Treatment of hypertension in special conditions

Posebna stanja u hipertenziji su ona koja zahtijevaju poseban pristup liječenju zbog specifične patofiziologije. Prema smjernicama ESH/ESC za liječenje hipertenzije iz 2013. takvih je stanja 19: hipertenzija bijele kute, maskirana hipertenzija, starije osobe, mlade osobe, žene, šećerna bolest, metabolički sindrom, nefropatija, cerebrovaskularne bolesti, srčana oboljenja, ateroskleroza i bolesti arterija, seksualna disfunkcija, rezistentna hipertezija, hipertenzivne emergencije i urgencije, maligna hipertenzija, perioperativno zbrinjavanje hipertenzije, opstruktivna apneja u spavanju, renovaskularna hipertenzija, primarni aldosteronizam. Najvažnije je pravilno izmjeriti tlak, a danas uz ambulantno mjerenje važno je i kontinuirano te kućno mjerenje tlaka. Od osnovnih pretraga rade se laboratorijske pretrage (koje uključuju krvne pretrage i pretragu urina), a važan je i nalaz elektrokardiograma. Važno je procijeniti da li su već nastupila organska oštećenja izazvana hipertenzijom te koji su još kardiovaskularni čimbenici rizika prisutni u pacijenta. U slučaju dijagnosticiranja hipertenzije većini pacijenata propisuje se mijenjanje životnih navika te medikamentozna terapija. Među promjenama životnih navika najvažnije je smanjenje tjelesne težine te redovita tjelovježba. Od antihipertenzivnih lijekova pet je skupina koje su ravnopravne u upotrebi: diuretici, beta-blokatori, blokatori kalcijevih kanala, inhibitori angiotenzinskog konvertirajućeg enzima te antagonisti angiotenzinskog receptora. Terapija bi se trebala temeljiti na preporukama koje proizlaze iz velikih randomiziranih kontroliranih studija i trebala bi biti individualizirana uzimajući u obzir sve komorbiditete pacijenta. To posebno vrijedi za liječenje hipertenzije u posebnim stanjima.Special conditions in hypertension are those that require a special approach to treatment because of the specific pathophysiology. According to the ESH/ESC guidelines for treatment of hypertension from 2013. there are 19 such conditions : white coat hypertension, masked hypertension, older people, young people, women, diabetes mellitus, metabolic syndrome, nephropathy, cerebrovascular diseases, heart diseases, atherosclerosis and arterial diseases, sexual dysfunction, resistant hypertension, hypertensive emergencies or urgencies, malignant hypertension, perioperative management of hypertension, obstructive sleep apnea, renovascular hypertension, primary aldosteronism. The most important task is to properly measure the blood pressure, and nowdays with office blood pressure measurement, ambulatory and home blood pressure measurement are important as well. When diagnosing hypertension basic laboratory tests (including blood tests and urine analysis) and electrocardiogram are done primarily. It is important to assess whether the organ damage caused by hypertension is existing and to asses all cardiovascular risk factors present in the patient. In the case of diagnosis of hypertension most patients are prescribed with lifestyle changes and pharmacological therapy. Among the most important lifestyle changes is a decrease in body weight and regular exercise. Five groups of antihypertensive drugs are equal in use: diuretics, beta - blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor antagonists. Therapy should be based on recommendations arising from large randomized controlled trials and it should be individualized, taking into account all patients' comorbidities. This is particularly true for the treatment of hypertension in special conditions

Treatment of hypertension in special conditions

Posebna stanja u hipertenziji su ona koja zahtijevaju poseban pristup liječenju zbog specifične patofiziologije. Prema smjernicama ESH/ESC za liječenje hipertenzije iz 2013. takvih je stanja 19: hipertenzija bijele kute, maskirana hipertenzija, starije osobe, mlade osobe, žene, šećerna bolest, metabolički sindrom, nefropatija, cerebrovaskularne bolesti, srčana oboljenja, ateroskleroza i bolesti arterija, seksualna disfunkcija, rezistentna hipertezija, hipertenzivne emergencije i urgencije, maligna hipertenzija, perioperativno zbrinjavanje hipertenzije, opstruktivna apneja u spavanju, renovaskularna hipertenzija, primarni aldosteronizam. Najvažnije je pravilno izmjeriti tlak, a danas uz ambulantno mjerenje važno je i kontinuirano te kućno mjerenje tlaka. Od osnovnih pretraga rade se laboratorijske pretrage (koje uključuju krvne pretrage i pretragu urina), a važan je i nalaz elektrokardiograma. Važno je procijeniti da li su već nastupila organska oštećenja izazvana hipertenzijom te koji su još kardiovaskularni čimbenici rizika prisutni u pacijenta. U slučaju dijagnosticiranja hipertenzije većini pacijenata propisuje se mijenjanje životnih navika te medikamentozna terapija. Među promjenama životnih navika najvažnije je smanjenje tjelesne težine te redovita tjelovježba. Od antihipertenzivnih lijekova pet je skupina koje su ravnopravne u upotrebi: diuretici, beta-blokatori, blokatori kalcijevih kanala, inhibitori angiotenzinskog konvertirajućeg enzima te antagonisti angiotenzinskog receptora. Terapija bi se trebala temeljiti na preporukama koje proizlaze iz velikih randomiziranih kontroliranih studija i trebala bi biti individualizirana uzimajući u obzir sve komorbiditete pacijenta. To posebno vrijedi za liječenje hipertenzije u posebnim stanjima.Special conditions in hypertension are those that require a special approach to treatment because of the specific pathophysiology. According to the ESH/ESC guidelines for treatment of hypertension from 2013. there are 19 such conditions : white coat hypertension, masked hypertension, older people, young people, women, diabetes mellitus, metabolic syndrome, nephropathy, cerebrovascular diseases, heart diseases, atherosclerosis and arterial diseases, sexual dysfunction, resistant hypertension, hypertensive emergencies or urgencies, malignant hypertension, perioperative management of hypertension, obstructive sleep apnea, renovascular hypertension, primary aldosteronism. The most important task is to properly measure the blood pressure, and nowdays with office blood pressure measurement, ambulatory and home blood pressure measurement are important as well. When diagnosing hypertension basic laboratory tests (including blood tests and urine analysis) and electrocardiogram are done primarily. It is important to assess whether the organ damage caused by hypertension is existing and to asses all cardiovascular risk factors present in the patient. In the case of diagnosis of hypertension most patients are prescribed with lifestyle changes and pharmacological therapy. Among the most important lifestyle changes is a decrease in body weight and regular exercise. Five groups of antihypertensive drugs are equal in use: diuretics, beta - blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor antagonists. Therapy should be based on recommendations arising from large randomized controlled trials and it should be individualized, taking into account all patients' comorbidities. This is particularly true for the treatment of hypertension in special conditions

Renal denervation in patients with resistant hypertension-beyond blood pressure reduction

Renal sympathetic denervation (RDN) has been demonstrated as an antihypertensive treatment in resistant hypertension patients, and triggers additional positive effects on glucose metabolism and insulin sensitivity in type 2 diabetes. The clinical implications of RDN in patients with type 2 diabetes, diabetic nephropathy and resistant hypertension have not yet been fully defined. We hypothesized that the small antihypertensive effects of RDN treatment will induce additional benefits on renal function in CKD patients with type 2 diabetes and resistant hypertension. We report the effects of RDN in two patients with type 2 diabetes, diabetic nephropathy, stage 3 chronic kidney disease and resistant hypertension. The blood pressure (BP) reduction after RDN was an 8-9% reduction of ABPM (sustained at consecutive follow-up visits at 3 and 6 months when compared to the baseline) and restoration of the night time dipping pattern was associated with amelioration of albuminuria (UAR). As proteinuria may accelerate kidney disease progression to end-stage renal failure, recognition of the antiproteinuric treatment is essential for providing renoprotection. Therefore, randomized clinical trials are required to assess the impact of reported changes

Ekspresija hormona rasta i receptora hormona rasta kod fibroadenoma dojke

Fibroadenoma is the most prevalent benign breast tumor. It consists of epithelial and stromal components. In general, breast tumors are highly hormonally dependent and growth hormone by its physiology may have a possible oncogenic potential. Therefore, the aim of this study was to determine the expression of growth hormone and growth hormone receptor in epithelial and stromal components of fibroadenomas. Study group included 30 randomly chosen fibroadenomas from female patients aged between 18 and 69 years. The expression of growth hormone and growth hormone receptor was defined in both histologic components of fibroadenomas. Growth hormone was expressed in 96.7% of both epithelial and stromal components of fibroadenomas, with stronger expression in the stromal component. The same percentage of positive reaction (96.7%) was obtained in the epithelial component of fibroadenomas for growth hormone receptor expression. Only 6.7% of stromal components tested for growth hormone receptor were positive. The high expression of growth hormone and growth hormone receptor in fibroadenoma tissue indicates their possible role in the pathogenesis of this tumor. Follow up of patients with high expression of growth hormone and growth hormone receptor may be suggested.Fibroadenom je najčešća dobroćudna novotvorina dojke, a sastoji se od epitelne i stromalne komponente. Uzimajući u obzir hormonsku osjetljivost tumora dojke, te potencijalni onkogeni potencijal hormona rasta, cilj našega rada bio je utvrditi ekspresiju hormona rasta i receptora hormona rasta u epitelnoj i stromalnoj komponenti fibroadenoma. U studiju je bilo uključeno 30 nasumice odabranih fibroadenoma nastalih u žena u dobi od 18 do 69 godina. Ekspresija hormona rasta i receptora hormona rasta određivana je u obje histološke komponente fibroadenoma. Ekspresija hormona rasta nađena je u 96,7% epitelne i stromalne komponente, uz jaču izraženost ekspresije u stromalnoj komponenti. Ekspresija receptora hormona rasta u epitelnoj je komponenti također iznosila 96,7%, a u stromalnoj samo 6,7%. Visoka ekspresija hormona rasta i receptora hormona rasta u fibroadenomima označava potencijalnu ulogu ovoga hormona u patogenezi ispitivane bolesti, te bi se u bolesnica ove skupine mogle preporučiti češće kliničke kontrole

UNDERESTIMATED FREQUENCY OF RESISTANT HYPERTENSION IN PREDIALYSIS NONDIABETIC PATIENTS

Prava prevalencija rezistentne hipertenzije (RH) nije poznata. Temeljem studija može se zaključiti da je prisutna u 10-15% pacijenata prethodno liječenih zbog hipertenzije, što je veliki broj bolesnika. RH se definira nemogućnošću postizanja vrijednosti krvnog tlaka (KT) koje su ispod ciljnih (za opću populaciju 140/90 mm Hg for the general population and >130/80 mm Hg for patients with diabetes or kidney disease. Prior to diagnosing a patient as having RH, it is important to document medication compliance and exclude white-coat hypertension, inaccurate BP measurement, and secondary causes. The role of aldosterone in RH has gained increasing recognition. There is strong evidence for the use of spironolactone as a highly effective antihypertensive agent. Aldosterone plays a signiicant role in RH pathogenesis, primarily due to its vasoconstrictive effects and the possibility of altering vascular compliance. In RH, there is a high prevalence of cardiac and extra-cardiac target organ damage. It is known that BP control in chronic kidney disease is the key factor for reducing cardiovascular risk and renal disease progression. The objective of the study was to evaluate the prevalence of RH in predialysis nondiabetic (CKD stage I-IV) patients

Treatment of hypertension in special conditions

Posebna stanja u hipertenziji su ona koja zahtijevaju poseban pristup liječenju zbog specifične patofiziologije. Prema smjernicama ESH/ESC za liječenje hipertenzije iz 2013. takvih je stanja 19: hipertenzija bijele kute, maskirana hipertenzija, starije osobe, mlade osobe, žene, šećerna bolest, metabolički sindrom, nefropatija, cerebrovaskularne bolesti, srčana oboljenja, ateroskleroza i bolesti arterija, seksualna disfunkcija, rezistentna hipertezija, hipertenzivne emergencije i urgencije, maligna hipertenzija, perioperativno zbrinjavanje hipertenzije, opstruktivna apneja u spavanju, renovaskularna hipertenzija, primarni aldosteronizam. Najvažnije je pravilno izmjeriti tlak, a danas uz ambulantno mjerenje važno je i kontinuirano te kućno mjerenje tlaka. Od osnovnih pretraga rade se laboratorijske pretrage (koje uključuju krvne pretrage i pretragu urina), a važan je i nalaz elektrokardiograma. Važno je procijeniti da li su već nastupila organska oštećenja izazvana hipertenzijom te koji su još kardiovaskularni čimbenici rizika prisutni u pacijenta. U slučaju dijagnosticiranja hipertenzije većini pacijenata propisuje se mijenjanje životnih navika te medikamentozna terapija. Među promjenama životnih navika najvažnije je smanjenje tjelesne težine te redovita tjelovježba. Od antihipertenzivnih lijekova pet je skupina koje su ravnopravne u upotrebi: diuretici, beta-blokatori, blokatori kalcijevih kanala, inhibitori angiotenzinskog konvertirajućeg enzima te antagonisti angiotenzinskog receptora. Terapija bi se trebala temeljiti na preporukama koje proizlaze iz velikih randomiziranih kontroliranih studija i trebala bi biti individualizirana uzimajući u obzir sve komorbiditete pacijenta. To posebno vrijedi za liječenje hipertenzije u posebnim stanjima.Special conditions in hypertension are those that require a special approach to treatment because of the specific pathophysiology. According to the ESH/ESC guidelines for treatment of hypertension from 2013. there are 19 such conditions : white coat hypertension, masked hypertension, older people, young people, women, diabetes mellitus, metabolic syndrome, nephropathy, cerebrovascular diseases, heart diseases, atherosclerosis and arterial diseases, sexual dysfunction, resistant hypertension, hypertensive emergencies or urgencies, malignant hypertension, perioperative management of hypertension, obstructive sleep apnea, renovascular hypertension, primary aldosteronism. The most important task is to properly measure the blood pressure, and nowdays with office blood pressure measurement, ambulatory and home blood pressure measurement are important as well. When diagnosing hypertension basic laboratory tests (including blood tests and urine analysis) and electrocardiogram are done primarily. It is important to assess whether the organ damage caused by hypertension is existing and to asses all cardiovascular risk factors present in the patient. In the case of diagnosis of hypertension most patients are prescribed with lifestyle changes and pharmacological therapy. Among the most important lifestyle changes is a decrease in body weight and regular exercise. Five groups of antihypertensive drugs are equal in use: diuretics, beta - blockers, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor antagonists. Therapy should be based on recommendations arising from large randomized controlled trials and it should be individualized, taking into account all patients' comorbidities. This is particularly true for the treatment of hypertension in special conditions

EFEKTI PRIMJENE VAŠINGTONSKOG KONSENZUSA NA MAKROEKONOMSKU STABILNOST BiH

S obzirom na specifičnu situaciju u BiHi specifične probleme, u ovom raduće se analizirati efekti prouzrokovanipridržavanjem pravila Vašingtonskogkonsenzusa, te će se ustanoviti u kojojmjeri su oni utjecali na stabilnost makroekonomskihagregata Bosne i Hercegovine.Osnovna teza Vašingtonskogkonsenzusa je da se pridržavanjemmjera istog ,makroekonomska situacijau zemlji stabilizuje. Međutim, stabilizacijačesto ne može da se održi udugom roku te se tako nastalo stanje uekonomiji može smatrati kvazi makroekonomskomstabilnošću.Primjena Vašingtonskog konsenzusaproizvodi kvazi makroekonomsku stabilnostu Bosni i Hercegovini, s obziromna to da se niska inflacija plaćavisokom nezaposlenošću. Suprotno neoliberalnomprofilu Vašingtonskog konsenzusa,čiji je osnovni cilj održavanjeravnotežnog stanja u budžetima putemfiskalnih stabilizacijskih mjera, u raduje istaknuta potreba rješavanja permanentnevisoke nezaposlenosti kao glavnogmakroekonomskog problema BiH