Orális antikoagulánssal kezelt pitvarfibrilláló betegek terápiahűsége a mindennapokban

Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulant (OAC), the patients' adherence to therapy is a very important factor in stroke prevention. Aim: To investigate the one-year persistence of different OAC therapies (vitamin K antagonist [VKA] and new oral anticoagulants [NOAC]) in patients with AF. Method: The authors investigated the persistence of oral anticoagulant (OAC = VKA/NOAC) in atrial fibrillation using the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2016 and December 31, 2016. Results: 122 870 patients met the inclusion criteria. 18 650 patients started OACs therapy newly (therapy-naïve group), while 104 220 were already on one of the OACs. Among new patients, the one-year persistence of NOACs was 65.7% and that of VKA was 39.0% (p<0.001). The one-year persistence rate was 72.6% for NOAC and 53.9% for VKA (p<0.001) in patients already on OACs. In the therapy-naïve group, the one-year persistence to rivaroxaban was 65.7%. To apixaban it was 62.6%, and to dabigatran it was 59.2% (logrank p<0.001 in all comparisons except rivaroxaban vs. apixaban: p = 0.017, and dabigatran vs. apixaban: p<0.01). The one-year persistence rate of patients treated with NOACs was 73.4% to rivaroxaban, 68.0% to apixaban, and 68.4% to dabigatran (logrank p<0.001 in all comparisons except apixaban vs. dabigatran, NS). Conclusions: The one-year persistence of NOACs was significantly higher in AF compared to VKA therapy (in therapy-naïve and in already treated patients, too). Among the NOACs, rivaroxaban has the best one-year persistence in all patient populations. Orv Hetil. 2020; 161(20): 839-845

A rendszeres alkoholfogyasztás és a dohányzás hatása a vérnyomásra és a vérnyomáscélértékek elérési arányára kezelt hypertoniás betegekben

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.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.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.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.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

Otthoni vérnyomásméréssel kapott "day-to-day" vérnyomás-variabilitás értéke a sikeres antihipertenzív kezelés igazolására

A szerzők nagy létszámú hypertoniás beteg esetében vizsgálták az antihipertenzív kezelés hatását a vérnyomás-variabilitásra az otthoni vérnyomásmérésre alapozott "day-to-day" módszer segítségével. A négy hónapos megfigyelési periódusban a vérnyomásátlag szignifikáns csökkenése mellett a vérnyomás-variabilitás alkalmazott jellemzői is szignifikáns javulást mutattak, és elérték a normális variabilitás szintjét. A ma már elvárható kettős célérték (célvérnyomás és normális vérnyomás-variabilitás) adja meg a reményt arra, hogy az eddigieknél sikeresebben tudjuk megelőzni, kivédeni a hypertonia okozta szervi károsodásokat. Az egyes gyógyszercsaládok, illetve gyógyszer-kombinációk hatását is vizsgálták a vérnyomás-variabilitás tekintetében. A RAAS-gátló szerek (ACE-gátló, illetve ARB) egyaránt szignifikánsan csökkentik a vérnyomás-variabilitást, az ARB-k nagyobb mértékben. Az ACE-gátlókhoz csatolt kalciumantagonisták, illetve 3. generációs b-blokkolók növelték a vérnyomás-variabilitás normalizálódását, az ARB-k esetében ilyen hatást nem tapasztaltak. A szerzők a módszer alkalmazását a mindennapos orvosi gyakorlat számára is javasolják, ezt az utóbbi években megjelent irányelvek is támogatják

Smoking has no impact on survival and it is not associated with gene I/D polymorphism in hemodialysis patients

Introduction: The relationship between smoking and mortality in patients on hemodialysis is controversial. Earlier studies showed that the insertion/deletion (I/D) polymorphism of the ACE gene might have an effect on mortality. The aim of this study was to test the impact of smoking on survival and whether this association was influenced by ACE gene I/D polymorphism in patients on maintenance hemodialysis. Participants and methods: In this prospective, multicenter cohort study we analyzed 709 prevalent patients on maintenance hemodialysis. Patients were allocated into groups based on their smoking habit. Outcome data were collected during the 144-month follow-up period. Outcomes of current smokers and lifelong non-smokers were compared. In order to control for interactions between predictor variables, we also identified 160 matched pairs for further sub-analysis. Results: The vast majority of patients (67%) were non-smokers, followed by current smokers (22.2%) and ex-smokers (9.8%). Smoking had no impact on survival in the matched pair analysis ( p = 0.99). After adjustment for ACE I/D polymorphism and other co-variates, smoking had no effect on survival. Conclusion: Our data suggest that smoking has no impact on survival; neither is it associated with ACE gene I/D polymorphism in hemodialysis patients