[Treatment of resistant primary glomerulopathies]. / Lijecenje rezistentnih primarnih glomerulopatija.

Considerable progress in understanding of the pathogenesis of a number of primary glomerular diseases is evident. Scientific achievements in this field led to reclassification of certain types of glomerulonephritides, development of new diagnostic tests, as well as new therapeutic approaches. These new findings will enable us to treat primary glomerulopathies more efficiently thus reducing incidence of resistant disease. Novelties in diagnostics, treatment algorithm, characteristics of the resistant disease and the possibilities of specific treatment are shown in this review.

[Blood pressure measurement--do not sweat the small stuff and it is all small stuff?! Position paper of the Croatian national referral center for hypertension, center of excellence of the European Society of Hypertension]. / Mjerenje arterijskoga tlaka--ne mari za male stvari i ostat ce male stvari?! Preporuke Hrvatskoga referalnog centra za hipertenziju centra izvrsnosti Europskog drustva za hipertenziju.

Office blood pressure measurement using mercury sphygmomanometer is the gold standard for making diagnoses of hypertension, evaluation of cardiovascular risk and estimation of obtained control of treated hypertensives. The vast majority of epidemiologic data are based on this method. However, the importance of blood pressure variability, white coat effect as well as availability of simple devices, home and ambulatory blood pressure measurements became routine parts in routine clinical work. As mercury will be soon forbidden in clinical work such devices and methodology will be even more important. In everyday clinical practice all three techniques should be implemented and in this paper advantages and drawbacks of all techniques are discussed. In the end, based on recent data and recommendations of international societies, diagnostic algorithm was proposed. Additionally, we described the technique of non-invasive central blood pressure measurement, determination of pulse wave velocity and calculation of augmentation index, new proposed risk factors.

[Clinical characteristics of patients with renovascular hypertension]. / Klinicke osobitosti bolesnika s renovaskularnom hipertenzijom.

The aim of our study was to show the value of comparing clinical parameters in patients with renovascular hypertension (RVH) and essential hypertension (EH). We examined the differences between renovascular hypertension patients with atherosclerosis (ATH) and those with fibromuscular dysplasia (FMD). The diagnosis of renovascular hypertension was established on the basis of renal angiography finding, which also defined the type of stenosis (ATH or FMD). Our patient group included 108 patients with atherosclerotic RVH (46 male / 62 female, median age 53 yrs), 16 patients with FMD (3 male / 13 female, median age 49 yrs), and 106 patients with EH (61 male / 45 female, median age 38 yrs). In comparison with patients with EH, patients with atherosclerotic RVH were found to be more frequently of female gender with lower body weight and height, older, and more frequently on therapy with antihypertensives. Their hypertension was of later onset and more severe stage. All those differences were statistically significant (P < 0.05). When analysis by genders was performed, women were more frequently smokers and had higher serum cholesterol levels, which is an explanation for higher proportion of female gender in atherosclerotic RVH patients. In patients with fibromuscular dysplasia a higher proportion of female gender was also present, but in comparison with ATH patients their hypertension was more often of a less than 5 years duration and they had lower serum creatinine and triglyceride levels. Our results are in agreement with the results of other authors who showed clinical parameters to be useful in screening of patients for further diagnostic procedure. This stresses the importance of good history, physical examination and well-chosen laboratory tests. They can't clearly establish or exclude the diagnosis of renovascular hypertension, but this approach could more easily point out those hypertensive patients who require a thorough work-up. Clinical parameters could furthermore help in determining the type of treatment of RVH.

Arterial stiffness in atherosclerotic renovascular hypertension.

OBJECTIVE: Arterial stiffness is an independent cardiovascular risk factor. Aging, high blood pressure and increased renin-angiotensin system activity contribute to increased arterial stiffness in patients with atherosclerotic renovascular hypertension (aRVH). A literature search failed to identify any study related to this topic. Therefore, our aim was to determine the arterial stiffness in patients with aRVH and analyze whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course. METHODS: In this 6-month longitudinal study, 37 patients with refractory hypertension and unilateral aRVH were enrolled. After stenting, all patients received multifactorial dug therapy including 80 mg of telmisartan. Arterial stiffness indices were determined using Arteriograph. The control group consisted of 44 patients with essential hypertension. RESULTS: There were no differences in brachial blood pressure values between the two groups (P > 0.05). At baseline, adjusted pulse wave velocity (PWV) was higher in aRVH patients than that of essential hypertensive patients (12.8 ±â€Š0.4 vs. 11.6 ±â€Š0.3 m/s; P = 0.029). In the aRVH group, at the end of the follow-up, a significant decrease in the aortic augmentation index (37.7 ±â€Š9.9 vs. 33.7 ±â€Š11.4; P = 0.02) without changes in PWV was observed (P > 0.05). CONCLUSION: This study is the first to show that arterial stiffness is higher in patients with refractory aRVH than in those with essential hypertension. Multifactorial therapy based on stenting and intensive medical treatment reduced central blood pressure and augmentation index. Failure to obtain PWV reduction is likely a consequence of the present irreversible structural vessel changes. Longer follow-up might enable us to resolve whether arterial stiffness indices have better predictive ability in patients with aRVH than brachial blood pressure.