Resistant hypertension: Causes and management / 대한내과학회지

Resistant hypertension is defined as when the blood pressure cannot be reduced to below 140/90 mmHg in patients who are adhering to an adequate and appropriate triple drug regimen that includes a diuretic, in near full doses. Before changing or increasing the antihypertensive medication, several factors should be checked. A careful evaluation of the patient's adherence to therapy and adequate measurement of blood pressure are needed to exclude pseudoresistance secondary to poor medical adherence or white coat hypertension. Patients should be asked regularly about medications or substances that could interfere with blood pressure control. Successful treatment requires the identification of causes and a reversal of life style factors contributing to treatment resistance. Diabetes, chronic kidney disease, nonsteroidal anti-inflammatory drugs, high salt intake, obesity, and alcohol abuse are frequent causes of uncontrolled hypertension in Korea. The diagnosis and appropriate treatment of secondary hypertension is also needed. When multiple medications are used, vasodilators are the most commonly used antihypertensive drugs that cause subsequent fluid retention or sympathetic tone elevation. Adequate, effective, and sufficient diuresis and catecholamine suppression are needed for patients who do not respond to several vasodilators.

Prevalence, Predictive Factor, and Clinical Significance of White-Coat Hypertension and Masked Hypertension in Korean Hypertensive patients

BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHDOS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7+/-22.0/ 95.3+/-13.1 mmHg, and the mean daytime ambulatory BP was 136.4+/-15.0/ 86.2+/-10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or =130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.

Antihypertensive medications for 24 hour blood pressure control / 대한내과학회지

No abstract available.

A Randomized Crossover Study of the Additive Effect of Lercanidipine and Indapamide in Patients with the Mild to Moderate Hypertension

BACKGROUND AND OBJECTIVES: There is evidence available from randomized control trials about the additive effects of combination regimens that are mainly based on diuretics and beta-blockers or ACE inhibitors. Yet there are some arguments about the effect of the combination of calcium channel blockers (CCBs) and diuretics. We aimed to study the blood pressure-lowering effects of lercanidipine, indapamide or a combination therapy on the home blood pressure (HBP) and the 24-hour ambulatory blood pressure (ABP), and we wanted to examine the agreement with using these two methods. SUBJECTS AND METHODS: 70 patients participated in this randomized open crossover design study. The treatments in each phase were 10 mg lercanidipine (L) and 1 mg indapamide (I), separately and also in combination (L+I). Each patient had their HBP checked twice during each phase and the 24h ABP was checked in two of the 3 phases. We also measured the agreement between the HBP and ABP by using a Bland-Altman plot. RESULTS: 58 patients (mean age: 49+/-9 (31-71) years; 37 males and 21 females) completed the study. The blood pressure was significantly reduced during all the active treatments compared with the baseline (L: 160.2+/-12/100.3+/-9 mmHg, I; 130.5+/-9.3/86.0+/-8.1 mmHg, 129.2+/-12.9/83.9+/-11.1 mmHg, L+I:124.9+/-10.9/81.3+/-8.5 mmHg, p<.000) and the BP for the combination therapy was also significantly less than those BPs for both the other monotherapies (L+I vs. L: p<.002, L+I vs. I: p<.01) by measuring the 24h ABP. The Bland-Altman plot showed+/-25 mmHg for the limit of agreement between both measurement methods. CONCLUSION: CCB and diuretics were effective agents for treating hypertensive patients. As a combination therapy, the effects on blood pressure are additive. Poor agreement of the blood pressures with using the two measurement methods was observed.

The Characteristics of Spontaneous Action Potential of Cardiac Myocytes in Rabbit Pulmonary Veins

BACKGROUND AND OBJECTIVES: Atrial fibrillation is one of the most prevalent arrhythmia with clinical significance. Recently, some subset of paroxysmal atrial fibrillation was reported to be originated from a focal, rapidly firing source inside the large thoracic veins, such as pulmonary veins, superior vena cava and coronary sinus. The pulmonary veins are known to be the most frequent source of this type of atrial fibrillation. The proximal segment of pulmonary vein was reported to be made up with cardiac muscle cells. This study was performed 1)to define the characteristics of action potential of cardiac myocytes inside the rabbit pulmonary vein in single cell preparation, 2)to observe the changes in action potential and current activation to acetylcholine and isoproterenol, and 3)to compare these changes with those in atrial myocytes. METHOD AND RESULTS: In most of rabbit specimens, myocardial tissue extended over the pulmonary vein for a few millimeters(1-2.5mm). Single atrial myocyte and myocyte in pulmonary vein were successfully isolated. With using whole cell patch clamp technique, spontaneous activities of action potentials(APs) with diastolic depolarization were observed in 75% of pulmonary vein myocytes, in contrast to the absence of spontaneous activity in atrial myocytes. During spontaneous APs of pulmonary vein myocytes, the maximal diastolic potential was -50.5+/-6.5 mV and peak potential was 32.5+/-9.5 mV, and the frequency of APs was 1-2.5 Hz. During perfusion of isolated pulmonary vein myocytes with acetylcholine, resting membrane potential was hyperpolarized and spontaneous APs activity was markedly reduced or completely disappeared. These effects were observed in very low concentration of acetylcholine, even with 1-2 nM. The analysis of change of currents by applying step pulse revealed this response was mediated by activation of IK(ACh) and the current change was more prominent in pulmonary vein myocytes than atrial myocytes. The responses of these cells to isoproterenol were variable from increased spontaneous APs to inhibition of APs. CONCLUSION: This study revealed that pulmonary vein myocytes was another automatic pacemaking focus, same as sinoatrial nodal and Purkinje cells. These characteristics explain why focal atrial fibrillation was frequently initiated inside pulmonary veins.

Does Unipolar Recording Predict Successful Ablation Site in Idiopathic Left Ventricular Tachycardia?

BACKGROUND: Unipolar electrogram was reported to be useful for localization of manifest accessory pathway conduction during surgical or transcatheter ablation. However, it is not clear whether the unipolar electrogram would also be useful for localizing the origin of idiopathic left ventricular tachycardia (ILVT) in which pace mapping, activation time and recording of Purkinje (P)-potential have been used for guiding the successful ablation. METHODS: In patients who underwent catheter ablation for ILVT, bipolar and unipolar electrograms were recorded at the sites of current delivery. We analysed the time from P-potential to QRS onset (P-QRS time), time from local ventricular electrogram to QRS onset (V-QRS time) and the morphology and slope of rapid downstroke of unipolar electrograms (Uni-slope) during induced ILVT both at successful and unsuccessful sites. RESULTS: In 14 consecutive patients (11M/3F, mean age 29.3) with ILVT and successful ablation, QRS morphology of ventricular tachycardia was of right bundle branch block (RBBB) with left axis deviation and right axis deviation in 11 and 3 patients, respectively. The average number of current delivery was 4.5 (range 2-12). P-potential was observed in 10/14 (71%) successful sites and 37/47 (79%) unsuccessful ablation sites. The morphology of unipolar electrogram was QS pattern in 12 and QrS pattern in 2 successful sites but rS pattern was not observed at successful sites. P-QRS time was 26.5+/-12.4 and 26.6+/-14.9 msec (p=ns), V-QRS time 3.9+/-7.7 and 0.2+/-8.9 msec (p=ns), Uni-slope 7.1+/-3.1 and 7.3+/-4.5 mV/10 msec (p=ns) at successful and unsuccessful sites, respectively, showing no significant differences between successful and unsuccessful sites. CONCLUSIONS: The slope of rapid downstroke in unipolar electrogram was not useful as a guide for localization of successful ablation in patients with ILVT. However, absence of initial 'r'wave in unipolar electrogram may be helpful in conjunction with other conventional criteria for successful ablation.

Effects of cilostazol treatment on angiographic restenosis after coronary stent placement

BACKGROUND AND OBJECTIVES: Cilostazol is a potent antiplatelet agent with antiproliferative properties. Few data are available about the effect of cilostazol on post-stenting restenosis. The aim of this study was to evaluate the impact of cilostazol on post-stenting restenosis. MATERIALS AND METHOD: Four hundred and nine patients (494 lesions) scheduled for elective stenting were randomized to receive aspirin plus ticlopidine (group A, n=01, 240 lesions) or aspirin plus cilostazol (group B, n=08, 254 lesions), starting 2 days before stenting. Ticlopidine was given for 1 month and cilostazol for 6 months. Follow-up angiography was performed at 6 months, and clinical evaluation at regular intervals. RESULTS: Baseline characteristics were similar between the two groups. Procedural success rate was 99.6% in group A and 100% in group B. There were no cases of stent thrombosis after stenting. Angiographic follow-up was performed in 380 of the 494 eligible lesions and angiographic restenosis rate was 27% in group A, and 22.9% in group B (p=S). However, diffuse type in-stent restenosis was more common in group A than in group B (54.2% vs 26.8%, respectively, p<0.05). In diabetic patients, angiographic restenosis rate was 50% in group A and 21.7% in group B (p<0.05). Clinical events during the follow-up did not differ between the two groups. CONCLUSION: The combination therapy with aspirin plus cilostazol seems to be an effective antithrombotic regimen with comparable results to aspirin plus ticlopidine, but it does not reduce the overall angiographic restenosis rate after elective coronary stenting.

Assessment of Diastolic Function using Mitral Annulus Velocity by Doppler Tissue Velocity in the Patients with Hypertension

BACKGROUND AND OBJECTIVE: Mitral annulus velocity measured by doppler tissue imaging (DTI) has been used as a method of evaluation of the left ventricular diastolic function. This study was aimed to evaluate the left ventricular diastolic function using the mitral annulus velocity measured by DTI in the patients with hypertension. METHODS AND SUBJECTS: One hundered twenty nine patients with blood pressure above 140/90mmHg and age sex matched 123 normotensive subjects were studied. For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical four chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocities were easily obtained from all subjects. In the hypertension group, mitral annulus E'velocity was significantly lower than normotensive controls (5.4 1.3 cm/sec vs 6.5 1.8 cm/sec, p<0.001) and mitral annulus A' velocity was significantly higher than normotensive controls (8.6 1.4 cm/sec vs 7.9 1.1 cm/sec, p<0.001). In comparison with patients with normal LVML(IV mass index in hypertension group and subjects with normal LVMI in normotensive controls, mitral annulus E'velocity was reduced in patients with normal LVMI in hypertension group compared with subjects with normal LVMI in normotensive controls (5.6 1.4 cm/sec vs 6.7 1.8 cm/sec, p<0.001). CONCLUSION: Mitral annulus velocity measured by DTI could be used as one of the parameters in evaluating the early changes of left ventricular diastolic function in the patient with hypertension.

Mitral Annulus Velocity Measured by Pulsed Wave Doppler Tissue Imaging in Healthy Korean People

BACKGROUNS AND OBJECTIVES: Mitral annulus velocity measured by Pulsed Wave Doppler Tissue Imaging has been used as method of evaluation of left ventricular diastolic function. However, there are few reports of mitral annulus velocity measured by doppler tissue imaging in healthy normal people. the puopose of this study is to know normal values of mitral annulus velocity in healthy korean people. SUBJECTIVES AND METHODS: Subjectives were 100 healthy normal korean (men : 58 and women : 42 average : 51+/-7, range : 41-67) without hyper-tension and heart disease. subjectives were divided three groups according to age, group I which are forties (n=42), group II which are fifties (n=46), and group III which are sixties (n = 14). For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjectives. mitral annulus E'velocities were significantly decrease with aging (group I * 7.5+/-l.3 cm/sec, group II 5.7+/-1.3 cm/sec, group III 5.1+/-1.3 cm/sec. *p <0.001 in group I vs group lI and group I vs group III ) and also E'/A' ratios were significantly decrease with aging (group I * 1.0+/-0.2, group #II 0.8+/-0.2, group III 0.6+/-0.2. *p<0.001 in group I vs group ll and group I vs group III). mitral annulus A' velocities were increase with aging but has no statistical significance (group I 7.8+/-1.0 cm/sec, group II 7.9+/-1.2 cm/sec, group III 8.3+/-0.8 cm/sec. p=NS). mitral annulus E'velocities were correlated with age (r=-0.686, p <0.01) CONCLUSION: This results shows that mitral annulus E'velocities and E'/A' ratios were significantly decrease with aging and mitral annulus A' velocities were increase with aging, also there are good correlation between mitral annulus E' velocities and aging.

Assessment of Diastolic Function Using Mitral Annulus Velocity by Doppler Tissue Velocity in the Patients with Left Ventricular Hypertrophy

BACKGROUND AND OBJECTS: Mitral annulus velocity by Pulsed Wave Doppler has been used as method of evaluation of left ventricular diastolic function. However, it is unknown how this is altered in the patients with left ventricular hypertrophy (LVH). this study was aimed to compare a group of healthy subjects with a group of patients with LVH. METHODS: Subjects were 80 patients with LVH (left ventricular mass index125 g/m2) and 163 controls with normal left ventricular mass index (<125 g/m2). For measuring the mitral annulus velocities by doppler tissue imaging (=DTI), we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjects. in LVH group, mitral annulus E've#locity was significantly lower than controls (5.2+/-1.3 cm/sec vs 6.2+/-1.7 cm/sec, p(<0.001) and mitral annulus A' velocity was also significantly higher than controls (8.5+/-1.3 cm/sec vs 8.0+/-1.1 cm/sec, p<0.02). annular displacement measured by DTI-TVI (time velocity integral), also In LVH group, mitral annulus E'-TVI was significantly lower than controls (5.7+/-1.8 mm vs 6.8+/-2.2 mm, p<0.001). CONCLUSION: Mitral annulus velocity determined by DTI could be used as one of the parameters in evaluating diastolic function in patient with LVH.

ST Segment Depression and T-wave Inversion during Superaventricular Tachycardia

BACKGROUND: Paroxysmal supraventricular tachycardia(PSVT) is frequently associated with ST segment depression or T-wave inversion. However, the mechanism of ST-T changes in the context of various mechanisms of PSVT is not clear. The purpose of this study was to evaluate the prevalence of ST depression or T-wave inversion during PSVT and determine whether these changes are related to the mechanism of PSVT or the rate of the tachycardia. METHODS: Twelve-lead electrocardiograms were recorded during sinus rhythm and during PSVT in 163 patients who underwent an electrophysiologic study for ablation. Tachycardia cycle length, presence of ST depression or T-wave inversion during PSVT and the mechanism of tachycardia were evaluated. Significant ST depression was defined as at least 1mm horizontal or downsloping depression, measured 80ms after the J point and T-wave inversion as inversion of T-wave which was positive in the same lead during sinus rhythm. RESULTS: 1) The mechanism of PSVT analysed for ST segment depression was atrioventricular nodal reentry tachycardia in 60 cases and atrioventricular reentry tachycardia in 111 cases. The mean tachycardia cycle length was 373.8+/-68.0 msec. 2) ST depression and T-wave inversion was observed during PSVT in 56%(96/171) and 45%(77/171) of cases, respectively. 3) Tachycardia cycle length, degree of ST depression and number of leads with ST depression are not different according to the mechanism of PSVT. 4) ST depression and tachycardia cycle length had significant correlation, especially in atrioventricular reentry tachycardia. 5) Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia than atrioventricular nodal reentry tachycardia(p<0.05), but no difference between manifest and concealed bypass tract. CONCLUSIONS: ST segment depression is rate-related phenomenon and not different according to the mechanism of PSVT. Leads with T-wave inversion during tachycardia was observed more frequently in atrioventricular reentry tachycardia.

Radiofrequency Catheter Ablation in Patients with Atrial Flutter

BACKGROUND: Atrial flutter is a common arrhythmia for which no entirely satisfactory treatment is available. Despite the growing number of antiarrhythmic agents available for arrhythmia prophylaxis many patients are either intolerant of drug treatment or achieve inadequate relief from their symptoms. Recently, catheter ablation using radiofrequency energy has been used to result in high success rate for immediate prevention of atrial flutter but significant recurrence rate. We report our initial experience on radiofrequency cather ablation(RFCA) of atrial flutter in 8 patients. METHODS: The electrophysiologic approach guided by the earliest artial activation was used in the first patient and then anatomically guided approach in the remaining patients. The end point of RFCA was both demonstration of conduction block across the linear lesion at the atrial isthmus between the inferior vena cava and the tricuspid ring and noninducibility of atrial flutter with atrial burst pacing and extrastimulation up to 3 during isoproterenol infusion. RESULTS: Eight consecutive patients underwent RFCA.All were male and mean age was 53+/-22 years. Initial success was achieved in 7 patients(88%). During the follow-up period of 4+/-2.3 months, early sympomatic recurrence occurred in 2/7 patients(29%) within 1 month after initial success and the second ablation procedure was successfully performed in one patient. Overall success rate at the end of the follow-up period was 6/8(75%). there were no serious complications during and after the procedure. CONCLUSION: 1) radiofrequency catheter ablation is safe and highly effective treatment modality for prevention of atrial flutter. 2) Demonstration of conduction block across the lesion at the atrial isthmus should be achieved as an endpoint.

Left ventricular blood flow velocity line analysis in normal person;a color M-mode digitizing study

No abstract available.

A relationship between conduction disturbance on EKG and left ventricualr regional nonuniformity on echocardiography

No abstract available.

Effects of amlodipine on left ventricular diastolic function in patients with essential hypertension

BACKGROUND: In previous study, hypertensive patients with left ventricular diastolic dysfunction showed delayed relaxation time intervals and increased relaxation nonuniformity of regional wall motion. In this point of view, the effects of amlodipine on the regional wall motion and mitral flow patterns were evaluated. METHODS: Before and 32weeks after the antihypertensive medication of amlodipine, M-mode & Doppler echocardiogram were performed in 14 patients with moderate hypertension. We measured A2 to the peak thinning rate point of left ventricular(LV)posterior wall [A2-(-)dpw/dt] and the peak lengthening rate point of mitral annulus [A2-dL/dt] on M-mode echocardiogram and we defined nonuniformity as the time interval, (-)dpw/dt-dL/dt. RESULTS: 1) Mitral flow velocity E/A ratio was increased (0.95+/-0.4 vs 1.42+/-0.6, p<0.05) after amlodipine medication. 2) Heart rate and LV posterior wall thickness was decreased (79+/-9.3 vs 72+/-10.8 beats/min, 10.7+/-1.5 vs 9.4+/-2.0mm, p<0.05 respectively). 3) Long axis relaxation was improved (A2-dL/dt ; 165+/-44 vs 140+/-23msec, p<0.05) and nonuniformity index was decreased ((-)dpw/dt-dL/dt ; 63+/-49 vs 41+/-30msec p=0.07). CONCLUSION: Amlodipine improved E/A ratio of mitral flow (E/A ratio) in hypertensive patients with diastolic dysfunction, which could be attributed to the decreased heart rate, the decrease in wall thickness and the improvement in relaxation movement of LV long axis.

A Clinical Study of Antihypertensive Effect of Fosinopril in Essential Hypertension

BACKGROUND: This study was designed to evaluate the safety and the efficacy of fosinopril(Monopril(R)) in the treatment of mild to moderate essential hypertension. METHOD: Fosinopril(10mg) once a day was administrated as a starting dose in 20 patients with essential hypertension in the morning and a one step upward titration was performed(fosinopril 20mg once a day, after 4 weeks treatment). RESULT: After 2 weeks treatment with dose of 10mg, the systolic blood pressure(SBP) was decreased(183.8+/-28.5 vs, 161.5+/-25.9mmHg, p<0.05) and the diastolic blood pressure(DBP) was also decreased significantly(108.3+/-9.3 vs, 96.6+/-10.3mmHg, p<0.05). The effect of fosinopril were maintained. The SBP an DBP were decreased in 14 out of 20 patients till 8 weeks. There was no significant change in heart rate before and after fosinopril treatment(74.3+/-10 vs, 76.4+/-7.9beats/min). Fosinopril had no significant effects on laboratory findings such as serum creatinin, BUN, AST/ALT, WBC, Platelet and lipid profiles. Mild dry coughing was noticed only in 5 patients and it did not disturb continuing medication. CONCLUSION: Fosinopril is an effective antihypertensive agent, as monotherapy once a day in patients with mild to moderate hypertension.

The effects of cyclophosphamide on experimental viral myocarditis

BACKGROUND: Viral myocarditis is considered as a cause of dilated cardiomyopathy. At present, two pathogenic mechanisms may be involved in the pathogenesis of viral myocarditis and subsequent cardiomyopathy. First, the virus infection of myocyte may directly lead to either cell death or persistent metabolic dysfunction. Second, virus-induced immune or autoimmune mechanism may play a role. METHODS: To test the therapeutic efficacy of immunosuppression with cyclophophamide(CYP) on coxsackievirus B3(CB3) myocarditis, 10-14 week-old Balb/c mice were inoculated with 4000 plaque-forming units of CB3. In experiment 1, CYP (100mg/kg/day subcutaneous injection, s.c) was administrated daily on days 1-7(group 2, n=16). In experiment 2, CYP 30mg/kg/day s.c(group 3, n=32) or CYP 100mg/kg/day s.c(group 4, n=32) were administrated on days 8-14. The animals of infected controls(group 1, n=26) and group 2, 3, 4 were dissected at days 4, 7, 15, 22 and spleen, heart, thymus and body weights were measured. RESULTS: In experiment 1. survival rate in group 2 on day 7, 15 were low compared with group 1(85%, 0% vs 100%, p<0.05). and myocardial virus titers in group 2 on day 4 was 50 times, and on day 7, 1000 times higher compared with group 1, Histologically, on day 7, focal cellular infiltrations were prominent findings in group 1, but diffuse myocardial necrosis without cellular infiltration were observed in group 2. In experiment 2, survival rate, cardiac histopathology myocardial virus titer and serum neutralizing antibody titers did not differ among groups 1, 3 and 4. In experiment 1 and 2, the spleen-to-body-weight and thymus-to-body-weight ratios were significantly lower in CYP treated groups than those in controls and marked cellular depletions in spleens and thymus were observed in CYP treated groups. CONCLUSIONS: As the results of above, it can be concluded that the immunosuppression during viremic phase of murine viral myocarditis aggravated the myocardial necrosis, and during aviremic phase, the administration of CYP didnot affect the process of viral myocarditis. Thus, direct viral mechanisms in the production of cardiomyocyte injury in CB3-infected mice appear to bo more important than cell mediated immune mechanism. To understand relevant pathogenic mechanisms of clinical myocarditis and dilated cardiomyopathy resulting from viral infection, the experimental study expanding into nonmurine animals and into various models using other infectious agents may be required.

Antihypertensive Effects of Nilvadipine(Nivadil(R)) in Patients with Essential Hypertension

BACKGROUND: Form the 1970's calcium channel blockers have been used as one of the most effective drugs for antihypertensive therapy. Nilvadipine(Nivadil(R)) is a new vessel-selective calcium channel blocker with a markedly high oral bioaviliability and a long elimination half-life time. To evaluate the efficacy and side effects of nilvadipine, daily monotherapy was done in 22 patients with essential hypertension. METHOD: After more than 2 weeks of previous drug wash-out periods, Nilvadipine 8-12mg was administered daily in 2 or 3 divided dosage for 8 weeks in patients with mild to severe essential hypertension. The sitting blood pressure(BP) and heart rate were measured before and 2, 4, 8 weeks after medication. RESULT: Systolic and diastolic BP were significantly reduced at 2 weeks after medication and no further significant BP reduction were noted throughout the remainer of the trial(4 to 8 weeks). Normotension(diastolic BP < or =90mmHg) was achieved in 14 cases(67%) after 8 weeks therapy and in 7 cases(33%) BP reduced effectively. The side effect noted were headache and facial flushing in 2 cases and in one of them the medication were discontinued. And fatigue, dizziness were complaint in 1 case respectively. There were no significant laboratory changes before and after nilvadipine therapy. CONCLUSION: It can be concluded that nilvadipine(Nivadil(R)) monotherapy is effective in many patients with essential hypertension and a clinical study of combined therapy with other antihypertensive agents in larger numbers of patients will be needed.

Echocardiographic Evaluation of Regional Wall Motion Nonuniformity and Phase Difference in Asymmetric Septal Hypertrophy

BACKGROUND: A regional wall motion nonuniformity and a phase difference between LV posterior wall motion and transmitral flow are present during normal rapid filling period and are thought to be an evidence for involvement of ventricular restoring forces. To assess the role of nonuniformity on diastolic funtional impairment of asymmetric septal hypertrophy(ASH), the time relations between left ventricular regional wall motions and filling velocity were studied. METHOD: We measured the time intervals from A2 to peak rate of LV posterior wall(short axis) thinning(A2-(-)dpw/dt), peak rate of medial mitral annulus (long axis dimension) lengthening(A2-dL/dt) and peak mitral flow(A2-E) by M-mode and Doppler echocardiography. Result: In ASH patients, A2-(-)dpw/dt(106+/-6msec, mean SE) and the regional wall motion nonuniformity((-)dpw/dt-dL/dt, 89+/-11msec, mean SE) were increased significantly when compared with normal control values(88+/-4, 28+/-5msec, mean SE, p<0.01,respectively).In normal controls, peak mitral flow velocity lagged peak rate of regional wall motion, so the phase differences were present((-)dpw/dt-E :71+/-8msec, dL/dt-E:44+/-6msec). In ASH patients, (-)dpw/dt-E was present(90+/-16msec) but dL/dt-E was not present or reversed(-21+/-18 msec). So these chacteristic phase differences were disturbed. CONCLUSION: These data suggested that the relaxation nonuniformity of regional wall motion in ASH may act as an energy dissipating factor of restoring forces during rapid filling period.

Echocardiographic Measurement of Early Diastolic Time Intervals in Patients with Hypertension: With Reference to Regional Nonuniformity and Restoring Forces

BACKGROUND: It is known that left ventricular(LV) wall motion is not uniform even in normal heart, and the restoring forces make phase differences between LV wall motion and mitral flow velocity during rapid filling period. METHOD: To investigate the regional nonuniformity and restoring forces in 46 patients with hypertension(HT)(group:normal wall thickiness.n=12,II:LVH with fractional shortening(FS)>25%. n=22. III:FS<25%.n=12). We measured the time intervals from A2 to peak thinning rate point of LV posterior wall(A2-(-)dpw/dt).to mitral flow starting point (IRT).and to peak mitral flow velocity(A2-E) by M-mode and Doppler echocardiography. RESULTS: The noniformity((-)dpW/dt-dL/dt)and phase differance((-)dpw/dt-E) were increased in HT(control:HT.22+/-7.8 vs. 49+/-5.2msec, 63+/-4.5 vs, 86+/-6.2msec, p<0.05 respectively).In group comparison, nonuniformity increased in group II and III(group I: group II, III, 35+/-5.1 vs. 50+/-7.1,70+/-14msec, p<0.05 respectively). but phase difference increased only in group II(groupII: group I, III, 93+/-6.0 vs. 75+/-5.2, 80+/-20msec, p<0.05, respectively). CONCLUSION: We interpreted these data that in HT with hypertrophy or not, the nonuniformity of LV wall motion working on the restoring forces which can be expressed as phase difference between LV wall motion and mitral flow. But in HT with hypertensive heart failure group, no significant changes of phase difference and it's suggest that other mechanism could be also working on early diastolic filling.