The Relationship between the Upright Serum aldosterone Level and the Left Ventricular Geometry in Essentioal Hypertension

BACKGROUND: Aldosterone acts as a non-hemodynamic factors on the hypertensive heart regarding sodium retension or myocardial fibrosis. To elucidate whether aldosterone is associated with the specific left ventricular geometry or not, we investigated the relationship between the upright serum aldosterone levels and the echocardiographicleft ventricular structure in the essential hypertension patients never treated. METHODS: Echocardiographic indices included M-mode measured left ventricular mass index (LVMI), relative wall thickness (RWT). Aldosterone is measured by Radioimmunoassay for the serum withdrawn from the subjects at least 3 hours upright position. 63 patients and 20 normal control subjects were evaluated. RESULTS: 1) 84.1% (63/53) of cases showed left ventricular hypertrophy. 7 patients showed normal LVMI, 3 patients showed concentric remodeling geometry. 19 patients had concentric left ventricular hypertrophy (LVH). 34 patients had eccentric LVH. 2) The serum aldosterone level has negative correlation with the RWT (r=-0.27, p=0.03) but not with LVMI (r=0.08, p=NS). There was difference among groups (ANOVA, F=0.009). Serum aldosterone is higher in eccentric LVH group than in concentric LVH group (10.5+/-1.2 ng/dL vs 5.2+/-0.6 ng/dL, p=0.0001) and than in control group (10.5+/-1.2 ng/dL vs 6.6+/-0.8 ng/dL, p=0.01). CONCLUSION: In this study, we observed that the serum aldosterone level was not correlated with the LVMI but with RWT negatively so that eccentric LVH group showed higher serum aldosterone levels than control group and concentric LVH group.

Four Cases of Management of Congenital Coronary Arteriovenous Fistula

Four cases of congenital coronary arteriovenous fistula were diagnosed using coronary angiography. Three cases had fistula-related chest pain and the remaining case showed no symptoms but displayed electrocardiographic changes suggesting myocardial ischemia. As he was elderly and had a potential for future complications, we decided to close the fistulas of all cases. Three cases were closed with transcatheter coil embolization and one with surgical ligation due to a suspicious accompanying pericardial cyst. None of the patients demonstrated periprocedural or perioperative complications and all were relieved from symptoms during the 2 year follow-up period. We concluded that transcatheter coil embolization and surgical ligation are effective methods for use in the management of coronary arteriovenous fistula.

Relationship between ST segment of lateral leads and culprit arteries in acute inferior myocardial infarction

BACKGROUND AND OBJECT: We intended to assess the characteristics of ST segment deviation in lateral leads(aVL, I, V5, V6) in patients with acute inferior myocardial infarction(AIMI) and find out the relationship with culprit arteries. MATERIALS AND METHOD: The subjects were 51 patients diagnosed as AIMI by standard electrocardiogram, cardiac enzymes and typical chest pain. Subjects were devided into two groups by angiographically proven culprit arteries ; left circumflex artery(LCx) group and right coronary artery(RCA) group. We compared the frequencies of ST segment depression more than 1 mm and less than 1 mm in aVL and I, and ST segment elevation more than 0.5 mm and less than 0.5 mm in V5 and V6 in each culprit artery group. RESULTS: Among 51 patients with AIMI, 42 were RCA group and 9 were LCx group. The frequency of ST segment depression more than 1 mm in aVL was 44% in LCx group and 71% in RCA group(p=0.140). 11% of LCx group and 43% of RCA group showed more than 1 mm ST segment depression in lead I (p=0.128). 56% of LCx group showed more than 0.5 mm ST segment elevation in V5 and V6 and 81% of RCA group showed less than 0.5 mm ST segment elevation in V5 and V6 (p=0.036). CONCLUSION: Culprit arteries in patients with AIMI and ST segment deviation in V5 and V6 are significantly related with each other. ST segment elevation more than 0.5 mm in V5 and V6 was predominantly found in LCx group than RCA group. Observation for ST segment deviation in lateral precordial lead V5 and V6 would be important in predicting the culprit artery in AIMI.

Normalized Idioventricular QT Interval Variability in Patients with Q- and Non-Q Wave Myocardial Infarction

BACKGROUND AND OBJECTIVES: The aim of the study was to evaluate the difference of temporal lability in myocardial repolarization between acute non-Q (NQMI) and Q-wave myocardial infarction (QMI), and to discern whether the locations of myocardial infarction influence such temporal lability. SUBJECTS AND METHODS: Twelve patients with NQMI and 28 with QMI, including 16 anterior (AMI) and 12 inferior MI (IMI) patients were enrolled. Twenty four-hour ambulatory ECG recordings of each patient were analyzed, and the digitized data was partitioned into 30-min sections. The QT intervals were measured using a template matching strategy. We then calculated the low (LF:0.03 - 0.15 Hz) and high frequency (HF:0.15 - 0.4 Hz) power of the QT interval variability using an algorithm capable of removing the influence of the RR-interval on QT interval variability (Normalized Idioventricular QT variability Index:IV-QT). RESULTS: For patients with QMI, the low frequency IV QT (LF IV-QT) was higher than that of NQMI (1.941+/-0.101 and 1.556+/-0.114 respectively, p<0.05). No difference was seen in the high frequency IV QT (HF IV-QT) of the two groups. For QMI patients, both the LF IV-QT and HF IV-QT were higher in day time (6AM-6PM) than in night time (6PM-6AM). Comparing the differences of these indices by the location of QMI, both the LF IV-QT and HF IV-QT of AMI were higher than those of IMI patients (2.231+/-0.135 vs 1.355+/-0.131 and 2.341+/-0.161 vs 1.346+/-0.145 respectively, p<0.0005). Both indices of each group also demonstrated a circadian change. CONCLUSION: In cases of QMI, the temporal lability in myocardial repolarization is larger than that seen in NQMI. Moreover, it was worse in AMI than IMI. Finally, such temporal repolarization lability tends to have a circadian pattern in QMI.

Optimally Timed Rate-adaptive Atrioventricular Delay in AV Sequential Pacing

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.

Left Atrial Function in Various Type of Left Hypertrophy in Hypertensive Patients

BACKGROUND: Left atrium (LA) may serve as a conduit, as a reservoir and as a contractile chamber. Left atrial function in patients with left ventricular concentric hypertrophy was compared with that in eccentric hypertrophy. METHODS: LA volumes were echocardiographically measured in 54 hypertensive patients (mean age: 57.1+/-14.9 years, men: 24, women: 30, concentric hypertrophy: 21, eccentric hypertrophy: 18). Transmitral flow velocities were recorded with pulsed Doppler echocardiography. LA volumes were measured at mitral valve opening (LAVmax) and closure (LAVmin) and at onset of atrial systole (LAVp). LA function was evaluated by the following parameters: 1) LA reservoir volume (LARV=LAVmax-LAVmin), 2) LA conduit volume (LACV=left ventricular stroke volume-LARV), 3) LA active emptying fraction (EF active=[LAVp-LAVmin]/LAVp), 4) LA passive emptying fraction (EF passive=[LAVmax-LAVp]/LAVmax). RESULTS: In concentric hypertrophy compared with eccentric hypertrophy, LARV (59.9+/-20.0 vs 45.6+/-12.0 cm3, p<0.05) and EF active (56.8+/-10.0 vs 41.0+/-15.2%, p<0.01) increased but LACV (16.0+/-19.8 vs 43.7+/-15.0 cm3, p<0.01) decreased. Relative wall thickness (RWT) correlated with LARV (r=0.288, p<0.05) and EF active (r=0.561, p<0.01) but had negative association with LACV (r=-0.508, p<0.01) and EF passive (r=-0.490, p<0.01). There was a positive relationship of left ventricular mass index (LVMI) to LARV (r=0.293, p<0.05) but negative relationship of LVMI to EF passive (r=-0.494, p<0.01). CONCLUSION: The present study showed that LA reservoir function and active emptying fraction increased in concentric hypertrophy comparison with eccentric hypertrophy and LA conduit function decreased in concentric hypertrophy comparison with eccentric hypertrophy. Therefore, these findings suggest that the changes of left atrial function are remarkable in concentric hypertrophy.

Changes in t-PA and PAI-1 levels after exercise in patients with diabetes mellitus: A sex and age-matched control study / 대한내과학회지

OBJECTIVES: Plasma fibrinolytic activity is determined by the balance between plasmonogen activators and their inhibitors. The aim of this study was to compare the fibrinolytic activity before and after exercise of the type 2 diabetic patients with control group. METHODS: We measured plasma tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) antigen before and after standardized treadmill exercise in 21 type 2 diabetic patients (14 men, 11 women, ages 46.2+/-5.6 years) and 21 sex and age- matched control group (10 men, 11 women, ages 48.6+/-5.4 years). RESULTS: 1) Post exercise t-PA antigen increased in both diabetic group (from 7.36+/-3.89 to 10.62+/-4.81 ng/ml, p0.05) and control group (from 30.04+/-10.40 ng/ml to 31.06+/-10.88 ng/ml, p>0.05). 3) In diabetic group, significant correlations between base line PAI-1 antigen levels and serum triglyceride levels were observed. And post exercise PAI-1 antigen levels were correlated with systolic blood pressure. CONCLUSION: The results show that plasma t-PA antigen level is increased after vigorous exercise in patients with type 2 diabetes mellitus and plasma PAI-1 antigen level is not changed. The increment of plasma t-PA level is not different with healthy subjects.

Association of Chlamydia Pneumoniae Strain TWAR Antibody and Angiographically Demonstrated Coronary Artery Disease

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (ENGLISH=Ptimes-i or =1:128) antibody titers.

Association of Chlamydia Pneumoniae Strain TWAR Antibody and Angiographically Demonstrated Coronary Artery Disease

BACKGROUND: A recent case-control study from Finland reported a strong relationship between high antibody titers to Chlamydia pneumoniae , strain TWAR, and both chronic heart disease and acute myocardial infarction. Other studies also suggested an association between C. pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not been yet regarded as an established theory. The objective of this study was to investigate the relationship between C. pneumoniae immnoglobulin G antibody titers and angiographically diagnosed coronary artery disease. METHOD: Coronary angiography was performed. Controls (n=89) were coronary angiographically normal cases and coronary artery disease (n=115) was diagnosed if coronary artery luminal diameter is obstructed more than 50% in more than one coronary artery. Micro-IF assay was used to measure C. pneumoniae TWAR antibodies. The sera were titrated in two-fold dilutions starting from 1 in 8, and a titre of 1 in 8 or more was judjed positive. RESULTS: The estimated risk of coronary artery disease, adjusted for age and gender, was greater among subjects with high (> or =1:128) antibody titers than with low (ENGLISH=Ptimes-i or =1:128) antibody titers.

A case of arteriovenous type cardiac hemangioma

Cardiac hemangiomas are rare primary tumors of the heart and constitute only 2.8% of primary cardiac tumors. They are classified into capillary, cavernous, epitheloid and arteriovenous type and the last one is the most uncommon type. We experienced a case of cardiac hemangioma which was diagnosed as arteriovenous type for the first time in Korea in the literature. The patient was a 54-year-old woman who presented with palpitation and anterior chest pain. The diagnosis was based upon coronary angiography which showed two tumor blushings located in the interatrial and interventricular septum with venous drainage to the coronary sinus and right atrium. Associated atrial fibrillation with rapid ventricular response was controlled with digitalis.

Left Ventricular Geometry in Essential Hypertensive Patients Versus Hemodialysis Patients

BACKGROUND: In end stage renal disease, left ventricular hypertrophy developed frequently due to volume and pressure overload and other unclarified precipitating factors which could not be seen in essential hypertension. It is now well established that left ventricular hypertrophy and patterns of left ventricular geometry can influence the prognosis in essential hypertension. The aim of present study was to investigate the characteristics and prognostic significance of left ventricular hypertrophy and geornetrir patterns in hemodialysis patients and to compare them with essential hypertension group. METHOD: One hundred and forty essential hyertensive patients and forty eight hemodialysis patients were enrolled and their left ventricular geometric patterns(normal, roncentric remodeling, concentric hypertrophy, eccentric hypertrophy) were compared. RESULTS: 1) Mean age was higher in essential hypertension group(57.3+/-13.5 years versus 48.8+/-11,2 years) but the left ventricular mass index was higher in hemodialysis group(126.0+/-35.3g/m versus 142.6+/-44.4g/m, p=0.01). 2) Among left ventricular geometric patterns in hemodiaysis patients, only the prevalence of concentric hypertrophy was higher statistically compared with essential hypertensive patients(p= 0.014). 3) In essential hypertension group, age(B=0.18, p=0.016), systolic blood pressure(B=0.40, p<0.01) and total peripheral resistance(B=- 0.45, p<0.01) were correlated with left ventricular mass index. On the other hand, mean blood pressure(B=0.38, p<0.01), heart rate(B=- 0.39, p=0.012) and total peripheral resistance(B= - 0.70, p<0.01) were correlated with left ventricular mass index in hemodialysis group. 4) The hemodynamic characteristics of left ventricular hypertrophy were similar in both groups. Cardiac index was lowest and total peripheral resistance was highest in concentric remodeling. Left ventricular mass index, left ventricular septal and posterior wall thickness were highest in concentric hypertrophy and left ventricular internal dimension was highest in eccentric hypertrophy. 5) Comparing the difference between pre- and post-dialysis, only norrnal pattern slightly showed decreased left ventricular internal dimension in diastole, increased relative wall thickness and increased fractional shortening. CONCLUSION: It is considered that the characterization of geometric patterns of left ventricular hypertrophy and investigation of its precipitating factors in essential hypertensive patients and hemodialysis patients mll be helpful to improve their mortality and morbidity.

Vocal Cord Paralysis in Patent Ductus Arteriosus and Primary Pulmonary Hypertension

Nowadays left vocal cord paralysis is a rare presenting sign of cardiovascular diseaes, associated with pulmonary hypertension. This condition is known as Cardiovocal syndrome. The mechanism of this condition is thought to be due to compression of the recurrent laryngeal nerve by a dilated, tense pulmonary artery against its adjacent structure. Two patients complaining hoarseness were proven to have cardiovascular diseases. The one had patent ductus arteriosus and the other had primary pulmonary hypertension. A causal relation between cardiovascular problem and the vocal cord paralysis is proposed. We describen two cases of Cardiovocal syndrome with a review of the literature.

Evaluation of Correlation between Automatic Ocillometric Sphygmomanometer and Standard Korotkoff Auscultatory Sphygmomanometer

BACKGROUND: Early diagnosis and treatment of hypertension is imperative to prevent the complications associated with this condition. The development of accurate and convenient methods of blood pressure measurement, therefore, is indispensible. At present, the JNC V has acknowledged the use of automatic sphygmomanometer that can be used without the help of someone else. We compared automatic oscillometric sphygmomanometers manufactured by Sein Electronics, korea(SE-7000 and SE-5000) with the standard Korotkoff auscultatory mercuy sphygmomanometer meter. The correlation between these two methods were calculated to determine whether these products could actually be used in clinical practice. This study was undertaken to ensure the clinical evaluation of these two products and standardization of an antomatic sphygmomanometer in korea before it is actually used. METHODS: The study included eighty-three patients, ranging in age from 14 to 81 years, who were admitted to Hanyang University Hospital in October, 1995. The blood pressure measured by the automatic oscillometric sphygmomanometer(SE-7000) in the right arm and was compared with that measured by the standard mercury sphygmomanometer(baumanometer) in the left arm. Also the blood pressure measured by the automatic oscillometric sphygmomanometer(SE-5000) at the wrist was compared by the baumanometer in the same side arm. The correlation between these methods were determined by the paired Student`s t-test and by the simple liner regression method. RESULTS: The p value of systolic blood pressure between two methods(SE-7000 and baumanometer) in the both arms was 0.896 and correlation coefficient was 0.8286. The p value of diastolic blood pressure between this two methods was 0.352 and correleation coefficient was 0.7455. The p value of systolic blood pressure between two methods(SE-5000 and baumanomter) by the arm and the wrist was 0.00018 and correlation coefficient was 0.8588, the p value of diastolic blood pressure between this two methods was 0.000048 and correlation coefficient was 0.5944. CONCLUSION: The blood pressure measured by the SE-5000 at the wrist was statistically different from that measured with the baumanometer in the arm. Further studies are necessary to use this product in clinical practice. However, the systolic and diastolic blood pressures measured with the SE-7000 in the arm were relatively similar to those measured by the baumanometer enabling this products to be effectively used in clinical practice.

Left Ventricular Geometric Patterns of Dippers and Non-Dippers in Essential Hypertension

BACKGROUND: One of the unique feature of ambulatory blood pressure monitoring is its ability to describe the variations of BP throughout the day and night. Left ventricular hypertrophy and other measures of target organ damage in hypertension are more closely related to the average 24-h BP than to clinic BP. In addition to the mean levels of BP, the characteristics of the 24-h BP profile might be a further determinant of organ in essential hypertension. METHODS: Data were obtrained from 105 patients with essential hypertension and 44 normal subjects. Echocardiography and 24 hour ambulatory blood pressure monitoring were performed in all subjects. At first, relative wall thickness(RWT) and left ventrcular mass index were calculated from normal subject and normal values(RWT<0.44, LV mass index,120gm/m2) were applied to hypertensive patients which were classified to dipper and non-dipper according to the result of ambulatory monitoring. RESULTS: 1) There were 49 dippers and 56 non-dipper in hypertensive patients subjects. 2) Among the dippers, left ventricular mass index and relative wall thickness were normal in 51%, whereas 8.2% had increased relative wall thickness with normal ventricular mass(concentric remodeling), 32.7% had increased mass with normal relative wall thickness(eccentric hypertrophy) and 8.2% had typical hypertensive concentric hypertrophy. 3) Among the non-dippers, left ventriculat mass index and relative wall thicksness were normal in 40%, whereas 41.8% had eccentric hypertophy, 16.4% had concentric hypertrophy, only 1.8% had concentric remodeling. 4) The incidence of concentric hypertophy was significantly increased in non-dipper subjects(15.2%) than dippers(8.2%), especially in non-dipper female patients. 5) The incidence of concentric remodeling was increased in dipper(8.2%), especially in dipper female patients. 6) There were no difference between left ventricular geometies in duration of hypertension, ejecton fracton, fractional shortening, and cardiac index. 7) There were no difference between dipper and non-dipper subjects in total peripheral resistance except dipper female patients(1,484+/-535 dynes.s.cm5). CONCLUSION: Patterns of left ventricular hypertophy and geometric remodeling in essential hypertension may not be influenced by the duration of hypertension, but by gender, blood pressure level, diurnal rhythm and total peripheral resistance.

A Case of Turner's Syndrome Associated with Atrial Septal Defect and Mitral Valve Prolapse

We experience a case of 34-year-old Turner's syndrome(45, XO) associated with atrial septal defect(secondum type) and mitral valve prolapse who was admitten due to moderate exertional dyspnea. It is well know hat chromosomal abnormality is one of the etiology of congenital heart disease. In case of Turner's syndrome, coarctation of aorta or bocuspid aortic valve is frequently combined, but atrial septal defect simultaneously with mitral valve prolapse is not reported till now in Krea. We report this case with a brief review of the literature.

Hemodynamic Effects of Intravenous Enoximone in Moderately Severe Congestive Heart Failure

BACKGROUND: This clinical trial was performed to evaluate the hemodynamic and side effects of enoximone, a newly developed phosphodiesterase inhibitor, in moderately severe congestive heart failure in Korean population and to base the development of long acting oral preparations in the future. METHODS: Principal admission criteria for this trial were a left ventricular ejection fraction of less than 45% by radionuclide ventriculography, NYHA functional class II or III and a documented congestive cardiomyopathy. Exclusion criteria were restrictive cardiomyopathy, valvular heart disease, multisystemic lillness and uncontrolled ventricular tachyarrhythmia. The hemodynamic measurements were made by using the thermodilution Swan-Ganz catheter and radial arterial canulation. Enoximone was administered(continuous infusion) for 24 hours after initial bolus. The hemodynamic parameters to be observed were blood pressure, heart rate, cardiac output, pulmonary capillary wedge pressure, systemic and pulmonary vascular resistance. The clinical reponse, hematology, blood chemistry, and Holter monitoring were checked before and after enoximone trial. RESULTS: The following results are obtained. 1) The included patients were 15 females, 24 males, total 39 patients and mean age of 55.3 years old(28-70 years old). 2) The causes of congestive cardiomyopathy were idiopathic 35(89.9%), hypertensive 3(7.7%), and alcoholic 1(2.6%). 3) The mean ejection fraction measured by radionuclide left ventriculography were 28. 6%. 4) THe cardiac output was significantly increased(50%), and pulmonary capillary wedge pressure(38%), systemic vascular resistance(34%), pulmonary vascular resistance(27%) were significantly decreased during enoximone infusion. 5) NYHA Functional Class was improved by 1 step with enoximone. 6) There were no significant changes in hematology, blood chemistry, and Holter monitoring with enoximone. CONCLUSION: From the above results, the short term intravenous enoximone was very effective in moderately severe congestive heart failure in congestive cardiomyopathy without major adverse effects in Korean.

A Case of Bland-White-Garland Syndrome

The congenital anomalous origin of the left coronary artery arising from the pulmonary artery, or the Bland-White-Garland syndrome, is uncommon but frequently lethal lesion of both children and adults. In several series, it has a frequency of 0.26-0.46% of all congenital cardiac defects. The mortality rate among infants and children without operation has been eighty to ninety percent. Survival to teen-age and adult has been infrequent ; review of the literature regarding this anomaly in Korean disclosed only 3 cases in infants and children and 2 cases in adults. In a 45-year-old male with palpitation and effort angina, the anomalous origin of the left coronary artery from the pulmonary artery was diagnosed by echocardiogram and coronary arteriography.

Antihypertensive Effects and Safety of Isradipine in Patients with Essential Hypertension

BACKGROUND: Antihypertensive treatment represents the modification of one of the most important risk factors on the development of cardiovascular, cerebrovascular and peripheral vascular disease. In cases of markedly developed atherosclerosis, reduction of blood pressure can improve the survival of patients by reducing the incidence and/or severity cerebrovascular events. We studied a new dihydropyridine calcium antagonist isradipine to evaluate the efficacy and safety in patients with essential hypertension. METHOD: After a placebo run-in phase of four weeks duration, 2.5mg isradipine once daily orally was administered for four weeks to 84 patients (48 males, 36 females ; mean age ; 50.8 years). And then 5.0mg isradipine once daily was administered for four weeks to 59 patients whose diastolic pressure did not decrease less than 90 mmHg. RESULTS: 1) At the end of 8 weeks of therapy, systolic and diastolic blood pressure were significantly reduced from 158.2+/-11.5/101.7+/-5.1mmHg in sitting, 156.8+/-13.7/102.3+/-5.6mmHg in standing to 138.3+/-13.8/90.1+/-6.7mmHg in sitting, 137.6+/-13.7/91.2+/-7.6mmHg in standing (p<0.001). And the effectiveness rate was 84.3% in sitting, 83.2% in standing and normalization rate below 90mmHg in diastolic pressure was 67.5% in siting and 61.5% in standing position. 2) The sitting and standing pulse rate did not change significantly (72.7+/-7.4beats/min at baseline vs. 73.4+/-6.8 beats/min after 8 weeks trial in sitting, 73.5+/-7.2beats/min at baseline vs. 74.1+/-7.2 beats/min after 8 weeks trial in standing). 3) The reduction of mean systolic and diastolic blood pressure at the end of 8 weeks were 19.9/11.6mmHg in sitting and 19.2/11.1mmHg in standing. 4) At the end of 8 weeks the successes of therapy in sitting were 67.5% in excellent, 10.8% in good, and 6.0% in fair response. 5) There was no serious side effect except mild symptom of 5 cases(5.9%) of exertional dyspnea and one episode of (1.2%) tachycardia. CONCLUSION: These results indicate that isradipine is effective and safe antihypertensive agent in the treatment of essential hypertension.

A clinical study on the anti-Hypertensive effect of cilazapril in patients with mild to moderate essential hypertension

BACKGROUND: In order to investigate the efficacy and safety of cilazapril, a recently developed angiotensin converting enzyme inhibitor, a clinical study was performed in the patients with mild to moderate essential hypertension. METHODS: The study subject consisted of 31 patients with diastolic blood pressure of 95mmHg~115mmHg (mean age : 56.0+/-8.1 years, 16 males and 15 females). Cilazapril was administered orally in a daily dose of 2.5mg~5.0mg Q.D. for 8 weeks. During cilazapril medication, anti-hypertensive efficacy, side effects and laboratory changes were monitored. RESULTS: Cilazapril decreased blood pressure from baseline value of 162.2+/-4.7/98.4+/-2.8mmHg to 144.6+/-10.0/89.7+/-5.7mmHg after 4weeks of medication (p<0.05) and 138.2+/-4.5/87.8+/-4.0mmHg after 8 weeks of medication (p<0.05). Heart rate change was not significant (72.3+/-4.7/min vs 71.7+/-3.6/min). Body weight change was not significant (66.6+/-9.8 Kg vs 66.8+/-9.9 Kg). There were no significant change in blood chemistry and hematologic examination except mild elevation of alanine transaminase and serum creatinine values but these date were within normal ranges. The side effects were dry cough (4 case, 12.9%), headache (2 case, 6.4%), indigestion (1 case, 3.2%) and dry mouth (1 case, 3.2%). One patient dropped out due to severe dry cough but others were mostly mild in nature. CONCLUSIONS: Cliazapril 2.5mg~5.0mg once daily regimen was effective and well tolerated in patients with mild to moderate essential hypertension.

Effect of Cadmium Chloride on the Cardiac Muscle Ultrastructure in Rats

BACKGROUND: Cadmium, an environmental pollutant, has implicated in the pathogenesis of cardiovascular diseases. Biochemical and pathophysiological changes characterized by arterial hypertension, accelerated cholesterol plaque formation on arterial walls, cardiac conduction abnormalities, and reduction in myocardial contractility have been reported in experimental animals chronically exposed to low concentration of cadmium. This study was undertaken to evaluate the ultrastructural changes of the cardiac muscle in rats exposed to cadmium chloride and to ascertain whether these changes are modified after discontinuation of cadmium feeding. METHOD: Wistar strain rats(body weight 200~250gram) were injected intraperitoneally once weekly with 3.75mg/kg of cadmium chloride for 10 weeks and were sacrificed at 1 day, 1 week and 2 weeks after discontinuation of cadmium administration. RESULT: Ultrastructure if rat cardiac muscle fibers after cadmium administration revealed that mitochondria were increased in number and their cristae were severely damaged. Cardiac myofibrils and myofilaments were reduced. Z-disc were partly dislocated and A-bands and I-bands were not clearly defined. Irregularly arranged intercalated disc and disrupted sarcolemma were also found. These structural alterations resulting from cadmium feeding were partly reduced after removal of cadmium exposure for 2 weeks. These structural alterations resulting from cadmium feeding were partly reduced after removal of cadmium exposure for 2 weeks. CONCLUSIONS: It is suggested that exposure to cadmium chloride was associated with cardiac ultrastructural changes which might be responsible for physiologic abnormalities and these alterations may be partly reversible after discontinuation of cadmium administration.