Where is the border between normal and abnormal blood pressure and what is the therapeutic goal in cardiovascular and renal diseases? / Hol van a normális és a kóros vérnyomás közötti határ, és mi a terápiás cél a cardiovascularis és a renalis betegségekben?

Összefoglaló. Az irodalmi adatok arra utalnak, hogy a systolés vérnyomás értékének emelkedése már 110-115 Hgmm-tol együtt jár az atherosclerosissal összefüggo elváltozások kialakulásával is és ezzel együtt a cardiovascularis és a renalis funkció romlásával. Az összefüggés exponenciális, de mértékét az életkor jelentosen befolyásolja. A kezelés során az elérendo vérnyomás célértéke a jelenlegi adatok alapján 120-130 Hgmm között helyezkedik el a 18-65 év közötti populációban; idosebb 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 tényezot is figyelembe kell venni a páciens legmegfelelobb kezeléséhez. A populáció egészségének javításához és megorzéséhez az egyik legfontosabb és leggyakoribb cardiovascularis kockázati tényezot, a magas vérnyomást idoben fel kell fedezni, amihez a vérnyomást rendszeresen szükséges ellenorizni, és ezzel párhuzamosan kell végezni a prevenciót célzó tevékenységeket (nevelés, oktatás, szurés, 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 / A rendszeres alkoholfogyasztás és a dohányzás hatása a vérnyomásra és a vérnyomáscélértékek elérési arányára kezelt hypertoniás betegekben

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]. / Nemi különbségek a dohányzás gyakoriságában hazánkban 2010 és 2018 között.

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]. / Vérnyomás-variabilitás mérése és klinikai értéke.

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.

[Hungarian Hypertension Registry]. / Magyar Hypertonia Regiszter.

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]. / A kombinált antihipertenzív és antilipid-kezelés mint a polipill preventív stratégia egyik pillére a nagy cardiovascularis rizikójú egyénekben.

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 transztelefonos EKG-rendszer értéke a kardiológiai klinikai gyakorlatban.

Authors demonstrate the basic concepts and the application possibilities of transtelephonic ECG system in the clinical cardiological practice. The basic element of the system is a hand-size transducer that is capable to send ECG signals--through any telephone network to the Analysing Center. The application of system is very successful in the acute coronary syndrome, angina pectoris, dangerous arrhythmias and for home controlling of cardiac patients. They show the most important international results and their national system.

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]. / A diurnalis vérnyomás-ingadozás és cardiovascularis következményei.

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.