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Hypertension and nephrology

SEPTEMBER 30, 2020

[Post-career development of cardiometabolic changes and hypertension in competitive athletes]

LELBACH Ádám, KÁNTOR Márk, KOLLER Ákos

[Regular physical activity is essential in delaying the aging processes (e.g. arterial remodelling – stiffening, metabolism, bodyweight), the beneficial effects of competitive sports – especially strength sports – according to the recent data of the literature are questionable. The beneficial effects of physical activity on the cardiovascular (CV) system are well known, however less is known regarding the delayed impacts of high intensity competitive sports on the CV system, especially after the sport career is over. This review summarizes the effects of active competitive sport and the post-career period on the cardiometabolic system with special attention to the systemic blood pressure and the development of metabolic syndrome. After sport career, the welldeveloped high performance cardiovascular- and metabolic system suddenly is much less used, but still supported by sport-level diet. It is well known that hypertension is a significant pathogenic factor in the development of cardiovascular diseases, characterized – among others – by reduced elasticity of large- and medium- sized vessels thereby importantly contributing to the development of systolic hypertension. Inflammation and thrombus formation both play an important role in the development of vascular injury and atherosclerosis. The increased tone of microvessels can impair the blood supply of certain organs, including the coronary circulation. It has been ample shown, that regular non-competitive, aerobic exercise activities are important factors in preventing hypertension. Such pathological changes become more evident after the development of post-career obesity, as well as the development of hypertension due to the activation of the renin-angiotensin system through sodium retention and other metabolic changes (increased glucose tolerance, insulin resistance, type II diabetes mellitus). It has been ample shown, that regular non-competitive, dynamic aerobic exercise activities are important factors in preventing hypertension. The frequency, intensity, type, and time (FITT) principle of exercise prescription is the first and common therapeutic approach, which represents the translation of cardiovascular basic science research results into hypertension treatment, thus can provide a personalized physical activity program/therapy according to medical needs not just for the post-career sportspersons, but the wide range of patients.]

Lege Artis Medicinae

JULY 01, 2020

[Sarcopenia – muscle loss – pathomechanism, clinical presentation and metabolic comorbidities]

VERECKEI Edit, HODINKA László

[Sarcopenia, or the age-related involution of muscle strength and muscle mass, is a serious public health concern, due to the growing number of elderly population caused by nowadays demographic changes i.e. prolonged life expectancy. By ageing, the muscle tissue is shrinking gradually, leading to the loss of muscle strength and masses. This condition is called sarcopenia. Sar­co­penia is the simultaneous decrease of muscle mass, muscle strength and functional independence. In parallel the physical performance deteriorates (weakness, slowness and poor physical balancing). Fatigue, el­derly behaviour and weight loss are the consequences of these accumulating deficits, which associate with cognitive decline and result in increasing social isolation. The primary form of sarcopenia is the decrease of the energy production of muscle cells and then the death of muscle cells. Se­con­dary, endocrine dysfunctions, diseases of the nervous system, decreased physical activity, malnutrition or malabsorption, chronic infection accelerate the process and aggravate the patient’s condition. Complex genetic, biochemical and endocrine mechanisms take part in the development of sarcopenia. This involution is due to the impaired balance of restoring and depleting processes of muscles. A questionnaire and algorithm have been developed to recognize, screen and diagnose the risks of sarcopenic condition; these separate the sarcopenic and non-sarcopenic patients with specific cut-off values. Sar­co­penia can be diagnosed based on walking speed, decreased handgrip strength and measured or calculated muscle mass in persons over 65. Sarcopenia can be considered as a phenomenon of “physiological” aging, however, it becomes a disease when diagnostic cut-offs are exceeded and the patient experiences functional disability and declining quality of life. Prevention and treatment of sarcopenia and reducing the risk of falling are based on regular active resistance and coordination exercises. Options for pharmaceutical treatments are limited since despite of identified molecular targets there are no convincingly effective innovative therapy on the horizon. Nevertheless, there are some weak evidence for efficacy of the application of amino acids stimulating muscle cell differentiation, such as leucine or the analogue of beta-hydoxy-methylbutyrate beside exercise therapy.]

Hypertension and nephrology

JUNE 24, 2020

[Not all young, athletic university students have optimal blood pressure. Results of the May 2019 Measurement Month (MMM19)]

PATÓ Anna, NÉMETH Zoltán, JÁRAI Zoltán, KOLLER Ákos

[For about 100 years, it has been known that persistently high blood pressure (hypertension) is the leading cause of cardiovascular disease deaths, such as major risk factors for heart failure, myocardial infarction, stroke, kidney and eye disease. Unfortunately, one of the characteristics of hypertension is that it remains undetected for a long time until damage to one or more organs has already occurred. Therefore, it is very important that systemic blood pressure is monitored from time to time, especially above 45 years of age. The prevalence of hypertension is more than 35% in the Hungarian population. Recent data have pointed out that hypertension may occur at a younger age, although at a lower frequency. Our studies were conducted in the context of the May 2019 Measurement Month (MMM19), an international campaign that draws attention to hypertension and the lack of systematic screening at population level. We hypothesized that hypertension may occur in young, apparently healthy university students. The studies were conducted among students of the University of Physical Education (n = 33; 25 males, 8 females). The mean age was 24.3 years (20–34 years). To measure blood pressure, an automatic blood pressure monitor (Omron MIT5) was used, placed on individuals’ upper arms, as specified in the guidelines, in a relaxed, sitting position. The measurements were repeated three times at one-minute intervals and the average of the three measurements was statistically analyzed. Blood pressure values (mean ± SEM, averaged over 3 measurements) in the student population were systolic 121.9 ± 14.4 mmHg, diastolic 75.1 ± 9.1 mmHg, mean 90.7 ± 10.9 mmHg, and heart rate: 46.8 ± 5.3 mmHg. Although mean blood pressure was within the normal range, higher values were also found in some individuals. Systolic blood pressure fell by 33% due to elevated normal blood pressure, respectively of Grade 1 hypertension. These data confirmed our hypothesis that hypertension may occur at a young age, despite the fact that members of the study population exercise regularly, which is an important preventive factor in the development of cardiovascular disease. These results underscore the importance of regular blood pressure measurement in adolescents, which may reduce the global spread of hypertension and prevent the development of a number of cardiovascular diseases, including stroke, heart attack, renal failure and mental decline.]

Journal of Nursing Theory and Practice

OCTOBER 30, 2019

[Multimorbidity among older people participating in geriatric exercise programme]

KOVÁCS Éva, VIRÁG Anikó, MÉSZÁROS Lászlóné, HARKÁNYI Izabella, SIMON András

[Objective: To determine the exercises and dosis of the effective and safe geriatric exercise programme it is essential to know that what kind of chronic diseases an elderly people suffer from. However, the old age is characterized by multimorbidity which means that the same person may have two or more chronic diseases at the same time. Methods: The aim of our study was to investigate the prevalence of chronic diseases associated with aged and multimorbidity among older people participating in geriatric exercise programme. Data were collected with self-administered questionnaire at sites of geriatric exercises programmes, Budapest. Results: Seventy one percent of the sample of 180 participantes (N=128) suffered from more than one chronic diseases. In our sample, the proportion of people with osteoporosis and obesity was significantly higher than the national average. At the same time, the prevalence of type 2 diabetes, lower limb joint disease, cerebrovascular accident and myocardial infarction was significantly lower than the national average. As regards to asthma and hypertension the proportions observed in our sample did not differ from the national average. Conclusions: In case of newcommer older people we need to pay more attention to the effects of chronic diseases associated with aging and of multimorbidity.]

Hypertension and nephrology

DECEMBER 12, 2019

[The effect of the β-blockers on left ventricular sytolic and diastolic function]

MOSER György

[The author surveys the pharmacodynamic effects, by which the β- blockers can exercise an influence on systolic and diastolic function. He points out, that the constituents of the effect can be separated only in didactic aspect, its worthwile to take the situation of their interdependence. Analyses the how the when and the wherefore the hemodynamic state determines the component of the complex mode of action that sets off. Deals with the problem, that what kind of effects are desired in certain clinical settings and which of those are deletorious. On emphasized he discusses the greatest danger of the β-blockade, the negative inotropic effect, and the mode of its offset or rather counteraction of its hemodinamic result.]

Lege Artis Medicinae

MAY 20, 2019

[Physical inactivity and activity. Damage and benefit]

KÉKES Ede, APOR Péter

[Authors address the issue of inadequate physical activity worldwide and analyze their relationship with cardiovascular diseases and total mortality. In the inactivity "world map" it can be seen that in economically developed countries it is very common but other ethnic and regional factors also play a role and it is significantly more frequent at women. In our country this phenomenon due to combination of advanced civilization and computerization is also frequent. From 2000 to 2015, the trend of the presence of physical inactivity (FI) in the high income populations is steadily rising. Convincing evidence suggests that FI increases the risk of many common, serious diseases, including ischaemic heart disease, type 2 diabetes, breast cancer and colon carcinoma, and reduces the life expectancy. For these four diaseses, the incidence of FI occurs in about 1/3 of cases and 35% of total mortality. Its health value (PAF) ranges from 10 to 18%. Low (non-regular) exercise increases the risk of hypertension with or without family history. In subjects with moderate and intensive levels of physical activity (FA), there is a significantly lower mortality rate and the rate of occurrence of major cardiovasculars (CV) diseases compared to those with lower grade FA. Behind the positive effect of physical activity there is a multiple and complicated mechanism that manifests itself in the vascular system, in the physiological adaptation of the heart and in other metabolic and cellular effects. ]

Journal of Nursing Theory and Practice

DECEMBER 30, 2018

[Pulse Wave Velocity measurement among university students ]

KALMÁR Ágota, PÓSA Gabriella, FINTA Regina, NAGY Edit, SZILÁGYI Levente

[The aim of the study: The purpose of our investigation is to prove the favorable effect of regular physical activity on arteries. Material and method: 42 students (29 women; 13 men; age 24 ±2,71 years) volunteered for our research. Anthropometric data, segmental-, visceral body composition (TanitaSBCA) and arterial stiffness parameters (Arteriograph) were measured. Participants took part in an 8-week training. Interventional-group: started training during our research, control-group: doing sports constantly for years. Results: Compared to the age decadal artertial pulse wave velocity (PWVao) reference value both groups showed significant difference. PWVao significantly improved because of training by the interventional group (6,23±0,79; 5,87±0,59 p<0,01); while in the case of the control group there was no significant change (5,85±0,54; 5,87±0,63 p=0,80). The body composition data showed minimal correlation with PWVao. Conculsion: Regular training has favorable effect on one stiffness parameter of arteries. Already 8 weeks enough to reach significant change to reduce arterial stiffness and this condition can be maintained with long-term regular training.]

Lege Artis Medicinae

MARCH 20, 2019

[Physiological-pathological muscle atrophy in elderly - interventions potencially inhibiting this progressive process ]

SZÉKÁCS Béla, MOLNÁR Andrea, BESENYEI Attila, MARTONY Zsuzsanna

[In old and very old age, one of the most prevalent signs of aged body’s decline is the progressive loss of muscle mass and function. First itself the physiological aging process can be dominant in the complex causative background but later it is usually intertwined with pathological mechanisms. The importance of muscle system is extremely high in the physiological regulation of various vital life processes The paper also points out the far-reaching consequences of sarcopenia syndrome that leads to general weakness, falls, traumas, acceleration of co-morbidities, rapidly declining self independence, ultimately frailty syndrome, and death. The initial body mass index has been recently replaced by a more adequate, more complex diagnostic approachment of sarcopenia that evaluates both muscle mass/strength and physical performance. Prevention or breaking the process of sarcopenia needs complex intervention which includes special fast protein rich diet with leucin and vitamin D combined with frequent physical exercise. ]

Clinical Neuroscience

NOVEMBER 30, 2018

Pulmonary physiotherapy and aerobic exercise programs can improve cognitive functions and functional ability

TEKESIN Aysel, TUNC Abdulkadir, GÜNGEN Dogan Belma, AVCI Nalan, BAKIS Muhammed, PERK Seyma

Objective - The increasing prevalence of dementia over the previous decades has been accompanied by numerous social and economic problems. The importance of exercise in the prevention of dementia coupled with the impact of aspiration pneumonia on the mortality and morbidity of dementia patients cannot be overstated. This study investigates the effects of pulmonary rehabilitation combined with aerobic stretching exercises on the cognitive function, life quality, effort capacity, and level of depression in patients with mild cognitive impairment (MCI) in the early stages of dementia. Methods - Sixty-nine patients with MCI diagnosis were routinely monitored, and six were excluded because they did not attend the follow-up appointments. The remaining 63 patients undertook pulmonary physiotherapy (PPT) and extremity exercises for six months. The mini-mental state examination (MMSE), six-minute walk test (6MWT), Nottingham health profile (NHP), and Beck depression inventory (BDI) scores were evaluated before and after exercise. Results - PPT plus extremity exercises appeared to significantly improve the MMSE scores and increase the 6MWT (p < 0.001) by an average of 25 m. No significant improvement was observed in the BDI and NHP scores. Conclusion - PPT and aerobic exercise positively affected the cognitive ability of MCI patients and improved their walking distance. These results underscore the importance of combining medical treatment with physical rehabilitation at the onset of dementia, a disease which exerts a significantly negative impact on the economy.

Hypertension and nephrology

MARCH 20, 2018

[Nebivolol’s unique molecule structure and its effect onthe quality of life]

KERKOVITS Gábor

[The β receptor blockers have very different effects depending on their receptor selectivity, ISA effect, which gives a wide opportunity of beneficial therapeutic choice. Resulting from its unique molecule structure nebivolol has its unique effects. It consists two isomers in 1:1 ratio. D-nebivolol is a highly β1 receptor blocker, while l-nebivolol causes NO release resulting vasodilatation. As a result of this dual effect, nebivolol more strongly reduces the blood pressure. The pressure reducing effect of nebivolol is stronger than 25 mg of atenolol, and is equal with the effect of 100 mg of atenolol. Nebivolol has a significantly higher responders’ rate than bisoprolol, and significantly fewer adverse effect. Comparing to losartan nebivolol produces significantly higher reduction in systolic and in diastolic blood pressure as well. Nebivolol has beneficial haemodynamic effects. It raises the stroke volume by 20.6 percent, the cardias output by 7.1 per cent, the ejection fraction by 7.8 per cent while reduces the peripheral resistance by 13.2 per cent. Both at rest and during exercise nebivolol cases significantly higher reduction in pulmonary wedge pressure than atenolol. Nebivolol has a better profile of adverse effects. The following adverse effects were observed: fatigue in 1.3 per cent, cold extremities in 0.8 per cent, impotence in 0.08 per cent and dyspnea in 0.05 per cent. It has also a beneficial effect on erectile dysfunction. It cases a significant elevation in erectile dysfunction score from 17.22 to 22.09. The number of sexual activity also raised from 3.41 to 6.38 during nebivolol treatment. The prevalence of erectile dysfunction is also significantly lower as compared to any β receptor blocker. Nebivolol has a synergic effect on PDE5 blockers, raises the cGMP concentration in the erectile tissue. There is also a significant difference among the β receptor blockers in the reduction of exercise tolerance. The nonselective β receptor blocker cause 40 per cent, carvedilol 35 per cent, the β1 selective receptor blocker 25 per cent while nebivolol 6 per cent reduction in the duration time.]