István Barna

Relationship Between Blood Pressure Variability and Serum Dehydroepiandrosterone Sulfate Levels

Decreased diurnal blood pressure variability and low dehydroepiandrosterone sulfate (DHEAS) levels are important predictors of cardiovascular morbidity and mortality. The aim of the study was to determine the relationship between DHEAS levels and diurnal blood pressure variability in normotensive subjects and in patients with essential hypertension of both genders. An ambulatory blood pressure monitor (ABPM), Meditech O2 device and radioimmunoassay were used for ambulatory blood pressure monitoring and the determination of DHEAS levels, respectively. A close correlation (P < .001) was found between the diurnal indices and plasma DHEAS levels of the 387 subjects (86 normotensive and 301 hypertensive patients) participating in the study. Decreased plasma DHEAS levels were associated in both genders, and in both normotensive and hypertensive patients with significantly (P < .001) lower diurnal indices. There was a close correlation (P < .001) between the age-related decrease in plasma DHEAS levels and diurnal indices in both genders. Systolic and diastolic blood pressure variability changed parallel to plasma DHEAS levels in both genders, whether hypertension was present or not. Additional investigations are needed to find out whether reduced DHEAS levels play a role in decreased diurnal indices or whether both can be traced back to one and the same cause.

Diuretics and Bioimpedance-Measured Fluid Spaces in Hypertensive Patients

The authors examined the relationship between thiazide‐type diuretics and fluid spaces in a cohort of hypertensive patients in a retrospective study of 60 stable hypertensive patients without renal abnormalities who underwent whole‐body bioimpedance analysis. Overhydration was greater in the diuretic group, but only to a nonsignificant degree (5.9 vs 2.9%; P=.21). The total body water did not differ in the two groups (41.8 L vs 40.5 L; P=.64). Extracellular fluid volume (ECV) (19.7 L vs 18.5 L; P=.35) and intracellular fluid volume (ICV) spaces (20.8 L vs 21.3 L; P=.75) were also not significantly different in the two groups. The ratio of ICV:ECV, however, appeared different: 1.05 vs 1.15 (P=.017) and the effect was maintained in the linear regression–adjusted model (β coefficient: −0.143; P=.001). The diuretic‐related distortion of ICV:ECV ratio indicates potential fluid redistribution in hypertensive patients, with ICV participating in the process.

Atrial natriuretic peptide (ANP) in patients with chronic renal failure on maintenance haemodialysis

Atrial natriuretic peptide (ANP), a recently discovered cardiac hormone, is an important regulator of body fluid homeostasis. Twenty patients with established chronic renal failure and on maintenance haemodialysis were studied before and after dialysis with capillary dialysers. ANP was determined by RIA after extraction. Mean (±SD) pre-dialysis ANP concentration was 146±51 pg/ml and decreased significantly during dialysis to 68±38 pg/ml (p<0.001). Per cent and absolute changes in plasma ANP level correlated significantly with concomitant changes in body weight (r=0.764; p<0.001 and r=0.558; p<0.01, resp.) but not with changes in serum creatinine, blood pressure or serum electrolytes. The obtained results indicate that ANP levels in patients with chronic renal failure are elevated mainly due to fluid overload, and the rapid fall in ANP concentration observed during haemodialysis is caused by the removal of excess fluid from the body.

Treatment of hypertension associated with prediabetes

Condition prior to diabetes is designated as prediabetes. The use of this term is recommended if fasting plasma glucose exceeds normal level but does not reach the characteristic result of real diabetes. Prediabetes is often characterized by combination of visceral obesity, glucose and lipid metabolism disorders and changes in blood pressure. Change of life style is more important in the treatment of prediabetes associated hypertension than in other hypertensive diseases. In this case, metabolically neutral antihypertensive medication is the treatment of choice. The growing obesity epidemic underlines the significance of prediabetes associated hypertension in public health. While 25% of the adult population suffering from this kind of hypertensive disease, the optimal solution has to be found together with patients, physicians and the money lenders of the social security system.

A bélmikrobiom, a metabolikus betegségek és a hypertonia kapcsolatának irodalmi áttekintése

Gut flora has personal characteristics for each individual, similar to the fingerprints, consisting of a special mixture of bacterial species living in the intestines, now referred to as the gut microbiome. There is a strong correlation between the loss of microbial diversity and the functional bowel disorders, obesity, type 2 diabetes and cardiovascular disease as well as many autoimmune disorders. With genetic testing of stool diversity of the gut microbiome and exact analysis of the species and phylogenetic classification of the gut flora, the changes of diversity can be identified and the overgrowth of some bacteria can be revealed. In cases with pre- and manifest hypertension, an overgrowth of species from the phylum Firmicutes has been reported along with the relative decline of the phylum Bacteroidetes as opposed with cases of normotension. At the same time, the physiological balance among bacterial families was lost. According to the first studies, there is a correlation between hypertension and the lost balance of the gut microflora, both in animal experiments and in the human clinical setting. This evidence also suggests that targeted dietary alteration of the gut microbiome can be a new innovative approach in the treatment of hypertension. Orv Hetil. 2018; 159(9): 346-351.Absztrakt: A belflora olyan, mint az ujjlenyomat: minden embernek egyedi osszetetelű, ra jellemző bakteriumfajokbol allo mikrobanepesseg el a belrendszereben, amit ma belmikrobiomnak hivunk. A bakteriumok valtozatossaganak, sokszinűsegenek (diverzitasanak) csokkenese szoros kapcsolatot mutat a funkcionalis belbetegsegekkel, az elhizassal, a 2-es tipusu diabetesszel es a cardiovascularis betegsegekkel, valamint sok autoimmun megbetegedessel. A szekletgenomikai teszt soran a belflorat alkoto fajok pontos identifikalasa es filogenetikai azonositasa reven meghatarozhato a diverzitas valtozasa, illetve azonosithato bizonyos belbakteriumok tulnovekedese. Praehypertonias, hypertonias egyenekben a Firmicutes torzshoz tartozo bakteriumok elszaporodasa, mig a Bacteroidetes torzsek csokkenese gyakrabban volt kimutathato, mint normotonia eseten, mindemellett az egyes bakteriumtorzsek fiziologiai aranya kevesbe volt kiegyenlitett. Az első megfigyelesek arra utalnak, hogy kapcsolat allhat fenn a magas vernyomas es az i...

Whole-Body Exchangeable Sodium in Cardiovascular and Endocrine Disorders

Sodium is the major cation of the extracellular fluid and together with its anions, chloride and bicarbonate, constitutes more than 90% of the osmotically active solutes in the extracellular space (Schrier and Anderson 1980). Since biological membranes are freely permeable to water, changes in the amount of total body sodium will significantly alter extracellular fluid volume (ECV). Also, due to the inherent relationship between ECV, kidney function, and various pressor systems of the organism, body sodium is an important determinant of arterial blood pressure (Guyton et al. 1972).