Yuji Ogawa

Efficacy of long-term treatment with nipradilol, a nitroester-containing beta-blocker, in patients with mild-to-moderate essential hypertension

The effects of long-term treatment with nipradilol, a nitroester-containing beta-blocker, on casual and 24-hour blood pressures were studied in 70 patients with mild-to-moderate essential hypertension. Antihypertensive effects of nipradilol on casual blood pressure were observed in 68% of patients. Nipradilol reduced pulse rates, but no bradycardia was observed. The usefulness of nipradilol in the present study was 65%. The results of ambulatory blood pressure monitoring indicated that nipradilol reduced systolic blood pressure more than diastolic blood pressure, and reduced blood pressure during waking more than during sleep. These results suggest that nipradilol is a safe and useful long-term antihypertensive drug in both young and older patients with mild-to-moderate essential hypertension. When administered twice daily, nipradilol is effective throughout a 24-hour period.

Complete healing of spontaneous coronary artery dissection extending from the left main trunk to the left anterior descending and the left circumflex artery

Spontaneous coronary artery dissection (SCAD) is defined as a spontaneous separation of the coronary artery wall that is not iatrogenic or related to trauma and usually affects young women. We describe a 65-year-old woman who presented with SCAD extending from the left main trunk involving the left anterior descending artery and the left circumflex artery, and coronary artery bypass graft surgery was performed to treat the dissection. Coronary angiography performed 3 months later, showed complete angiographic healing. A conservative management strategy is known to be associated with spontaneous angiographic healing in patients with SCAD who are hemodynamically stable. Healthcare providers should consider SCAD among the differential diagnoses in patients presenting with acute coronary syndrome, particularly in women. Further studies are needed to establish an optimal management strategy for SCAD. <Learning objective: Spontaneous coronary artery dissection (SCAD) might be a cause of acute coronary syndrome not only in younger but also in older women. Even if the area of the dissection is broad, healing can be expected in future. Therefore, it is important to select between conservative and invasive therapy such as percutaneous coronary intervention or coronary artery bypass graft including selection of graft, i.e. saphenous vein graft and radial arteries, and internal mammalian arteries.>.

Renal Artery Stenosis Emerged After Angiotensin-Converting Enzyme Inhibitor Treatment for Myocardial Infarction A Case Report

A 76-year-old woman with acute myocardial infarction underwent percutaneous coronary angioplasty followed by treatment with an angiotensin-converting enzyme (ACE) inhibitor, lisinopril. Her renal function deteriorated after the administration of lisinopril, so it was changed to another ACE inhibitor, temocapril. Renography suggested a complication of severe right renal artery stenosis, and renal angiography revealed bilateral renal artery stenoses. Her renal hemodynamics were assessed by 99mTc-Mercaptoacetyltriglycine (99mTc-MAG3)-renography before and after withdrawal of temocapril. The authors concluded the patient had essential hypertension complicated by atherosclerotic renovascular disease. In the treatment of elderly patients with heart disease, hypertension, or both, with ACE inhibitor, the possibility of coexisting renal artery stenosis should be considered. Renography is recommended as a reliable tool for detecting renal artery stenosis.

Effects of long-term oral magnesium treatment on blood pressure and vascular reacitivity in Dahl salt-sensitive rats

BackgroundThis study was designed to investigate the effects of long-term oral magnesium treatment on blood pressure and vascular reactivity in Dahl salt-sensitive and Dahl salt-resistant rats.MethodsThe rats were fed a low-salt (0.3% sodium chloride [NaCl]) or a high-salt (8% NaCl) diet, with or without magnesium in the drinking water (aspartic acid magnesium, 15.4 g/L), for 4 weeks. Blood pressure, urinary electrolytes, and noradrenaline excretion were measured. Vascular reactivity to potassium chloride (KCl), 5-hydroxytryptamine, acetylcholine and sodium nitroprusside were studied using the rings of isolated superior mesenteric arteries.ResultsFour weeks of oral magnesium treatment significantly prevented blood pressure elevation in salt-loaded salt-sensitive rats, and decreased heart rate and urinary noradrenaline excretion. Alteration of vascular reactivity, hypercontractility to KCl or 5-hydroxytryptamine, and the decrease in endothelium-dependent relaxation to acetylcholine were observed in the superior mesenteric arteries of salt-loaded salt-sensitive rats, and magnesium treatment improved the hypercontractility to KCl.ConclusionsIn salt-sensitive rats fed the high-salt diet, 4 weeks of oral magnesium treatment prevented the blood pressure elevation, and improved hypercontractility to KCl, in isolated superior mesenteric arteries. These results suggest that an appropriate oral magnesium treatment may be effective in salt-loaded hypertensive salt-sensitive rats.