Peter Legrady

High Prevalence of Prehypertension and Hypertension in a Working Population in Hungary

BACKGROUND Hungary has one of the highest mortality rates due to strokes among the European Union countries. As elevated blood pressure (BP) is the principal risk factor for strokes, we assessed BP levels, as well as awareness and treatment status of hypertension and prehypertension in a working population sample in Hungary. METHODS Worksite employees in Budapest and Szeged were screened for their BP using an automated BP measuring instrument (BpTRU). BpTRU readings of heart rate (HR) were also recorded. Respondents were classified as normotensives (NT), prehypertensives (PHTN) and hypertensives (HTN) according to their BP levels, as defined by the JNC 7 guidelines. Body height and body weight were measured and body mass index (BMI) was calculated. Self-reported information regarding smoking was collected. RESULTS In total, 2,012 respondents were recruited (1,000 white collar; 1,012 blue-collar workers), with a mean (±s.d.) age of 34.8 (±9.9) years. Of all respondents, 22.6% were identified as HTN and 39.8% as PHTN. Among HTN, 40% were unaware of their condition and only 18.5% were adequately treated. PHTN were similar in age as NT, but showed significantly higher HR. CONCLUSIONS A high proportion of relatively young and apparently healthy Hungarian employees were diagnosed with prehypertension and hypertension. Only a small proportion of HTN had their BP controlled. BMI and HR were significantly higher among individuals with prehypertension compared to NT. Whether the high rates of hypertension, prehypertension, and low levels of control explain the high stroke mortality and unfavorable cardiovascular disease (CVD) profile of Hungary needs further study.

Neurovascular Pulsatile Compression and Neurosurgical Decompression of the Rostral Ventrolateral Medulla in Medically Resistant Hypertensive Patients

Background/Aims: In cases of severe primary hypertension not responding to conventional medical therapy, neurovascular pulsatile compression of the rostral ventrolateral medulla on the left side may be considered as an etiological factor in the hypertension. Through neurosurgical decompression, the blood pressure can be reduced in these cases, and the conventional medication can also become more effective. Methods:The authors retrospectively analysed the changes in the blood pressure and therapy of patients with or without neurosurgical decompression over a 2-year period. The 2-year data were available for 9 operated and 7 non-operated patients with neurovascular compression. The data of control examinations performed 1, 3, 6, 12 and 24 months after the intervention (or after MR-angiography in the non-operated cases) were analysed. Results: After the decompression, both the systolic and diastolic blood pressure decreased significantly and permanently in all cases, and there was an improved response to the medication. In the non-operated group, the blood pressure did not change significantly during the 2 years. Conclusion: In severe hypertension that does not respond to conventional therapy, neurosurgical decompression of the brain stem on the left side can guarantee a long-lasting blood pressure reduction and a better response to antihypertensive medication.

Hypertension screening in a salami factory: A worksite hypertension study

The prevalence, awareness and control of hypertension are important epidemiological research topics worldwide. The screening of hypertension in a workplace has some special aspects. We have screened the employees in a Hungarian salami factory (Pick Salami Factory, Szeged, Hungary) for hypertensives. In a cross-sectional survey, the blood pressure (BP) was measured with an instrument meeting accepted measuring principles (BP-TRUTM BP) and a questionnaire was filled. In all, 1012 factory workers were screened (600 male and 412 female) and 25.7% of the workers proved to be hypertensives. Of these, 61.5% of the hypertensive employees were aware that their BP is high. Among the treated hypertensives, 21.9% were controlled. These results suggest that the efficacy of the management of hypertension in Hungary cannot be solely responsible for the high cardiovascular morbidity and mortality. The improvement of the management of hypertension should decrease the cardiovascular risk in the hypertensive population. The worksite screening and follow-up of hypertension seem to be logical health service solutions. This has been proven to be cost-effective.

Brainstem auditory-evoked potential examinations in diabetic patients

Brainstem auditory-evoked potential (BAEP) examinations were performed in 15 patients with long-standing type-1 diabetes mellitus (DM). Cardiovascular reflex tests were applied for assessment of autonomic neuropathy. The aim of our investigation was to compare the BAEP results of this patient group with controls and to look for a possible correlation between the alteration of the auditory brainstem function and the cardiovascular autonomic neuropathy. Analysis of the latencies (waves I, II, III and V) and the inter-peak latencies (waves I-III and I-V) of BAEPs revealed a significant difference between diabetics and healthy controls. The amplitudes of waves I, III and V were definitely lower in comparison with those of healthy controls. A positive correlation was observed between the overall autonomic score and the latencies (waves III and V) and inter-peak latencies (waves I-III and I-V). These data support the hypothesis that long-standing DM and diabetic neuropathy might be related as a cause of certain dysfunctions of the central auditory pathways.

Observations of Changes of Blood Pressure Before and after Neurosurgical Decompression in Hypertensive Patients with Different Types of Neurovascular Compression of Brain Stem

Aims: The neurovascular pulsatile compression of the rostral ventrolateral medulla can be divided into different subtypes. The posterior inferior cerebellar artery and/or vertebral artery can compress either the rostral ventrolateral medulla or the cranial nerves IX and X or both and on left, right or both sides. Methods: It was retrospectively investigated whether the types of neurovascular compression can influence blood pressure values. Data from 13 resistant hypertensive patients after decompression were investigated. Results: Six patients had 2 compressions, two had only medulla compression, four had only nerve compression on the left side and one had 2 compressions on both sides. There was no correlation between the types of compression and the levels of blood pressure, either before or after the decompression. Both, systolic and diastolic blood pressures and pulse pressure also decreased in all cases after the decompression but the change was significant only in the group with 2 compressions on the left side. Conclusion: According to our data, in a severe hypertension not responding to conventional antihypertensive therapy, the surgical decompression of the brain stem independently of the types of neurovascular compression could guarantee a decrease of blood pressure and improved sensitivity to antihypertensive medication.

Investigation of cardiac autonomic and peripheral sensory neuropathy in diabetic and nondiabetic patients with hypertension.

Peripheral sensory function and cardiac autonomic neuropathy were studied in 18 nondiabetic and 10 type-2 diabetic hypertensives compared with 11 healthy controls. All the patients were treated with antihypertensive drugs. Cardiac autonomic neuropathy using Ewing method was detected in all patient groups. The current perception threshold values on peroneal nerve at 250 Hz in nondiabetic group and at 250 Hz and at 5 Hz in diabetic group were found increased compared with the controls. In conclusion, so-called typical complications of diabetes can be observed in nondiabetic hypertensives also. Our data might support the essential role of vascular factors in the development of neuropathy.

The prevalence of resistant and undercontrolled hypertension among patients of a Hypertension Outpatient Clinic

Introduction. Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to an ESH Newsletter published in 2011, the prevalence of resistant hypertension is 2.9–43%. Objective. Analysing only the therapy of hypertensive patients of the Hypertension Outpatient Clinic of the University of Szeged, the authors wanted to answer following main questions: How many patients were therapeutically resistant according to the definition of resistant hypertension? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached target SBP values? How many drugs were usually used in combination therapy? Material and methods. Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analysed, of all cases only one visit was taken into account. For those patients who visited the Clinic more than once during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140 mmHg. Results. In this population, 234/310 (76%) patients had resistant hypertension according to the definition (158 ± 17/97 ± 8 mmHg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136 ± 20 mmHg) and 134 of them (52% of 257 patients) reached the therapeutic goal. A fourfold combination of antihypertensive agents was the most frequent in this population. Conclusion. It is advised to use multiple drug combinations and it is recommended to spend enough time but not longer than necessary to find the most effective combination in every case.

Effect of left-sided brain stem decompression on blood pressure and short-term cardiovascular regulation in resistant hypertension

Effect of left-sided brain stem decompression on blood pressure and short-term cardiovascular regulation in resistant hypertension