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  • 1
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    Online Resource
    The Importance of Home Versus 24-Hour Ambulatory Blood Pressure Monitoring and Assessment of Blood Pressure Variability in Hypertension
    Walter de Gruyter GmbH ; 2016
    In:  Acta Medica Marisiensis Vol. 62, No. 2 ( 2016-6-1), p. 239-242
    Details
    In: Acta Medica Marisiensis, Walter de Gruyter GmbH, Vol. 62, No. 2 ( 2016-6-1), p. 239-242
    Abstract: Background : A number of studies reveal that home blood pressure variability is associated with cardiovascular risk factors. However, we do not have a consensus regarding the variability index and the frequency of measurements. Objective: The aim of the study was to assess home blood pressure variability for a period of 7 consecutive days and 24-hour ambulatory blood pressure variability using the average real variability index and to test whether home blood pressure variability represents a suitable parameter for long-term monitoring of the hypertensive patients. Material and methods : A number of 31 hypertensive patients were included in the study, 8 male, 23 female, mean age 60.19±7.35 years. At the inclusion ambulatory blood pressure monitoring was performed, home blood pressure monitoring was carried out for 7 consecutive days with 2 measurements daily. We compared ambulatory blood pressure values, variability using paired t-test. We were looking for correlations between HBP values and cardiovascular risk factors. Results : Ambulatory versus home blood pressure derived mean blood pressure was 131.38±15.2 versus 131.93±8.25, p=0.81. Ambulatory derived variability was 10.65±2.05 versus home variability 10.56±4.83, p=0.91. Home versus ambulatory pulse pressure was 51.8± 9.06 mmHg vs. 54.9±11.9 mmHg, p=0.046. We found positive correlation between HBPV and home BP values, p=0.027, r2=0.1577, (CI: 0.04967 to 0.6588). Home, as well as ambulatory derived variability were positively correlated to age p=0.043, r2=0.1377 (CI: 0.01234 to 0.6451) versus p 〈 0.0001, CI: 0.3870 to 0.8220, r2=0.4302. Conclusion : Assessment of home blood pressure monitoring and variability could represent a well-tolerated alternative for long-term follow-up of hypertension management.
    Type of Medium: Online Resource
    ISSN: 2247-6113
    URL: Article
    DOI: 10.1515/amma-2016-0020
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2016
    detail.hit.zdb_id: 2625583-2
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  • 2
    Online Resource
    Online Resource
    Increase of Short-Term Heart Rate Variability Induced by Blood Pressure Measurements during Ambulatory Blood Pressure Monitoring
    Hindawi Limited ; 2017
    In:  Computational and Mathematical Methods in Medicine Vol. 2017 ( 2017), p. 1-5
    Details
    In: Computational and Mathematical Methods in Medicine, Hindawi Limited, Vol. 2017 ( 2017), p. 1-5
    Abstract: Objective. The possible effect of blood pressure measurements per se on heart rate variability (HRV) was studied in the setting of concomitant ambulatory blood pressure monitoring (ABPM) and Holter ECG monitoring (HM). Methods. In 25 hypertensive patients (14 women and 11 men, mean age: 58.1 years), 24-hour combined ABPM and HM were performed. For every blood pressure measurement, 2-minute ECG segments (before, during, and after measurement) were analyzed to obtain time domain parameters of HRV: SDNN and rMSSD. Mean of normal RR intervals (MNN), SDNN/MNN, and rMSSD/MNN were calculated, too. Parameter variations related to blood pressure measurements were analyzed using one-way ANOVA with multiple comparisons. Results. 2281 measurements (1518 during the day and 763 during the night) were included in the analysis. Both SDNN and SDNN/MNN had a constant (the same for 24-hour, daytime, and nighttime values) and significant change related to blood pressure measurements: an increase during measurements and a decrease after them ( p 〈 0.01 for any variation). Conclusion. In the setting of combined ABPM and HM, the blood pressure measurement itself produces an increase in short-term heart rate variability. Clarifying the physiological basis and the possible clinical value of this phenomenon needs further studies.
    Type of Medium: Online Resource
    ISSN: 1748-670X , 1748-6718
    URL: Article
    DOI: 10.1155/2017/5235319
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2017
    detail.hit.zdb_id: 2256917-0
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  • 3
    Online Resource
    Online Resource
    The Secret of Preserved Quality of Life in Elderly Patients with Peripheral Artery Disease and Decreased Ankle-Brachial Index
    Walter de Gruyter GmbH ; 2018
    In:  Internal Medicine Vol. 15, No. 3 ( 2018-07-01), p. 27-32
    Details
    In: Internal Medicine, Walter de Gruyter GmbH, Vol. 15, No. 3 ( 2018-07-01), p. 27-32
    Abstract: Objective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment. Method . 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test. Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI 〈 0.5 and VascuQol-6 〉 12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02). Conclusions . The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.
    Type of Medium: Online Resource
    ISSN: 1220-5818
    URL: Article
    DOI: 10.2478/inmed-2018-0019
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2018
    detail.hit.zdb_id: 2978055-X
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  • 4
    Online Resource
    Online Resource
    Is There a Risk Factor More Responsible for Disaster?
    Walter de Gruyter GmbH ; 2015
    In:  Acta Medica Marisiensis Vol. 61, No. 3 ( 2015-9-1), p. 245-247
    Details
    In: Acta Medica Marisiensis, Walter de Gruyter GmbH, Vol. 61, No. 3 ( 2015-9-1), p. 245-247
    Abstract: Background : Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension. Case report : We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking. Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation. Conclusions : There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.
    Type of Medium: Online Resource
    ISSN: 2247-6113
    URL: Article
    DOI: 10.1515/amma-2015-0054
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2015
    detail.hit.zdb_id: 2625583-2
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  • 5
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    Online Resource
    Inflammatory Markers and Thromboembolic Risk in Patients with Non-Muscle-Invasive Bladder Cancer
    MDPI AG ; 2021
    In:  Journal of Clinical Medicine Vol. 10, No. 22 ( 2021-11-12), p. 5270-
    Details
    In: Journal of Clinical Medicine, MDPI AG, Vol. 10, No. 22 ( 2021-11-12), p. 5270-
    Abstract: Introduction: Patients with bladder cancer have a high risk of venous thrombosis that represents a key challenge for physicians in the decision-making for initiating anticoagulation therapy. Non-muscle-invasive bladder cancer (NMIBC) represents more than 70% of all diagnosed bladder malignancies; therefore, we aimed to evaluate the relationship of the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and risk of thrombosis by using the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score as well as the risk of bleeding by using the IMPROVE Bleeding Risk Assessment Score in a study cohort. Material and Methods: This was a retrospective observational study involving 130 patients who met the inclusion criteria: age 〉 18 years, stage pTa-pT1 NMIBC. The exclusion criteria were age 〈 18 years; stage pT2 or higher; or a presentation of metastasis, inflammatory, liver or autoimmune diseases, or other systemic neoplasms. In order to evaluate the risk of thromboembolic events as well as those of bleeding, the IMPROVE scores were calculated for each patient. Subjects were categorized in a Low IMPROVE group ( 〈 4 points) or a High IMPROVE group. By using uni- and multivariate regression models, we analyzed CBC-derived parameters which could be associated with a higher risk of venous thrombosis in subjects with low or high IMPROVE scores. Results: Patients with IMPROVE score greater than 4 were associated with higher NLR, LMR and lymphocyte values (p 〈 0.05). In a multivariate regression model, the IMPROVE score was significantly influenced by lymphocyte count (p = 0.007) as well as the NLR value (p 〈 0.0001). Conclusions: In our study population, subjects with NMIBC with low lymphocytes and NLR 〉 3 were at a higher risk of developing venous thromboembolic events, reflected by an IMPROVE score of greater than 4. The IMPROVE and IMPROVE Bleeding Risk Assessment Scores are easy to use, and, complemented with the CBC-derived lymphocyte to monocyte ratio as a prothrombotic marker, could aid in the decision of prophylactic anticoagulation therapy during admission.
    Type of Medium: Online Resource
    ISSN: 2077-0383
    URL: Article
    DOI: 10.3390/jcm10225270
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2662592-1
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  • 6
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    Online Resource
    Extensive Left Ventricular Thrombosis with Concomitant Pulmonary Embolism
    MDPI AG ; 2021
    In:  Clinics and Practice Vol. 11, No. 2 ( 2021-05-18), p. 303-308
    Details
    In: Clinics and Practice, MDPI AG, Vol. 11, No. 2 ( 2021-05-18), p. 303-308
    Abstract: A 57-year-old non-obese female patient with a history of heavy smoking, chronic obstructive pulmonary disease and hypertension was admitted to the hospital as an emergency for acute hemoptysis and signs of congestive heart failure. To assess the source of hemoptysis, computed tomography (CT) pulmonary angiography was performed, which confirmed a bilateral pulmonary embolism of the apical branches. The routinely performed transthoracic echocardiography (TTE) revealed an enlarged left ventricle with severely reduced ejection fraction (EF = 25%) due to global hypokinesia and multiple, mobile, echogenic masses. To increase the diagnostic accuracy, real-time three-dimensional (Live 3D) imaging of the masses was added which described multiple left ventricular (LV) thrombi. Successful resolution of intraventricular thrombi was noticed after treatment with oral anticoagulant therapy (acenocumarol), despite the lack of regular INR control.
    Type of Medium: Online Resource
    ISSN: 2039-7283
    URL: Article
    DOI: 10.3390/clinpract11020043
    Language: English
    Publisher: MDPI AG
    Publication Date: 2021
    detail.hit.zdb_id: 2605724-4
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  • 7
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    Peritonealis dialízis gyermekkorban. A Semmelweis Egyetem I. Gyermekgyógyászati Klinikájának eredményei
    Akademiai Kiado Zrt. ; 2017
    In:  Orvosi Hetilap Vol. 158, No. 46 ( 2017-11), p. 1831-1840
    Details
    In: Orvosi Hetilap, Akademiai Kiado Zrt., Vol. 158, No. 46 ( 2017-11), p. 1831-1840
    Abstract: Abstract: Introduction, aim and method: At the 1st Department of Paediatrics, Semmelweis University – the largest center for treating children with chronic kidney disease in Hungary – peritoneal dialysis has a leading role. Between 2010–2017, while being part of the International Pediatric Dialysis Network, we collected and analyzed our data in a prospective study. Beside our patients’ basic data, we registered medication statistics, treatment- and laboratory results every 6 months. Results: During this period we had 39 patients on peritoneal dialysis, the average age of dialysis-initiation was 9.3 ± 6.6 years, with 1.3 ± 1.3 years spent on dialysis. The most common causes of ESRD were glomerulopathies and renal-/urinary malformations. A high rate of comorbidities was found, and in 13 cases complex syndromes. Many patients’ height- and BMI SDS values differed from the normal for their age. Average glucose-monohydrate concentration was 1.6 ± 0.2%. During our investigation we used lactate-based, acidic or neutral (balanced) dialysates. Between 2010–2017 we diagnosed peritonitis in 18 of our cases. The patients were hospitalized average 70.5 ± 97.7 days. There were differences from the normal range for age in PTH- and phosphate values. Drug-statistics met the requirements of recommendations, though some medications are not available for children in Hungary. The short time spent on dialysis is due to fast- and also living-donor transplantations and efficient management of the transplantation list. The high rates of special diseases and comorbidities are due to being a tertiary referral center. Conclusion: Our practice is suitable for the international guidelines, any differences are results of individual considerations. Being a part of the Registry should be maintained. Orv Hetil. 2017; 158(46): 1831–1840.
    Type of Medium: Online Resource
    ISSN: 0030-6002 , 1788-6120
    URL: Article
    DOI: 10.1556/650.2017.30857
    Language: Hungarian
    Publisher: Akademiai Kiado Zrt.
    Publication Date: 2017
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  • 8
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    Online Resource
    Diagnostic and Treatment Algorithm in a Plurivascular Patient – Case Report
    Walter de Gruyter GmbH ; 2022
    In:  Journal Of Cardiovascular Emergencies Vol. 8, No. 2 ( 2022-06-01), p. 35-38
    Details
    In: Journal Of Cardiovascular Emergencies, Walter de Gruyter GmbH, Vol. 8, No. 2 ( 2022-06-01), p. 35-38
    Abstract: Introduction: Atherosclerosis represents the main cause of arterial stenosis, mostly affecting the arteries of the lower extremities. Atherosclerotic arterial disease presents multiple localizations, including the carotid, subclavian, coronary, and kidney arteries. The severity of the stenosis does not always correlate with the symptomatology. Case report: We present the case of a patient with multisite atherosclerotic disease. A 70-year-old smoker male patient, with a history of myocardial infarction and renal artery stenosis, presented in the emergency department complaining of vertigo, chest pain, and intermittent claudication. The diagnostic and treatment algorithm represented a challenge. Imaging assessment showed atherosclerotic lesions in a new vascular territory, which involved the left subclavian artery with a stenosis of 70%. Conclusions: Subclavian artery stenosis can be a hidden form of atherosclerotic disease, often undiagnosed, which needs urgent interventional treatment and can be easily unmasked using simple tools such as measuring the blood pressure on both arms. Patients with athero-sclerotic lesions must undergo comprehensive screening for multisite atherosclerotic disease.
    Type of Medium: Online Resource
    ISSN: 2457-5518
    URL: Article
    DOI: 10.2478/jce-2022-0006
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2022
    detail.hit.zdb_id: 2861779-4
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  • 9
    Online Resource
    Online Resource
    Ambulatory monitoring derived blood pressure variability and cardiovascular risk factors in elderly hypertensive patients
    IOS Press ; 2014
    In:  Bio-Medical Materials and Engineering Vol. 24, No. 6 ( 2014), p. 2563-2569
    Details
    In: Bio-Medical Materials and Engineering, IOS Press, Vol. 24, No. 6 ( 2014), p. 2563-2569
    Type of Medium: Online Resource
    ISSN: 0959-2989 , 1878-3619
    URL: Article
    DOI: 10.3233/BME-141071
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2014
    detail.hit.zdb_id: 2011596-9
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  • 10
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    Online Resource
    Time-Dependent Drug Administration in Hypertension and its Effect on Blood Pressure Variability
    Walter de Gruyter GmbH ; 2017
    In:  Journal of Interdisciplinary Medicine Vol. 2, No. 2 ( 2017-6-1), p. 132-135
    Details
    In: Journal of Interdisciplinary Medicine, Walter de Gruyter GmbH, Vol. 2, No. 2 ( 2017-6-1), p. 132-135
    Abstract: Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure. Aim of the study: We have proposed to test whether the divided treatment regimen also lowers blood pressure variability. Material and methods: A number of 37 treated hypertensive patients were enrolled, who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at inclusion and at 8 weeks after therapeutic intervention with divided treatment regimen. BPV was assessed using average real variability. Results: The 24-hour systolic blood presure decreased from 139.5 ± 8.8 mmHg to 127.4 ± 8.9 mmHg (p 〈 0.0001), and we noted a 2.1 mmHg drop in blood pressure variability (p 〈 0.0001), as well as a two-fold increase in the percentage of dippers. After baseline ABPM assessment, in 15 cases an angiotensin-converting-enzyme-inhibitor was scheduled at bedtime, and in 10 cases it was given twice a day. In 17 cases a thiazide diuretic was administered in the afternoon, and in 18 cases a calcium channel blocker was administered at bedtime. Conclusions: For a more accurate management of patients with hypertension, the assessment of circadian blood pressure profile and the implementation of an individualized treatment that uses divided antihypertensive agents at bedtime or midday administration have the ability to optimize blood pressure control, restore dipper-profile, and decrease blood pressure variability.
    Type of Medium: Online Resource
    ISSN: 2501-8132
    URL: Article
    DOI: 10.1515/jim-2017-0043
    Language: English
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2017
    detail.hit.zdb_id: 2935867-X
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