[Clinical effect of arotinolol hydrochloride and its influence on renal function in elderly patients with essential hypertension].

Arotinolol hydrochloride with alpha-and beta-receptor blocking action, developed in Japan, is mainly used for the treatment of hypertension. The study population consisted of 42 outpatients with essential hypertension with a blood pressure greater or equal to 160/96 mmHg. 10 men and 32 women, with a mean age of 77.5 year. The patients received 10 mg arotinolol hydrochloride daily for 24 weeks which was taken orally twice a day. We evaluated the changes of blood pressure, heart rate and chief complaints of patients before and every 4 weeks during treatment and the renal function before, 12 weeks after and 24 weeks after, the administration of arotinolol hydrochloride. Blood pressure and heart rate decreased significantly after 4 weeks of treatment with arotinolol hydrochloride (p < 0.05). However, no significant changes were found in blood urea nitrogen, serum creatinine, serum albumin, beta2-microglobuline, NAG or creatinine clearance during the 24 weeks of treatment. These results indicate that arotinolol hydrochloride has antihypertensive effects without renal dysfunction in elderly patients with essential hypertension.

[Multicenter prospective survey of prognosis of hypertensive elderly outpatient under antihypertensive treatment--morbidity and mortality of cardiovascular diseases and cancer].

Although calcium-channel blockers and angiotensin-I-converting enzyme inhibitors are often used for treatment of hypertension in the elderly in Japan compared to those in the United States and in European countries, there have been few investigations on the prognosis of the elderly receiving these antihypertensive treatments. The Research Group for "Guidelines on the Treatment of Hypertension in the Elderly" collaborated with the Comprehensive Research Projects on Aging and Health group of the Ministry of Health and Welfare of Japan in performing a 3-year survey on the outcome of 700 hypertensive elderly outpatients (> or = 60 years) receiving treatment of antihypertensive drugs. Antihypertensive drugs including dihydropyridine-type calcium channel blockers, beta blockers, angiotensin-I-converting enzyme inhibitors, diltiazem, diuretics and old-type antihypertensives (hydralazine, budralazine, and centrally acting drugs such as clonidine, methyldopa and guanabenz) were administered to 71.3%, 30.4%, 26.2%, 14.0%, 8.6%, and 6.4% of the 642 elderly patients surveyed for three years, at the time of registration, respectively. Morbidity and mortality rates of total cerebro-cardiovascular diseases, stroke, and heart diseases, were 27.6 and 7.81/1,000 patient-years, 15.1 and 3.6/1,000 patient-years, 10.4 and 4.2/1,000 patient-years, respectively. These results were similar or even better than those of megatrials of antihypertensive treatments for elderly patients in Europe and United States. After adjustment for potential confounding factors, multiple logistic analysis revealed that a past history of ischemic heart disease, use of the old-type antihypertensive drugs, male gender, and diastolic high blood pressure were independent risk factors for the morbidity of cerebro-cardiovascular diseases taking the group of non-cerebro-cardiovascular disease as the reference group. We also identified 22 cases of newly occurred malignancies including 7 fatal cases. However, none of the antihypertensives was significantly related to the occurrence of malignancies. These results lead support to the tendencies in the use of antihypertensive drugs in Japan.

Impaired endothelial function in hypertensive elderly patients evaluated by high resolution ultrasonography.

BACKGROUND: Multiple investigations both in experimental models and in middle-aged patients with essential hypertension have demonstrated impaired endothelium-dependent vasodilation. OBJECTIVE: To determine whether hypertension exerts an additional negative effect on endothelial function of large arteries in hypertensive elderly patients who may already be affected by endothelial dysfunction due to aging. PATIENTS AND METHODS: Thirteen elderly patients with hypertension (69 9 years of age [mean SD]) were compared with 13 matched healthy elderly subjects (72 6 years of age). High resolution vascular ultrasound was used to measure brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and to sublingual nitroglycerine (causing endothelium-independent dilation). RESULTS: Flow-mediated diameter (FMD) was significantly impaired in the hypertensive elderly group (6.7 3.3% versus 13.3 3.8% in the control group, P<0.05). No significant difference could be found in nitroglycerine-induced dilation between the elderly control group (12.1 4.9%) and the hypertensive elderly (10.2 6.8%). On simple linear analysis, FMD was inversely correlated with age (r=-0.60, P=0. 03) in the healthy elderly group. FMD in the hypertensive elderly was inversely related to age (r=-0.41, P=0.04) and mean blood pressure (r=-0.67, P=0.01). CONCLUSIONS: This study showed decreased FMD with aging even in the healthy elderly, with a further decline in hypertensive elderly compared with healthy elderly subjects. This impairment of FMD in the hypertensive elderly group was related to age and mean blood pressure, indicating that aging and hypertension may impair endothelial function in the brachial artery of elderly patients with hypertension.

[An elderly patient with an insulinoma who had prolonged dementia-like symptoms].

A 77-year-old woman had suffered from memory disturbance and disorientation for two years before she was admitted to the hospital because of confusion. Her score on the Hasegawa dementia scale revised (HDS-R) was 12 points at the time of the first medical examination. No other abnormalities could be found except for a blood glucose concentration of 34 mg/ dl. A Magnetic Resonance Image (MRI) of the brain showed some small lacunae on both sides in the frontal white matter and basal ganglia. After hospitalization, glucose was administered and the blood glucose concentration increased, but the dementia-like symptoms did not resolve. She was discharged because the symptoms were too difficult to control in the general hospital. Although dementia-like symptoms were present even after discharge, they did not necessarily appear during fasting. Six months later she was rehospitalized. The insulin-blood sugar ratio was at least 0.3 and abdominal echogram showed a 1-cm tumor at the tail of pancreas. The pancreas tail was removed and the tumor cells were reacted with anti-insulin-antibodies. One month after the operation, the dementia-like symptoms had resolved. The HDS-R score was improved to 27 points (normal range) 40 days after the operation. The amount of the slow waves in the electroencephalogram decreased 5 months after the operation. The dementia-like symptoms observed in this case could be regarded as the Durchgangssyndrom of Wieck. This syndrome is observed transiently at the time of recovery of deterioration of disturbances of consciousness. But it is treatable. This patient was an interesting case that showed Durchgangssyndrom mimiking dementia associated with insulinoma.

Determination of mitral valve area in patients with mitral stenosis by the flow-convergence-region method during changing hemodynamic conditions.

Twenty-eight patients with mitral stenosis underwent Doppler echocardiography at rest and during exercise to determine the accuracy of mitral valve area determination by the flow-convergence-region method during exercise-induced changing hemodynamic conditions. The mitral valve area calculated by using the flow-convergence-region method correlated strongly with that measured by the Gorlin formula both at rest (r = 0.85) and during exercise (r = 0.92) for all 28 patients studied. Although mitral valve area obtained by the flow-convergence-region method did not change (p = 0.1) in 16 patients with echocardiographic mitral scores > or = 12, it increased significantly during exercise (p = 0.0001) in 12 patients with echocardiographic mitral scores < 12. This study suggests that in mitral stenosis, the mitral valve area can be accurately estimated by the flow-convergence-region method both at rest and during changing hemodynamic conditions induced by supine bicycle exercise.

[Echocardiographic assessment of the effect of aging on the diastolic and systolic functions of the left ventricle].

The effects of aging on the diastolic and systolic functions of the left ventricle were studied by echocardiography as follows. (1). Maximum velocity of circumferential fiber lengthening (negative peak Vcf) and shortening (peak Vcf) was assessed by digital M-mode echocardiography in 20 healthy young subjects and 26 healthy elderly subjects. The mean value of negative peak Vcf (-cir/sec) was -3.87 +/- 0.85 in the 20's. -4.48 +/- 1.14 in the 30's, -3.71 +/- 1.21 in the 40's, -2.70 +/- 0.90 in the 60's, -2.57 +/- 0.64 in the 70's, -2.33 +/- 0.77 in the 80's and -2.57 +/- 0.65 in the 90's showing significant difference among young and elderly groups (p less than 0.05- p less than 0.005). The mean value of peak Vcf showed no significant difference among young and elderly groups except for the group in the 30's which showed significant (p less than 0.05) difference between other groups. (2). Indices of the left ventricular systolic and diastolic functions were calculated by standard M-mode echocardiographic technique in 227 healthy subjects from 5 to 94 years in age by dividing them into 3 young groups and 4 elderly groups. As for the left ventricular internal diameters a tendency of increase was observed in the end diastolic diameter of the left ventricle in accordance with ageing. Fractional shortening of the left ventricular diameter which ranged from 36.2% to 36.7% in the 3 young groups and 36.9 to 40.3% in the 4 elderly groups and cardiac output showed no age dependent decrease.(ABSTRACT TRUNCATED AT 250 WORDS)