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Hypertension and nephrology

SEPTEMBER 12, 2018

[More than bodyguard? The ramipril/amlodipine FDC effect on their whole blood pressure spectrum]

SIMONYI Gábor, ZSUZSA Pál, GENCSIOVA Kristína, FINTA Ervin

[Hypertension is a significant cardiovascular risk factor. Effective treatment of hypertension contributes to avoiding the risk of later cardiovascular complications. Rapid access to blood pressure targets is also important in new untreated hypertensive patients. In the new ESH/ESC Hypertension Recommendation - during the initiation of antihypertensive therapy - the immediate introduction of drug combinations is explicitly recommended. In our retrospective data collection study we studied the effect of the ramipril/amlodipine fixed combination on the 24-hour brachial and central blood pressure parameters of the fresh hypertensives.]

Hypertension and nephrology

MAY 10, 2019

[One-year persistence of fixed-dose combinations of angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertensive patients]

SIMONYI Gábor, FERENCI Tamás, FINTA Ervin, IGAZ Iván, BALOGH Sándor, GASPARICS Roland, MEDVEGY Mihály

[Introduction: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as the first therapeutic option. In antihypertensive therapy, the patient’s adherence is one of the most important factors in reducing unwanted cardiovascular events. Aim: Our aim was to assess the one-year persistence of angiotensin-converting enzyme inhibitor (ACEI) and CCB FDCs in hypertensive patients. Method: Authors have analysed the prescription database of the National Health Insurance Fund in Hungary on pharmacy claims between October 1, 2012 and September 30, 2013. Those patients were identified who filled prescriptions for FDCs of ACEI and CCBs prescribed for the first time for hypertensive patients and who had not re ceived similar drugs during the year before. Apparatus of survival analysis was used, where ‘survival’ was the time to abandon the medication. Results: 124,388 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinua tion in patients with ramipril/amlodipine FDC was 54% (HR = 1.00, reference), perindopril/amlodipine 47% (HR = 1.30, p<0.0001), lisinopril/amlodipine 36% (HR = 1.79, p<0.0001), ramipril/felodipine 26% (HR = 2.28, p<0.0001) and trandolapril/verapamil 12% (HR = 4.13, p<0.0001). The average survival time of drug limited to 360 days was 270.2 days for ramipril/amlodipine FDC, 242.7 days for perindopril/amlodipine FDC, 211.2 days for lisinopril/amlodipine FDC, 186.3 days for ramipril/felodipine FDC and 125.7 days for trandolapril/verapamil FDC. Conclusions: The authors demonstrated that the one-year persistence of ACEI/CCB FDCs was significantly different in hypertensive patients. Ramipril/amlodipine FDC was more advantageous for patient adherence.]

Lege Artis Medicinae

MARCH 20, 2019

[How can we reach more effective antihypertensive treatment in diabetic patients with hypertension?]

BENCZÚR Béla, TORZSA Péter

[Hypertension is the leading “silent killer” accounting for 10 million deaths worldwide. It frequently occures together with other metabolic risk factors, including type-2 diabetes mellitus and dyslipidemia augmenting the global cardiovascular risk of patients. Their treatment and reaching target blood pressure means a real challenge for practising physicians. According to the recent hypertension guidelines RAAS-inhibitors are the first choice agents which can be excellently combined with diuretics. RAAS-inhibitor based therapy frequently needs to be completed with Ca-antagonist to which statin should be added in the presence of metabolic risk factors. The benefits of amlodipin/atorvastatin fixed combination are multiple: both agents are capable to inhibit the progression of atherosclerosis and to reach blood pressure and LDL target values. In addition the well-known poor statin-adherence can be improved with fixed combination which can contribute to the reduction of risk of these high-risk subjects. ]

Lege Artis Medicinae

NOVEMBER 15, 2019

[Hypertension in the elderly ]

BARNA István

[Elevated isolated systolic pressure is the most common and greatest cardiovascular risk factor with age. The prevalence of hypertension increases with age and ex­ceeds 60% over 70 years. Proper treatment of hypertension in the elderly, even in very old age (> 80 years), increases life expectancy and reduces the risk of cardiovascular events. For patients over 65 years of age, the target blood pressure range is between 130-139 / 70-80 mmHg if the patient tolerates the treatment. In elderly patients with poorer conditions, systolic blood pressure may be <150 mmHg. White-coat hypertension is common, nondipper ratio is increased, autonomic nervous system dysregulation is more common, and orthostatic decrease of blood pressure. The renal function is decreased or already impaired, often resulting in poorer therapeutic cooperation due to impaired cognitive function. The blood pressure lowering effect of targeted lifestyle changes may be the same as medication monotherapy, with the main disadvantage of decreasing adherence over time, for which a proper physician-patient relationship is essential. First-line agents for the treatment of elderly hypertension include angiotensin converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), long-acting calcium channel blockers, and thiazide, thiazide-like diuretics. Beta-blockers should be used in the treatment of elderly hypertension if they have other indications (coronary heart disease, heart failure, arrhythmias). More than 70% of hypertensive patients should use combination therapy to achieve target blood pressure. Take advantage of fixed dose combination to improve compliance to optimize treatment. ]

Clinical Oncology

APRIL 30, 2020

[Immunotherapy of hepatocellular carcinoma]

DEMETER Gyula

[The systemic treatment of HCC was based exclusively on sorafenib near 10 years. In the past 2-3 years some new molecules demostrated their effectivites in phase III clinical trials. So the immuncheckpoint-inhibitors (ICI) demands their place in systemic treatment of HCC. Nivolumab and pembrolizumab are recommended already in second line in NCCN and ESMO clinical guidelines. Nivolumab demostrated his effectivity against the standard treatment sorafenib in a phase III clinical trial, although the results were not signifi cant. However, the combination treatment of atezolizumab and bevacizumab seems better than sorafenib in a phase III clinical trial, so the combination is recommended already in fi rst line in the NCCN guideline. There are more clinical trials with ICIs in progress as in monotherapy as in combination therapy with other modalities.]

Clinical Oncology

DECEMBER 30, 2019

[Targeted and immune therapies for hepatocellular carcinoma: Predictions for 2019 and beyond]

MASATOSHI Kudo

[Systemic therapy for hepatocellular carcinoma (HCC) has markedly advanced since the survival benefi t of a molecular targeted agent, sorafenib, were demonstrated in the SHARP and Asia Pacifi c trials in 2007. Treatment options for patients with advanced HCC increased by sorafenib, and long-term survival for patients with advanced stage HCC has become possible to some extent. However, development of a more potent fi rst-line novel molecular targeted agent replacing sorafenib and a potent second-line agent after disease progression on or intolerant to sorafenib has been warranted because sorafenib lacks tumor shrinking/necrotizing effects and induces relatively severe adverse events such as hand foot skin reaction. Many agents in the 1st line and 2nd line setting were attempted to develop between 2007 and 2016, but all of these clinical trials failed. On the other hand, clinical trials of 4 agents (regorafenib, lenvatinib, cabozantinib, and ramucirumab) succeeded in succession in 2017 and 2018, and their use in clinical practice is possible (regorafenib and lenvatinib) or underway (cabozantinib and ramucirumab). Furthermore, all of 5 clinical trials of combination therapy with transcatheter chemoembolization (TACE) plus a molecular targeted agent failed to date, however, the combination of TACE and sorafenib (TACTICS trials) was reported to be successful and presented at ASCO in 2018. Phase 3 clinical trials of immune checkpoint inhibitors and a combination therapy of immune checkpoint inhibitors and molecular targeted agents are also ongoing, which suggests treatment paradigm of HCC in all stages from early, intermediate and advanced stage, is expected to be changed drastically in the very near future.]

Lege Artis Medicinae

DECEMBER 10, 2018

[Modalities of the therapy of patients with high cardiovascular risk]

FARSANG Csaba

[International and Hungarian guidelines emphasize the need of the combinations in the therapy of hypertension. Single pill combinations (SPC) are preferred. The importance of the treatment reducing cardiovascular risk is underlined by the fact that in most hypertensive patients other cardiovascular risk factors, among them most frequently dyslipidemia is present. In addition to antihypertensive drugs these patients should be treated also with those decreasing plasma lipids. Adherence / persistence to therapy of patients is greatly improved by the use of single pill combinations. Today we also have SPCs decreasing both, blood pressure and plasma lipids. Among them there is the combination containing amlodipine and atorvastatin. Several international and Hungarian clinical studies have been conducted. Results of these investigations have been described in several publications. In this paper I summarise the most important results of some of these studies. ]

Lege Artis Medicinae

DECEMBER 21, 2020

[Changing glaucoma care in Hungary: is technical development accompanied by the improvement of glaucoma management?]

HOLLÓ Gábor

[Success and failure of the last thirty years of glaucoma care in Hungary are summarized in the current review on the occasion of the thirtieth anniversary of the establishment of Lege Artis Medicinae. Lege Artis Medicinae has been supporting glaucoma care with publishing scientific papers on glaucoma management since its establishment. During the last three de­cades our understanding of the pathomechanism of glaucoma has been changed, modern automated threshold perimetry became widely available for ophthalmologists, quantitative retinal imaging became established, modern topical glaucoma medication including the fixed dose combination and preservative-free eye drops appeared in clinical practice, and glaucoma microsurgery considerably improved. However, better converting the achievements into routine clinical practice requires further efforts from Hungarian ophthalmologists.]

Lege Artis Medicinae

NOVEMBER 30, 2020

[GLP-1 receptor agonists in the elderly]

WINKLER Gábor

[According to current guidelines of type 2 diabetes, treatment, glucagon-like pep­tide (GLP) -1 receptor agonists (RAs) are primary suggested drugs of the early antidiabetic medication, just after the first an­ti­­diabetic metformin. However, more and more arguments support their optional application in old age diabetes. These include multi-target strong glycemic ef­fects, low risk of hypoglycaemia, proven cardio- and nephroprotective nature of long- and ultra long-acting derivatives, multifaceted be­neficial pleiotropic effects, as well as the appearence of their fixed combinations with analogue basal insulins effective in weight loss and lowering the blood pressure. This study reviews specific aspects of blood sugar lowering treatment in the elderly and the potential benefits of choosing GLP-1 RAs in this age group. While presenting data of relevant literature and own experiences it is emphasized, that these preparations can be used safely in long term also in this age group.]

Clinical Oncology

DECEMBER 10, 2018

[Treatment of head and neck cancer]

KATONA Csilla, LANDHERR László

[Head and neck cancers cause worldwide a signifi cant problem in health care systems. Despite great advances in therapeutic modalities its prognosis has not changed in the past few decades. It is mainly caused by classical risk factors, like alcohol consumption and smoking, but in a signifi cant number of oropharyngeal cancers HPV infection plays a major role, which is associated with a new patient group characterized by a much better prognosis and therapeutic response. In the diagnostic phase staging examinations (CT scan, MRI, FDG-PET) are also involved which are necessary to multidisciplinary decision making. It can be largely infl uenced by the patient’s preference. The therapy is based on multimodality approach; surgery, radiotherapy, chemoirradiation, chemotherapy and the combination of these are used in early or locally advanced tumours. Targeted agents like EGFR inhibitors are partly used in the recurrent/metastatic setting or in combination with radiotherapy. Immun checkpoint inhibitors are new therapeutic options for pretreated, recurrent/metastatic patients and their role is under investigation in earlier therapeutic lines. Several clinical trials aim treatment desintensifi cation strategies in HPV positive tumours. Molecular genetic tests try to defi ne subgroups of patients to plan individualized treatment. Regarding the signifi cant functional and aesthetic damage of both disease and treatment, supportive care and rehabilitation are of great importance.]