk of stroke/systemic embolism which contributes to the increased cardiovascular morbidity/mortality. Long-term oral anticoagulant therapy is a cornerstone of stroke prevention in patients with atrial fibrillation. Until recently Vitamin-K antagonists were the only available therapeutic option but its everyday use has several limitations, eg. bleeding risk, narrow therapeutic range, drug and food interactions and the need of monthly INR-control. The advent of NOAC-s may prevent a lot of difficulties regarding VKA-treatment and lead to as efficacious as and safer therapy than VKAs. These benefits can help better adherence of patients to the anticoagulant therapy which is one of the most important element of more effective stroke prevention. NOACs can be used more safely both in real life and in special patient populations (eg. elderly, type 2 diabetes, chronic kidney injury) than VKAs so they can contribute to effective cardiovascular risk reduction.]

Hypertension and nephrology

APRIL 20, 2018

[Summary of guidelines for American, European and International Companies in diabetes mellitus type 2 associated with hypertonia]

KÉKES Ede, DOLGOS Szilveszter

[The importance of hypertension in type 2 diabetes mellitus, the method of continuous blood pressure control and patient’s careas well as the forms of non-drug and drug therapy have been disclosed by presenting therapeutical recommendations from American, European scientific societies and international organizations. It has been established that the principles of care and treatment of hypertonia have basically remained unchanged in diabetes all over the world, despite the recent widespread debate over the interpretation of normal blood pressure and the consideration of the benefits of intensive or standard treatment.]

Clinical Neuroscience

JANUARY 30, 2018

Association of cardiovascular risk factors and Parkinson’s disease - case-control study in South East Hungary

MARKÓ-KUCSERA Mária, VÉCSEI László, PAULIK Edit

Aims - Parkinson’s disease (PD) has the second highest incidence among neurodegenerative diseases in the world population. The study aimed to investigate the presence of some cardiovascular risk factors - dyslipidemia, diabetes, and hypertension - in PD patients and to compare their risk with non-PD population in South East Hungary. Methods - A case-control study was conducted at the Department of Neurology, University of Szeged, Hungary. The study included 1299 subjects out of which 620 patients were identified as cases of diagnosed PD and 679 as controls. Logistic regression analyses were conducted to reveal the association of vascular risk factors with PD. Results - In the univariate analysis, diabetes mellitus was positively associated with PD, while dyslipidemia showed negative association to it in the total population, and no significant associations were found between hypertension and PD. The multivariate logistic regression models showed that the odds of diabetes mellitus was higher (OR=2.86), while the odds of dyslipidemia was lower (OR=0.58) among PD patients than in the control group. Hypertension showed a different pattern by gender: the odds of registered hypertension was significantly lower in female PD patients (OR=0.68), whereas the result was not significant in males. Conclusions - This is the first study that provides a comprehensive view of the cardiovascular risk factors in PD patients in Hungary and shows considerable relationship between diabetes mellitus and PD.

Lege Artis Medicinae

SEPTEMBER 20, 2017

[United Nations program to reduce premature cardiovascular mortality by 2025 and the estimation of the success of the program]

KÉKES Ede, SZEGEDI János, KISS István

[Worldwide surveys show that cardiovascular (CV) mortality is the decisive element of total mortality. Between 1990 and 2013, the absolute number of CV deaths increased by 40.8%. Within this, ischemic heart disease (IHD) and stroke, such as the two main elements of mortality, have also increased to such an extent. Compared to the increase in absolute deaths, the age-standardized mortality rate per 100,000 population declined by 21.9%. The cause of the paradox is the development of therapy and the increase in the average age of the population. What is decisive for the lost life years (YLL) in CV cause of deaths IHD is moved from 4th to 1st place, stroke from 5th to third. This change is typical in the most regions of the world, including Central Europe and, above all, Hungary. The following factors contribute to increasing IHD and stroke mortality: smoking, hypertension, obesity, physical inactivity, diabetes. In 2011, the United Nations Conference on Communicable Diseases a uniform resolution was made, that it is a key objective for all nations to reduce their premature mortality by 25% in 2025. The CV diseases have been highlighted in a separate program and their name was “Heart of 25 by 25”. The main objective is to reduce the of premature CV mortality (probability of dying between 30 and 70 years). The target consists of main points: 30% reduction in smoking, 25% reduction in the prevalence of high blood pressure, halt the rise in obesity and diabetes type 2. Worldwide estimations were made on what would be expected in 2025 when the program was successful or unsuccessful. If the current trend remains then 30% in women and 34% in men would increase premature mortality. If all factors are influenced, then the increase will be only 1% for women and a reduction by 6% for men for developed countries, a reduction in both sexes would exceed 20%.]