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The efficacy of beta-blockers for improving the survival rate of patients with chronic heart failure has been confirmed by results deriving from a series of randomized controlled trials (RCTs) such as MERIT-HF, CIBIS-II, and COPERNICUS. Thus, treatment guidelines recommend that beta-blockers should be used in all patients with heart failure resulting from left ventricular systolic dysfunction who can tolerate with beta-blockers. Despite these guidelines, actual rates of beta-blocker prescription has been lower than expected, and when used, beta-blockers are generally prescribed in doses lower than what has been shown to reduce morbidity and mortality in RCTs. In the MUCHA trial conducted in Japan, the beta-blocker carvedilol decreased the cardiovascular risk for hospitalization in a dose-dependent manner. The 5 mg/day dose achieved a remarkable reduction that was nearly as great as the 20 mg/day dose. Whether this low-dose therapy was sufficient was not fully investigated by the MUCHA trial. Moreover, there is an ethnic difference in the effective dose between patients in Japan and Western countries, which may depend on a difference in beta1-receptor sensitivity. J-CHF trial may suggest that low doses of carvedilol under 2.5 mg/day have a beneficial effect. This trial is a randomized multi-center parallel group dose-comparison study, and with sub-studies such as an analysis of genetic polymorphisms on voluntary participation. This trial may serve as a tailored approach for Japanese physicians in the clinical management of heart failure.

Objectives: The efficacy of antihypertensive agents can vary in patients. Four to 8 weeks may be required before antihypertensive agents become fully effective. Predicting the efficacy can help agent selection and dose setting. This study determined whether nitroglycerin-induced vasodilation of brachial arteries can predict the antihypertensive action of angiotensin II receptor antagonist., Methods: Untreated uncomplicated patients with essential hypertension, who gave informed consent, were studied (n = 20, mean age 55 years). Before antihypertensive treatment, nitroglycerin-induced vasodilation of the brachial arteries was measured using a novel method of 15 MHz high-frequency high-frame-rate ultrasound imaging (Hitachi EUB8000). Diameter of the brachial artery at the end-systolic phase was measured before and after 0.3 mg nitroglycerin sublingual spray and percentage vasodilation (%D-N) was calculated. The reduction of mean blood pressure after nitroglycerin (%BP-N) was calculated. Valsartan monotherapy (40-80 mg/day)was administered for 3-6 months (mean 132 days). Reduction of mean blood pressure after valsartan monotherapy (%BP-V) was calculated., Results: Valsartan decreased systolic blood pressure from 138 +/- 13 to 130 +/- 17 mmHg, and diastolic blood pressure from 83 +/- 11 to 78 +/- 11 mmHg (p < 0.05). %D-N was correlated closely with %BP-V (r = - 0.70, p < 0.001). %BP-N had no correlation with %BP-V (r = 0.13, p = 0.58)., Conclusions: Direct vasodilatory action of nitroglycerin on vascular smooth muscle cells may predict the chronic antihypertensive effect of angiotensin II receptor antagonist.

Very limited epidemiological data are available regarding the prognosis of heart failure and temporal changes in survival in a population-based setting in Japan. It is estimated from the total sales of digitalis, its prescription rate and usage ratio for arrhythmias that at least one million of patients suffer from heart failure in Japan. Dilated cardiomyopathy (DCM) is a major cause of severe heart failure. Over the past 27 years, three cohorts corresponding to three different periods of 9 years were investigated. Ten-year survivals were progressively improved. Patients were older and less severely affected, partly explaining the improvement in survival. In the subgroups treated with ACE inhibitors and beta blockers, calculated ten-year survival rate reached over 90%.

New anti-arrhythmic drugs have been developed by the progress of molecular-biological and physiological research on an ion channel and the elucidation of pharmacological effects of traditional anti-arrhythmic drugs. After CAST study, K+ channel blockers instead of Na+ channel blockers were developed and used in anti-arrhythmic treatment. In Sicilian Gambit, it was advocated that the anti-arrhythmic drug selection was based on both pharmacological action of drugs and mechanism of arrhythmias, including electrical remodeling which was mainly studied on atrial fibrillation and structural remodeling such as myocardial fibrosis. Furthermore, the target of anti-arrhythmic treatment will be not only the arrhythmic control with drugs but changing many factors related to the arrhythmic substrates, modulators and triggers of arrhythmias.

Women are about 10 years older than men to suffer from ischemic heart disease(IHD) and they often experience a sudden rise in cholesterol after menopause. These phenomena are thought to be caused by the production of estrogen in women during normal menstruation cycle and its loss after menopause. Hormone replacement therapy(HRT) has been shown to reduce IHD by nearly 50 per cent. This is caused in part by effects of estrogen on lipid metabolism; it reduces LDL and Lp(a), and increases HDL. Although the first large prospective trial of HRT for secondary prevention of IHD failed to demonstrate estrogen's protective effects, HRT was effective in women with high Lp(a). Thus, selection of patients and HRT regimen seems important.