Effectiveness of the direct renin inhibitor, aliskiren, in patients with resistant hypertension.

Currently there is no consensus regarding which add-on therapy to use in resistant hypertension. We have conducted an open observational study of the use of aliskiren in resistant hypertensive patients. Forty-three patients with resistant hypertension were included in the study. The inclusion criteria were as follows: 1) office blood pressure (BP) > 140/90 mmHg despite treatment with at least three or more antihypertensive drugs; 2) no prior therapy with aliskiren; and 3) no renal insufficiency. Follow-up BP was determined at 1 and 3 months. Baseline BP was 153 ± 12/79 ± 12 mmHg. After 3 months, systolic BP (SBP) and diastolic BP (DBP) dropped significantly: 140 ± 19/73 ± 13 mmHg (P < 0.0001). Twenty-one patients (49%) had an office BP < 140/90 mmHg, and these patients were assigned to the good BP control group. Another 22 were placed into the poor BP control group. BP reductions from baseline in the good BP control group (SBP/ DBP: 19 ± 11/8 ± 7 mmHg) were larger than those in the poor BP control group (5 ± 15/3 ± 9 mmHg, P < 0.05). Mean BP (MBP) values at baseline, 1, and 3 months were higher in the poor BP control group. There was no significant difference in pulse pressure at baseline between the 2 groups. In multivariate analysis, only MBP at baseline correlated with lack of BP control. Aliskiren administration to resistant hypertensive patients was effective in reducing BP. The present findings suggest aliskiren may be useful as a fourth-line or fifth-line treatment added to other drugs in the treatment of resistant hypertension.

Efficacy of a low dose of pitavastatin compared with atorvastatin in primary hyperlipidemia: results of a 12-week, open label study.

BACKGROUND: Pitavastatin has a potent cholesterol-lowering action. The clinical efficacy and safety of a low dose, 1 mg, of pitavastatin were examined. METHODS: The effect of 12 weeks' treatment with pitavastatin 1 mg in an open label, non-randomized trial involving 137 patients with hypercholesterolemia as compared with treatment with atorvastatin 10 mg. RESULTS: Total cholesterol, low-density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and triglyceride (TG) levels at baseline did not differ between the two groups. At follow-up, there were no significant differences in total cholesterol, LDL cholesterol and HDL cholesterol levels between the groups. The TG levels at follow-up were higher in the pitavastatin group than atorvastatin group (p < 0.01). In patients with hyperlipidemia type IIa, TG levels at follow-up were lower in the atorvastatin subgroup (p < 0.01). However, there was no significant difference in TG levels at follow-up between the two subgroups in patients with hyperlipidemia type IIb. CONCLUSION: Pitavastatin 1 mg daily was safe and efficacious in reducing LDL cholesterol levels as compared with atorvastatin 10 mg daily. Further randomized comparative studies are needed to clarify the effect of a low dose of pitavastatin.

Relationship between insulin resistance and effect of atorvastatin in non-diabetic subjects.

BACKGROUND: Although insulin resistance (IR) is present in non-diabetic subjects, it is unknown whether IR affects statin treatment. We assessed the relationship between IR and the changes of lipid profile in patients with hyperlipidemia treated by atorvastatin. METHODS: Forty-four non-diabetic patients were included. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. We used the value of 2.5 as the threshold for IR. RESULTS: High-density lipoprotein (HDL) cholesterol at baseline was lower and triglyceride (TG) at baseline was higher in the IR group than in the nonIR group (p < 0.05). Changes in all lipid measurements did not differ between the two groups. HOMA-IR was correlated with HDL cholesterol at baseline and at follow-up and correlated with TG at baseline and at follow-up (r = -0.40, r = -0.53, r = 0.38, r = 0.35, p < 0.01, respectively). However, HOMA-IR did not associate with changes in total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and TG. CONCLUSION: The IR did not affect the degree of reduction in cholesterol by atorvastatin in non-diabetic subjects. The IR may influence hypertriglyceridemia greater than the effect of atorvastatin in non-diabetic subjects.

Relation of pulsatility of brachial artery pressure to resistant hypertension.

Few studies have examined predictors of resistant hypertension. The aim of this study was to observe the relationship between resistant hypertension and the pulsatility of the brachial artery pressure, which is characterized as pulse pressure/diastolic pressure (PP/DP) and is a simple index of aortic input impedance. We obtained home blood pressure (BP) measurements for 102 patients aged 40-75 years with either office systolic BP (SBP) > or =140 mmHg or office diastolic BP (DBP) > or =90 mmHg. Patients were given a single antihypertensive agent or left untreated during the 2-week baseline period. Thereafter, patients were treated with 1 to 3 antihypertensive drugs for 1 year with a goal of achieving a home BP of less than 135/85 mmHg. At follow-up, 72 patients were taking a single drug with good BP control, 21 were taking two drugs with good BP control, and 9 were taking three drugs with poor BP control. Although office SBP at baseline was similar among the three groups, home morning and evening SBP at baseline in the single drug group were lower than those of the two- or three-drug groups (p <0.01). Although office PP/DP at baseline did not differ among the three groups, home morning and evening PP/DP at baseline were highest in the three-drug group (p <0.01). In multivariate analysis, only mean home PP/DP at baseline was correlated with BP control. There is a correlation between the pulsatility of the brachial artery pressure and the degree of BP control.

Related factors of meeting National Cholesterol Education Program-recommended goals with atorvastatin.

The aim of this study was to observe the efficacy of atorvastatin and the related factors of meeting the National Cholesterol Education Program (NCEP)-recommended low-density lipoprotein (LDL) cholesterol levels in patients with hypercholesterolemia. A total of 107 patients were treated with atorvastatin 10 mg/day for 12 weeks. Eighty % of the patients achieved the target goals. There was a significant difference in the initial body mass index (BMI) between patients achieving the target goals and those not achieving the target goals (p < 0.05). In multiple stepwise logistic regression analysis, initial BMI and complications correlated with reaching the NCEP-recommended target goals (p < 0.05). A great number of patients treated with atorvastatin, including those previously poorly controlled with other therapies, reached the target goals at the starting dose 10 mg/day. BMI may be a useful index of achieving the NCEP-recommended target goals with atorvastatin.

Primary cardiac lymphoma--a case report.

Primary cardiac lymphoma, which is very rare, is generally regarded to have a poor prognosis. A case of a 69-year-old man with primary cardiac lymphoma diagnosed by antemortem examination is reported. A computed tomography scan of the chest demonstrated a huge right atrial mass with invasion into the other chambers. No mediastinal lymphadenopathy was detected. Cytologic analysis of pericardial effusion revealed diffuse large B-cell type non-Hodgkin malignant lymphoma. The patient died on the 18th day of chemotherapy (cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone) due to low-output syndrome and multiple organ failure. At autopsy, massive gray-white tumor almost occupied the right atrium and invaded the right inferior lobe of the lung. Although prognosis of primary cardiac lymphoma remains poor, early diagnosis may improve the prognosis.

Peristent tissue proliferation of multilink stents is dependent on preprocedural plaque area: a serial intravascular ultrasound analysis.

It is not known whether any factors are related to tissue proliferation within and surrounding stents in humans. The authors used serial intravascular ultrasound (IVUS) to evaluate the relationship between IVUS parameters and tissue proliferation within and surrounding Multilink stents. They were able to analyze preinterventional and postinterventional and follow-up IVUS studies in 33 native vessel lesions in 33 patients with stable angina pectoris. Quantitative coronary angiography and IVUS measurements were performed before and after intervention and at follow-up. IVUS imaging using an automatic transducer pullback device allowed follow-up analysis of the same lesion site. The vessel area at the lesion site increased from 17.1 +/- 4.5 mm2 after intervention to 18.5 +/- 5.9 mm2 at follow-up (p<0.01). The in-stent tissue growth (after intervention to follow-up) in-stent plaque area (PA) was 1.6 +/- 1.1 mm2, and the peristent tissue growth (after intervention to follow-up) peristent PA was 0.8 +/- 2.3 mm2. In multivariate analysis, the preprocedural PA at the lesion site was the best predictor of the peristent tissue growth, whereas no factors predicted the in-stent tissue growth. Risk factors, clinical characteristics, and quantitative coronary angiographic parameters showed no relation to the peristent tissue growth or the in-stent tissue growth. The peristent tissue growth was closely related to the preprocedural plaque size, while the factors that affect the in-stent tissue growth were not identified.

Significance of pulsatility of brachial artery pressure for blood pressure control.

Few studies have examined predictors of poor blood pressure (BP) control. The aim of this study was to observe the relationship between the pulsatility of brachial artery pressure characterized as pulse pressure/diastolic pressure (PP/DP), suggesting aortic input impedance, and poor BP control. We obtained office BP measurements for 94 patients aged 40-75 years with either office systolic BP (SBP) >or= 140 mmHg or diastolic BP (DBP) >or= 90 mmHg. Patients were given a single antihypertensive agent or were untreated at baseline. The angiotensin II receptor blocker valsartan (80 mg) was administered to all patients. Patients were treated with 1 to 2 antihypertensive drugs (valsartan only or valsartan + Ca antagonist) for 6 months to achieve an office BP of less than 140/90 mmHg. At follow-up, 32 patients were taking a single drug (valsartan) with good BP control, 24 were receiving two drugs with good BP control, and 38 were on two drugs with poor BP control. SBP and DBP at baseline were similar in the 3 groups. PP/DP at baseline differed in the 3 groups (P<0.01). In multivariate analysis, only PP/DP at baseline correlated with lack of BP control. The pulsatility of brachial artery pressure is associated with achieving adequate BP control.

Significance of mean blood pressure for blood pressure control.

The significance of pulse pressure (PP) and mean blood pressure (MBP) for blood pressure (BP) control is unclear. The aim of this study was to examine the relationship between PP and MBP and BP control. We obtained home BP measurements for 117 patients aged 40-75 years with either office systolic BP (SBP) >or= 140 mmHg or office diastolic BP (DBP) >or= 90 mmHg. Patients were treated with 1 to 2 antihypertensive drugs for 6 months to achieve home SBP < 135 mmHg and home DBP < 85 mmHg. At follow-up, 72 patients were taking a single drug with good BP control, 23 were taking two drugs with good BP control, and 22 were taking two drugs without good BP control. Although office SBP and DBP at baseline were similar in the three groups, home SBP and DBP at baseline in the single drug group were lowest among the three groups (P < 0.01). Home MBP at baseline in the single drug group was lowest among the three groups (P < 0.01). Home PP at baseline was highest in the two-drug without good control group (P < 0.001). In multivariate logistic regression analysis, only home MBP at baseline was significantly correlated with a lack of BP control. Home MBP rather than home PP is associated with achieving adequate BP control.