Where is the border between normal and abnormal blood pressure and what is the therapeutic goal in cardiovascular and renal diseases?

Összefoglaló. Az irodalmi adatok arra utalnak, hogy a systolés vérnyomás értékének emelkedése már 110-115 Hgmm-től együtt jár az atherosclerosissal összefüggő elváltozások kialakulásával is és ezzel együtt a cardiovascularis és a renalis funkció romlásával. Az összefüggés exponenciális, de mértékét az életkor jelentősen befolyásolja. A kezelés során az elérendő vérnyomás célértéke a jelenlegi adatok alapján 120-130 Hgmm között helyezkedik el a 18-65 év közötti populációban; idősebb korban - különösen 80 év felett - ennél magasabb, a 130 Hgmm alatti érték elérése nem reális, de talán nem is szükséges. A leghelyesebb az egyéni vérnyomásprofil meghatározása, és számos befolyásoló tényezőt is figyelembe kell venni a páciens legmegfelelőbb kezeléséhez. A populáció egészségének javításához és megőrzéséhez az egyik legfontosabb és leggyakoribb cardiovascularis kockázati tényezőt, a magas vérnyomást időben fel kell fedezni, amihez a vérnyomást rendszeresen szükséges ellenőrizni, és ezzel párhuzamosan kell végezni a prevenciót célzó tevékenységeket (nevelés, oktatás, szűrés, egészségtudatos életmód) is. Orv Hetil. 2021; 162(34): 1351-1361. Summary. The data in the literature suggest that the increase in the value of systolic blood pressure from 110-115 mmHg leads to the development of atherosclerotic process and to the deterioration of cardiovascular and renal function. The correlation is initially linear, then above 140-150 mmHg it is already exponential, but it is also related to the progression of the age. The systolic target for therapy is between 120-130 mmHg in the population aged 18-65; in older ages - especially over 80 years - it is higher and reaching the value below 130 mmHg is unrealistic, and may even be not necessary. It is the best to determine the individual treatment, taking into account the individual blood pressure profile and the factors influencing the patient. In order to improve and maintain the health of the population - in addition to unknown hypertension - it is necessary to regularly monitor blood pressure and apply the known preventive methods (education, training, screening, etc). Orv Hetil. 2021; 162(34): 1351-1361.

The combined effect of regular alcohol consumption and smoking on blood pressure and on the achievement of blood pressure target values in treated hypertensive patients

INTRODUCTION

The combined effect of alcohol consumption and smoking on hypertension in hypertensive patients is still not completely clear, although both are known to be cardiovascular risk factors.

AIM

The aim of our study was to compare the blood pressure, the achievement of target blood pressure and heart rate of non-smokers and non-drinkers in the middle-aged hypertensive patients with those who smoke and drink regularly.

METHOD

From the database of the Hungarian Hypertension Registry, 12 615 patients (6341 men and 6274 women) aged 45-64 years were included in the current analysis, who self-reported smoking habit and alcohol consumption.

RESULTS

The mean age of the patients was 55.8 ± 5.7 years (males) and 56.1 ± 5.5 years (females). The percentage of regular smokers was 40.8% and 27.2% among men and women, respectively. 38.1% of males and 12.5% of females were regular alcohol drinkers. The ratio of patients reaching goal blood pressure values was higher in all investigated groups of females than males (p<0.001). Regular smokers and drinkers have lower percentage of reaching goal blood pressure values: 31.1% versus 46.6% in males (p<0.001) and 41.1% versus 49.8% in females (p<0.01), respectively. The average of pulse rate was higher in patients who are smokers and regular drinkers.

CONCLUSION

Regular alcohol consumption and smoking decrease the chance of reaching blood pressure goal values in middle-aged, treated hypertensive patients. Orv Hetil. 2020; 161(30): 1252-1259.

[The prevalence of smoking and gender differences according to the data of the national health screening program in 2010-2018]

Introduction: The harmful effects represent an important public health problem in tha world. Aim: Our aim is to report and compare the results of screenings performed in Hungary's Comprehensive Health Screening Program 2010-2020-2030 (MÁESZ) with international data. Method: During the 9-year continuous screening, we analyzed the data of 71 922 women and 60 934 men in the 18-80-year-old population and examined the occurrence of regular daily smokers. Data were collected with the help of special screening data sheets. Results: 24.4% of males and 24.2% of females smoked regularly during the 9-year screening period. Between 2012 and 2015, smoking prevalence showed a temporary significant decline, then, from 2016, it started to increase again. The downturn coincided with the opening of national tobacco stores. In men, the proportion of smokers was significantly higher in young adults (18-25 years) than in women. Later in life, the difference leveled off and even between 46-55 years, the prevalence of smoking was greater in women. There is a difference in smoking patterns between the two genders, which is probably related to marriage and motherhood in women. After 56 years, the proportion of smokers in both genders decreased rapidly. The prevalence of smoking in Hungary in all age groups significantly exceeds the European and world average. Transient increases in middle-aged women have also been reported in European surveys. Conclusion: Compared to 2010, the proportion of smokers has decreased in Hungary, but a new surge observed after 2015 is not a positive phenomenon. We find the high proportion of smoking women worrying. Orv Hetil. 2019; 160(52): 2047-2053.

Measurement of blood pressure variability and the clinical value

Authors have collected and analyzed literature data on blood pressure variability. They present the methods of blood pressure variability measurement, clinical value and relationships with target organ damages and risk of presence of cardiovascular events. They collect data about the prognostic value of blood pressure variability and the effects of different antihypertensive drugs on blood pressure variability. They underline that in addition to reduction of blood pressure to target value, it is essential to influence blood pressure fluctuation and decrease blood pressure variability, because blood pressure fluctuation presents a major threat for the hypertensive subjects. Data from national studies are also presented. They welcome that measurement of blood pressure variability has been included in international guidelines. Orv. Hetil., 2014, 155(42), 1661–1672.

[Hungarian Hypertension Registry]

Today, hypertension is considered endemic throughout the world. The number of individuals with high blood pressure and the increasing risk, morbidity and mortality caused by hypertension despite modern therapy do not decrease sufficiently. Hypertension has become a public health issue. Prevention and effective care require integrated datasets about many features, clinical presentation and therapy of patients with hypertension. The lack of this database in Hungary prompted the development of the registry which could help to provide population-based data for analysis. Data collection and processing was initiated by the Hungarian Society of Hypertension in 2002. Data recording into the Hungarian Hypertension Registry was performed four times (2002, 2005, 2007, 2011) and the registry currently contains data obtained from 108,473 patients. Analysis of these data indicates that 80% of the patients belong to the high or very high cardiovascular risk group. The registry provides data on cardiovascular risk of the hypertensive populations and the effectiveness of antihypertensive therapy in Hungary. Based on international experience and preliminary analysis of data from the Hungarian Hypertension Registry, establishment of hypertension registry may support the effectiveness of public health programs. A further step would be needed for proper data management control and the application of professional principles of evidence-based guidelines in the everyday practice.

[Combined antihypertensive and antilipemic therapy as one of the pillars in the poly-pharmacologic preventive strategy for patients with high cardiovascular risk]

Hypertension is a highly prevalent disease and a strong risk factor for cardiovascular disease in industrialized countries in Europe and North America. About 40-50% of hypertensive patients have some other cardiovascular risk factors as smoking, dyslipidemia, glucose intolerance, metabolic syndrome and diabetes. The realization of optimal therapy of these patients is a difficult task, and reaching target blood pressure values is almost impossible by monotherapy. It was realized that the simultaneous normalization of blood pressure and that of abnormal lipid profile with 2-3 or more drugs have great importance for preventing atherosclerotic complications.We started an open-formed study with about 1000 hypertensive patients complicated with dyslipidemia, visceral obesity, metabolic syndrome and diabetes type 2. The base of our therapeutic strategy was a typical poly-pharmacologic treatment with ACE inhibitor (lisinopril), calcium antagonist (amlodipine), statin (atorvastatin) and antiplatelet therapy (if it was necessary).

The real value of the transtelephonic ECG system in the clinical cardiological practice

A szerzők ismertetik a transztelefonos EKG-rendszer alapelveit és ennek alkalmazási lehetőségeit a kardiológiai klinikai gyakorlatban. A rendszer alapeleme a kisméretű felvevőegység, melynek révén tetszés szerinti telefonrendszeren keresztül lehet a jelet a fogadó- és irányítóközpontba küldeni. A rendszer használata előnyös heveny kardiológiai esetekben, angina pectoris szindrómában, szívritmuszavarokban és a kardiológiai gondozás keretében (rehabilitáció, pacemaker-ellenőrzés). Ismertetik a nemzetközi gyakorlat eddigi legfontosabb eredményeit és bemutatják a hazánkban működő rendszert.

Prevalence of metabolic syndrome estimated by International Diabetes Federation criteria in a Hungarian population

AIMS

In recent years, metabolic syndrome (MS) became a distinct pathological entity. MS is positively associated with cardiovascular mortality. The prevalence of MS is high and a continuing increase is expected. For this reason, all attempts to prevent or manage MS by interventions are extremely important. The new set of definition by International Diabetes Federation (IDF) standardizes criteria for the diagnosis of MS and facilitates its recognition. In a large sample (n = 13 383) of outpatients visiting their general practitioners, we determined the prevalence of risk factors of MS according to the earlier Adult Treatment Panel (ATP) III and the new IDF criteria.

METHODS AND RESULTS

The age-standardized prevalence of MS was 14.9% in males and 8.6% in females (11.5% for all). The most prevalent factors were obesity (ATP III: 38.8% and IDF: 60%) and hypertriglyceridemia (34.1%). Hypertension dominated in men (28.7%), whereas in women obesity was the most prevalent factor (ATP III: 47.4% and IDF: 64%).

CONCLUSION

The prevalence of MS depends on applied definition. The new IDF criteria offer the possibility of focusing on the importance of different components. The real comparison of prevalence among special populations has to be based on age-standardized data and the use of the same components. In our study, the dominance of obesity, hypertension and hypertriglyceridemia appears to be the major detrimental factors. The 11.5% general prevalence of MS in Hungarians, which means a 25-30% value in the middle-aged population, needs an urgent preventive approach with lifestyle changes.

[Diurnal changes in blood pressure and their consequences]

Author analyses the daily blood pressure and heart rate alterations due to circadian rhythm and their effects to development of dangerous clinical situations (sudden death, stroke, myocardial infarct, ischaemic episodes) in hypertension with or without ischemic heart disease. The most dangerous time-period is the morning hours, but serious problems are the sudden increases in blood pressure in any time of day as well. The daily changes in blood pressure (rise in blood pressure variability) are often associated with the alteration in heart rate (decrease in heart rate variability) and loss of dipp at night. The main cause of this "death-three" is the overactivity of the sympathetic nervous system. An antihypertensive drug with good quality can be capable to depress the high blood pressure continuously during the whole day inhibiting the rapid rise periods of blood pressure. The best measure of this effect is the high through/peak ratio.

[Cardiovascular risk factors in essential hypertension]

Authors analysed the cardiovascular risk factors, their relationship to each other, the rate of multiple appearance in 1476 patients (774 men, 702 women) with essential hypertension. They produced a special questionnaire and risk factor analysing program for performing static and dynamic investigations on the base of international and domestic experiences. The data of their investigations verified, that the occurrence of obesity is very frequent and is associated with abnormal cholesterol and triglyceride values. The appearance of glucose metabolism disorder was in 44% of patients. The rate of metabolic syndrome can be estimated on 25-30% in the hypertensive population.

[Current status and possibilities of distant education in medicine]

Author analyses the concept and methods of distance education. The definition of distance education consist of geographic separation of the learner and the teacher, the high level of educational organisation, the use of modern technology for communication with interactivity. Before the widespread use of electronic communications for teaching and learning, the conventional method for distance education was the books and postal service. Since the mid 1980's the attention shifted to the computer technology and computer networks the internet is radically different with previous electronic media. Pfaffenberger estimated in 1994, that by 1998 about 100 million people would have access to the Internet. The web servers gives a multimedia environment, which potencially can provide a truely integrated teaching and learning system to educators worldwide.

[Captopril in the treatment of heart failure]

The author takes the characteristic hemodynamic features and neurohumoral factors associated with heart failure as the starting point for the discussion. He specifies fundamentals of the current strategies and goals of the management of heart failure. Treatment with vasodilatator and ACE inhibitors has paved novel way for treatment of heart failure, because it is not only able to alleviate the symptoms, but also to improve hemodynamic parameters and increase survival. Initiation of treatment at early stage (silent ventricular dysfunction) is able to prevent the development of manifest signs of heart failure. Captopril, a classical ACE inhibitor, is suitable for modern treatment of heart failure, as well for prevention of myocardial remodelling following acute myocardial infarction.

[Antianginal effect of transdermal isosorbide dinitrate (multicenter study)]

Efficacy of transdermal isosorbid-dinitrate spray was investigated in 167 of 254 patients with stable angina pectoris. The transdermal application of isosorbid-dinitrate decreased successfully the number of anginal attacks and the sublingual nitroglycerin or isosorbid-dinitrate consumption. Very few side effects were observed and the patients well-being was good during treatment.

[Dual-chamber rate responsive cardiac pacing]

The authors describe in this report their first experience with the implantation of a rate responsive, dual chamber pacemaker. They emphasize the advantages of this type of pacemakers: the maintenance of AV-synchrony and the rate increase in response to exercise. Meanwhile they call attention on the complexity of the ECG interpretation.

Acute global ischaemia and nitroglycerine-induced changes of the contraction-relaxation and diastolic properties of isolated rabbit heart

In our previous studies on in situ dog hearts it has been shown that nitroglycerine has a direct myocardial effect. It was suggested that nitroglycerine is involved, besides its negative inotropic action, in active relaxation and passive diastolic properties of the heart [2, 24]. In some aspects nitroglycerine seems to be in synergy with the effect of coronary ligation. The purpose of the present study was confirmation and evaluation of the nature of the supposed direct myocardial effect of nitroglycerine, and comparison in this action with that of acute arrest of coronary perfusion in rabbit heart.

Atrial reentry in chronic repetitive supraventricular tachycardia

Atrial reentrance as a mechanism of the tachycardia was demonstrated in a 28-year-old patient suffering from chronic repetitive supraventricular tachycardia. Criteria for diagnosis included the following: (1) Repetitive supraventricular tachycardia was induced and terminated by properly timed atrial extrastimuli. (2) Return cycles of all atrial extrastimuli not abolishing the tachycardia were fully compensatory. (3) A-H prolongation was not a prerequisite to induce the tachycardia. (4) The contours of P and A waves during tachycardia differed from those in sinus rhythm, but atrial activation remained antegrade. (5) A concealed anomalous pathway could not be proved.