Akiko Soyama

Impact of outdoor temperature on prewaking morning surge and nocturnal decline in blood pressure in a Japanese population

Seasonal variations in blood pressure (BP) have often been attributed to meteorological factors, especially changes in outdoor temperature. We evaluated the direct association between meteorological factors and circadian BP variability. Twenty-four-hour ambulatory BP was monitored continuously for 7 days in 158 subjects. Mean awake, asleep, morning (first 2 h after waking) BP, prewaking morning BP surge (morning systolic BP (SBP)−mean SBP during the 2-h period before waking) and nocturnal BP decline were measured each day. We compared BP values for the lowest and highest days with regard to the daily mean outdoor temperature and mean atmospheric pressure. Morning BP and prewaking morning BP surge on the coldest day were significantly higher than those on the warmest day (morning SBP, 136.6±1.6 vs. 133.1±1.5 mm Hg, P=0.002; morning diastolic BP, 84.4±0.9 vs. 82.6±0.9 mm Hg, P=0.02; and prewaking morning BP surge, 20.8±1.3 vs. 15.3±1.3 mm Hg, P=0.0004). The magnitude of nocturnal BP decline on the coldest day was significantly greater than that on the warmest day (15.8±0.7 vs. 13.9±0.7%, P=0.01). Outdoor temperature is an important determinant of morning BP, prewaking morning BP surge and the magnitude of nocturnal BP decline. These findings may have important implications in management of hypertension and prevention of cardiovascular events.

Localized Pulmonary Edema After Blunt Chest Trauma

Although it is well recognized that acute mitral regurgitation (MR) is caused by acute myocardial infarction and infective endocarditis, blunt chest trauma is also, albeit rarely, reported as the cause. In most cases, acute MR provokes pulmonary edema and hemodynamic deterioration. We report a case of a 45-year-old man with atypical pulmonary edema caused by acute traumatic MR. The patient fell down the stairs and injured his …

A Case of Penetrating Atherosclerotic Ulcer Treated With Thoracic Endovascular Aortic Repair.

Penetrating atherosclerotic ulcer (PAU) is defined as ulceration of an aortic atherosclerotic plaque penetrating through the internal elastic lamina into the media.1–3 PAU accounts for 2% to 7% of all acute aortic syndrome.4 PAU is at risk of intramural hematoma, pseudoaneurysm, aortic rupture, or an acute aortic dissection.5 Symptomatic PAU has to be assumed to indicate an emergency because the adventitia is reached and aortic rupture is expected.5 The rupture rate of symptomatic PAU has been reported to be as high as …