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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.]

Hypertension and nephrology

SEPTEMBER 14, 2018

[Role of ketoanalogue amino acids and diet in the treatment of patients with chronic kidney disease]

KISS István, HARIS Ágnes, DEÁK György

[Low protein diet is an important component of the non-pharmacological treatment of patients with chronic kidney disease (CKD). Along with the diet it is important to maintain appropriate energy intake to avoid malnutrition. It is recommended to supplement low protein diet (0.6-0.7 g protein/kg body weight/day) with essential amino acids and their ketoanalogues (ketoacids) in a dose of 1 tablet/8-10 kg body weight if there is a threat of protein malnutrition (eg. vegan diet). Very low protein diet (0.3-0.4 g protein/kg body weight/day) should be supplemented with ketoacids in a dose of 1 tablet/5 kg body weight. Low protein diet is recommended for patients with CKD stage 3 and progressively declining renal function, or nephrotic syndrome; in diabetic nephropathy; in CKD stage 4 and non-dialyzed CKD stage 5. Nephroprotective effect of very low protein diet is primarily expected is patients with an eGFR below 20-25 ml/min/1.73 m2 and good compliance. Dietary protein restriction may diminish acidosis and proteinuria, slow the progression of CKD and delay initiation of dialysis. Diets reduced in protein supplemented with appropriate energy intake and ketoacids are nutritionally safe. Dietary education and guidance of patients by qualified dietitians are of great importance in nephrology clinics. We illustrate the main points of our review with case reports.]

Hypertension and nephrology

MAY 20, 2017

[New agents in the therapy of hyperkalaemia]

PATÓ Éva, DEÁK György

[Serum potassium level higher than 5,5 mmol/l denotes hyperkalemia that becomes severe above 7,5 mmol/l being a potentially life threatening condition due to ventricular arrythmias. It may develop as a consequence of high potassium intake, decreased renal excretion, and extracellular potassium shift. Its treatment is a challenge even nowadays especially in the setting of chronic kidney disease, diabetes mellitus, and heart failure where RAAS inhibion is an essential component of the therapy. Sodium polystyrene sulfonate, an ion exchange resin is applied for more than fifty years. Recently new angents, patiromer and sodium zirconium cyclosylicate (ZS-9) were introduced and available results show a safer, more tolerable and predicatble effect. Efficiency of patiromer to reduce hyperkalemia is verified in clinical trials in patients with chronic kidney disease, or diabetes mellitus, or hypertension or heart failure on RAAS inhibitor therapy.]

Hypertension and nephrology

SEPTEMBER 10, 2016

[Hypertension and left ventricular hypertrophy]

MATOLTSY András

[Left ventricular hypertrophy (LVH) is defined as an increase in the mass of the left ventricle. In addition to the absolute increase in mass, the geometric pattern of LVH also may be important. LVH can be secondary to an increase in wall thickness, an increase in cavity size, or both. LVH as a consequence of hypertension usually presents with an increase in wall thickness. This increase in mass predominantly results from a chronic increase in afterload of LV caused by the hypertension, although there is also a genetic component. A significant increase in the number and/or size of sarcomeres is the main pathologic mechanism, but hypertension may also result in interstitial fibrosis. The estimation of mass is commonly derived from measurements obtained by echocardiography. LVH is associated with increased incidence of systolic and/or diastolic dysfunction, heart failure, myocardial infarction, ventricular arrhythmias, sudden cardiac death, aortic root dilatation, and a cerebrovascular event. The cardiovascular risk is directly related to the degree of mass. The regression of LVH is associated with a reduction in cardiovascular risk and improved cardiac function. Regression of LVH is associated with weight loss, dietary sodium restriction, and use of ACE inhibitors, ARBs, some calcium channel blockers, and some sympatholytic agents.]

Clinical Neuroscience

MAY 30, 2016

[New opportunities in neuro-rehabilitation: Robot mediated therapy in conditons post central nervous system impairments]

FAZEKAS Gábor, TAVASZI Ibolya, TÓTH András

[Decreasing the often-seen multiple disabilities as a consequence of central nervous system impairments requires broadening of the tools of rehabilitation. A promising opportunity for this purpose is the application of physiotherapy robots. The development of such devices goes back a quarter of century. Nowadays several robots are commercially available both for supporting upper and lower limb therapy. The aim is never to replace the therapists, but rather to support and supplement their work. It is worthwhile applying these devices for goal-oriented exercises in high repetition, which one physically fatiguing for the therapist or for the correction of functional movement by various strategies. Robot mediated therapy is also useful for motivation of the patient and making the rehabilitation programme more versatile. Robots can be used for assessment of the neuromotor status as well. Several clinical studies have been executed in this field, all over the world. Meta-analyses based on randomized, controlled trials show that supplementing the traditional physiotherapy with a robot-mediated component presents advantage for the patients. Further studies are necessary to clarify which modality and intensity of the exercises, in which group of patients, in which stage lead to the expected outcome.]

Hypertension and nephrology

SEPTEMBER 20, 2014

[Changes in prescribing practice of diuretics in the treatment of hypertension between 2007 and 2013 in the mirror of insurance data]

BARNA István, GYURCSÁNYI András

[Amongst diuretics, thiazides are the most commonly used antihypertensive agents. Due to their long-term effect, they are ideal for treatment of hypertension. Indapamide is a long-acting (half-life 14-16 hours) thiazide-like diuretic, which is effective in very small doses (1.25 to 5 mg). Indapamide mainly provides a forceful blood pressure lowering effect, by decreasing arteriolar and peripheral resistance due to its vasodilatative effect. Even in hypertensive, diabetic patients, indapamide does not affect the lipid metabolism or the carbohydrate metabolism. As an antihypertensive medicine, thiazide-type diuretics (only in small doses - 6.25- 12.5 mg hypothiazide, 12.5 mg chlorthalidone, 5 mg clopamide) can be the first choice, when dealing with essential hypertension disease without complications. They may also be used in monotherapy. When dealing with hypertension associated with old age or with isolated systolic hypertension, these products are recommended with “A” type evidence. For the treatment of left ventricular hypertrophy and post-stroke conditions associated with the treatment of hypertension, it is recommended to use indapamide in case of diabetes, furosemide and thiazide in case of a left ventricular dysfunction and heart failure, or a combination of these. When reviewing the national sales of mono-component diuretics between 2007 and 2013 in the National Health Insurance (OEP) database, we could see that the sales of hydrochlorothiazide, clopamide, and chlorthalidone decreased. In 2013 however, the sales of the latter experienced a turnover, which might indicate the activity of the followers of the new guideline. The use of diuretics with indapamide as their active substance increased. The prescription of diuretics used in a combination increased continuously between 2007 and 2010 and reached a monthly one million prescribed boxes. During the time in question, the use of products combined with hydrochlorothiazide (most products contain this agent) was the most dominant, but its share fell from 88% to 66% due to the growth of combinations containing the active ingredient indapamide. This is interesting because this combination is “unique” (perindopril + indapamide). During the period in question, only the prescription of this combination increased steadily. The use of diuretics is very important in antihypertensive therapy. If we compare the diuretics and their combinations to the recommendations, we can state that the treatment is done along the guidelines, or in other words the use of the metabolic neutral combination therapy is increasing.]

Lege Artis Medicinae

JULY 20, 2014

[Amlodipine/atorvastatin fix combination in general practice]

ÁBRAHÁM Erzsébet Judit

[In total 50 patients with hypertension and dyslipidaemia received combined antihypertensive and antilipid treatment. The main component of therapy was a fixed combination of amlodipine/ atorvastatin in different dose variations. The goal of the observation was to achieve optimal target blood pressure and lipid profile. During the six- month therapy, the baseline average blood pressure value was 161/90 mmHg and it decreased to 133/84 mmHg. The lipid profile also changed successfully. The average value of total cholesterol decreased from 5.9 mmol/l to 4.76 mmol/l. Over the six month period, amlodipine/ ator vastatin usage not only decreased the number of the heart and vascular system events, but increased the patients medicine compliance and therapy loyalty.]

Clinical Neuroscience

MARCH 30, 2014

[CENTRAL NEUROENDOCRINE MECHANISMS OF GASTROPROTECTION]

GYIRES Klára

[Selye recognized the importance of activation of hypothalamic- pituitary-adrenal axis during stress and the connection between central nervous system and neuroendocrine regulation. This concept basically contributed to initiation of the studies, which revealed the importance of brain gut axis in regulation of gastric mucosal integrity. Several neuropeptides, such as thyreotrop releasing hormones, adrenomedullin, peptide YY, amylin, opioid peptides, nociceptin, nocisatin, substance P, ghrelin, leptin, orexin-A, angiotensin II were shown to induce gastroprotective effect injected centrally. Though the involvement of dorsal vagal complex and vagal nerves in conveying the central action to the periphery has been well documented, additional mechanisms have also been raised. The interaction between neuropeptides further component that may modify the gastric mucosal resistance to noxious stimulus.]

Hypertension and nephrology

MARCH 22, 2013

[Obstructive sleep apnea, hypertension and cardiovascular risk]

ALFÖLDI Sándor

[Obstructive sleep apnea (OSA) is a surprisingly frequent disease worsening the quality of life of the patients, associated with serious complications, however, largely underdiagnosed and undertreated. OSA, hypertension and other symptoms of the metabolic syndrome are closely and independently correlated. OSA has been substantially emphasized as a new (emerging) cardiometabolic risk factor, not only a risk marker. The severe form of OSA (apnea-hypnea index>20/hour) has been accepted as a component of high cardiovascular risk on the Hungarian Cardiovascular Consensus Conference in 2008. Greater attention both to the identification and to the treatment of blood pressure increase associated with OSA as well as to the detection of OSA in patients with the diagnosis of hypertension has been suggested by the new European OSA and Hypertension Position Papers, because hypertension associated with OSA is frequently resistant and the proper management of OSA and hypertension could decrease the cardiovascular risk in patients followed up either in sleep or in hypertension centres.]

Hypertension and nephrology

MARCH 22, 2013

[The success of fixed combined amlodipine/atorvastatin (Amlator®) therapy in patients with hypertension and dyslipidemia]

KÉKES Ede

[In total 2606 patients with hypertension and dyslipidemia got combined antihypertensive and antilipid-treatment. The main component of therapy was amlodipine/ atorvastatin fixed combination in different dose variations. The goal of the study was to access optimal target blood pressure and lipid profile. The baseline average blood pressure value was 155.9/90.18 mmHg and it decreased to 132.77/80.04 mmHg during the six months therapy. The lipid profile also changed successfully: the average value of total cholesterol decreased from 5.97 mmol/l to 4.68 mmol/l, LDL cholesteron from 3.45 mmol/l to 2.49 mmol/l and serum triglyceride from 2.1 mmol/l to 1.69 mmol/l. We reached the target values in respect of LDL cholesterol (<2.5 mmol/l) and of triglyceride (<1.7 mmol/l) prescribed in guidelines for subjects with high cardiovascular risk. According to the global cardiovascular risk estimation (European Heart Score) the risk ratio in percent was significantly decreased in each age group, in both genders and in smoking or nonsmoking subjects.]