Genetic factors associated with elevation of uric acid after treatment with thiazide-like diuretic in patients with essential hypertension.

We investigated changes in blood pressure (BP) and metabolic adverse effects, especially elevation of uric acid (UA), after treatment with a thiazide-like diuretic (TD) in patients with essential hypertension. Furthermore, the role of genetic factors in the elevation of UA by TD was assessed by a 500 K SNP DNA microarray. The subjects included 126 hypertensive patients (57 women and 69 men, mean age 59 ± 12 years) who registered for the GEANE (Gene Evaluation for ANtihypertensive Effects) study.

Factors Associated with Outcomes of Percutaneous Transluminal Renal Angioplasty in Patients with Renal Artery Stenosis: A Retrospective Analysis of 50 Consecutive Cases.

Background: The results of recent trials have brought some confusion to the treatment strategy for renal artery stenosis (RAS). To evaluate the applicability of percutaneous transluminal renal angioplasty (PTRA) for RAS, we extracted the factors that may affect the effectiveness of PTRA from cases experienced at a hypertension center.

Methods And Results: We retrospectively assessed the blood pressure (BP) lowering effects and renoprotective effects in 50 consecutive patients that had hemodynamically significant RAS and had undergone PTRA and stenting during 2001-2005.

Association of intima-media thickening of carotid artery with genetic polymorphisms of the regulator of G-protein signaling 2 gene in patients with hypertension and in the general population.

Regulator of G-protein signaling 2 (RGS2) is a key molecule in signal pathways of vasoactive peptides, such as angiotensin II and endothelin 1, and is believed to have an important role in the pathophysiology of atherosclerosis. We have previously reported that common polymorphisms of RGS2 are associated with hypertension in Japanese. In this study, we studied whether the three previously identified common polymorphisms of RGS2 (-638A>G, 1026T>A and 1891-1892delTC) could be implicated in carotid atherosclerosis in Japanese patients with hypertension (459 men and 382 woman) and in a Japanese general population (814 men and 956 woman).

Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease.

Background: Plasma B-type natriuretic peptide (BNP) is a diagnostic and prognostic marker in heart failure (HF). Although renal function is reported as an important clinical determinant, precise evaluations of the relationships of renal function with hemodynamic factors in determining BNP have not been performed. Therefore, we evaluated the association of plasma BNP concentrations with LV end-diastolic wall stress (EDWS) in a broad range of HF patients including those with chronic kidney disease (CKD) and end-stage renal disease (ESRD).

Genetic polymorphisms of L-type calcium channel alpha1C and alpha1D subunit genes are associated with sensitivity to the antihypertensive effects of L-type dihydropyridine calcium-channel blockers.

Background: The response of blood pressure (BP) to L-type dihydropyridine calcium-channel blockers (dCCBs) differs among individuals.

Methods And Results: A pharmacogenomic analysis was undertaken in 161 patients with essential hypertension who were treated with dCCBs to study whether genetic polymorphisms of the calcium channel alpha1C and alpha1D subunit genes, CACNA1C and CACNA1D, are associated with the antihypertensive effects of dCCBs. Responders were defined as those in whom systolic BP (SBP) was lowered by more than 20 mmHg or diastolic BP (DBP) was lowered by more than 10 mmHg after treatment with dCCBs.

Renal artery stenosis and renal parenchymal damage in patients with abdominal aortic aneurysm proven by autopsy.

Background: Chronic kidney disease is a major risk factor for patients with cardiovascular diseases (CVD). The aim of this study is to evaluate the relationship between clinical characteristics and renal histology in patients with abdominal aortic aneurysm (AAA).

Methods: We studied 79 cases with AAA autopsied at the National Cardiovascular Center.

The cutoff value of aldosterone-to-renin ratio for the diagnosis of primary aldosteronism in patients taking antihypertensive medicine.

Background: Primary aldosteronism (PA) may account for as much as 6-20% of cases of refractory hypertension referred to hypertension clinics. Because antihypertensive agents affect the physiologic renin-angiotensin-aldosterone system, screening diagnostic tests for PA are generally performed after antihypertensive agents are discontinued. However, such tests can be dangerous for patients with severe hypertension or other cardiovascular complications.

Plasma B-type natriuretic peptide levels reflect the presence and severity of stable coronary artery disease in chronic haemodialysis patients.

Background: Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality in haemodialysis (HD) patients. Although the plasma B-type natriuretic peptide (BNP) levels may be a strong marker of long-term mortality in HD patients, what plasma BNP levels reflect is not well known in this setting. Therefore, we examined the relationship between plasma BNP levels and the presence and severity of stable CAD based on coronary angiography (CAG) in chronic HD patients.

Associations of hypertension and its complications with variations in the xanthine dehydrogenase gene.

Hyperuricemia and oxidative stress participate in the pathophysiology of hypertension and its complications. Xanthine dehydrogenase (XDH) produces urate and, in its oxidase isoform, reactive oxygen species. Here we have studied whether or not the genetic variations in XDH could be implicated in hypertension and its complications.

Decreased coronary flow reserve in haemodialysis patients.

Background: Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work.

Methods: Forty-one patients who had already undergone coronary angiography were studied. They consisted of 21 haemodialysis patients with no significant left anterior descending coronary artery (LAD) stenosis and 20 non-renal failure patients without LAD stenosis.

Relationship between insulin resistance and the renin-angiotensin system: analysis for patients with essential and renovascular hypertension.

Insulin resistance is frequently observed in patients with essential hypertension (EHT), and the renin-angiotensin system (RAS) has been demonstrated to modulate the status of insulin resistance. The aims of present study are to investigate the relationship between systemic RAS and insulin resistance in 82 patients with EHT and compare the impact of RAS to insulin resistance with 10 renovascular hypertension (RVHT) patients who have a highly activated systemic RAS. From patients who were admitted to our hospital, patients with overt diabetes and hypertensives who had secondary HT except RVHT or chronic renal failure were excluded.

Brain natriuretic peptide in hemodialysis patients: predictive value for hemodynamic change during hemodialysis and cardiac function.

Background: Though brain natriuretic peptide (BNP) is widely used as a clinical marker of cardiac function, there is considerable confusion in the interpretation of its value in hemodialysis (HD) patients whose BNPs are often elevated without cardiac diseases. The aim of the present study is to examine the predictive value of BNP for blood pressure (BP) fall during HD and cardiac function.

Methods: Subjects consisted of 205 (160 males, 45 females; age 66.

Midregional proadrenomedullin reflects cardiac dysfunction in haemodialysis patients with cardiovascular disease.

Background: Although adrenomedullin is an indicator of cardiac dysfunction in haemodialysis patients, the clinical significance of midregional proadrenomedullin has not been elucidated. Objectives. We evaluated whether midregional proadrenomedullin reflects cardiac dysfunction, systemic inflammation or blood volume in haemodialysis patients.

Effect of early nephrology referral on the initiation of hemodialysis and survival in patients with chronic kidney disease and cardiovascular diseases.

Background: The timing of referral to nephrologists is highly variable in patients with chronic kidney disease (CKD). The impact of early referral on the timing of hemodialysis (HD) and mortality in the patients with CKD and cardiovascular diseases (CVD) was evaluated in this present study.

Methods And Results: A total of 366 patients with CKD and CVD began HD at the National Cardiovascular Center between 1983 and 2003, and survival was followed until 2005.

Reverse white-coat effect as an independent risk for microalbuminuria in treated hypertensive patients.

Background: The influence of the converse phenomenon of white-coat hypertension called 'reverse white-coat hypertension' or 'masked hypertension' on hypertensive target organ damage has not been fully elucidated. The present study assessed the hypothesis that this phenomenon may specifically associate with microalbuminuria, a marker of early renal damage, in treated hypertension.

Methods: A total of 267 treated essential hypertensive patients (133 men and 134 women; mean age, 66 years) without renal insufficiency or macroalbuminuria were enrolled in this study.

Masked hypertension and target organ damage in treated hypertensive patients.

Background: Recent studies have shown that an elevated ambulatory or home blood pressure (BP) in the absence of office BP-a phenomenon called masked hypertension-is associated with poor cardiovascular prognosis. However, it remains to be elucidated how masked hypertension modifies target organ damage in treated hypertensive patients.

Methods: A total of 332 outpatients with chronically treated essential hypertension were enrolled in the present study.

Renal function in patients with abdominal aortic aneurysm. Comparison with hypertensive patients.

Aims: Renal dysfunction occurs occasionally after the repair of abdominal aortic aneurysm (AAA), and preoperative renal function is considered as one of the potential causes. The present study was designed to evaluate and compare renal function and risk factors of AAA patients with those of hypertensive patients.

Methods: We prospectively examined 95 patients with AAA and 72 patients with essential hypertension (HT) without other cardiovascular diseases (CVD).

Positive correlations between cerebral choline and renal dysfunction in chronic renal failure.

Introduction: Cerebral metabolism in chronic renal failure (CRF) patients has not been fully evaluated. This study examined cerebral metabolites in CRF, using proton magnetic resonance spectroscopy (MRS).

Methods: Subjects comprised 19 CRF patients and 21 healthy volunteers.

Primary aldosteronism combined with preclinical Cushing's syndrome in an elderly patient.

Pre-clinical Cushing's syndrome (pre-CS) is sometimes seen with adrenal cortical tumors. An 80-year-old woman had severe hypertension and hypokalemia, the typical clinical features of primary aldosteronism, but detailed hormonal examinations revealed the accompanying pre-CS. After adrenalectomy by laparoscopy, her blood pressure was remarkably reduced and the hypokalemia also recovered.

Life-threatening hyperkalemia during a combined therapy with the angiotensin receptor blocker candesartan and spironolactone.

We describe a hypertensive nephrosclerosis patient presenting with severe hyperkalemia due to a combination therapy of the angiotensin receptor blocker (ARB) candesartan and spironolactone despite mildly decreased renal function. Recently, ARBs are replacing the ACE inhibitors. The combined therapy with ARB and spironolactone will eventually become the standard regimen.

Relationship between renal artery stenosis and intrarenal damage in autopsy subjects with stroke.

Background: In patients with cardiovascular disease (CVD), renal dysfunction is a risk factor for the prognosis, but substantial evidence is still lacking about the relationship between clinical characteristics and renal histology. The aim of our study was to evaluate the relationship between the extent of renal parenchymal damage, renal artery stenosis (RAS) and clinical characteristics in autopsy subjects with stroke.

Methods: During the 17-year period 1980-1997, 2167 subjects were autopsied at the National Cardiovascular Center.

Adrenomedullin reflects cardiac dysfunction, excessive blood volume, and inflammation in hemodialysis patients.

Background: Plasma adrenomedullin (AM) reflects cardiac dysfunction and predicts survival after myocardial infarction. The present study was designed to investigate whether the mature AM (mAM) reflects status of cardiac function, systemic blood volume, or inflammation in hemodialysis patients with cardiovascular disease, and whether mortality and additional cardiovascular morbidity can be predicted by mAM.

Methods: Plasma levels of mAM, atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), norepinephrine (NE), and C-reactive protein (CRP) before hemodialysis were measured in 67 chronic hemodialysis patients with cardiovascular disease, along with 2-dimensional and Doppler echocardiographic variables.

Asymptomatic renal infarction, due to fibromuscular dysplasia, in a young woman with 11 years of follow-up.

We report a 27-year-old woman with renovascular hypertension, renal infarction, and hepatic artery aneurysm due to fibromuscular dysplasia. The patient was first noted to have renal artery aneurysm and hepatic artery aneurysm at the age of 17. The renal infarction was asymptomatic and was incidentally detected by magnetic resonance imaging (MRI) examination.

QTc dispersion in haemodialysis patients with cardiac complications.

Background And Aims: QTc dispersion (Maximum - Minimum QTc interval on a standard 12-lead electrocardiogram (ECG)) is a useful predictor of tachyarrhythmic events and related sudden cardiac death. Recent studies have reported that QTc dispersion is prolonged in patients receiving haemodialysis (HD), and it is often further prolonged following HD treatment. In the present study, we examine whether the patients who are susceptible to prolongation of QTc dispersion by HD are prone to life-threatening cardiovascular events and related deaths.

The thiazide-sensitive Na(+)-Cl(-) cotransporter gene, C1784T, and adrenergic receptor-beta3 gene, T727C, may be gene polymorphisms susceptible to the antihypertensive effect of thiazide diuretics.

The response of blood pressure to thiazide diuretics (TZDs) differs among individuals. The prediction of the antihypertensive effect of TZDs is important for realizing individualized therapy in the management of hypertension. The aim of this study was to identify the single nucleotide polymorphisms (SNPs) susceptible to the antihypertensive effect of TZDs, particularly focusing on genes related to water-electrolyte absorption in the kidney.