Background：We previously reported enhanced pressure wave reflection in adult patients with congenital heart disease, which can result in high systolic blood pressure. Although hypertension could cause significant damage to vulnerable systemic ventricles, few studies have reported on blood pressure in adults with congenital heart disease thus far. The purpose of this study was to investigate the incidence and risk factors associated with hypertension in adult patients with congenital heart disease. Methods and Results：One-hundred and thirty-one adults with congenital heart disease were enrolled in this study. Brachial blood pressure was measured using an HEM-9000AI system (Omron Healthcare Co., Ltd., Kyoto, Japan). Patients with systolic/diastolic blood pressure ≥140/90 mmHg or those taking medication for hypertension were defined as hypertension. A systolic blood pressure ≥ +2 SD of systolic blood pressure in the age- and sex-matched general population was defined as high systolic blood pressure. The patients were aged 37.0 ± 15.0 years. Hypertension was observed in sixteen patients (16%), and logistic regression analysis revealed that the determinant of hypertension was age (years) (odds ratio [OR], 1.078; 95% confidence interval [CI], 1.029-1.129; p = 0.001). High systolic blood pressure was observed in twenty patients (20%). Logistic regression analysis revealed that the determinants of high systolic blood pressure were age (years) (OR, 1.072; 95%CI, 1.020-1.126; p = 0.016) and body mass index (kg/m²) (OR, 1.261; 95% CI, 1.054-1.508; p = 0.011). The body mass index in young patients (≤ 30 years) with high systolic blood pressure was remarkably high (31.2 ± 3.0 kg/m²). Conclusions：The incidence of high systolic blood pressure is high in adult patients with congenital heart disease. High systolic blood pressure is common in older patients and is associated with a high body mass index in young patients.

Background：Reverse redistribution (RR) is a unique finding in Thallium-201 chloride (²⁰¹TlCl) stress scintigraphy, but there is no established notion of its mechanism. We hypothesized that RR enhances blood flow in the RR area and that the fractional flow reserve (FFR) is low in the RR area if there is decreased microvascular resistance. We aimed to clarify the mechanism of RR by comparing FFR with ²⁰¹TlCl stress scintigraphy. Methods and Results：This single-center retrospective study enrolled forty consecutive patients who underwent both FFR and stress/rest ²⁰¹TlCl stress scintigraphy between April 2012 and April 2016. A total of 11 patients were excluded due to the following reasons: percutaneous coronary intervention performed between FFR and scintigraphy (n = 1), unreliable FFR value (n = 1), and severe coronary artery stenosis (n = 5). Finally, 29 patients were analyzed. Each coronary territory was classified into three groups according to the value of summed difference score (SDS): control (SDS = 0; n = 6), redistribution (SDS ≥ 1; n = 12), and RR (SDS ≤ -1; n = 11) regions. The FFR values among the 3 groups were compared using Kruskal-Wallis test. The redistribution region as well as the RR region showed significantly lower FFR value than the control region (control; 0.93 vs. redistribution; 0.85, P = 0.03, vs. RR; 0.85, P = 0.03). Conclusions：The RR region had significantly lower FFR value than the control region. Reduced microvascular resistance due to the increased collateral wash-out may be one of the mechanisms of RR.

Background：End-stage renal failure is escalating due to the increased prevalence of renal damage (chronic kidney disease, CKD) secondary to arteriosclerosis resulting from metabolic syndrome (MetS). In congruence with the observed renal damage, the occurrence of cerebrovascular/cardiovascular disease (CCVD) affecting the patient's vital prognosis and quality of life also increases. Our previous study reported on surrogate markers utilized for the early diagnosis of CKD pathophysiologically based on MetS. In the present study, the vasodilator response is investigated for their potential diagnostic value in the early diagnosis of CCVD. Subjects and methods：The vasodilator responses (flow-mediated dilation [FMD] and nitroglycerin-induced dilation [NID]) to the right brachial artery were measured accordingly as efficient indicators to serve as surrogate markers for early diagnosis of CCVD in 208 Japanese males who are diagnosed with MetS. Before the analysis of FMD and NID data, the subjects were divided into groups according to the presence or absence of CCVD or the number of risk factors for MetS. Results：FMD values were generally extremely low and showed no significant differences between the two groups with respect to the presence of CCVD or the number of MetS risk factors. In contrast, NID values were generally low but the decrease in NID values was significant and was more marked in the group with CCVD and in those with MetS risk factors compared to their respective pairing groups. Conclusion：Although FMD values already showed a decrease at the time of MetS diagnosis, NID values showed a delayed decrease, and this decrease in NID values was accompanied by the onset of CCVD. These findings suggest that FMD (lowered values) may serve as a surrogate marker for the early prediction of CCVD due to arteriosclerosis and that NID (lowered values) may serve as a surrogate marker for the diagnosis of a progressive pathophysiological change in CCVD.

Background：The biological actions of fucoidan depend on its molecular weight. 20-30 kDa fucoidan has been reported to stimulate angiogenesis in ischemic limbs. We purified very high molecular weight fucoidan (HMWF) from mozuku (brown algae of the Okinawan coontail family) to assess its effect on angiogenesis. Methods and Results：We examined the angiogenic effects of mozuku HMWF (300 kDa) and akamoku (Sargassum seaweed) HMWF (80 kDa) in a mouse ischemic limb model by measuring laser Doppler blood flow (LDBF) and capillary density. We also studied the angiogenic actions of mozuku HMWF administered pre- and post-ischemia as compared to post-ischemia treatment. Mozuku HMWF increased both LDBF and capillary density in the ischemic leg, whereas akamoku HMWF did not. Treatment with mozuku HMWF pre- and post-ischemia increased both LDBF and capillary density, which was not seen in post-ischemia treatment alone. Conclusions：This study demonstrated the therapeutic effect of pre- and post-ischemia treatment with mozuku HMWF in ischemic limbs, and the timing of administration is important for its angiogenic activity.

Background: Luseogliflozin (SGLT2i) was originally developed as an anti-diabetic (DM) medicine. SGLT2i has several other effects such as anti-atherosclerotic, anti-NAFLD (non-alcoholic fatty liver disease), and decreases heart failure incidence through vascular function. This study aimed to investigate the effects of luseogliflozin on liver function, brain natriuretic peptide (BNP), and vascular function in DM patients with suspected NAFLD and coronary artery disease (CAD). Methods: Out of 201 patients prescribed SGLT2, 51 patients with poorly controlled diabetes (31 men, HbA1c > 6.5%; 78±8 years old) as well as suspected NAFLD and CAD treated with luseogliflozin at 2.5 mg daily for 12 months and measured following clinical tests were selected. Blood serum indices of liver function (serum aspartate aminotransferase [AST], serum alanine aminotransferase [ALT], γ-glutamyl transpeptidase [γ-GTP]), brain natriuretic peptide (BNP), fasting blood sugar (FBS), and HbA1c were measured before and every 6 months until 12 months after commencing luseogliflozin treatment. BaPVW was recorded before treatment and 12 months after starting treatment. Results: Luseogliflozin decreased body weight (BW) from 64±10 kg by 8% after 12 months of treatment, whereas no changes in heart rate and blood pressure were observed. In addition, luseogliflozin improved AST, ALT, and γ-GTP as well as FBS and HbA1c. At 6 months, luseogliflozin significantly decreased BW by 6%, and improved γ-GTP (36±35 vs. 28±19 U/L, P < 0.05), HbA1 (7.3±0.8 vs. 6.8±0.8%, P < 0.05), BNP (108±60 vs. 65±37 pg/mL, P < 0.05), and baPWV (1,810±311 vs. 1,662±233 cm/s, P < 0.05). Conclusion: Results suggest that luseogliflozin has salutary effects on anti-NAFLD, BNP, and baPWV even if some fluctuating diabetic controls exit. This might indicate possible anecdotal ameliorating effects of prognosis in diabetics with CAD by luseogliflozin.