Specialities

Infectology

Hypertension and nephrology

APRIL 29, 2021

[When should antihypertensive be taken: in the morning and/or evening? Chronopharmacotherapy of hypertension in practice]

SZAUDER Ipoly

[The circadian (24-hour) variability of blood pressure (BP) is influenced by constant and variable (external and internal) factors. With this in mind and by determining the type of hypertension with a 24-hour blood pressure monitoring (ABPM), individual chronopharmacological (chronopharmacotherapy) treatment can be planned. There are significant differences in the chronokinetics of antihypertensive drugs administered at different times. Their therapeutic range and efficacy depend significantly on their circadian timing. Although the most modern antihypertensives have a 24-hour effect, they are not able to lower blood pressure at all times. Morning intake of ACE inhibitors, ARB-s, alpha-blockers mainly affect the afternoon and early evening rise, while evening intake reduces nocturnal and morning rise. Calcium channel blockers, beta-blockers (except carvedilol and labetolol), do not affect the circadian blood pressure profile. Therefore, in nondipper hypertension or in the case of morning rise, the twice daily morning and evening administration is more effective than the single morning administration. (Usually a lower dose is sufficient in the evening.) Adequate control of nocturnal or morning blood pressure elevations can be achieved with medication taken in the evening. According to the relevant studies the conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events, so evening intake only is not recommended. In particular the administration of antihypertensive drugs at bedtime, especially in the case of elderly patients may cause excessive BP fall at night with increased risk of silent cerebral infarct and the myocardial ischemia in patients with coronary heart disease.]

Hypertension and nephrology

APRIL 29, 2021

[Independent risk factors for fatal cases of the Covid-19 pandemic]

KÉKES Ede

[Already at the beginning of the Covid-19 pandemic, it was known to be severe and critical mortality rates (crude fatality rate (CFR) is a major and crucial factor in this age on the other hand, men have a higher incidence of fatalities. Another known fact is that comorbidities (coronary heart disease, hypertension, diabetes, COPD) are more common in severe or fatal cases. However, for these the causal role of diseases has not been clarified for a long time, then it turned out that the occurrence corresponded to that age observed population age ratios (1, 2).]

Hypertension and nephrology

APRIL 29, 2021

[Medical letters about Covid-19. II. part]

FARSANG Csaba

[In March 2020, the coronavirus epidemic reached Hungary as well, which had and has had a multifaceted effect on society as a whole, to the medical community and, to a greater extent, to patients. In the second letter, seek medical help, a I deal with the role and significance of patient symptoms, stress, and physical activity.]

Hypertension and nephrology

APRIL 29, 2021

[Covid-19 and peripheral arterial disease]

FARKAS Katalin

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

Hypertension and nephrology

APRIL 29, 2021

[Pyelonephritis acuta]

[Primarily bacterial infections (E. coli, Proteus mirabilis, Klebsiella, Enterococcus), tubules, interstitium, acute inflammatory condition of the renal calves and pelvic pelvis. Most often as a result of ascending urinary tract infection less frequently due to haematogenic variance. Risk factors for the development of diabetes are immunosuppressive condition, obstructive in maintaining urinary retention uropathies (kidney stones, tumors, or congenital urotra or acquired dysfunction and / or anatomical abnormalities), and instrumental interventions on the urinary tract and pregnancy.]

Hypertension and nephrology

FEBRUARY 24, 2021

[Gender differences in sport-adaptation of intramural coronary resistance arteries]

TÖRÖK Marianna

[Biomechanical and functional remodeling of coronary resistance arteries in physiological left ventricular hypertrophy has not been analyzed yet, and the possible sex differences are unknown. We aimed to study the biomechanics and function of these arteries during an exercise intervention. Wistar rats were divided into four groups: male and female sedentary controls (MSe and FSe) and male and female animals undergoing a 12-week intensive swim training programme (MEx and FEx). After the training sessions, LV morphology and function were checked by echocardiography, the coronary artery biomechanics and function were examined by pressure arteriography. Elastica remodeling was studied in resorcin-stained histological sections. The female animals had enhanced heart weight/body weight ratio compared to male rats. A similar outer radius and reduced inner radius resulted in an elevated wall-to-lumen ratio in the MEx and FEx animals compared to the sedentary controls. The wall elastic moduli increased in the MEx and FEx rats. The spontaneous tone and TxA2 agonist-induced tone was raised only in ExF animals, whereas the endotheliumdependent relaxation became more effective in ExM rats. Arteries of ExF rats had stronger contraction, whereas arteries of ExM animals had improved dilation. Range of coronary vascular reactivity increased in both exercised male and female rats, but its mechanism was different depending on sex. According to our results the coronary arterioles adapted to an elevated load during long-term exercise and this adaptation depended on sex. The observed sex differences in the biomechanics and function of the coronary resistance arteries of rats may contribute to better understanding of the physiological and pathological function of these arteries in active and retired athletes.]