Ibudilast selectively vasodilates cerebral vessels without reducing blood pressure. We investigated the effect of the drug on retinal circulation in 8 patients with diabetes mellitus, using the video-densitometric image analysis of fluorescein angiography. We compared the build up time, the time constant of washout rate and the mean circulation time (MCT) before and after oral therapy with ibudilast. After 2 weeks of daily administration (30 mg), MCT was shortened significantly (4.2 ± 2.8 vs. 3.0 ± 1.6 s, p = 0.0215). Since retinal circulation in patients with diabetes mellitus was improved by ibudilast, the drug may be useful to treat disorders such as diabetic retinopathy.
Moxisylyte hydrochloride (α1-blocker) selectively vasodilates cerebral vessels without reducing blood pressure. We investigated the effect of the drug on retinal circulation in 15 patients (17 eyes) with diabetes mellitus, using the video-densitometric image analysis of fiuorescein angiography. We compared the build-up time (BT), the time constant of washout rate (TC) and the mean circulation time (MCT) before and after oral therapy with moxisylyte. In 16 eyes, BT was shortened significantly and MCT was only slightly shortened 1 h after oral therapy with moxisylyte. After 2 weeks of daily administration, MCT was shortened and TC of the artery was increased significantly in 6 eyes. Since retinal circulation in patients with diabetes mellitus was improved by moxisylyte, the drug may be useful to treat ocular disorders such as diabetic retinopathy.
Obstructive sleep apnea syndrome (O-SAS) is one of the emerging non-communicable health hazards with high rates of morbidity and mortality. O-SAS is known to induce excessive activity of sympathetic nervous system and result in secondary hypertension. Although continuous positive airway pressure (CPAP) is the first line therapy for O-SAS, its poor adherence induces resistant hypertension. Sacubitril/valsartan has a sympatho-inhibitory effect and may contribute to antihypertensive therapy in patients with O-SAS. We present a successful case of a 39-year-old male with O-SAS using sacubitril/valsartan alone. He visited our clinic with severe hypertension noted during a routine health checkup. He was a heavy drinker, resulted in high body mass index. His family members worried about his loud snoring and witnessed apnea during sleep. The polysomnography showed a markedly increased apnea-hypopnea index of 37, which led to a diagnosis of severe obstructive sleep apnea. At first, we started treatment with CPAP and azilsartan, but he stopped CPAP due to excessive drinking. Then, we switched azilsartan to sacubitril/valsartan, and succeeded in improving his blood pressure.This case indicates that sacubitril/valsartan may be an effective therapy for uncontrollable hypertenstion due to O-SAS even without CPAP.
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