Sleep-predominant lowering of ambulatory blood pressure by bedtime inhalation of a novel muscarinic M3 receptor antagonist: a new "bronchoantihypertensive" strategy targeting the lung in hypertension with chronic obstructive pulmonary disease.

Bedtime inhalation of a novel muscarinic M3 receptor antagonist markedly lowered ambulatory blood pressure (ABP), predominantly during sleep, in a chronic obstructive pulmonary disease (COPD) patient with masked nocturnal hypertension. This is the first case demonstrating that a bronchodilator significantly lowered ABP in a COPD patient with hypertension. This case suggests that bronchodilator therapy may have potential as a new antihypertensive strategy targeting the lung in hypertensive patients with impaired lung function. This "bronchoantihypertensive" therapy seems to be more effective for reducing sleep blood pressure in hypertensive patients with COPD and sleep hypoventilatory/hypoxemic syndromes.

Effects of strict blood pressure control by a long-acting calcium channel blocker on brain natriuretic peptide and urinary albumin excretion rate in Japanese hypertensive patients.

Strong adherence to antihypertensive therapy has been shown to reduce the frequency of cardiovascular events by strictly controlling blood pressure. Although calcium channel blockers (CCBs) are among the most popular antihypertensive drugs in Japan, few trials have been conducted using high CCB doses in Japanese patients. In this study, we administered amlodipine 5 mg or 10 mg to patients with hypertension in order to compare the efficacy and tolerability of low and high doses, and measured two surrogate markers of hypertensive target organ damage, i.e., brain natriuretic peptide (BNP) as a risk marker of cardiac overload and microalbuminuria as a measure of renal damage. Seventy-two patients were randomly assigned to either amlodipine 5 mg (n = 35) or 10 mg (n = 37) dose groups. The latter group achieved greater reductions in clinic as well as both morning and evening home BP levels without an increase in pulse rate (the differences between the two groups in clinic/morning/evening systolic BP were 4.7/4.7/5.4 mmHg, and for diastolic BP they were 4.2/3.6/3.8 mmHg). Reductions in BNP and urinary albumin/creatinine ratio (UAR) levels were significantly correlated with the reductions in systolic BP levels (BNP, clinic/morning BP: r = 0.256, p = 0.030/r = 0.330, p = 0.005; UAR, clinic BP: r = 0.316, p = 0.007). In conclusion, the higher dose (10 mg) of amlodipine induced greater reductions in all BP levels than did the lower dose, without increasing the pulse rate. These additional reductions were significantly correlated with reductions in hypertensive cardiac overload, as evaluated by BNP levels, and a reduction in renal damage, as evaluated by microalbuminuria levels. Moreover, a reduction in the microalbuminuria may have occurred concomitant with a reduction in clinic systolic BP level.

Dioxin concentration in human milk in Hebei province in China and Tokyo, Japan: potential dietary risk factors and determination of possible sources.

Very limited information is available on body burdens and environmental levels of dioxins and dioxin-like PCBs (dl-PCBs) in mainland China. In the current studies, human milk samples were collected from 30 breastfeeding mothers in Shijiazhuang city (industrialized) and 11 in the Tanshan countryside (agricultural) of Hebei Province in northern China. An additional 20 samples were obtained from mothers in Tokyo, Japan. PCDDs, PCDFs, and dl-PCBs in human milk were analyzed by high-resolution gas chromatography/high-resolution mass spectrometry. Our results show that arithmetic means for body burdens of PCDDs/Fs and dl-PCBs in Hebei were 3.6 and 1.9 pg TEQg(-1) fat, respectively, which were only about one fourth of the levels in Japan. In addition, no difference was found in the chemical levels except dl-PCBs between the urban and rural areas. Based on the results of an in-person interview of the Chinese mothers using a 59-item questionnaire, freshwater fish consumption was found to correlate with the body burden of dioxins. Principal component analysis of dioxin congeners revealed that the patterns of dioxins in the Hebei urban and rural areas are quite similar; however, they are clearly different from those in Japan. Collectively, our results suggest that the lower body burdens of dioxin in Hebei may be due in part to the relatively slow industrialization and a lower consumption of marine foods. Finally, the results indicate that comprehensive monitoring of dioxins and dl-PCBs in humans as well as in the environment and foods is necessary in China.

[Effects of volcanic sulfur dioxide on reconstruction workers and residents returning to Miyake Island].

Four and half years have passed since Mt. Oyama in Miyake Island erupted. Ambient sulfur dioxide (SO2) is still above the environmental air standard in parts of the island, even though emission of the volcanic gas has diminished. Reconstruction of life-support infrastructure in the island and safety measures started in July 2002, and a short-term trial stay project for former residents was completed in April 2003 for the total rehabilitation of the island. We conducted health examinations, and questionnaires on clinical symptoms among the reconstruction workers in January 2003, as well as questionnaires on respiratory symptoms among former residents who joined the trial stay, in late fall of 2003. The peak expiratory flow rate and symptoms of the workers and the symptoms of the short-term residents were not correlated to SO2 concentrations. In addition, we investigated the medical histories of outpatients at Miyake-mura National Insurance Center Clinic. We could not recognize any cases directly connected with higher ambient SO2 concentration in the area of the island, but there was a male worker, in his thirties, who suffered an initial attack of bronchial asthma, which required intensive care and treatment. As a general rule, all the workers and the residents are asked to wear gas masks for SO2 when its concentration is above 2.0 ppm and to stay in the house with desulfuration facilities as a precautionary measure at night. The residents are now well informed about the risks of volcanic gas and preventive measures for adverse health effects. We could not evaluate correlations between SO2 exposure indices and health effects sufficiently due to the limitation of the field study, but this study presents useful pieces of information as a risk communication for reconstruction workers and former inhabitants to the island.