Comparison between High-dose Telmisartan and Fixed dose Combination of Telmisartan and Hydrochlorothiazide in Patients with Hypertension

We compared treatment with a high-dose angiotensin II receptor blocker(ARB)and combination of ARB with a thiazide diuretic in 17 patients with hypertension. A randomized crossover study was performed giving 80 mg telmisartan or fixed-dose combination of 40 mg telmisartan and 12.5 mg hydrochlorothiazide for 16 weeks each. Although the clinic blood pressure was comparable between the high-dose ARB period(134/81 mmHg)and the combination period(134/82 mmHg), the morning home blood pressure was lower in the combination period than in the high-dose ARB period(138/82 vs. 151/88 mmHg, p=0.026/0.013). No significant difference was observed in urinary albumin excretion, but estimated glomerular filtration rate was lower in the combination than in the high-dose ARB period(58.9 vs. 62.1 mL/min/1.73 m^2, p=0.039). Serum uric acid was higher in the combination than in the high-dose ARB period(6.7 vs. 5.9 mg/dL p=0.022). The indices of glucose metabolism, serum lipids, oxidative stress, inflammation and adipocytokine did not significantly differ between the two periods. There was no significant difference in the measurement of endothelium-dependent vasodilation between the two periods. It is suggested that the addition of thiazide diuretic to medium-dose ARB is more effective in lengthening the hypotensive effect than high-dose ARB, however, care should be taken for the elevation of serum uric acid and the decrease in renal function

Protective Effects of Olmesartan and Azelnidipine against Cardiovascular Organ Injuries in Spontaneously Hypertensive Rats

In the treatment of hypertension, care should be taken for preventing of hypertensive organ injuries as well as lowering blood pressure to the adequate level in order to reduce the risk of cardiovascular diseases. The purpose of this study is to examine the effects of angiotensin II receptor blockers (ARB), calcium channel blockers (CCB) and their combination on the development of cardiovascular organ injuries in spontaneously hypertensive rats (SHR). Four groups of male 8-week-old SHR (n=9 each) were given vehicle(control), 10 mg/kg azelnidipine (AZL), 10 mg/kg olmesartan (OLM, n=9), or the combination of AZL and OLM(5 mg/kg each)for 12 weeks, and their effects on cardiovascular organ injuries were evaluated. Tail-cuff blood at 12 weeks was similarly lowered by AML, OLM and the combination therapy(148, 143 and 143 mmHg, respectively)as compared with the control SHR (198 mmHg). Pulse rate was significantly less in the AZL group but not in the OLM group or the combination therapy group than in the untreated control group (-27, -12, +6 bpm, respectively). The cardiac ventricular weight (AZL -12%, OLM -15%, combination -18% vs. control) and aortic thickness (AZL -17%, OLM -16%, combination -19% vs. control) were reduced by similar extents in the three groups given antihypertensive treatments. Regarding the myocardial fibrosis, left ventricular hydroxyproline content was reduced in the OLM and the combination groups but the change was not significant in the AZL group (AZL -14%,OLM -30%, combination -27% vs. control). In the echocardiographic evaluation of cardiac function, the index of left ventricular diastolic function is significantly improved in the OLM and the combination groups but not in the AZL group, while the index of systolic function was not different between the four groups. It is suggested that the antihypertensive therapy including ARB is superior to the monotherapy by CCB in preventing the myocardial fibrosis and preserving the left ventricular diastolic function

Influence of Obstructive Sleep Apnea on Diastolic Heart Failure

Heart failure is frequently complicated by obstructive sleep apnea, which raises blood pressure and arrhythmiaand worsens prognosis. However, the incidence and influence of obstructive sleep apnea in patientswith diastolic heart failure is unknown. We hypothesized that patients with diastolic heart failurecomplicated by obstructive sleep apnea may have a worse outcome compared to those without obstructivesleep apnea. The study included 49 patients with an ejection fraction ≥ 50 %, of whom 34 had diastolic heartfailure and 15 did not have diastolic heart failure. The patients were examined in a sleep study and byechocardiography. Brain natriuretic peptide (BNP) levels were determined at admission and 1, 6 and 12months thereafter. The prevalence of obstructive sleep apnea in patients with diastolic heart failure( 18/34,53 %) was significantly higher than that in those without diastolic heart failure (3/15, 20 %)(p=0.032).BNP levels were high at admission in patients with diastolic heart failure, but then decreased gradually inthose without obstructive sleep apnea. However, BNP in patients with diastolic heart failure and obstructivesleep apnea remained high and was significantly elevated compared to the level in patients without obstructivesleep apnea at 6 and 12 months after admission. Patients with diastolic heart failure and obstructivesleep apnea showed prolongation of elevated BNP, indicating that complication of diastolic heart failure byobstructive sleep apnea may aggravate cardiac function

Qualitative Improvement of a Coronary Plaque after Treatment with a Strong Statin : Observation using Virtual Histology Intravascular Ultrasound

Statins are used currently for treatment and prevention of coronary artery disease, but it is difficult to assess the therapeutics effects and patient responses to different statins. Virtual histology intravascular ultrasound (VH-IVUS) has been used to evaluate detailed quantitative changes in coronary plaques, and here we report a case in which marked qualitative improvement in a coronary plaque was observed using VH-IVUS after a change in treatment from a conventional statin to a strong statin

Hemodynamic Effects of Positive end-expiratory Pressure on Right Ventricular Diastolic Function in Patients with Acute Myocardial Infarction

The effects of positive end-expiratory pressure (PEEP) on the right ventricular (RV) diastolic function in patients with congestive heart failure (CHF) due to acute myocardial infarction (AMI) are unknown. The aim in this study was to investigate PEEP associated variations in RV diastolic function in CHF due to AMI. The subjects comprised the control group (26 subjects) and the AMI group (36 subjects) classified as 20 patients with pulmonary capillary wedge pressure (PCWP) < 18 mmHg (CHF-low PCWP group) and 16 patients with PCWP≧18mmHg (CHF-high PCWP group). PEEP was applied for 30 minutes at 0, 5, 10 and 15 cmH_20. Two-dimensional echocardiography with continuous and pulse wave Doppler studies was performed. RV diastolic functional parameters included the ratio of peak early tricuspid valve filling and peak atrial filling velocities, the decelation time of the tricuspid E valve and the RV isovolumic relaxation time. In the control and CHF-low PCWP groups, right atrial pressure, mean pulmonary arterial pressure (mPAP), total pulmonary resistance (TPR) and systemic vascular resistance (SVR) increased, output (CO) decreased and RV diastolic functional parameters worsened significantly at the transition from 10 to 15 cmH_20 PEEP. In the CHF-high PCWP group, mPAP, TPR and SVR decreased, while CO increased and RV diastolic functional parameters improved significantly at the transition from 10 to 15 cmH_20 PEEP. From these findings, it is clear that PEEP induced hemodynamic deterioration and reduces RV diastolic function in intact and mildly failing hearts. On the other hand, in severely failing hearts, PEEP effers hemodynamic improvement and ameliorates RV diastolic function. It appears possible to predict responses to PEEP by determining RV diastolic function in CHF. Therefore, we conclude that evaluation of the RV diastolic function during PEEP is highly important in terms of recognizing the effectiveness of PEEP therapy in CHF

The Relationship between Apelin and Angiotensin II in Paroxysmal Supraventricular Tachycardia

Background: We aimed to investigate apelin and angiotensin II serum levels in patient whit paroxysmal supraventricular tachycardia. Methods: This was a cross-sectional study on 38 patients with paroxysmal supraventricular tachycardia (PSVT), and 38 age- and sex-matched healthy individuals. Blood samples were taken from these people, and angiotensin II/apelin levels were measured using enzyme-linked immunosorbent assay (ELISA). To analyze the data, descriptive statistics were used. Results: Apelin levels were lower in PSVT group compared to control group; but the difference was not significant (P = 0.302). Angiotensin II levels were significantly lower in PSVT groups compared to controls (P = 0.003). Conclusion: Like similar studies, this study showed that apelin serum levels were lower in PSVT groups, but this difference was not significant. However, mean serum levels of angiotensin II was significantly lower in PSVT groups. This could be due to the consumption of calcium blockers in these patients. Keywords Apelin; Angiotensin II; Supraventricular tachycardi

A Novel Cardioprotective Drug, K201 (JTV519), Induces Prolongation of QT and QTc Intervals, but not Torsades de Pointes

K201 (JTV-519; 4-[-3{1-(4-benzyl) piperidinyl} propionyl]-7-methoxy-2, 3, 4, 5-tetrahydro-1, 4-ben-zothiazepine), is a multi-channel blocker and a ryanodine receptor stabilizer that exhibits strong cardiopro-tective and antiarrhythmic effects. In this study, we examined how intravenous infusion of K201 without an α-agonist prolongs the QT interval in chloralose-anaesthetized rabbits, and whether the maximum dose of K201 given concomitantly induces torsades de pointes. The QT interval was significantly prolonged in the group receiving 6-hour infusion of K201 at 20 μg/kg/min, but the QTc interval was not prolonged (n=5). With infusion of K201 at 0 (vehicle; n=5), 40 (n=6), 100 (n=6), 200 (n=6) and 400 μg/kg/min (n=5), blood pressure and HR were decreased, and prolongation of PQ, QRS complex, QT and QTc intervals occurred dose-dependently. The QTc interval was significantly prolonged from 211.5±11.9 ms of the baseline to 319.9±31.1 ms at a concentration of 400 μg/kg/min, which is the maximum dose of K201, but tors-ades de pointes was not induced at this dose. These results show that K201, which has a suppressive effect on Ca^ leakage from the sarcoplasmic reticulum and an α_1-adrenoceptor-blocking effect, does not induce torsades de pointes, although it causes prolongation of the QT interval

Effects of Norepinephrine on Left Ventricular Hemodynamics and Myocardial Blood Flow in Rats with and without Calcium Overload

Heart failure patients have been shown to have an increased blood norepinephrine concentration, and patients with a high norepinephrine concentration have a poor prognosis. Norepinephrine is a catecholamine with α_1 and β_1 effects, which lead to a vasoconstrictive action and enhancement of myocardial contraction. However, the consequences of norepinephrine-induced changes in myocardial blood flow in heart failure patients remain unknown. In this study, the influence of norepinephrine on hemodynamics and blood flow in the left ventricular myocardium was investigated using rats with and without a calcium load. Norepineph-rine without a calcium load induced a 29.3% reduction of myocardial blood flow (MBF), but had no significant effect on ejection fraction (EF) and left ventricular end-diastolic pressure (LVEDP). With simultaneous calcium administration, norepinephrine induced a 33.2% reduction of MBF and increased LVEDP significantly, but caused no reduction in EF. These results suggest that norepinephrine decreases MBF but has no effects on systolic function, and increases LVEDP and decreases MBF more markedly in combination with calcium

Schizencephaly Type I : Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Features

We report a case of type I schizencephaly diagnosed by magnetic resonance imaging in a 2-year- old boy with delayed speech and hemiplegia. Cerebral single photon emission computed tomography showed an abundant cerebral blood flow at the site of the cleft lesion. Single photon emission computed tomography thus may provide useful cerebral blood flow images in schizencephaly patients

Impaired cardiac autonomic nervous control after cardiac bypass surgery for congenital heart disease

We undertook a study to describe changes in heart rate variability (HRV) postoperatively in children undergoing cardiac bypass surgery for congenital heart disease (CHD). HRV was recorded for a 1-h period preoperatively and a 24-h period postoperatively in 20 children with CHD. We found a highly significant reduction in HRV in both time and frequency domain indices compared to preoperative values, which was sustained throughout the 24-h study period. There was a negative correlation between both time and frequency domain HRV measurements and length of cardiac bypass. HRV is reduced postoperatively and correlates with cardiac bypass time. Length of cardiac bypass time may be one mechanism whereby HRV is reduced following surgery