[Hypertension and the kidneys].

V Monhart

Vnitr Lek 1999, 45(11):631-635

The relationship between the kidneys and hypertension is multiple. Impaired renal function preventing adequate sodium excretion participates in the pathogenesis of primary hypertension. Renal diseases are the most frequent cause of secondary hypertension. Bilateral and unilateral parenchymatous affections predominate (5% of all hypertensions) over renovascular causes (2%). In the course of hypertension regardless of its etiology renal damage may develop--nephroangiosclerosis or atherosclerosis of the renal arteries with unilateral or bilateral affection (renal ischaemic disease). Hypertension is an important factor in progression of chronic renal diseases...

[Renovascular hypertension].

J Stríbrná

Vnitr Lek 1999, 45(11):636-640

UNLABELLED: Renovascular disease frequently escapes clinical diagnosis. Critical stenosis of the renal artery causes hypoperfusion of the kidney which in turn is the cause of renovascular hypertension and ischaemic nephropathy. Detection of renovascular disease in the population of hypertonic patients should be based on clinical symptoms. In a selected group one of the imaging methods can be used. The increasing number of patients with stenosis of the renal artery is indicated for percutaneous transluminal angioplasty or surgical revascularization as the function of the ischaemized kidney is a risk. Medicamentous treatment of hypertension, which is...

[Hypertension in hemodialyzed uremic patients].

D Sobotová, A Zharfbin, J Svojanovský, M Nedbálková

Vnitr Lek 1999, 45(11):641-644

The pathogenesis of hypertension in haemodialyzed uraemic patients is multifactorial. The following are involved: sodium and water retention as a result of the impaired excretory capacity of the kidneys, excessively increased activity of the RAAS and sympathetic nerve, increased levels of the vascular constrictor endothelin-1, cumulation of endogenous inhibitors of NO synthesis and reduced formation of vasodepressor factors. As to other factors in the development of hypertension raised intracellular calcium associated with hyperparathyroidism may participate, the stiffness of calcified arteries, erythropoietin treatment and preexisting essential hypertension....

[Hypertension after kidney transplantation].

D Sobotová, A Zharfbin

Vnitr Lek 1999, 45(11):645-649

Hypertension is the most frequent non-rejection complication after transplantation of the kidney. It is encountered in 60 to more than 80% of recipients, depending on the investigated population and the definition of hypertension. It develops also in recipients who were normotensive before transplantation. While in dialyzed uraemic patients in the pathogenesis the most important part is played by hypervolaemia, after transplantation most frequently immunosuppressive treatment plays a part. The objective of our study was to assess the incidence of hypertension in the 1st and 2nd year after transplantation resp., the achieved blood pressure level (BP)...

[Effect of ACE-inhibitors on changes in creatinine in the blood-- introduction].

K Sevela, J Zicha, V Pokorná

Vnitr Lek 1999, 45(11):650-654

In a retrospective study a total of 44 ambulatory examinations were made before enalapril was administered to 13 patients with essential hypertension and 52 ambulatory examinations during enalapril treatment of these patients. All patients were followed up on a long-term basis: 1. without enalapril treatment (2-24 months), 2. during enalapril treatment (4-24 months). For both investigation periods arithmetic means of plasma creatinine were calculated. The length of the investigation period was intentionally used as the sole criterium for inclusion in the group of patients. In nine patients during treatment the serum creatinine levels rose. The authors...

[Hypertension and diabetes mellitus--pathophysiology and risk].

H Rosolová

Vnitr Lek 1999, 45(11):655-660

The author submits a review on the combined prevalence of diabetes and hypertension which increases with age and is a basic risk factor of vascular cardiac and cerebral complications. It is associated with a higher incidence of obesity, hypertriglyceridaemia and reduced HDL-cholesterol. It is part of the metabolic syndrome X, the syndrome of insulin resistance. Hypertension is found in 60-80% type 2 diabetics and in 40% type 1 diabetics. Obesity is found on average in 40% type 1 diabetics and 85% type 2 diabetics. Macroangiopathy leads to ischaemic heart disease, cerebrovascular episodes and ischaemia of the lower extremities. British investigations...

[Antihypertensives and their metabolic effects in diabetics].

V Zácková

Vnitr Lek 1999, 45(11):661-663

Due to its frequent occurrence in diabetics, hypertension is a serious problem from the aspect of its effect on cardiovascular morbidity and mortality. Evaluation of metabolic and clinical effects of treatment of hypertension in diabetics should precede considerations on the selection of suitable antihypertensive treatment.

[Antihypertensives and their importance in the initial stages of diabetic nephropathy].

D Krusová

Vnitr Lek 1999, 45(11):664-669

Diabetic nephropathy is a serious microangiopathic late complication of diabetes and is one of the most frequent causes of premature death of diabetic subjects. The main task of diabetologists and nephrologists in these patients is an attempt to arrest or at least delay progression of nephropathy. As to therapeutic possibilities, antihypertensive drugs are most suitable, i.e. angiotensin converting enzyme inhibitors, Ca blockers of the IInd generation and also blockers of AT1 receptors.

[The effect of antihypertensive therapy on insulin resistance].

J Olsovský

Vnitr Lek 1999, 45(11):670-672

Insulin resistance is one of the main causes of diabetes mellitus type 2. This primary, genetically determined, by external environmental factors enhanced, reduced insulin effectiveness in target tissues (liver, muscle, adipose tissue) associated with compensatory hyperinsulinaemia is manifested by a prohypertensive effect. Secondary insulin resistance causes deterioration of diabetes compensation regardless of its type. It may have a number of causes and after their elimination it is fully reversible. Secondary insulin resistance can be influenced also by drugs. This fact must be born in mind when selecting antihypertensive treatment in diabetics.

[Results of the United Kingdom Prospective Diabetes Study and its importance in the treatment of hypertension in diabetics].

J Mertl

Vnitr Lek 1999, 45(11):673-676

In 1997 the United Kingdom Prospective Diabetes Study (UKPDS), the largest and longest study in type 2 diabetes so far, was finished. Answers to fundamental questions of non-insulin dependent diabetes mellitus therapy were expected: 1. What is the benefit from a good metabolic control of diabetes? 2. Has any particular antidiabetic therapy advantages over the other ones? 3. What is the importance of concurrent antihypertensive therapy? The evidence was given that intensive therapy (with antidiabetics or insulin) substantially and significantly reduced the risk of microvascular complications, but the reductions of mortality and macrovascular complications...

[Overview of the most important studies of hypertension and diabetes mellitus].

J Spinar, J Vítovec

Vnitr Lek 1999, 45(11):677-679