Association of arterial stiffness indiced with coronary flow and coronary flow reserve in first diagnosed, never treated patients with essential hypertension

INTRODUCTION: Coronary microcirculation is disturbed in patients with arterial hypertension. Carotid intima-media thickness and arterial stiffness are markers of subclinical atherosclerosis with prognostic significance. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients as well as whether the combination of increased carotid intima-media thickness and arterial stiffness, has a greater predictive value for the presence of impaired of coronary flow reserve than each index alone in never-treated hypertensives. METHODS: We studied 110 untreated patients (age: 54.5±12 years) with newly diagnosed arterial hypertension and 20 healthy controls. We measured a) carotid-to-femoral pulse wave velocity (PWV) b) systolic (Vs) and diastolic (Vd) coronary flow velocity, decceleration time (DT-Vd) and time integral (VTI-Vd) of the diastolic component of coronary flow, as well as coronary flow reserve (CFR) after adenosine by means of colour-guided transthoracic Doppler echocardiography c) ratio of E wave from mitral inflow to Em of mitral annulus, as an index of LV diastolic pressures using tissue Doppler d) carotid intima-media thickness (IMT), as an index of vascular damage e) 24-hour blood pressure parameters using ambulatory blood pressure monitoring. RESULTS: Patients had abnormal PWV, IMT, E/Em, resting Vd/Vs, DT-Vd and CFR than controls (p10.2 m/s and intima-media thickness >1mm were the optimal cut-off values to predict a coronary flow reserve 10.2 m/sec predicted a CFR 1 mm, PWV>10.2 m/s or their combination had an odds ratio of 3.5, 5.0 and 11.2, p<0.05, for a coronary flow reserve <2.5, respectively. CONCLUSIONS: Elevated LV diastolic compressive forces on coronary microcirculation and the presence of generalised vascular damage may explain the association between PWV and CFR. PWV has an incremental value in the determination of impaired coronary microcirculation in hypertensive patients. The combination of increased carotid intima-media thickness and arterial stiffness has a greater predictive value for impaired of coronary flow reserve than each index alone in never-treated hypertensives

Medical Expulsive Therapy for Distal Ureteral Stones

Although minimally invasive treatments for ureteral stones are efficacious, they are not free of complications and are associated with high cost. Medical expulsive therapy (MET) has recently emerged as an alternative strategy for the initial management of small distal ureteral stories. A MEDLINE search was undertaken to evaluate all currently available data on efficacy and safety of MET therapy in such patients. The specific mechanism of action on the ureteral smooth muscle and the emerging evidence of the efficacy (defined as either an increase in expulsion rate or a decrease in time to expulsion) and low-risk profile suggest that alpha-adrenergic receptor antagonists (alpha-blockers) and calcium channel antagonists should be the initial medical treatment in patients amenable to conservative therapy. NSAIDs and anticholinergics have not shown efficacy as single agents or in combination with alpha-blockers or nifedipine. Corticosteroids may provide a small additive effect when combined with either alpha-blockers or nifedipin