Akiko Matsuo

Hypoadiponectinemia is an independent risk factor for hypertension

Adiponectin is one of the key molecules in the metabolic syndrome, and its concentration is decreased in obesity, type-2 diabetes, and coronary artery disease. Genetic investigation has revealed that 2 polymorphisms (I164T and G276T) are related to adiponectin concentration and diabetes. To examine whether adiponectin affects hypertension genetically or biologically, we performed a case-control study. A total of 446 diagnosed cases of hypertension (HT) in men and 312 normotensive (NT) men were enrolled in this study. Plasma adiponectin concentration was measured using an enzyme-linked immunosorbent assay system. Single nucleotide polymorphisms were determined by TaqMan polymerase chain reaction method. After adjustment for confounding factors, adiponectin concentration was significantly lower in HT (HT: 5.2±0.2 μg/mL; NT: 6.1±0.2 μg/mL; P <0.001). Furthermore, multiple regression analysis indicated that hypoadiponectinemia was an independent risk factor for hypertension (P <0.001). Blood pressure was inversely associated with adiponectin concentration in normotensives regardless of insulin resistance. In subjects carrying the TC genotype of the I164T polymorphism, adiponectin concentration was significantly lower (TC: 2.6±0.9 μg/mL; TT: 5.5±0.1 μg/mL; P <0.01), and most of them had hypertension. In contrast, the G276T polymorphism was not associated with adiponectin concentration or hypertension. In conclusion, hypoadiponectinemia is a marker for predisposition to hypertension in men.

G2736A polymorphism of thiazide-sensitive Na-Cl cotransporter gene predisposes to hypertension in young women.

Objective The thiazide-sensitive Na-Cl cotransporter (TSC) is located in the distal renal tubules. Several mutations of the TSC gene cause Gitelmans syndrome, which is an autosomal recessive disease characterized by low blood pressure and hypokalemia. Recently, an association between TSC gene polymorphisms (Arg904Gln, G2736A; Thr465Thr, C1420T; Gly264Ala, G816C) and essential hypertension has been reported in Sweden. We examined the genetic involvement of the TSC gene in essential hypertension in Japanese. Design Participants were recruited from outpatients of Osaka University Hospital. We investigated 386 hypertensive and 371 normotensive subjects. Methods Genotypes of TSC polymorphisms (G2736A, C1420T, G816C) were determined by the TaqMan polymerase chain reaction (PCR) method, and statistical significance was examined using JMP 5.0.1J (SAS Institute Inc., Cary, North Carolina, USA). The allele frequency of A2736 and T1420 was 6.0 and 3.0%, respectively, whereas we could not detect the G816C polymorphism in this study. Only the G2736A polymorphism was significantly associated with the prevalence of hypertension (P < 0.04), and the estimated odds ratio was 1.8 (95% confidence interval, 1.1–3.0) in A2736 allele carriers. The odds ratio for hypertension in A2736 carriers was increased to 2.2 (1.1–4.9) in women (n = 413), and further to 3.3 (1.4–8.0) in women with early onset of hypertension (⩽ 50 years old). In addition, all subjects with the homozygous A2736 allele in this study (n = 2) and the Swedish study (n = 5) were hypertensive. Conclusion G2736A polymorphism of the TSC gene is a genetic predisposing factor for essential hypertension in Japanese women.

Risk factors for pressure ulcers in bedridden elderly subjects: Importance of turning over in bed and serum albumin level

The purpose of the present paper was to determine clinical risk factors for the development of pressure ulcers in bedridden elderly inpatients.

Clinical Outcome After Permanent Pacemaker Implantation in Patients With a High Percentage of Ventricular Pacing

Previous reports have suggested that right ventricular apical pacing may lead to cardiac dysfunction. Septal pacing is thought to be superior to apical pacing in the prevention of cardiac dyssynchrony, however, there have been no reports on the contribution of septal pacing to improving clinical outcome.We retrospectively evaluated factors associated with cardiac events in patients with right ventricular pacing.The study population consisted of 256 consecutive patients newly implanted with permanent pacemakers and followed-up for 29 ± 18 months. Cardiac events, consisting of cardiac death or heart failure requiring hospitalization, occurred in 22 patients. Kaplan-Meier curves revealed that patients with a high percentage of ventricular pacing (> 90%, n = 101, group H) had a higher incidence of cardiac events than patients with a low percentage of ventricular pacing (< 10%, n = 83, group L) (P = 0.002). In group H, multivariate analysis showed that age (HR: 1.174, 95%CI: 1.066-1.291, P = 0.001), ejection fraction (EF) (HR: 0.898, 95%CI: 0.836-0.964, P = 0.003), QRS duration during cardiac pacing (HR: 1.059, 95%CI: 1.017-1.103, P = 0.006), and existing basal cardiac diseases (HR: 13.080, 95%CI: 2.463-69.479, P = 0.003) were significant predictors of cardiac events, although pacing site had no significant association with prognosis (P = 0.56).Higher age, lower EF, longer QRS duration during cardiac pacing, and existing basal cardiac diseases are associated with poor prognosis in patients with a high percentage of ventricular pacing.

Hypertension in a patient with Gitelman's syndrome

Gitelmans syndrome is an autosomal recessive disorder characterized by sodium wasting and hypotension. A middle-aged woman was diagnosed with Gitelmans syndrome because of typical clinical manifestations in the youth and homozygous mutations of 18-base-pair insertion in exon 6 of thiazide-sensitive NaCl-cotransporter gene. It was unusual that she showed hypertension with advancing age. Her serum potassium levels remained low at around 3.5 mEq/l despite potassium supplementation. This case demonstrates that hypertension could result in spite of the extremely decreased sodium reabsorption in Gitelmans syndrome and that essential hypertension is genetically heterogeneous, and abnormality of all genes may not be necessarily required to cause blood pressure rise.

Optical coherence tomography findings after longitudinal ablation for an underexpanded stent in a heavily calcified lesion: a case report

BackgroundHeavy coronary artery calcification is responsible for stent underexpansion, which is associated with increased in-stent restenosis. Here we report a case in which optical coherence tomography (OCT) demonstrated that the metal component of an underexpanded stent previously implanted in a heavy calcified lesion had been completely removed after ablation with rotational atherectomy.Case presentationAn 83-year-old man with exertional angina was referred to our hospital. Coronary angiography revealed severe stenosis in the proximal portion of the right coronary artery and left circumflex artery and chronic total occlusion (CTO) in the mid portion of the left anterior descending artery (LAD). We performed complete revascularization with percutaneous coronary intervention. Because the CTO lesion in LAD contained napkin-ring heavy calcifications, rotational atherectomy with a 1.75-mm burr was undergone, followed by the deployment of drug-eluting stents and postdilation with a high-pressure balloon. However, expansion of the stent was incomplete. To address the recurrence of in-stent restenosis and resistance to the dilation with the high-pressure balloon, we decided to simultaneously ablate both the heavy calcification and underexpanded stent. Longitudinal stent ablation with 1.75- and 2.0-mm burrs was successful, and OCT demonstrated that the metallic component of the underexpanded stent had been completely removed.ConclusionIf a stent fails to completely extend in heavy calcification, longitudinal stent ablation by rotational atherectomy could be an effective remedy.

Genetic risk factors for cerebral infarction using data from a large-scale genetic epidemiological study: the Ohasama Study

Background:  With the imminent advent of an extremely aged society, there will be an increasing requirement for the prediction, early detection and treatment of cerebral infarction. Involved in the etiological mechanisms of cerebral infarction are a number of complex genetic and environmental factors related to the onset and progression of hypertension and arteriosclerosis. Elucidation of the significance of the various risk factors will require definite identification of phenotypes using large numbers of subjects.

Cholesterol crystal depth in coronary atherosclerotic plaques: A novel index of plaque vulnerability using optical frequency domain imaging

Background The involvement of cholesterol crystals (CCs) in plaque progression and destabilization of atherosclerotic plaques has been recently recognized. This study aimed to evaluate the association between the intraplaque localization of CCs and plaque vulnerability. Methods We investigated 55 acute coronary syndrome (ACS) and 80 stable angina pectoris (stable AP) lesions using optical frequency domain imaging (OFDI) prior to percutaneous coronary intervention. The distance between CCs and the luminal surface of coronary plaques was defined as CC depth. Results Although the incidence of CCs had similar frequencies in the ACS and stable AP groups (95% vs. 89%, p = 0.25), CC depth was significantly less in patients with ACS than in those with stable AP (median [25th to 75th percentile]: 68 μm [58 to 92 μm] vs. 152 μm [115 to 218 μm]; p < 0.001). The incidences of plaque rupture, thrombus, lipid-rich plaques, and thin-cap fibroatheroma were significantly greater in patients with ACS than in those with stable AP (62% vs. 18%, p < 0.001; 67% vs. 16%, p < 0.001; 84% vs. 57%, p < 0.01; and 56% vs. 19%, p < 0.001, respectively). Conclusion OFDI analysis revealed that CCs were found in the more superficial layers within the coronary atherosclerotic plaques in patients with ACS than in those with stable AP, suggesting that CC depth is associated with plaque vulnerability. CC depth, a novel OFDI-derived parameter, could be potentially used as an alternative means of evaluating plaque vulnerability in coronary arteries.

Successful Complete Revascularization With PCI Using Super-Low Volume of Contrast Medium in a Patient With Three-Vessel Disease Including 2 Chronic Total Occlusions With Severe Renal Dysfunction

The most important factor for preventing contrast-induced nephropathy (CIN) during percutaneous coronary intervention (PCI) in patients with severe renal dysfunction is to minimize the contrast volume. Herein, we report a successful case of complete revascularization after 3 separate PCI procedures using a super-low volume of contrast medium in a patient with 3-vessel disease, including two chronic total occlusions (CTOs). A 70-year-old man having exertional angina despite maximal medical therapy was referred to our hospital. He had severe renal dysfunction (estimated glomerular filtration rate 19 mL/minute/1.73 m2). Coronary angiography, in which a total volume of 15 mL (over 3 injections) of contrast medium was used after hydration with normal saline, demonstrated 2 CTOs in the proximal left circumflex artery (LCX) and the proximal right coronary artery (RCA) as well as focal stenosis in the mid left descending artery (LAD). Because the patient refused coronary artery bypass grafting, we opted for revascularization with PCI, divided into 3 procedures. We made full use of microcatheter tip injection and evaluation with intravascular ultrasound and achieved complete revascularization with a total of 31 mL of contrast medium: 9 mL for RCA, 6 mL for LAD, and 16 mL for LCX, without the occurrence of CIN. Additionally, we present tips for performing PCI using super-low contrast medium.

573 Antihypertensive efficacy and safety of Losartan/hydrochlorothiazide vs. high-dose angiotensin receptor blocker (ARB) in patients with uncontrolled hypertension: Kamanza Anti-Hypertensive Treatment Trial (KAHT-Trial)

Objectives: According to the current guidelines, archiving strict blood pressure control is essential to reduce cardiovascular events in patients with hypertension. The aim of this study was to evaluate antihypertensive efficacy and safety of losartan/hydrochlorothiazide (Los/HCTZ) combination drug vs. high-dose angiotensin receptor blocker (ARB) in patients with uncontrolled hypertension. Methods: This study was conducted at 11 centers for the KAHT-Trial group. A total of 65 hypertensive patients receiving regular-dose ARB therapy whose BP remained above 140/90 mmHg were prospectively enrolled. The patients were randomly assigned to receive Los/HCTZ combination drug (Los/HTCZ group, n = 67) or high-dose ARB (high-dose ARB group, n = 68) and followed for 1year. Results: After 3 months of treatment, BP significantly decreased from 157 ± 12/87 ± 9 mmHg to 137 ± 14/78 ± 8 mmHg in the Los/HCTZ group and from 158 ± 12 /91 ± 12 mmHg to 139 ± 12/80 ± 8 mmHg in the high-dose ARB group. Decreases in BP were well-maintained for 1year in the both groups. However, decreases in BP were not different between the two groups. After 1 year of treatment, levels of HbA1c, eGFR, plasma glucose, cholesterol and uric acid showed no significant changes in the both groups. Conclusions: Our results suggest that Los/HCTZ combined therapy was effective in reducing uncontrolled hypertension without deteriorating glucose, lipid and uric acid metabolism as well as high-dose ARB. Los/HCTZ combined therapy may have beneficial effect in terms of tolerability and medical economics.