Objective: Although the role of beta blocker in major hypertension guideline is limited, the role of vasodilating beta blocker is suggested to be different from the conventional beta blocker. Despite of many small sized studies for the pharmacological properties, there are few large sized real world data for blood pressure (BP) lowering efficacy of nevibolol in hypertension patients in Asia. Design and method: In the open, non-controlled, prospective, multicenter observational study to identify BEnefits after 24 weeks of NEvibolol administration For essential hypertensIon patients wiTH various co-morbidities and treatment environments in KOREA (BENEFIT-KOREA), 3011 patients was enrolled and 2571 patients (85.3%) completed 24 week follow up. The efficacy of nevibolol was measured according to four prescription patterns, i.e., de novo therapy (n = 279), single drug switching (n = 257), switching for combination therapy (n = 978), and add-on therapy (n = 1057). Results: Age was 63.5 ± 12.9. Female was 40.4% and the elderly aged > 65 was 52.7%. Dyslipidemia, obesity, and diabetes mellitus were noted in 50.5%, 37.4%, and 28.9%. Co-morbidity was noted in 89.1% and majority was ischemic heart disease. Concomitant medication rate for calcium antagonist, ARB/ACEI, diuretics were 54.3%, 53.5/9.2%, and 23.7%. Median dosage of nevobolol was 5 mg. For de novo therapy, BPs decreased from 142.4/84.9 mmHg to 127.9/75.1 mmHg (−13.9/−9.5 mmHg, p < 0.0001). For single drug switching group, BPs decreased from 134.3/78.7 mmHg to 127.1/75.3 mmHg (−7.5/−3.6 mmHg, p < 0.0001). For switching for combination therapy group, BPs decreased from 137.8/80.1 mmHg to 131.6/76.6 mmHg (−6.4/−3.6 mmHg, p < 0.0001). For add-on therapy group, BPs decreased from 146.0/85.5 mmHg to 130.9/76.3 mmHg (−15.0/−9.1 mmHg, p < 0.0001). Adverse drug reaction was noted in 1.2%. Conclusions: Nevibolol was demonstrated to be a comparable drug for switching in single or combination therapies and to be an effective BP lowering drug for de novo or add-on therapies in a real world Asian hypertension patient with aging, cardiovascular risk factors, and co-morbidities.
BACKGROUND:A considerable number of patients with dilated cardiomyopathy (DCM) experience left ventricular reverse remodeling (LVRR).LV global longitudinal strain (LV GLS) offers sensitive and reproducible measurement of myocardial dysfunction.The authors sought to evaluate whether LV GLS at the time of diagnosis may predict LVRR in DCM patients with sinus rhythm and investigate its prognostic role in long-term follow-up in this population.METHODS: We enrolled 160 DCM patients with sinus rhythm who had been initially diagnosed, evaluated, and followed at our institute.We analyzed their medical records and echocardiographic data.RESULTS: During the mean follow-up duration of 37.3 ± 21.7 months, LVRR occurred in 28% of patients (n = 45).The initial LV ejection fraction (LVEF) of patients who recovered LV function was 26.1 ± 7.9%, which was not significantly different from the value of 27.1 ± 7.4% (p = 0.49) in those who did not recover.There was a moderate and highly significant correlation between baseline LV GLS (-%) and follow-up LVEF (r = 0.717; p < 0.001).Using multivariate Cox analysis, LV GLS (hazard ratio: 1.474, 95% confidence interval: 1.170-1.856;p = 0.001) was an independent predictor of LVRR.CONCLUSIONS: We demonstrated that LV GLS was an independent predictor for LVRR and the optimal cut-off point of LV GLS for LVRR was -10% in DCM patients with sinus rhythm.There was a significant correlation between baseline LV GLS and follow-up LVEF.
Amlodipine, widely used as a first-line treatment for hypertension, has inconclusive clinical evidence regarding its efficacy in patients with heart failure. This retrospective cohort study aimed to investigate the clinical effectiveness of amlodipine treatment after hospitalization for heart failure in patients with dilated cardiomyopathy (DCMP).A total of 20,851 patients who were diagnosed with DCMP and admitted for heart failure between 2005 and 2016 according to Korean nationwide medical insurance service database were enrolled. Amlodipine use was defined as its prescription at the time of discharge and for at least 180 days within a year. The primary outcome was all-cause death, and the secondary outcome was heart failure rehospitalization during a 5-year period. The outcomes between patients who received amlodipine (n = 6,798) and those who did not (n = 14,053) were compared.During the 5-year follow-up, the group treated with amlodipine exhibited a significantly lower risk of all-cause death and heart failure rehospitalization than the group not treated with amlodipine [all-cause death: adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.59-0.70, p < 0.001; cardiovascular death: adjusted HR: 0.71, 95% CI: 0.62-0.81, p < 0.001; heart failure rehospitalization: adjusted HR: 0.92, 95% CI: 0.86-0.98, p = 0.006]. In a subgroup analysis, amlodipine had a significant impact on decreasing all-cause mortality in older adults, those with a higher systolic blood pressure, and those with a lower Charlson Comorbidity Index.In summary, amlodipine use after hospitalization for heart failure in patients with DCMP was associated with a lower risk of all-cause death and readmission for heart failure.
The presence of severe pulmonary arterial hypertension (PAH) in patients with atrial septal defect (ASD) is still thought to preclude shunt closure, although there are several reports of good clinical outcomes after vasodilator therapy. We report the case of a young woman with ASD and severe PAH who was able to successfully undergo percutaneous shunt closure following 1 year use of the oral endothelin receptor antagonist, bosentan.
The aim of the present preclinical study was to investigate the capability of a new formulation of biphasic calcium phosphate (BCP) in achieving new bone formation either by itself or in combination with different concentrations of growth factors. Twenty-four 3-month-old male New Zealand white rabbits (weight range, 2.5 to 3.0 kg) that had been bred exclusively for biomedical research purposes and obtained from a licensed vendor were used. Four calvarial defects were created in each animal, for a total of 96 defects. Each defect received alloplastic BCP (Osteon III, Genoss) that was composed of 60% hydroxyapatite and 40% β-tricalcium phosphate) (porosity, ~80%; macropore size, 200 to 400 μm; crystallinity, 95%) combined with different concentrations of recombinant human platelet-derived growth factor BB (rhPDGF-BB), human recombinant basic fibroblast growth factor-2 (rhFGF-2), or recombinant human bone morphogenetic protein-2 (rhBMP-2). A custom-made polycarbonate tube was fixed to each defect site by applying slight pressure, and a mixture of bone graft and growth factor was implanted into the tubes. Data were collected 2, 4, and 8 weeks after creation of the defects to assess early and late healing. Various amounts of newly formed bone and remnant BCP particles formed inside of the tube throughout the study period. The BCP + 0.5 mg/mL rhBMP-2 group exhibited the most bone formation. At 8 weeks, more new bone formation was noted in the Osteon III + rhBMP-2 combined group than in other groups. The present study results indicate that BCP can be combined with different concentrations of rhBMP-2, rhFGF-2, and rhPDGF-BB to produce new bone formation within a polycarbonate tube in calvarial defects in a rabbit model.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), have shown benefits in patient with heart failure (HF), however, adherence remains a significant issue: with only 60% of patients continuing usage beyond a year. This study aims to identify patients at risk of discontinuing SGLT2i and promote its judicious use to reduce hospitalizations and improve cardiovascular outcomes. Using the Korean National Health Insurance Service database, patients diagnosed with HF and diabetes mellitus (n = 1,665,565) between 2013 and 2018 were identified. Among them, 55,694 participants prescribed SGLT2i were enrolled. The primary endpoint included 1) all-cause mortality and 2) SGLT2i-related hospitalization, encompassing incidents such as ketoacidosis, acute kidney injury, urinary tract infections, fall-related fractures, and other unplanned hospitalizations. During the follow-up period (median: 2.3 years; range: 1.2-3.6 years), 8,463 participants reached the primary endpoint (25.5 for all-cause death and 39.4 for SGLT2i-related hospitalizations per 1,000 person-years). Independent risk factors for the primary endpoint in multivariate Cox regression and propensity-score matching analyses included age of ≥ 70 years, body mass index (BMI) <18.5 kg/m2, body weight <60 kg, anemia, chronic kidney disease, and the use of diuretics. Age (hazard ratio [HR] 1.45, 95% confidence interval [CI]: 1.36-1.54), BMI (HR 1.78, 95% CI: 1.29-2.45), body weight (HR 1.17, 95% CI: 1.09-1.26) and the use of furosemide (HR 1.45, 95% CI: 1.22-1.74) (all p<0.001) were consistent independent risk factors in the propensity score-matched cohort. Having three or more risk factors was associated with an adjusted HR that was 3.04 times higher than cases with no risk factor (95% CI: 2.83-3.28, p<0.001). Old age, low weight or BMI, and the use of diuretics are risk factors that hinder the continuous use of SGLT2i in diabetic patients with HF. Close monitoring for side effects is essential when prescribing SGLT2i, particularly for those with multiple risk factors.
Background : The strength of each heart beat and the stiffness of large arteries contribute to blood pressure (BP).When the large arteries are stiff and their resistance greater, the afterload increases and this may change the function of the heart.However, the relation between common carotid artery stiffness and heart function in hypertensive patients has not been clarified.Methods: Two hundred and twenty hypertensive patients underwent transthoracic and carotid echocardiography.Measurements of local arterial stiffness were taken at the right common carotid artery level and stiffness parameter (β), pressure-strain elasticity modulus and intima-media thickness were calculated.Brachial cuff BP was measured just before starting the carotid study.The patients with any cardiovascular disease, diabetes mellitus, stroke, transient ischemic attack, or carotid stenosis were excluded.Results: Carotid artery stiffness parameter (β) was correlated with age and left ventricular mass index (p < 0.005).Even though β was not correlated with LV systolic function, it was inversely correlated with diastolic function as measured by early mitral annular velocity.When the artery was stiffer, early mitral annular velocity (e') decreased (p < 0.001) and the index of left atrial (LA) pressure (early diastolic mitral inflow E velocity/e') increased (p = 0.001).In logistic regression, diastolic dysfunction was affected by age (beta -0.385, p = 0.001), LA volume index (beta 0.175, p = 0.013) and β (beta -0.273, p = 0.019). Conclusion:In hypertensive patients, changes in carotid artery stiffness can affect the diastolic function, independent of age and LA volume index.Therefore, measurements and control of carotid stiffness can play an important role in the prevention of diastolic heart failure.
Though clinical practice guidelines (CPGs) for cardiac rehabilitation (CR) are an effective and widely used treatment method worldwide, they are as yet not widely accepted in Korea. Given that cardiovascular disease is the second leading cause of death in Korea, it is urgent that CR programs be developed. In 2008, the Government of Korea implemented CR programs at 11 university hospitals as part of its Regional Cardio-Cerebrovascular Center Project, and three additional medical facilities will be added in 2019. In addition, owing to the promotion of CR nationwide and the introduction of CR insurance benefits, 40 medical institutions nationwide have begun CR programs even as a growing number of medical institutions are preparing to offer CR. The purpose of this research was to develop evidence-based CPGs to support CR implementation in Korea.
Introduction: The prevalence and clinical outcomes of unknown coronary artery disease (CAD) among the patients with peripheral artery disease, particularly for those undergoing lower extremity endovascular intervention, were not well evaluated. Methods: Between 2006 and 2014, a total of 208 consecutive patients (73±10 years, 165 men) without angina and prior coronary revascularization, were underwent lower extremity endovascular intervention. All patients evaluated coronary angiography without simutaneous coronary revascularization. CAD was defined as angiographically significant (≥50%) stenosis. All-cause mortality and major adverse cardiac and cerebrovascular event (MACCE) rate were compared between the patients with CAD and those without CAD. MACCE included cardiac death, cerebrovascular death, myocardial infarction, stroke, or heart failure. Results: Of the 208 patients, 103 patients (50%) had CAD; 1-VD (17%); 2-VD (17%); 3-VD (15%). Independent predictors of CAD were critical limb ischemia (OR=2.4) and below-the-knee lesions (OR=2.0). During the median follow-up of 1.2 years, all-cause mortality and MACCE rate at 3 year were 16.3% and 19.8%. At 3 year, patients with CAD had significantly higher mortality (19% vs. 14%, P=0.018) and higher MACCE rate (28% vs. 9%, P=0.001) compared to those without CAD. The severity of CAD had graded relations with the mortality and MACCE rate (Figure). Presence of CAD was an independent predictor of mortality (HR=1.5, P=0.025) and MACCE rate (HR=1.9, P<0.001). Conclusions: Previously unknown CAD was detected in half of the patients undergoing lower extremity endovascular intervention and associated with higher mortality and MACCE rate. Detection of CAD might be important for risk stratification for these patients, especially with below-the-knee lesions.
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