[ effect of renal arteries sympathectomy on refractory hypertension]

Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension [HTN]. We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension. In this prospective cohort study, patients who received three or more antihypertensive medications with 160mmHg systolic blood pressure [BP] or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects. One hundred and seventeenth patients [54%] out of 212 screened patients were included in the first group [renal denervation] and 95 patients as the second group. The mean of BP changes in the first group was 35.15 mmHg with standard deviation of 22.11mmHg. [P<0.001] in the second group, the mean changes of BP was not statistically significant. [5.0mmHg +/- 22.11, P=0.79 for systolic BP and P=0.96 for diastolic BP].92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls [P=0.001]. There was no observed complication after denervation in the first group. It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.

[Effects of simvastatin with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia: a brief report]

Various therapeutic protocols have been recommended for treating dyslipidemia, particularly in patients with coronary artery disease. The purpose of this study was to assess the efficacy of statin use with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia. This clinical trial was conducted on 124 patients with coronary artery disease and dyslipidemia in Baqiyatallah Hospital in Tehran, Iran during 2008 to 2010. The first group of patients [64] received simvastatin [20 mg] and fenofibrate [200 mg] with low lipid diet and exercise while the second group [60] only received simvastatin with low lipid diet and exercise for one year. The mean age of the participants was 54.3 +/- 6.5 years. The first group showed significant changes in lipid profile and left ventricular ejection fraction [LVEF], [P<0.05]. Left ventricular diastolic function parameters showed no significant changes in both groups upon 12 months of treatment. The results of this study show, one-year treatment by simvastatin and fenofibrate can be effective on lipid profiles, and improve LVEF with resultant positive effect on heart function

Echocardiographic and exercise test findings in patients with dyslipidemia and coronary artery disease before and after treatment with simvastatin with or without fenofibrate

Various treatment protocols for dyslipidemia and coronary artery disease have been suggested. In spite of lipid-lowering effects, various effects of statins and fi-brates have been reported in the literature. The aim of this study was to assess the cardiac efficacy of Simvastatin with or without fenofibrate on cardiac function. A cohort study was conducted on 124 patients with dyslipidemia and coronary artery disease. Patients were randomly divided into two groups: the first group [n = 64] received Simvastatin [60 - 20 mg/day] and fenofibrate [200 mg/day], and the second group [n = 60] received Simvastatin [20 - 60 mg/day] alone. Treatment lasted l year, and the patients were evaluated after treatment. The mean age was 54.3 + 6.5 years, and 53.2% of patients were male. Compared to baseline, after 12 months of treatment the lipid profiles of both groups decreased significantly [P< 0.05]. The change in left-ventricular ejection fraction in the first group was statistically significant [P = 0.01]. The exercise test time and metabolic equivalent of tasks index significantly increased in the first group [P = 0.014, P = 0.006], but these changes were not significant in the second group [P = 0.289, P = 0.744]. Lipid-regulating therapies including Simvastatin and fenofibrate improved myocardial function and reduced myocardial ischemia, so combined therapy is recommended for treating dyslipidemia in high-risk patients for cardiovascular problems