Yuhei Shiga

High Efficacy of Disopyramide in the Management of Ventricular Fibrillation Storms in a Patient with Brugada Syndrome

The patient was a 57‐year‐old man with Brugada syndrome, who had been implanted with a implantable cardioverter defibrillator (ICD). The frequency of ventricular fibrillation (VF) started to increase about 4 years after ICD implantation, occurring, at worst, six times in one night. Immediately after starting oral administration of disopyramide, VF stopped occurring. He then discontinued taking disopyramide, but immediately after the discontinuation VF started occurring again, so he restarted taking disopyramide. Thereafter, VF completely stopped occurring. Findings observed in our case suggest that disopyramide could be added in our arsenal of medications for treating arrhythmic storms in patient with Brugada syndrome. (PACE 2010; 33:e53–e56)

Efficacy and safety of a single-pill fixed-dose combination of high-dose telmisartan/hydrochlorothiazide in patients with uncontrolled hypertension

Objective: Many patients still have high blood pressure (BP) after treatment with high-dose angiotensin II type 1 receptor blockers (ARBs) or Preminent® (medium-dose of losartan (50 mg/day)/hydrochlorothiazide (HCTZ) (12.5 mg/day)). Therefore, we analyzed whether Micombi®BP (high-dose telmisartan (80 mg/day)/HCTZ (12.5 mg/day)) could provide better results with regard to efficacy and safety for patients with uncontrolled hypertension. Methods: In total, 44 hypertensive patients (22 males, age 71±14 years) who showed uncontrolled BP despite the use of high-dose ARBs or Preminent® were enrolled in this study. We used a changeover design in which the patients were switched from high-dose ARBs or Preminent® to Micombi®BP. We analyzed BP, heart rate (HR), and biochemical parameters before and after treatment for 3 months. Results: Systolic BP and diastolic BP significantly decreased (125±15/69±11 mmHg) and 85% of the patients achieved their target BP at 3 months after changeover. Patients who switched from ARBs and those who switched from Preminent® showed similar BP-lowering effects. In addition, the reductions in BP after 3 months in patients with or without chronic kidney disease and in those with or without metabolic syndrome (MetS) were also similar. There were no significant changes in HR during the study period. Although blood levels of potassium, hemoglobin A1c and uric acid (UA) significantly increased after 3 months for all of the patients, none of the patients showed serious adverse effects. Conclusion: High-dose telmisartan/HCTZ therapy was associated with a significant reduction in BP and helped patients achieve their target BP.

The Ratio of Low-Frequency to High-Frequency in Ambulatory Electrocardiographic Monitoring Immediately Before Coronary Angiography as a Predictor of the Presence of Coronary Artery Disease

Background There is considerable evidence that impaired autonomic control may be associated with the etiology of coronary artery disease (CAD). We hypothesized that the autonomic imbalance as assessed by measuring heart rate variability (HRV) and biological parameters before and after coronary angiography (CAG) may predict the presence of CAD. Methods Ambulatory electrocardiographic (ECG) examination using eHEART® (Parama-Tec) is a novel, rapid, and simple method with which we can measure HRV within 5 min. We selected patients (n = 78, 68 ± 10 y) who underwent CAG and analyzed their ambulatory ECGs and blood levels of neuropeptides at both 1 day and immediately before and after CAG. The patients were divided into the presence (n = 64, CAD group) and absence of CAD (n = 14, non-CAD group). Results Although the CAD group showed an increase in blood pressure immediately before CAG, the ratio of low-frequency to high-frequency (LF/HF) was significantly decreased in the CAD group, but not in the non-CAD group. On the other hand, there was no difference in a coefficient of variation of the R-R interval or pulse rate between the two groups. CAD was independently associated with hypertension (P = 0.011), dyslipidemia (P = 0.009), and LF/HF immediately before CAG (P = 0.046) by a logistic regression analysis. Conclusions These findings suggest that LF/HF immediately before CAG in addition to hypertension and dyslipidemia might predict the presence of CAD.

Effect of fixed-dose losartan/hydrochlorothiazide on brain natriuretic peptide in patients with hypertension

Objective: Losartan/hydrochlorothiazide (HCTZ) (Preminent®) is a fixed-dose combination of angiotensin II receptor blocker (ARB) and the thiazide diuretic HCTZ that has consistently been shown to be more effective than either losartan or HCTZ. Little is known about the relationship between losartan/HCTZ and blood levels of brain natriuretic peptide (BNP). Methods and results: In this study, 44 patients with hypertension who were being treated with ARB were enrolled. The ARB was changed to losartan/HCTZ because of uncontrolled hypertension. Blood pressure (BP), pulse rate (PR), plasma levels of BNP and other biochemical parameters were analyzed at baseline and 6 and 12 months after the change from ARB. Of the total 44 patients, 33 (75%) achieved the target BP at 12 months. While there was no significant change in PR, systolic and diastolic BP were significantly reduced (−23 ± 3 mmHg and −10 ± 2 mmHg, respectively) during this period. Although there were no significant changes in biochemical parameters, plasma levels of BNP were significantly decreased, especially in patients who had higher levels of BNP at baseline, during this period. Conclusion: Losartan/HCTZ therapy significantly reduced not only BP but also plasma levels of BNP in patients with hypertension. These findings suggest that losartan/HCTZ might have cardioprotective effects in patients with higher levels of BNP.

Visit-to-Visit Variability and Seasonal Variation in Blood Pressure With Single-Pill Fixed-Dose Combinations of Angiotensin II Receptor Blocker/Calcium Channel Blocker and Angiotensin II Receptor Blocker/Diuretic in Hypertensive Patients

Background The visit-to-visit variability in blood pressure (BP) has been shown to be a strong predictor of cardiovascular events. It is not known whether anti-hypertensive therapy using a single-pill fixed-dose combination of angiotensin II receptor blocker (ARB)/calcium channel blocker (CCB) or ARB/diuretic (DI) in hypertensive patients affects the visit-to-visit variability and seasonal variation of BP. Methods We enrolled 47 hypertensive patients who had received a single-pill fixed-dose combination of either ARB/CCB (n = 30) or ARB/DI (n = 17) for 15 months. Beginning 3 months after the start of ARB/CCB or ARB/DI treatment, we determined the visit-to-visit variability in BP expressed as the standard deviation (SD) of average BP and the seasonal variation in BP expressed as the SD of average BP in each season (spring, summer, fall and winter were defined as lasting from March to May, June to August, September to November and December to February, respectively) for a year. Results There were no significant differences in baseline patient characteristics except for the prevalence of coronary artery disease and the percentage of CCB excluding amlodipine in the ARB/CCB group between the ARB/CCB and ARB/DI groups. There were no significant differences in the 1-year time course of systolic and diastolic BP (SBP and DBP) between the groups, although there were significant differences in SBP in August and November and DBP in December. Interestingly, the visit-to-visit variability and seasonal variation of BP in the ARB/CCB group were similar to those in the ARB/DI group. Conclusion Single-pill fixed-dose combinations of ARB/CCB and ARB/DI had similar effects on visit-to-visit variability and seasonal variation in BP in hypertensive patients.

Comparison of the Efficacy and Safety of Irbesartan and Olmesartan in Patients With Hypertension (EARTH Study)

Fifty-four patients were randomly divided into irbesartan and olmesartan groups. Blood pressure (BP) was significantly decreased in all patients at 12 weeks. In particular, BP in patients who initially received irbesartan showed significant reductions. The equality of variance of BP in the irbesartan group was significantly smaller than that in the olmesartan group at 12 weeks. Blood concentrations of adiponectin were significantly increased in the irbesartan group at 12 weeks. Log [pentraxin-3] in the irbesartan group were significantly decreased. In conclusion, the ability of irbesartan to reduce BP is comparable to that of olmesartan with equivalent safety.

Association Between Hypertension and Coronary Artery Disease as Assessed by Coronary Computed Tomography

Multidetector row computed tomography (MDCT) enables the accurate noninvasive assessment of coronary artery stenosis and plaque imaging. The characteristics of patients who have coronary artery disease (CAD) as assessed by MDCT coronary computed tomography (CT) are not well known. Participants consisted of 513 consecutive patients with suspected CAD who underwent coronary CT. The authors quantified patient characteristics, including the prevalence of hypertension (HTN), hyperlipidemia and diabetes mellitus (DM), visceral fat area (VFA) and subcutaneous fat area using CT, and plasma levels of metabolic factors, including adiponectin and leptin. Although plasma levels of adiponectin in men and leptin in women were significantly associated with chronic kidney disease, there were no differences in these levels between patients with and without CAD. HTN was most significantly associated with the presence of CAD by multivariate logistic regression analysis (men, P=.002; women, P=.048). Finally, the percentage of CAD significantly increased as systolic blood pressure increased (trend, P=.0002) in men but not women. In conclusion, hypertension was significantly associated with CAD as assessed by coronary CT. J Clin Hypertens (Greenwich). 2011;13:198–204.

Associations between glycated albumin or hemoglobin A1c and the presence of coronary artery disease.

OBJECTIVE We investigated the associations between serum levels of glycated albumin (GA) or hemoglobin A1c (HbA1c) and the presence of coronary artery disease (CAD) in patients who underwent coronary computed tomography angiography (CTA). METHODS AND RESULTS The study consisted of 244 consecutive patients who underwent CTA and in whom we could measure the levels of both GA and HbA1c. Any narrowing of the normal contrast-enhanced lumen to >50% that could be identified in multiplanar reconstructions or cross-sectional images by CTA was defined as significant stenosis in CAD. We divided the patients into two groups: CAD group (n=72) and non-CAD group (n=172), as assessed by CTA. The CAD group showed significantly higher GA and HbA1c than the non-CAD group. GA and HbA1c showed a positive correlation (r=0.551, p<0.0001). A multivariate logistic regression analysis was performed to examine the associations between the presence of CAD and age, gender, body mass index, and coronary risk factors (hypertension, dyslipidemia, and smoking), in addition to GA and HbA1c. Age [odds ratio (OR): 1.04, p=0.02], gender (OR: 2.84 p=0.01), hypertension (OR: 3.20, p=0.01), and GA (OR: 1.16, p=0.03) were identified as significant independent variables that predicted the presence of CAD. In particular, GA (OR: 1.30, p=0.02) was the only predictor of the presence of CAD in the diabetes mellitus group by a multivariate logistic regression analysis. We defined the cut-off value of GA for the prediction of CAD in patients with diabetes as 17.9% (sensitivity 0.639, specificity 0.639) by a receiver-operating characteristic curve analysis. CONCLUSION GA may be superior to HbA1c as a marker for evaluating the presence of CAD.

Significance of Plasma Levels of Pigment Epithelium-Derived Factor as Determined by Multidetector Row Computed Tomography in Patients with Mild Chronic Kidney Disease and/or Coronary Artery Disease

Little is known about the association between plasma levels of pigment epithelium-derived factor (PEDF), coronary artery disease (CAD) and/or chronic kidney disease (CKD). This study evaluated 289 consecutive patients with chest pain or at least one coronary risk factor who underwent coronary angiography using multidetector row computed tomography (MDCT). Presence of CAD and CKD, CAD severity (i.e. number of significantly stenosed coronary vessels, described as vessel disease [VD]), coronary calcification scores, visceral fat area (VFA), subcutaneous fat area on MDCT, and metabolic biomarkers were recorded. PEDF levels correlated significantly with sex, VFA, CKD presence/hyperuricaemia and high-density lipoprotein cholesterol levels. PEDF levels were closely associated with CKD and were significantly higher in CKD patients than in non-CKD patients, regardless of the presence of CAD. CKD patients with two-VD or three-VD had higher plasma PEDF levels than non-CKD patients with two-VD or three-VD. It is concluded that PEDF may be associated with CKD regardless of the presence of CAD.

Effects of Tolvaptan With or Without the Pre-Administration of Renin-Angiotensin System Blockers in Hospitalized Patients With Acute Decompensated Heart Failure

We examined whether tolvaptan combined with an angiotensin II receptor blocker (ARB) or angiotensin converting enzyme inhibitor (ACE-I) is more effective than tolvaptan alone in the treatment of patients with heart failure (HF). Sixty-five hospitalized patients with acute decompensated HF were included in this study. They were divided into 2 groups; an ARB/ACE-I group (n = 44, who received ARB or ACE-I before the use of tolvaptan) and a non-ARB/ACE-I group (n = 21). There were no significant differences in patient characteristics including medications at baseline between the non-ARB/ACE-I and ARB/ACE-I groups with the exception of the percentages of hypertension and ischemic heart disease. Urinary volume (UV) at baseline in the ARB/ACE-I group was slightly higher than that in the non-ARB/ACE-I group. The increase in UV after the use of tolvaptan in the non-ARB/ACE-I group was significantly higher than that in the ARB/ACE-I group. The cardiothoracic ratio and the reduction in body weight were similar between the groups after tolvaptan use. Finally, in a logistic regression analysis, a response to the use of tolvaptan was independently associated with the non-use of ARB/ACE-I, but not with age, gender, body mass index, loop diuretic, or human arterial natriuretic peptide. In conclusion, tolvaptan alone might induce an increase in UV in decompensated HF patients without ARB/ ACE-I, although the treatment of HF with ARB/ACE-I is the first choice strategy.