Dobun Hayashi

Amlodipine versus angiotensin II receptor blocker; control of blood pressure evaluation trial in diabetics (ADVANCED-J)

BackgroundThe coexistence of type 2 diabetes mellitus and hypertension increases the risk of cardiovascular diseases. The U.K. Prospective Diabetes Study has shown that blood pressure control as well as blood glucose control is efficient for prevention of complications in hypertensive patients with diabetes mellitus. However, some reports have shown that it is difficult to control the blood pressure and the concomitant use of a plurality of drugs is needed in hypertensive patients with diabetes mellitus. In recent years renin-angiotensin system depressants are increasingly used for the blood pressure control in diabetic patients. Particularly in Japan, angiotensin II (A II) antagonists are increasingly used. However, there is no definite evidence of the point of which is efficient for the control, the increase in dose of A II antagonist or the concomitant use of another drug, in hypertensive patients whose blood pressure levels are inadequately controlled with A II antagonist.Methods/DesignHypertensive patients of age 20 years or over with type 2 diabetes mellitus who have been treated by the single use of AII antagonist at usual doses for at least 8 weeks or patients who have been treated by the concomitant use of AII antagonist and an antihypertensive drug other than calcium channel blockers and ACE inhibitors at usual doses for at least 8 weeks are included.DiscussionWe designed a multi-center, prospective, randomized, open label, blinded-endpoint trial, ADVANCED-J, to compare the increases in dose of A II antagonist and the concomitant use of a Ca-channel blocker (amlodipine) and A II antagonist in hypertensive patients with diabetes mellitus, whose blood pressure levels were inadequately controlled with A II antagonist. This study is different from the usual previous studies in that home blood pressures are assessed as indicators of evaluation of blood pressure. The ADVANCED-J study may have much influence on selection of antihypertensive drugs for treatment in hypertensive patients with diabetes mellitus. It is expected to give an important hint for considering the validity of selection of antihypertensive drugs from the aspects not only of the antihypertensive effect but medical cost-effectiveness.

Electrostatic field can preserve red blood cells in stored blood preparations

PurposeDuring the storage of red blood cell concentrates (CRCs), red blood cells are progressively destroyed and free hemoglobin and potassium concentrations increase. In this study, we focused on an electrostatic field that maintains food freshness without freezing, even at less than the freezing point. We hypothesized that the storage of CRCs under an electrostatic field could keep red blood cells in better condition than conventional storage.MethodsEach of 15 packs of 2-day-old CRCs, preserved in MAP (mannitol, adenine, glucose, phosphate, and citrate) solution (MAP-CRC) was divided into 4 smaller equal-size packs and stored at 4°C in a newly developed refrigerator that can generate an electrostatic field. Each group was exposed to a 0-, 500-, 1500-, or 3000-volt (V) electric field for 30 days. Concentrations of free hemoglobin, total haptoglobin, sodium (Na), and potassium (K), and the pH, were measured in the supernatant.ResultsHaptoglobin was not detected. The Na concentration decreased with time but was significantly lower in the 0-V than in the 500-, 1500-, and 3000-V groups. K and free hemoglobin concentrations increased with time, with significantly higher values in the 0-V than in the 500-, 1500-, and 3000-V groups. The pH decreased in the 500-, 1500-, and 3000-V groups, while it did not change in the 0-V group. The pH decrease was smaller in the 500-V than in the 1500- and 3000-V groups.ConclusionStoring MAP-CRC in an electrostatic field of 500 to 3000 V could decrease hemolysis in the preparation. Considering the lower pH decrease, 500 V might be the field of choice.