Differences in 24-h blood pressure profile of Japanese hypertensive patients under ARB treatment.

Blood pressure (BP) control throughout the entire day is recommended for cardiovascular protection. Angiotensin-II receptor blockers (ARBs) are widely used in hypertensive patients because of beneficial class effects. It is uncertain, however, whether are there any differences in 24-h BP profiles among ARBs. We examined ambulatory blood pressure monitoring (ABPM) among 211 Japanese hypertensive patients (age, 69.4 ± 9.6 years; female, 59.2%) under treatment with five different ARBs. Patients were divided into five groups according to ARBs prescribed. Patient backgrounds were almost identical in all the groups and there were no differences in office, 24-h and daytime BP; however, nighttime BP with olmesartan was significantly lower than with other ARBs. Office BPs with candesartan and telmisartan, but not other ARBs, correlated well with 24-h BP (p < 0.01). Also, there were higher correlations between daytime and nighttime BP with candesartan and telmisartan. In all patients, pulse pressure with office BP was significantly correlated with ambulatory arterial stiffness index (p = 0.001) and fluctuation of systolic BP on ABPM (p = 0.002). In conclusion, different ARB treatments produced meaningful differences in 24-h profiles.

Diuretics enhance effects of increased dose of candesartan on ambulatory blood pressure reduction in Japanese patients with uncontrolled hypertension treated with medium-dose angiotensin II receptor blockers.

Abstract Although blockade of the renin-angiotensin system by increasing the dose of angiotensin II receptor blockers (ARBs) is recommended to achieve clinical benefits in terms of blood pressure (BP) control and cardiovascular and renal outcomes, the effect of this increased dose on ambulatory BP monitoring has not been evaluated completely in Japanese patients with uncontrolled hypertension undergoing medium-dose ARB therapy. The primary objective of this study was to examine the effect of the relatively high dose of the ARB candesartan (12 mg/day) on 24-h systolic BP and the attainment of target BP levels in uncontrolled hypertension treated with a medium dose of ARBs. A total of 146 hypertensive patients (age: 69.9 ± 9.3 years; females: 65.8%) completed the study. After switching to candesartan at 12 mg/day, all these BP measurements decreased significantly (p<0.001). Attainment of the target office BP (p=0.0014) and 24-h BP levels (p=0.0296) also improved significantly. Subgroup analysis indicated that the reduction of 24-h systolic BP was larger in patients treated with diuretics than those without (p=0.0206). Multivariate analysis revealed a significant correlation between the combined ARB and diuretic therapy, and the change in 24-h systolic BP irrespective of preceding ARBs. In conclusion, the switching therapy to increased dose of candesartan caused significant reductions in office and ambulatory BP levels, and improved the attainment of target BP levels in patients with uncontrolled hypertension treated with a medium dose of ARBs. Combination with diuretics enhanced this effect.

[A case of mixed infection by Nocardia asteroides and Mycobacterium tuberculosis].

A 55-year-old man with diabetes mellitus was admitted to our hospital because of abnormal shadows in his chest radiographs. Both chest radiography and CT revealed infiltrative shadows in the right upper lung field. Repeated sputum smears showed no mycobacterium, so bronchoalveolar lavage (BAL) was performed bronchoscopically at the right B3b. The BAL fluid and the sputum obtained on the day after BAL contained acid-fast, branching filamentous structures. The microorganism was identified as Nocardia asteroides. Trimethoprim-sulfamethoxazole (ST) and SPFX were therefore administered. Later, Mycobacterium tuberculosis was detected in a 6-week culture of the sputum and BAL fluid. This case was diagnosed as a mixed infection by Nocardia asteroides and Mycobacterium tuberculosis, so the three anti-tuberculosis agents INH, RFP and EB were added. After 6 months of the combined therapy, neither microorganism could be detected in the sputum, and the lesion in the CT scan had decreased markedly in size. Since such a mixed infection is very rare, no treatment strategy has yet been established. The combined therapy was judged to have been effective in this case.