There are several aspects of blood pressure. Clinically, how to best assess blood pressure average and variability is still a matter of the ongoing debate. Besides office blood pressure, we must pay more careful attention focused on hypertension with blood pressure fluctuation. Impaired endothelial function is intimately associated with the development of hypertension and atherosclerosis. In this review, we describe the relation between endothelial dysfunction and hypertension, the effect of gene polymorphism on endothelial dysfunction, the effects of antihypertensive agents and dietary supplementation on impaired endothelial function in hypertension. In order to predict the future atherosclerosis and cardiovascular events in subjects with hypertension, the adequate assessment of endothelial function is one of the most reliable markers. Furthermore, we discuss the close relationship between blood pressure variability and endothelial function. Blood pressure variability during a day or a week is an important, new risk factor for cardiovascular disease and restoring impaired endothelial function might be a target to prevent blood pressure variation and future cardiovascular events.
Antihypertensive Agents ; Atherosclerosis ; Blood Pressure ; Cardiovascular Diseases ; Dietary Supplements ; Hypertension ; Nitric Oxide ; Nitric Oxide Synthase Type III ; Risk Factors

Serum lipid levels in female handball players were studied. A group of well trained female handball players, in comparison with a group of less active females, had a significantly lower level of triglyceride, higher levels of HDL-cholesterol and HDL₂-Cholesterol subfractions, and higher apolipoprotein A-I and LCAT activities. The ratio of apolipoprotein B/apolipoprotein A-I, as an atherogenic index, was also significantly lower in the handball players. These results suggest that prolonged regular exercise such as handball training may produce favorable changes in serum lipids, thus helping to prevent and reduce the incidence of atherosclerosis.

Background: In 2011, Osaka University abolished the paper–based final examination at the end of 6th year of medical school and introduced a new examination that evaluates comprehensive clinical competency after clinical training.
Method: For this examination, sequential scenarios were developed that demonstrate the process of problem solving in patient care. The examiners administered an oral test to students using the scenarios in the same manner as ward rounds and evaluated the clinical competency of students according to their attitudes, knowledge, and thinking.
Results: The examination was administered smoothly. Eighty–nine percent of examiners and 59% of students affirmed the significance of the examination in a questionnaire.
Discussion: Our reform of the final examination was met with acceptance, especially by examiners. To assess clinical competency more accurately, our next goal is to integrate performance–based assessment into the sequential scenarios..

Because of societal aging, Japanese pharmacists have an increasingly important role in home medical care. This is particularly true because more pharmacists are required to perform physical assessments to optimize patient treatment. However, few investigations have examined whether patients understand the role of pharmacists and the importance of home medical care. In this study, a questionnaire was provided to 260 patients aged 20-90 years to determine patients’ attitudes toward home medical care and pharmaceutical interventions. After conducting factor analysis, items related to home medical care were excluded at the stage of exploratory factor analysis, indicating that patients are not interested in home medical care. However, regarding pharmaceutical interventions, the questionnaire revealed that 42% of the patients required the pharmacists to provide information regarding the prescribed drugs during home medical care visits. Furthermore, it was demonstrated that 85% of the patients were unaware that physical assessments are also perform by pharmacists. In contrast, >50% of the patients believed that pharmacists had an important role in physical assessment interventions.

Background: As a complementary medicine we have evaluated the efficacy of Benihuuki green tea, which contains methylated form of tea catechin reported stronger anti-allergic activities than ordinary catechin, on Japanese Cedar Pollinosis (JCP) in comparison with Yabukita green tea, contains ordinary catechin. This study was carried out during the pollination season, Feb.–April, in 2005.
Method: Four hundred eighty six patients with JCP, visiting 12 otorhinolaryngology clinics in Fukuoka prefecture were divided into A and B groups and subjected to quasi-single blind clinical trials. Under ordinary conditions, A-group patients took Benihuuki green tea and B-group took Yabukita green tea every day from February 1^st to the end of Japanese cedar and Cupressaceae pollination season. We compared nose and eye symptom scores, medication scores and disturbance of quality of life (QOL).
Result: There were no differences observed between the two groups with respect to their symptom scores and the disturbance of QOL. However, decreasing trend of the medication scores was observed in A-group (p < 0.1).
Conclusion: It has been suggested that Benihuuki green tea is a possible candidate as a complementary medicine for JCP during the pollination season.

Objective To observe myocardial cathepsin (Cat) S expression and activity in hypertensive heart failure rats.Methods The expression and activity of Cat S were determined in the left ventricular (LV) myocardium (LVM) of Dahl salt-sensitive rats fed either a high-salt(HS,8%)or low-salt(LS,0,3%,controls) diet starting at age 7 weeks for 12 weeks(hypertrophy model,H-LVH) or 19 weeks(heart failure model,H-HF).Age-matched rats served as controls and human normal,hypertensive and heart failure myocardial specimen were also examined for changes on the expression and activity of Cat S.Resuits Reverse transcription and real-time polymerase chain reaction analysis revealed significantly upregulated Cat S mRNA in rats with H-HF than in rats with H-LVH or in control rats and Cat S mRNA expression is negetively correlated with LVEF(r=-0.88.P＜0.05).In situ and immunohistochemistry examinations showed that Cat S was localized predominantly in cardiac myocytes(CMCs)and coronary vascular smooth muscle cells(SMC).Elastic lamina fragmentations and Cat S-dependent elastolvtic activity were significantly increased in H-HF-rats.The expression of interleukin-1β was also increased in the LVM of H-HF rats,and this cytokine was found to increase the Cat S protein expression in cultlife neonatal CMCs.Similar results were revealed in human myocardial specimens.Conclusion Elastolytic Cat S might play an important role in the pathogenesis of myocardial remodeling and heart failure and Cat S might serve as a novel therapheutic target in preventing or reversing hypertension induced LV remodeling and heart failure.