The association between orthostatic increase in pulse pressure and ischemic heart disease.

The clinical meaning of changes in PP with posture remains unclear. We performed treadmill exercise testing on 144 subjects to diagnose ischemic heart disease, and measured the PPs in the supine and standing positions. The differences in the two PPs ranged between -35 and 45 mmHg. Eleven subjects were diagnosed with significant coronary ischemia. The differences in the PPs were significantly increased, and PP in the standing position was significantly elevated in these subjects. A large difference in the PPs in the standing and supine positions was associated with significant coronary ischemia, independent of significant covariables.

The association between orthostatic increase in pulse pressure and ischemic heart disease.

The clinical meaning of changes in PP with posture remains unclear. We performed treadmill exercise testing on 144 subjects to diagnose ischemic heart disease, and measured the PPs in the supine and standing positions. The differences in the two PPs ranged between -35 and 45 mmHg. Eleven subjects were diagnosed with significant coronary ischemia. The differences in the PPs were significantly increased, and PP in the standing position was significantly elevated in these subjects. A large difference in the PPs in the standing and supine positions was associated with significant coronary ischemia, independent of significant covariables.

[A case of nonarteritic anterior ischemic optic neuropathy with hypertension, diabetes mellitus, hyperlipidemia and severe stenosis of the internal carotid artery].

A 76 year-old man had had hypertension, diabetes mellitus and hyperlipidemia since 1985, and bruit in his left neck since 1993. He had abrupt decrease in left visual acuity on November 24, 2005, and visited an ophthalmologist. On November 28, his corrected visual acuity was 1.0 in the right and 0.1 in the left. The examination of optic fundi showed ear-side edema of the left optic disk. Fluorescence examination of the left optic fundus showed delay in early filling and later hyperfluorescence. Goldman visual field examination showed horizontal lower semiblindness. Since he did not complain of eye pain, his blood examination showed no reaction of inflammation, and he had hypertension, diabetes mellitus and hyperlipidemia, anterior ischemic optic neuropathy was diagnosed. The treatment with aspirin, alprostadil and prednisolone transiently improved the optic fundi and visual acuity, but his left visual acuity returned to 0.1. Carotid ultrasonography showed 95 percent stenosis in the left internal carotid artery. As there is no established treatment for ischemic optic neuropathy, the management of risk factors is most important.

Effect of add-on aliskiren to type 1 angiotensin receptor blocker therapy on endothelial function and autonomic nervous system in hypertensive patients with ischemic heart disease.

The aim of this study was to evaluate the add-on effect of aliskiren to valsartan on endothelial-dependent vasodilation in hypertensive patients with ischemic heart disease (IHD). After 4 weeks of treatment with 80 mg of valsartan, 28 patients were allocated to either continued treatment with valsartan or an add-on treatment with valsartan plus 150 mg of aliskiren. Aliskiren significantly decreased plasma renin activity, whereas endothelium-dependent vasodilation measured by flow-mediated dilation (FMD) did not change. In contrast, heart rate significantly decreased (73.1 ± 9.8 to 66.3 ± 7.0 beats per minute at baseline and 24 weeks, respectively [P = .009]) and the standard deviation of the R-R intervals (SDNN) significantly increased in the aliskiren group. The add-on aliskiren to valsartan therapy may not improve endothelial functions, although it significantly reduced resting heart rate via regulation of the autonomic nervous system in hypertensive patients with IHD.

Left bundle branch block with intermittent QRS axis switching: observation of a hypertensive patient for 18 years.

A 64-year-old man who had been prescribed antihypertensive drugs since 1971 attended our clinic in 1988 with hypertension and electrocardiographic abnormalities. An electrocardiogram revealed left axis deviation (LAD) in 1988 and slightly prolonged PQ intervals in 1993. Complete left bundle branch block (CLBBB) with LAD developed in May 1995. The wide QRS of the CLBBB had never returned to the normal narrow QRS and had intermittently alternated between LAD and normal axis. The PQ intervals were longer when the QRS axis showed LAD compared to that with normal QRS axis. The QRS complexes in leads V1-V3 revealed an R wave at LAD and a QS pattern at normal axis. During a deep breathing test, the QRS axis switched from normal axis to LAD at the end of forced expiration and also switched from normal axis to LAD within a few minutes after the exercise test. These results suggest that the shift of the QRS axis might be related to the tone of the autonomic nervous system.

Effects of aging and sex on progression of carotid intima-media thickness: a retrospective 6-year follow-up study.

AIM: We retrospectively examined the relationship of aging, sex and risk factors to increased carotid intima-media thickness (IMT) over a follow-up period of 6 years in patients with multiple risk factors. METHODS: Subjects were comprised of 463 patients (287 men, 176 women) with a mean age of 64 +/- 0.4 years who had undergone carotid ultrasonography twice or more at intervals of 5 years or older. The mean follow-up period was 6.0 +/- 0.1 years. RESULTS: Mean baseline IMT for all subjects was 1.40 +/- 0.02 mm, and no significant difference was seen between sexes. Mean IMT after 6 years for all subjects was 1.84 +/- 0.03 mm, and was significantly greater in men than in women. Mean annual increase in IMT (Delta IMT) for all subjects was 0.073 +/- 0.005 mm/year, with a significant positive correlation between baseline age and Delta IMT (r = 0.11, P < 0.05), and Delta IMT was significantly greater in men than in women (0.087 +/- 0.007 mm vs 0.050 +/- 0.007 mm, P < 0.001). IMT increased with age in both men and women, but Delta IMT increased with age only in men. Multivariate analysis showed baseline age and diabetes mellitus as significant risk factors with baseline IMT as the objective variable. Age and sex represented significant risk factors with DeltaIMT as the objective variable. CONCLUSION: Sex differences exist in the relationship between increases in IMT and age. Age, sex and diabetes mellitus represented the main risk factors.