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Introduction: Oscillometric devices in contrast to the traditional Doppler based method for ankle-brachial index measurements have promising advantages like no need for special training, faster performance, and operator independence., Aim: Comparative assessment of the oscillometric and Doppler-based ankle-brachial index measurement., Method: Ankle-brachial index measurements were performed by continuous wave Doppler and an automatic oscillometric device (BOSO ABI-system 100) in consecutive subjects. The comparative assessment was performed by Bland-Altman and ROC analysis., Results: The two kinds of measurements (734 measurements) showed a good agreement in the ankle-brachial index spectrum close to the cut-off value of 0.9. The agreement diminished below or above this value. The optimal oscillometric ankle-brachial index diagnostic cut-off value was 0.96., Conclusions: The oscillometric device is not interchangeable for Doppler devices in the whole ankle-brachial index spectrum. Nevertheless, owing to its discriminative power, the oscillometric measurement potentially has an efficient role in the screening of asymptomatic patients. Orv Hetil. 2018; 159(5): 176-182.

Authors constructed a software helping the prevention programme of coronary and vascular diseases as the classical risk factors are used for graphic presentation of coronary risk as compared to "normal" risk. By repeated estimation alterations in coronary risk status can be compared to previous ones and thereby help evaluating the changes. This programme is highlighted by the presentation of changes in coronary risk of a patient during a 4-year-long period of her medical history. It is also shown how graphic presentation of risk can support the more effective treatment and patient care.

Background: First line antihypertensive treatment's drugs have to be able to decrease the cardiovascular morbidity and mortality. This kind of efficacy of thiazides type diuretics were published earlier in several studies. The efficacy of indapamide was investigated in several studies, but there is no analysis which is including all of the indapamide-studies., Objective: We conducted a meta-analysis of all relevant randomized-controlled-trials with indapamide. Efficacy of indapamide was analyzed in different cardiovascular and safety outcomes., Methods: We searched the MEDLINE database 1995-2005 for indapamide-trials. Only double-blind, parallel-group design trials were involved. Both the fixed effect model and the random effect model were used for data synthesis, results were probed with Mantel-Hanzel test and inverse variance test., Results: Data were combined from 9 trials that included 10 108 patients. Indapamide treatment of 48 patients with a history of stroke prevents another stroke (NNT = 47.8 95% CI 29.6-126.6). Data from 5 trials including 7085 patients show that indapamide is superior to placebo in reducing blood pressure, the differences are: 7.28 mm Hg (95% CI: 6.37-8.19) in systolic blood pressure and 3.50 mm Hg (95% CI 2.99-4.01) in diastolic blood pressure. Data from 5 trials including 2856 patients show that indapamide is superior to active controls in reducing systolic blood pressure, the difference is significant: 1.30 mm Hg (95% CI 0.28-2.31). The difference in diastolic blood pressure was not significant. Data of 505 patients show that indapamide reduced left ventricular mass index significantly more than enalapril 20 mg, the difference is 6.50 g/m(2) (95%CI: 0.81-12.19). Data of 6206 patients show that frequency of adverse drug reaction is similar in the indapamide and placebo groups (rr = 0.97 95%CI 0.76-1.22)., Conclusions: Indapamide is efficacious in prevention of further stroke, reduces effectively the blood pressure and the left ventricular mass index. Indapamide treatment is well tolerated.

Background: The third generation beta-blocker (carvedilol) is effective in reduction of hypertension, and of mortality and morbidity as a supplement to conventional drugs of heart failure therapies (diuretics, ACE inhibitors), based on randomized controlled trials and retrospective analysis., Objective: To analyse the efficacy of carvedilol in the treatment of heart failure with special focused on morbidity, mortality endpoints., Methods: We assessed the multicenter, randomised, double-blind studies involving more than 150 patients (1995-2005) from MEDLINE database, in which carvedilol was used in the case of moderate to severe heart failure. We also present the results of health-economic publications (2000-2005)., Results: In U.S. Carvedilol Heart Failure Study (n 1096) the mortality declined by 65% (3.2% vs. 7.8%; p <0.001) with carvedilol vs. placebo, while the cardiovascular hospitalization decline was 27% (14.1% vs. 19.6%; p = 0.036) in heart failure (LVEF < or = 5%) applied together with the basic therapy (diuretic and ACE-inhibitor). In the COPERNICUS trial the efficacy of carvedilol was compared to placebo in the case of severe HF patients (LVEF < 25%, n = 2889). The annual mortality risk declined by 35% (19.7% vs. 12.8%, 95% CI 19-48%, p = 0.00013) while the risk of mortality or any risk of hospitalisation by 24% (p = 0.00004) in the active group. The CAPRICORN study (LVEF < or = 0%, n=1959) showed that carvedilol is efficacious in reduction of total (HR: 0.77; 95% CI 0.60-0.98; p = 0.031) and cardiovascular mortality (HR: 0.75; 95% CI 0.58-0.96; p = 0.024) as far as high-risk patients are concerned., Conclusion: The effectiveness of carvedilol is certified in reduction of mortality and hospitalization in the treatment of moderate-severe heart-failure as part of the combination therapy. The benefits of use of the drug are well measurable not only on the level of patients but on the suppliers and the financer as well, thanks to the decline of resource utilization.

Background: End stage renal disease and hypertension are associated with higher cardiovascular mortality. Endothelial dysfunction plays an important role in the pathogenesis of cardiovascular diseases. The authors investigated the endothelium-dependent and -independent vasodilation in the forearm skin microcirculation and the plasma markers of endothelial damage in hypertensive hemodialysed patients and in normotensive control subjects., Methods: Laser Doppler flowmetry with iontophoresis of acetylcholine and sodium nitroprusside and the postocclusive reactive hyperemia test was performed in 22 normal control subjects and in 21 hemodialysed patients with hypertension. Levels of endothelin-1, big-endothelin, and von Willebrand Factor were measured, as well., Results: The average hyperemic response to the two doses of acetylcholine iontophoresis was 474 +/- 83%; 836 +/- 97% in the control subjects, and 160 +/- 26%; 360 +/- 67% in the hemodialysed patients group (p < 0.05). The vasodilation after the two doses of sodium nitroprusside was 381 +/- 60%, 782 +/- 81% in the control group and 186 +/- 42%; 379 +/- 63% in the dialysed patients group (p < 0.05 compared to control, respectively). The average peak flow during the postocclusive reactive hyperemia test was significantly lower in hemodialysed hypertensives (234 +/- 48%) compared to healthy control subjects (434 +/- 36%, p < 0.05). Levels of endothelin-1, big endothelin, von Willebrand Factor and von Willebrand Factor activity were significantly higher in the patient group compared to the control subjects., Conclusions: In hemodialysed hypertensive patients, both endothelium-dependent and -independent vasodilation are impaired. Markers of endothelial damage are elevated referring the progression of vascular disease.

Unlabelled: In nonvalvular atrial fibrillation stroke prevention by anticoagulation is clearly recommended by evidence based medicine. Underusage of coumarin treatment however is a general problem. The aim of this study was the analysis of prehospital and hospital practice of anticoagulant therapy in a Hungarian cohort. 106 consecutive patients hospitalized in a Budapest medical department with chronic non-valvular atrial fibrillation were included. Mean age was 76 years, the percentage of males was 30%. High stroke risk factors were found in all patients, at least two of them in 72%. 70% of patients were 75 years old or more. Thus anticoagulant treatment was indicated in all patients, however at admission only 30% were anticoagulated, moreover therapeutic range was achieved in only 28% of them. At discharge in 77% of all patients and in 82% without contraindications coumarin treatment could be started, practically independently of age., Conclusions: In the Hungarian prehospital practice anticoagulant treatment of nonvalvular atrial fibrillation is underused and inefficient, but excellent rates even in international comparison can be achieved by adequate medical approach even in the elderly.

The efficacy and safety of the HMG-CoA reductase fluvastatin was investigated in a multicenter, open label clinical therapeutic trial in the treatment of hypercholesterinaemia in hypertensive patients (WHO I-II.). 49 patients were involved, 6 patients were dropped out because of th lack of compliance, 43 patients were investigated (mean age: 57.6 +/- 9.4 years, mean blood pressure: 146 +/- 16/88+/- g mmHg (systolic/diastolic). The antihypertensive treatment was unchanged during the study. An 8 weeks low-lipid diet was started if the fasting total cholesterol (TC) level was equal or higher than 6.5 mM/L and the triglyceride level was lower than 4.6 mM/L. After the dietary period fluvastatin treatment was started (20 mg o.d.), if the level of LDL-C was higher than 4,1 mM/L. Blood pressure, heart rate, TC, HDL-C (HDL2-C, HDL3-C), apoA1, apoB, TG were measured at the 4th, 8th, 12th weeks of treatment. LDL-C was calculated with Fridewald equation. The daily dose of fluvastatin was increased to 40 mg, if LDL-C level was higher than 3.5 mM/L after 4 weeks of treatment. 36 patients completed the study (Group B). 7 patients were dropped out at the end of the dietary period, because of the significant decrease of TC and LDL-C levels (Group A). In Group B fluvastatin significantly reduced the level of TC (from 7.22 +/- 0.88 to 5.99 +/- 0.98 mM/L), of LDL-C (from 5.13 +/- 0.71 to 3.95 +/- 0.88 mM/L), and the level of ApoB (from 0.97 +/- 0.26 to 0.85 +/- 0.15 mM/L), but did not influence significantly the level of HDL-C, ApoA1 and TG. The diastolic blood pressure decreased significantly during the dietary period, while after beginning the fluvastatin treatment the decrease of the systolic blood pressure became significant. There was no change in the heart rate. Only minor side effects were observed in 3 patients (dysuria, constipation, lack of appetite). Fluvastatin proved to be an effective and well-tolerated drug in the treatment of hypercholesterinaemia in hypertensive patients.

The "white coat effect" has been investigated by non-invasive automatic blood pressure monitoring in patients with hypertension, defined by casual blood pressure readings. A significant "white coat effect" has been demonstrated in 30 (32%) of the 93 patients: the average values were 17/9 mmHg and 6 beat/min, the highest values were 37/29 mmHg and 13 beat/min. The examination has been repeated after 24 hours in 11 cases and the phenomenon was reproducible. The "white coat effect" did not disappear even when the changes were compared to the averages of three subsequent automatic blood pressure measurements. There were significantly more women, than men among the "white coat" positive patients. However, no difference was found in age, occupation and the known duration of hypertension. Neither was any correlation between the "white coat effect" and the blood pressure reaction to mental arithmetic test. It is emphasized that the casual readings can significantly overestimate the blood pressure. This finding must be considered especially in the diagnosis of borderline hypertension.

Prazosin (Minipress) monotherapy was given to 152 patients with essential hypertension for one year in a multi-center study involving 13 hospitals and university clinics. In three centers serum levels of total cholesterol, HDL-cholesterol and triglycerides were also determined in 32 patients with hypertension and hyper/dys-lipoproteinemia. As a consequence of Minipress monotherapy significant decreases were found in serum level of cholesterol (after three months and also after one year), triglycerides (after one year), while the serum concentration of HDL-cholesterol increased. Atherogenic index (a ratio of total cholesterol over HDL-cholesterol) was significantly decreased by Minipress. As new data showing a causative correlation between hypertension and hyperlipoproteinemia were published in the literature authors, on the basis of their results, suggest to determine lipid profile in every patient with hypertension. They regard Minipress as the first line drug in young patients with "familial dyslipidemic hypertension". When choosing an antihypertensive drug metabolic side effects should be taken into consideration.

The authors summarized the relationships between the cardiovascular diseases and smoking. In their retrospective study they studied the acute antihypertensive effect of nifedipine in patients with essential hypertension who were smokers and nonsmokers. They suggest that the antihypertensive effect of nifedipine did not decrease in smokers. Therefore the nifedipine can be the first choice in the antihypertensive therapy in smokers with essential hypertension.

A noninvasive, fully automatic blood pressure monitoring system has been developed to make the measurement of blood pressure more reliable and to help individualizing anti-hypertensive therapy. The authors draw attention to the importance of the circadian blood pressure variability and the "white coat hypertension" phenomenon. The error due to overlooking the changes in circadian blood pressure and to the "white coat" effect could be avoided with automatic blood pressure monitoring. Their system consists of two subunits: the Nippon Colin (BP 203 MII) blood pressure monitor, which has been fitted to the Commodore 64 computer by their own interface and data transfer program. Data analyzing and graphic displaying programs have also been developed by them. The diagnostic and therapeutic importance of blood pressure monitoring are demonstrated with representative cases of patients with essential, renoparenchymal and renovascular hypertension. The perspectives of this method in clinical pharmacology are also illustrated and discussed.