Analysis of Factors Relating to Day-to-day Home Blood Pressure Variation in Hypertensive Patients

　In order to prevent cardiovascular events and organ injuries in hypertensive patients, strict blood pressure（BP）control over 24 hours is of utmost importance. In addition to the BP level, it has been indicatedthat the variabilities of blood pressure during a day or between visits also influence the risk of cardiovascular disorders. This study aimed to delineate the factors relating to the variations of office and home BPs throughout a year in hypertensive outpatients under antihypertensive therapy. The office BP value（131/77 mmHg）was comparable to the morning home BP（130/76）, but was higher compared to the evening home BP（126/73）, however, the coefficient of variation（CV）values were comparable between the office and the home BPs. Correlations of BP and CV were stronger between the morning and the evening home BPs than between the office and the home BPs. The CV of systolic office BP was greater in patients with diabetes mellitus than the patients without diabetes（7.8 vs 6.1％）. In patients with chronic kidney disease, the CVs of diastolic office BP and evening home BP were greater than the patients without chronic kidney disease（8.0 vs 6.2％ and 8.1 vs 6.7％, respectively）. In addition, The CVs of diastolic morning and evening home BP were positively correlated with serum creatinine and a negatively correlated with estimated glomerular filtration rate. Patients with cardiovascular diseases such as stroke and coronary artery disease showed greater CV of diastolic morning home BP than the patients without cardiovascular diseases（8.2 vs 6.6％）. These results suggest that the home BP exhibits different variability from the office BP, and the BP variability is increased in high-risk hypertensive patients with diabetes mellitus, chronic kidney disease or cardiovascular diseases

Therapeutic Effects of a Sodium Glucose Cotransporter 2 Inhibitor in Diabetic Patients with Chronic Kidney Disease

Multiple large-scale clinical trials have indicated that sodium glucose cotransporter 2（SGLT2）inhibitors reduce the incidence of cardiovascular events, deterioration of renal function and mortality. However, the therapeutic effects of SGLT2 inhibitors are supposed to be limited in patients with reduced renal function considering the mechanism of their action. In this study, a SGLT2 inhibitor, ipragliflozin was given to 30 type 2 diabetic patients with nephropathy whose estimated glomerular filtration rate（eGFR）was not lower than 30 mL/min/1.73 m2. After 12 to 16 weeks, hemoglobin A1c decreased by 0.6％（p＜0.001）, body weight was reduced by 1.8 kg（p＜0.01）and blood pressure was lowered by －10/－6 mmHg（p＜0.001/p ＜0.001）. This was accompanied by reductions in serum uric acid（－0.7 mg/dL, p＜0.001）, triglycerides （－25 mg/dL, p＝0.028）and g-glutamyl transferase（－8 U/L, p＝0.001）. On the other hand, plasma B-type natriuretic peptide also decreased by 12％（p＝0.020）and urinary albumin excretion was reduced by 23％ （p＝0.018）although the eGFR was not significantly changed. It is concluded that ipragliflozin is effective in lowering blood glucose even in patients with diabetic kidney disease and is beneficial in improving theaccompanying obesity and hypertension. In addition, ipragliflozin is thought to have favorable influences on the metabolisms of uric acid and lipids. These properties of ipragliflozin is expected to bring about protective effects against the progression of nephropathy and the development of cardiovascular disease resulting in the improvement of prognosis in diabetic patients with mild to moderate chronic kidney disease

Mechanical vibration transmission characteristics of the left ventricle: Implications with regard to auscultation and phonocardiography

Systolic-diastolic phasic alteration of left ventricular mechanical vibration transmissibility was studied in an open chest canine preparation. A continuous vibratory tone was applied to the base of the heart, and a miniature heart surface vibration sensor applied to the epicardium near the ventricular apex. This allowed the detection of the percent of the vibration that was transmitted from source to sensor. These data were compared with those from intracardiac phonocardiograms obtained using a micromanometer-tipped catheter. It was found that in systole, the ventricle transmitted a vibratory tone from the cardiac base to the apex so that it was readily detected by the heart surface sensor. In marked contrast, during diastole the relaxed ventricle failed almost completely to transmit the vibration to the apical position. When the dog experienced heart failure during hypoxia, the ventricular diastolic vibration transmissibility was found to equal or exceed that of the systolic phase