Ayumu Yamagami

Seasonal Blood Pressure Variation and Its Relationship to Environmental Temperature in Healthy Elderly Japanese Studied by Home Measurements

The purpose of the present study was to examine seasonal blood pressure variation and its relationship to environmental temperature in healthy elderly Japanese, as studied by home measurements. Fifteen healthy elderly Japanese (79.3 ± 5.9 yrs) measured their blood pressure at home each morning for more than 25 times per month for 3 years. Monthly mean outdoor temperatures were obtained from the Takamatsu meteorological Observatory. The highest levels of systolic and diastolic blood pressure measured at home were observed in February (129 ± 14 and 81 ± 13 mmHg). The lowest levels of systolic and diastolic blood pressure measured at home were observed in August (117 ± 11 and 73 ± 10 mmHg). Likewise, the lowest and highest means of outdoor temperature were observed in February (5.0°C) and August (29.2°C), respectively. Hence, both systolic and diastolic blood pressure demonstrated a close inverse correlation with the means of outdoor temperature (r = −0.973, p < 0.001 and r = −0.985, p < 0.001, respectively). A 1°C decrease in the mean outdoor temperature was associated with rises of 0.43 mmHg in systolic blood pressure (SBP) and 0.29 mmHg in diastolic blood pressure (DBP). Seasonal variations in home blood pressure and outdoor temperature showed complete correspondence in healthy elderly Japanese, with the blood pressures being inversely related to the ambient temperature. These seasonal home blood pressure variations should be kept in mind when controlling blood pressure in elderly patients.

Echocardiographic Assessment of the Cardio-Renal Connection: Is Left Ventricular Hypertrophy or Diastolic Function More Closely Correlated with Estimated Glomerular Filtration Rate in Patients with Cardiovascular Risk Factors?

Although left ventricular (LV) hypertrophy and diastolic function assessed by echocardiography and chronic kidney disease (CKD) have been established as predictors of cardiovascular events in hypertensive patients, the relationships between the echocardiographic parameters and renal function have not been fully examined. We examined which echocardiographic parameter correlates best with estimated glomerular filtration rate (eGFR) in patients with cardiovascular risk factors. Enrolled in the study were 309 patients (mean age 67 ± 13 y) with cardiovascular risk factors. Echocardiography was performed to measure left ventricular mass index (LVMI) as an index of LV hypertrophy. Transmitral early to atrial velocity (E/A) ratio and peak early diastolic mitral annular velocity (E′) were measured as indexes of LV diastolic function. E/E′ was calculated as a parameter of LV preload. eGFR was measured using the equation proposed by the Japanese Society of Nephrology. The correlations of LVMI (r = −0.333, p < 0.001) and hypertension (r = −0.326, p < 0.001) to eGFR were closer than those of E′ (r = 0.276, p < 0.001) and E/A (r = 0.224, p < 0.001) to eGFR. Stepwise regression analysis showed that hypertension (β coefficient = −0.211, p < 0.001) and LVMI (β coefficient = −0.206, p < 0.001) were independently associated with eGFR. The E/E′ increased with a decrease in eGFR, and E/E′ in CKD stage 5 (16.0 ± 6.8) was significantly higher than that in patients in whom eGFR ≥ 90 mL/min/1.73 m2 (10.5 ± 4.5) (p < 0.001). Left ventricular diastolic function may be influenced by the increase in LV preload due to progression of CKD stage. Therefore, LV hypertrophy may be superior to LV diastolic dysfunction in predicting low eGFR in patients with CKD using echocardiography.

Influences of Hypertension and Diabetes on Normal Age-Related Changes in Left Ventricular Function as Assessed by Tissue Doppler Echocardiography

Although the impact of hypertension (HT) and type 2 diabetes mellitus (DM) on left ventricular (LV) function has recently been studied using tissue Doppler echocardiography (TDE), there are few studies discriminating between the impact of the disease and that of normal aging on LV function. The purpose of the present study was to elucidate the LV function in patients with HT and DM in various age strata in order to assess the independent roles of HT and DM on normal age-related changes in cardiac function. The population of the study consisted of four groups: 20 control subjects (Control), 20 patients with hypertension alone (HTN), 20 patients with type 2 diabetes alone (DM), and 20 patients with both hypertension and diabetes (HTN+DM) in each of five age strata—the 40s, 50s, 60s, 70s, and 80s. The strain and strain rate, which reflected both LV systolic and diastolic function, were assessed by TDE. The strain and strain rate decreased with advancing age in healthy control subjects and in all the patient groups. The strain and strain rate in the HTN group and the DM group showed lower values than those in the healthy control subjects in each age stratum. Furthermore, the strain and strain rate in the HTN+DM group showed the lowest values among all four groups in each age stratum. These results indicate that LV function as assessed by TDE demonstrates age-related deterioration with normal aging. Although HT or DM affects normal age-related changes in LV function, the co-existence of HT and DM has a more harmful effect on the normal age-related changes than HT alone or DM alone.

Relationship of Cardiac Hypertrophy and Diastolic Dysfunction Assessed by Echocardiography with Atherosclerosis in Retinal Arteries in Hypertensive Patients

Although left ventricular (LV) hypertrophy and diastolic dysfunction assessed by echocardiography are established risk markers of cardiovascular events in hypertensive patients, relationships between these echocardiographic findings and atherosclerosis have not been fully elucidated. The purpose of this study was to examine the relationships between atherosclerosis of the retinal arteries and echocardiographic findings in hypertensive patients. Forty hypertensive patients were divided into two groups according to Scheies classification by ophthalmologists: 20 patients with stage 1 changes (visible broadening of the light reflex from the artery with minimal arteriovenous compression) and 20 patients with stage 2 changes (more prominent than those in stage 1). Standard echocardiography was performed to measure LV mass index for evaluating LV hypertrophy and conventional diastolic transmitral flow velocities for assessing LV diastolic function. Mitral annular velocities were also measured for evaluating LV diastolic function using tissue Doppler echocardiography. The LV mass index was larger in stage 2 (130 ± 39 g/m2) than stage 1 (96 ± 16 g/m2) patients (p = 0.001). Peak early diastolic mitral annular velocity (E′) was lower in stage 2 (5.9 ± 0.9 cm/s) than stage 1 (7.9 ± 1.7 cm/s) patients (p = 0.001). The optimal cutoff points for the diagnosis of Scheie stage 2 were 6.6 cm/sec for E′ (sensitivity 75%, specificity 85%) and 111 g/m2 for LV mass index (sensitivity 70%, specificity 90%). In conclusion, in hypertensive patients, the extent of atherosclerosis in the retinal arteries can be estimated by LV hypertrophy and diastolic dysfunction assessed by echocardiography.

Acute superior mesenteric venous thrombosis with advanced gastric cancer: a case report

Although the advanced stages of neoplasms have a risk of superior mesenteric venous thrombosis (MVT), an initial clinical diagnosis of MVT is sometimes difficult and it can be treated as a cancer-related pain using NSAIDs and/or opioids.We herein present a case of palliative stage of cancer with acute MVT, which was successfully treated with immediate anticoagulant therapy. We believe this case provides an important clinical lesson, which is that we should remember that MVT is one of the potential causes of abdominal pain with cancer patients and the thrombosis can be easily identified by US and CT.