Ambulatory Blood Pressure Monitoring in Diabetic Hypertensive Patients, Single Center Report – Preliminary Results

ABPM (ambulatory blood pressure monitoring) has been considered to be a useful tool for the diagnosis and manage- ment of arterial hypertension and is a better predictor of future cardiovascular events as compared with conventional of fice-based BP measurements. Despite its potential values, ABPM is not yet widely used in many clinical offices mainly because of lack of knowledge and unavailability. Aims of this preliminary study are to determine the control of hyperten- sion and circadian BP characteristics in patients referred to our Centre whom we enrolled in the »HRKMAT« Study- Croatian Registry of ABPM. Although patients included in HRKMAT Study had other risk factors for cardiovascular diseases, in this paper we analyzed differences between hypertensive diabetics (N=20) and nondiabetics (N=57). 24- hours ABPM was performed with an automated oscillometric device Mobil-O-Graph NG Vers.20 and office BP using mercury sphygmomanometer. Average office BP was 139/90 mmHg, and average 24h ABPM was 130/82 mmHg. Majority of hypertensive patients used antihypertensive drugs (79.2%). Diabetic patients had higher systolic BP but lower diastolic BP . There were no statistically significant differences in dipping status, but earlier BP surge was noticed in reverse diabetic dippers than in reverse non-diabetic dippers. Though no significant, there was higher prevalence of WCH (»whi te coat hypertension«) in diabetics, and we found MH (masked hypertension) in only two patients. These are preliminary results on ABPM from our centre and of HRKMAT registry. Further and more valuable data and results are awaited from the main HRKMAT database

CHRONIC KIDNEY DISEASE – MINERAL AND BONE DISORDER: WHY AND HOW TO CONTROL PHOSPHATE

Kronična bubrežna bolest (KBB) je globalni javno zdravstveni problem. Koštana bolest i poremećaj mineralnog metabolizma česti su u KBB. Značaj fosfora u patogenezi koštane bolesti odnosno sekundarnog hiperparatireoidizma dobro je poznat. Postoje brojni dokazi kako je hiperfosfatemija predskazatelj povećane smrtnosti u KBB, odnono kako je hieprfosfatemija novi rizični čimbenik kalcifikacije krvnih žila, hipertrofije lijeve klijteke i progresije kronične bubrežne bolesti. Prevencija i liječenje hiperfosfatemije u KBB je veliki stručni izazov. Novi vezači fosfata pružaju nove i bolje mogućnosti liječenja.Chronic kidney disease (ckd) is a global public health problem. metabolic bone disease and mineral metabolism disturbance are common disturbance of ckd. a critical role of phospohorus in metabolic bone disease, i.e. secondary hyperparatyhroidism is well known. there is growing evidence that hyperphosphatemia isa strong predictor of mortality in ckd, i.e. is a novel risk factor for vascular calcification, left ventricular hypertrophy and kidney disease progression. Prevention and treatment of phosphate disturbace in ckd is still great challenge and new phosphate binders ofer new and advanced possibilites

Combination therapy with perindopril / amlodipine - optimal synergy in the treatment of arterial hypertension and cardiovascular risk reduction

Arterijska hipertenzija je vodeći promjenjivi kardiovaskularni čimbenik rizika. U čak 75% bolesnika je potrebna kombinirana antihipertenzivna terapija za postizanje ciljnih vrijednosti arterijskog tlaka (AT). Kombiniranom terapijom postiže se veće snižavanje AT i brže postizanje ciljnih vrijednosti, a primjenom fiksne kombinacije pojednostavljuje se liječenje i poboljšava suradljivost bolesnika. Kombinacija ACE inhibitora i blokatora kalcijskih kanala, osim aditivnog učinka na sniženje vrijednosti AT, donosi dodatnu dobrobit na smanjenje ukupnog kardiovaskularnog rizika.Arterial hypertension is the leading modifiable cardiovascular risk factor. In 75% of patients, the combination antihypertensive therapy is required to achieve target values of blood pressure (BP). The combination therapy leads to greater lowering of BP and faster achievement of target values whereas the fixed combination simplifies the treatment and improves the patient compliance. The combination of ACE inhibitors and calcium channel blockers, in addition to an additive effect on lowering the value of BP, provides an additional benefit in reducing the overall cardiovascular risk

Vitamin D and cardiovascular diseases.

Vitamin D je važan hormon u regulaciji mineralnog metabolizma i u procesu mineralizacije kostiju. Kako je receptor za vitamin D prisutan u mnogobrojnim tkivima, postoji veliko zanimanje za istraživanje drugih potencijalnih uloga vitamina D, pogotovo u srčanožilnim bolestima (SŽB). Mnoge studije su pokazale da je manjak vitamina D povezan s povećanim rizikom od razvoja SŽB, uključujući arterijsku hipertenziju, zatajivanje srca i ishemijsku bolest srca. Prospektivne studije su pokazale da manjak vitamina D povećava rizik za razvoj arterijske hipertenzije i iznenadne srčane smrti u bolesnika s postojećim SŽB.Vitamin D is an important hormone in the regulation of mineral metabolism and bone mineralization process. Since the receptor for vitamin D is present in many tissues, there is a great interest in exploring other potential roles of vitamin D, particularly in cardiovascular diseases (CVDs). Many studies have shown that vitamin D deficiency is associated with an increased risk of developing CVDs, including hypertension, heart failure and ischemic heart disease. Prospective studies have shown that vitamin D deficiency increases the risk of developing hypertension and sudden cardiac death in patients with existing CVD

METFORMIN-INDUCED LACTIC ACIDOSIS: ARE WE UP TO THE CHALLENGE OF A GROWING PROBLEM?

Metforminom uzrokovana laktacidoza je rijetka, životno ugrožavajuća komplikacija koja se javlja u bolesnika s oštećenjem bubrežne funkcije. Nastaje kao posljedica nakupljanja metformina zbog nemogućnosti izlučivanja putem bubrega te neravnoteže između stvaranja i razgradnje laktata što ima za posljedicu tešku metaboličku acidozu. Brojne studije su pokazale malu incidenciju ove nuspojave u odnosu na veliki broj bolesnika koji uzima metformin i u odnosu na njegove brojne pozitivne terapijske učinke. Uz pridržavanje strogih uputa o doziranju metformina u bolesnika s oštećenom bubrežnom funkcijom, lijek se pokazao sigurnim, međutim akutna narušavanja zdravstvenog stanja uz brzo pogoršanje bubrežne funkcije mogu dovesti do ove teške nuspojave čak i u bolesnika koji su do tada imali urednu bubrežnu funkciju. Temeljem vlastitih kliničkih iskustava u liječenju ove teške nuspojave zaključujemo da svaku tešku laktacidozu u bolesnika sa šećernom bolešću tipa 2 uz oštećenje bubrežne funkcije, koji u redovnoj terapiju uzima metformin, treba shvatiti kao metforminom uzrokovanu laktacidozu i pristupiti svim raspoloživim mjerama intenzivnog liječenja. Ključnu ulogu u liječenju ima hemodijaliza u svojim različitim oblicima (intermitentna ili kontinuirana) pri čemu je važan ispravan odabir otopina bez laktata. Zbog visoke smrtnosti metforminom uzrokovana laktacidoza ostaje i dalje veliki terapijski problem, a liječnicima obiteljske medicine i dijabetolozima izazov u provođenju mjera prevencije.Metformin-induced lactic acidosis is an uncommon, life-threatening complication occurring in patients with impaired kidney function. It develops as a result of metformin accumulation due to the inability of renal excretion and the imbalance of lactate metabolism, resulting in severe metabolic acidosis. Various studies have shown a small incidence of this complication as opposed to the large number of patients taking metformin. Provided the strict dosage measures are implemented, metformin has been shown to be a safe drug. However, any acute illness resulting in rapid kidney function deterioration can lead to this severe complication, even in patients with normal initial renal function. Based on our clinical experience in treating this severe side effect, we conclude that any severe lactic acidosis in patients with type 2 diabetes treated with metformin, with impaired renal function should be understood as metformin-induced lactic acidosis, and all available intensive care measures should be taken. Hemodialysis in its different forms (intermittent or continuous) plays a key role in the treatment, whereby it is important to appropriately select solutions that should not contain lactate. Due to the high mortality, metformin-induced lactic acidosis remains a major therapeutic problem, as well as a challenge in implementing preventive measures by family physicians and diabetologists

Chronic kidney disease mineral bone disorder

Chronic kidney disease – mineral bone disease (CKD-MBD) is a syndrome defined as a systemic mineral metabolic disorder associated with CKD. The term renal osteodystrophy, as a part of CKD-MBD, indicates a pathomorphological concept of bone lesions. High morbidity and mortality of CKD patients is a consequence of CKD-MBD. The pathogenesis of this syndrome is not completely understood, but undoubtedly the development of mineral and bone disorder begins in the earliest stages of CKD. The diagnosis is made by non-invasive methods (biochemistry, x-ray, ultrasound, etc.) and bone biopsy as an invasive method. In addition to new drugs, e.g. non-calcium phosphate binders, vitamin D analogs, calcimimetics, prevention and treatment is still a major challenge for the nephrologist. In this article we will briefly discuss the pathophysiology, diagnosis, prevention and treatment of CKD-MBD

Chronic kidney disease mineral bone disorder

Chronic kidney disease – mineral bone disease (CKD-MBD) is a syndrome defined as a systemic mineral metabolic disorder associated with CKD. The term renal osteodystrophy, as a part of CKD-MBD, indicates a pathomorphological concept of bone lesions. High morbidity and mortality of CKD patients is a consequence of CKD-MBD. The pathogenesis of this syndrome is not completely understood, but undoubtedly the development of mineral and bone disorder begins in the earliest stages of CKD. The diagnosis is made by non-invasive methods (biochemistry, x-ray, ultrasound, etc.) and bone biopsy as an invasive method. In addition to new drugs, e.g. non-calcium phosphate binders, vitamin D analogs, calcimimetics, prevention and treatment is still a major challenge for the nephrologist. In this article we will briefly discuss the pathophysiology, diagnosis, prevention and treatment of CKD-MBD