The prevalence of resistant and undercontrolled hypertension among patients of a Hypertension Outpatient Clinic

Introduction. Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to an ESH Newsletter published in 2011, the prevalence of resistant hypertension is 2.9–43%. Objective. Analysing only the therapy of hypertensive patients of the Hypertension Outpatient Clinic of the University of Szeged, the authors wanted to answer following main questions: How many patients were therapeutically resistant according to the definition of resistant hypertension? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached target SBP values? How many drugs were usually used in combination therapy? Material and methods. Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analysed, of all cases only one visit was taken into account. For those patients who visited the Clinic more than once during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140 mmHg. Results. In this population, 234/310 (76%) patients had resistant hypertension according to the definition (158 ± 17/97 ± 8 mmHg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136 ± 20 mmHg) and 134 of them (52% of 257 patients) reached the therapeutic goal. A fourfold combination of antihypertensive agents was the most frequent in this population. Conclusion. It is advised to use multiple drug combinations and it is recommended to spend enough time but not longer than necessary to find the most effective combination in every case

Częstość występowania opornego na leczenie lub niedostatecznie kontrolowanego nadciśnienia tętniczego u pacjentów poradni leczenia nadciśnienia tętniczego

Wstęp. U około 57% chorych z nadciśnieniem tętniczym na Węgrzech wartości ciśnienia tętniczego utrzymują się poza docelowym zakresem. Według newslettera European Society of Hypertension (ESH) opublikowanego w 2011 roku częstość występowania nadciśnienia tętniczego opornego wynosi 2,9–43%. Cel pracy. Analizę danych pacjentów z nadciśnieniem tętniczym (HT, hypertension) leczonych w poradni nadciśnienia tętniczego przy uniwersytecie w Szeged przeprowadzono w celu uzyskania odpowiedzi na następujące pytania: U ilu chorych występowało nadciśnienie tętnicze oporne (RHT, resistant hypertension) zgodne z obowiązującą definicją? Ilu chorych przyjmowało trzy lub więcej leków przeciwnadciśnieniowych? Ilu spośród badanych osiągnęło docelowe wartości SBP? Ile leków stosowano najczęściej w terapii skojarzonej? Materiał i metody. Dane pozyskiwano retrospektywnie w okresie od 1 stycznia do 31 sierpnia 2011 roku z elektronicznej dokumentacji medycznej pacjentów z HT. Do analizy włączono 310 chorych, uwzględniając dane tylko z jednej wizyty. W przypadku chorych, którzy odbyli więcej niż jedną wizytę w wymienionym wyżej okresie, brano pod uwagę tylko pierwszą wizytę. Obliczano średnią z dwóch pomiarów. Jako docelową przyjęto wartość ciśnienia skurczowego (SBP, systolic blood pressure) wynoszącą 140 mm Hg. Wyniki. W badanej populacji u 234/310 (76%) rozpoznano nadciśnienie tętnicze oporne zgodnie z obowiązującą definicją (158 ± 17/97 ± 8 mm Hg). Trzy lub więcej leków przeciwnadciśnieniowych stosowało 257/310 (83%) chorych (136 ± 20 mm Hg), a 134 osoby z tej grupy (52% spośród 257 chorych) osiągnęło cel terapeutyczny. W badanej populacji stosowano najczęściej cztery leki przeciwnadciśnieniowe. Wnioski. Zaleca się stosowanie terapii skojarzonej kilkoma lekami przeciwnadciśnieniowymi, przy czym w przypadku każdego pacjenta należy poświęcić wystarczająco dużo czasu, jednak nie więcej niż to konieczne na znalezienie najbardziej skutecznej kombinacji leków

Hypertonia és RAS-gátlók előfordulása SARS-Cov-2 fertőzés miatt intézeti ellátásra került 18 év feletti egyénekben = Effect of hypertension and RAS-inhibitors to adult patients (over 18 years old) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection who were admitted to hospital

Célunk az volt, hogy az SZTE Belgyógyászati Klinika Nyugati telephely fekvőbeteg Járványellátó Központ részlegén felvételre került, 18 év feletti Covid-pozitív betegek között a kezelt hypertonia előfordulását, a szedett vérnyomáscsökkentők számát, a RAS-gátló vérnyomáscsökkentők (ACE-gátló és/vagy ARB) előfordulását felmérjük. A vizsgálatban véletlenszerűen kiválasztott 165 (94 férfi, 71 nő) gyorsteszttel vagy PCR-rel Covid-pozitív, 2021. február közepe és április vége között felvett betegek adatainak retrospektív elemzése történt. A betegek életkora 59,9±12,9 év volt (26–92), a BMI 30,7±6,6 kg/m2 (20,3–55,4). A betegek között felvételkor 103 (62,4%) már ismert hypertoniás egyén volt (56 férfi, 47 nő). A szedett vérnyomáscsökkentők száma felvételkor 1,6±1,6 darab (maximum hat), a kezelés végén 1,8±1,7 darab. Területen több mint három szert 23-an, éppen hármat 25-en szedtek. Monoterápiában felvételt megelőzően 20-an részesültek, a kezelés végén 25-en. A vérnyomáscsökkentők száma a kezelés végén 74 esetben nem változott, hat esetben csökkent, 31 esetben nőtt, ezek között 11 új indítás volt. Egy betegnél a csökkenés 100%-os volt, a monoterápiát el kellett hagyni, a többi öt esetben pedig 50%-os. A hypertoniás betegek több napot töltöttek intézetben, mint a nem hypertoniás egyének (10,9±6,8 vs. 9,2±6,3). A felvételkor mért spontán O2-szaturáció a hypertoniás beteg között alacsonyabb volt, mint a nem hypertoniás egyéneknél (92,6±4,8 vs. 89,6±9,7%), ARB-t szedők között volt a legalacsonyabb (87,5±8,5%, p=0,01 vs. nem hypertoniás). Az összes halálozás a hypertoniás betegek között 8,7%, a nem hypertoniás betegek között csak 1,6% volt. A hypertoniás betegeket vizsgálva, a RAS-gátlót szedők és nem szedők között az intenzív ellátás 16,3 vs. 13%. Az összes halálozás a RAS-gátlót szedők között 10%, a nem szedők között 4,3%, az ARB-t szedők között 13% és az ACE-gátlót szedők között 8,8% volt. Eredményeink alapján a hypertonia nagyobb kockázatot jelenthet a rosszabb Covid-kimenetel tekintetében. A RAS-gátló kezelésben részesültek nagyobb kockázatát észleltük a RAS-gátló kezelésben nem részesültekhez képest. = Our aim was to assess the prevalence of treated HT, the number of antihypertensive agents, especially ACE-inhibitors or ARBs among Covid-positive patients older than 18 years admitted to the Center for Disease Control of Department of Medicine of the University of Szeged. Data of 165 randomly selected patients (mean age 59.9±12.9 years, mean BMI 30.7±6.6 kg/m2) were analysed retrospectively. They were admitted between middle of February and end of April 2021. At the time of admission there were 103 (62.4% of all) HT patients (56 men, 47 women). The mean number of antihypertensive drugs were 1.6±1.6 pieces (max. 6) at the time of admission. 23 patients took more than 3 antihypertensives and 25 patients took exactly 3 drugs at home, and 20 patients had monotherapy. The antihypertensive therapy did not change in 74 cases, decreased in 6 cases and increased in 31 cases. In one case we could reduce therapy with 100%, monotherapy was finished, in the other 5 cases it was reduced by 50%. HT patients spent more days in hospital than non-HT patients (10.9±6.8 vs. 9.2±6.3). Spontaneous oxygen saturation (SatO2) was lower in HT patients compared to non-HTs at admission (89.6±9.7 vs. 92.6±4.8%) and patients who were on ARBs had the lowest SatO2 (87.5±8.5%, p=0.01 vs. non-HT). The total mortality rate was 8.7% in HT patients and it was just 1.6% in non-HT patients. 16.3% of HT patients with RAS-inhibitors and 13.0% without it required admission to the intensive care unit. The mortality rate was 10% of patients with RAS-inhibitors and 4.3% of them without it. This rate was 13% in patients with ARB and 8.8% with ACE-inhibitor. According to our results, HT may have higher risk for worse Covid-19 outcomes, including RAS-inhibitors also may have a higher risk

EASY-APP : An artificial intelligence model and application for early and easy prediction of severity in acute pancreatitis

Acute pancreatitis (AP) is a potentially severe or even fatal inflammation of the pancreas. Early identification of patients at high risk for developing a severe course of the disease is crucial for preventing organ failure and death. Most of the former predictive scores require many parameters or at least 24 h to predict the severity; therefore, the early therapeutic window is often missed.The early achievable severity index (EASY) is a multicentre, multinational, prospective and observational study (ISRCTN10525246). The predictions were made using machine learning models. We used the scikit-learn, xgboost and catboost Python packages for modelling. We evaluated our models using fourfold cross-validation, and the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUC), and accuracy metrics were calculated on the union of the test sets of the cross-validation. The most critical factors and their contribution to the prediction were identified using a modern tool of explainable artificial intelligence called SHapley Additive exPlanations (SHAP).The prediction model was based on an international cohort of 1184 patients and a validation cohort of 3543 patients. The best performing model was an XGBoost classifier with an average AUC score of 0.81 ± 0.033 and an accuracy of 89.1%, and the model improved with experience. The six most influential features were the respiratory rate, body temperature, abdominal muscular reflex, gender, age and glucose level. Using the XGBoost machine learning algorithm for prediction, the SHAP values for the explanation and the bootstrapping method to estimate confidence, we developed a free and easy-to-use web application in the Streamlit Python-based framework (http://easy-app.org/).The EASY prediction score is a practical tool for identifying patients at high risk for severe AP within hours of hospital admission. The web application is available for clinicians and contributes to the improvement of the model

The effect of an exam period as a stress situation on baroreflex sensitivity among healthy university students

Purpose: Authors investigated the effect of a university exam period on blood pressure (BP) and baroreflex-sensitivity (BRS) among healthy students.Materials and methods: Fifty-three healthy normotensive university students participated in the test. BP values and BRS were recorded once during a 14-week long semester and once during a 6-week long exam period with a Finometer device. The time-domain spontaneous BRS in lying position and after standing up was calculated with Nevrokard software. Students were divided into optimal, normal, high-normal and hypertension (HT) groups by BP values.Results: All the BRS values calculated in the exam period were significantly lower compared to the semester period in the same positions. In supine position: (semester vs. exam) up-BRS was 21.9 ± 13.2 ms/mmHg vs. 18.5 ± 11.9 ms/mmHg (p = .013), down-BRS was 22.3 ± 9.3 ms/mmHg vs. 18.4 ± 8.2 ms/mmHg (p = .019). After standing up: (semester vs. exam) up-BRS was 9.3 ± 3.3 ms/mmHg vs. 7.6 ± 3.1 ms/mmHg (p = .02), down-BRS was 9.5 ± 3.6 ms/mmHg vs. 7.0 ± 2.8 ms/mmHg (p < .0001). The number of students decreased in optimal BP group and increased in normal and HT groups in the exam period.Conclusions: A 6-week long exam period had enough stress effect to change cardiovascular parameters towards a higher risk even in healthy young people

Ancrage orthodontique ou orthopédique insuffisant (Apport de l'implantologie)

MONTROUGE-BUFR Odontol.PARIS5 (920492101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF