Karolina Hoffmann

Aliskiren - an alternative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the therapy of arterial hypertension.

There has been enormous progress in antihypertensive therapy over the last few decades. However, the management of arterial hypertension is still insufficient and more efforts are needed to improve both non-pharmacological and pharmacological treatment of this widely prevalent disease. Renin-angiotensin-aldosterone system (RAAS) inhibition is crucial both for blood pressure (BP) control and for prevention of organ damage or its development in patients with hypertension. Angiotensin-converting enzyme inhibitors and/or sartans block RAAS incompletely. Aliskiren is one of the novel drugs that has been introduced to antihypertensive therapy recently. Up to now no trial has confirmed that aliskiren is efficacious in reducing cardiovascular events. Double RAAS blockade with aliskiren was not always safe. This review article presents the current view on the place of aliskiren in the therapy of arterial hypertension.

Lumbar paravertebral blockade as intractable pain management method in palliative care

Optimal symptoms control in advanced cancer disease, with refractory to conventional pain treatment, needs an interventional procedure. This paper presents coadministration of local anesthetic (LA) via paravertebral blockade (PVB) as the alternative to an unsuccessful subcutaneous fentanyl pain control in a 71-year old cancer patient with pathological fracture of femoral neck, bone metastases, and contraindications to morphine. Bupivacaine in continuous infusion (0.25%, 5 mL · hour−1) or in boluses (10 mL of 0.125%–0.5% solution), used for lumbar PVB, resulted in pain relief, decreased demand for opioids, and led to better social interactions. The factors contributing to an increased risk of systemic toxicity from LA in the patient were: renal impairment; heart failure; hypoalbuminemia; hypocalcemia; and a complex therapy with possible drug-drug interactions. These factors were taken into consideration during treatment. Bupivacaine’s side effects were absent. Coadministered drugs could mask LA’s toxicity. Elevated plasma α1-acid glycoprotein levels were a protective factor. To evaluate the benefit-risk ratio of the PVB treatment in boluses and in constant infusion, bupivacaine serum levels were determined and the drug plasma half-lives were calculated. Bupivacaine’s elimination was slower when administered in constant infusion than in boluses (t½ = 7.80 hours versus 2.64 hours). Total drug serum concentrations remained within the safe ranges during the whole treatment course (22.9–927.4 ng mL−1). In the case presented, lumbar PVB with bupivacaine in boluses (≤ 137.5 mg · 24 hours−1) was an easy to perform, safe, effective method for pain control. Bupivacaine in continuous infusion (≤150 mg · 12 hours−1) had an acceptable risk-benefits ratio, but was ineffective.

Managing metastatic bone pain: New perspectives, different solutions

Bone metastases are the most frequent cause of cancer-induced bone pain (CIBP). Although palliative radiotherapy and pharmacotherapy conducted according to World Health Organization (WHO) analgesic ladder are the treatment of choice for CIBP reduction, these methods are not always successful, especially with regard to alleviation of incidental pain. Antiresorptive drugs (bisphosphonates) are able to inhibit bone destruction (loss), proliferation of cancer cells and angiogenesis, but their prolonged use may lead to a spectrum of adverse effects. In this paper, types of bone metastases, their complications, as well as diagnostic and therapeutic implications are presented. Moreover, the paper discusses presently used CIBP treatment methods and research directions for future methods, with special focus on bone metastases.

Economic aspects of hypertension treatment in Poland.

Introduction The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B). Material and methods The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated. Results The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient. Conclusions The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.

The Relationship between Serum Apelin Concentration and Selected Anthropometric Parameters, Serum Lipids and Carotid Intima-Media Thickness in Young Subjects with Primary Arterial Hypertension

Objective: Apelin and its specific receptor, APJ system, seems to be involved in the development of arterial hypertension (HTN). The aim was to estimate plasma apelin concentration in young patients (pts) with primary HTN and to assess the relationship between apelin and selected anthropometric parameters, serum lipids and carotid intima-media thickness (right and left cIMT). Methods: 70 pts (48 males, 22 females) aged 18-33 with newly diagnosed, untreated primary HTN were recruited. There were 15 age- and gender-matched healthy people in the control group. Anthropometric and BP measurements were done. Fasting serum apelin and lipids were evaluated. The cIMT was estimated using ultrasonography. Results: Serum apelin was higher in whole group (but not statistically significant, 98.04 ± 51.82 vs. 79.19 ± 39.51 pg/ml, p >0.05) and in males with HTN (compared to healthy males, 105.86 ± 53.21 vs. 61.42 ± 24.04 pg/ ml, p= 0.04). We observed a statistically significant negative correlation between apelin concentration and left cIMT in normal-weight women (R = -0.74), a negative correlation between triglyceride levels and apelin concentration in overweight subjects (R = -0.49), a negative correlation between apelin concentration and right cIMT (R = -0.99) and a positive correlation between apelin concentration and WHR (R = 0.99) in obese women. Conclusion: In whole examined group with HTN there were no statistically significant differences in serum apelin and no relationships between its concentration and anthropometric parameters, serum lipids or cIMT. However, higher serum apelin concentration in young males with HTN and some statistically significant correlations between serum apelin and analyzed parameters in groups divided by sex and BMI may suggest a possible role of apelin in the development of HTN. Further studies are required to clarify the relationship between apelin, metabolic parameters and the early markers of atherosclerosis in pts with HTN.