Percutaneous transluminal balloon pulmonary valvoplasty--long-term results

Thirty-two patients with isolated valvar pulmonary stenosis (21 male; 11 female, age range 4 to 53 years, mean 14 years) underwent cardiac catheterization and balloon valvoplasty. Right ventricular systolic pressure before valvoplasty ranged from 65 to 210 mm Hg (mean 120.2 +/- 44.8 mm Hg). It fell to 24-200 mm Hg (mean 73.1 +/- 42.4 mm Hg) immediately after dilation. Peak systolic gradient across the pulmonary valve before valvoplasty ranged from 42 to 193 mm Hg (mean 98 +/- 45.3 mm Hg) and decreased significantly to 5 to 182 mm Hg (mean 52.7 +/- 43.1 mm Hg) immediately after dilation. At repeat cardiac catheterization in 21 patients 3 to 6 months after valvoplasty, a further significant fall of gradient was noted in 15 patients with no change in the remaining six patients. The right ventricular systolic pressure ranged from 30 to 100 mm Hg (mean 55.1 +/- 21.8 mm Hg) while the transpulmonary gradient varied from 12 to 84 mm Hg (mean 34 +/- 23.8 mm Hg). In the four patients evaluated 1 to 1 1/2 years after valvoplasty, the gradient further reduced in 2 patients and was unchanged in the remaining two patients. Patients with isolated valvar pulmonary stenosis can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.     

Long-term efficacy of balloon pulmonary valvoplasty in late adult life

We performed percutaneous transluminal balloon valvoplasty in a 53-year-old woman with severe valvar pulmonary stenosis. Peak systolic gradient across the pulmonary valve reduced from 112 mm Hg before valvoplasty to 47 mm Hg immediately after dilatation, which further fell to 30 mm Hg six months after valvoplasty with virtual disappearance of gradient at one year follow up. Patients of isolated valvar pulmonary stenosis presenting in late adult life can be adequately and safely treated with balloon valvoplasty, without recourse to surgery with excellent immediate and long-term results.     

Anterograde balloon valvuloplasty for the treatment of neonatal critical valvar aortic stenosis.

We report our experience with anterograde balloon valvuloplasty in 17 neonates treated between November 1996 and June 2001 for critical aortic stenosis. Patients with hypoplastic left heart syndrome were excluded. Anterograde balloon valvoplasty of the aortic valve was possible in all 17 patients. The mean peak systolic gradient prior to cardiac catheterization was 73 mm Hg (range, 30-117 mm Hg) and decreased to 37 mm Hg (range, 21-60 mm Hg) after the dilation. Aortic regurgitation after balloon valvoplasty was absent or mild in 14/17 patients, moderate in 2 patients, and severe in 1 patient. There was no mortality or echocardiographic evidence for aortic cusp perforation or mitral regurgitation associated with the procedure. Redilation was necessary in 3/17 patients. Two patients are awaiting elective Ross operation. One patient with endocardial fibroelastosis died at 11 months of age. Anterograde balloon valvoplasty can be safely and effectively performed to palliate neonates with critical aortic valve stenosis.     

Restenosis is a common feature of the angiographic follow-up after balloon valvoplasty of calcified aortic stenoses

Balloon dilatation of calcified aortic stenosis was attempted in 12 patients, 6 men and 6 women, aged 38-82 years. Two patients underwent emergency surgery because of myocardial injury or pericardial tamponade. One patient with severe depressed left ventricular function in whom the procedure was attempted in cardiogenic shock died during the procedure. One patient experienced severe aortic insufficiency after dilatation. The remaining pressure gradient was higher than 50 mm Hg in another patient. Seven dilatations were considered to be successful with a remaining pressure gradient below 50 mm Hg and a mean gradient reduction of 53 mm Hg. In one of these 7 patients, who suffered from severe heart failure, valvoplasty had been carried out to make aortic valve replacement possible. The operation was performed 2 weeks later without complications. Five of 6 patients treated medically after successful valvoplasty had restenosis within 3 to 12 months. One of them exhibited a good result at 3 months but severe restenosis after one year. It is concluded that balloon valvoplasty of calcified aortic stenosis cannot be considered an alternative to surgery. If, however, left ventricular function improves after successful valvoplasty, valve replacement will then carry less risk.     

Pulmonary valvoplasty--experience of 100 cases

One-hundred patients with pulmonary valve stenosis underwent pulmonary valvoplasty, their ages ranging from 1 to 59 years. The systolic gradient across the valve ranged from 47 to 260 mm Hg (97.67 +/- 41.15) prior to the valvoplasty, and from 0 to 55 mm Hg (14.72 +/- 11.40) immediately after dilatation (P less than 0.0001). The clinical follow-up of 18.2 months of 56 patients showed a tendency for the systolic thrill to disappear, the systolic murmur became softer and there was a tendency to normalization of the electrocardiogram. A hemodynamic restudy was carried out in 54 patients and the systolic gradients across the valve ranged from 21.55 +/- 23.86. Seven patients required redilatation. In patients with hypertrophy of the infundibulum prior to valvoplasty this was observed to regress, indicating that infundibular hypertrophy is reversible.     

Accuracy of continuous wave Doppler predicted gradient in patients undergoing balloon pulmonary valvoplasty

14 patients who underwent balloon valvoplasty had trans-pulmonic gradient evaluated by continuous wave Doppler echocardiography. Maximum systolic gradients measured from Doppler flow velocities were correlated with peak to peak gradient obtained at cardiac catheterisation. Prior to valvoplasty, there was good correlation between the Doppler maximum gradient (92.85 +/- 34.7mm Hg) and the peak to peak catheter gradient (105.57 +/- 56.60 mm Hg), (r = 0.91, p = less than 0.001). Immediately after balloon valvoplasty, the maximum Doppler gradient did not correlate with the peak to peak catheter gradient (r = 0.33, p = NS). Exclusion of patients with infundibular gradients improved the correlation coefficient between the Doppler maximum and peak to peak catheter gradient to 0.69. At late restudy following valvoplasty, when regression of infundibular stenosis was noted in 6 out of 8 patients, the Doppler maximum and catheter peak to peak gradient had excellent correlation (r = 0.97, p = less than 0.001). In patients with lone valvular gradient immediately following valvoplasty and at late restudy, maximum Doppler gradients correlated well with catheter gradients in 14 estimations (r = 0.66, p = less than 0.01). This study shows that the non-invasive quantification of pulmonary valve stenosis can be reliably undertaken, using continuous wave Doppler echocardiography before balloon valvoplasty and during follow-up, after the procedure when the infundibular stenosis has regressed. The presence of an infundibular gradient immediately after balloon dilatation makes the Doppler prediction less reliable.     

Continuous wave Doppler assessment of patients subjected to pulmonary balloon valvoplasty

To evaluate the role of Doppler ultrasound in accurately quantitating patients with valvar pulmonary stenosis, we studied 30 patients (20 patients undergoing balloon pulmonary valvoplasty before and after the procedure, and 10 patients who had previously undergone pulmonary balloon valvoplasty) by Doppler echocardiography and cardiac catheterization. The peak systolic gradient was calculated by the two methods within 24 hours of each other. The maximal velocity of blood flow was obtained by non-imaging, continuous wave Doppler ultrasound examination performed from various parasternal and subcostal positions and the valve gradient was calculated using a modified Bernoulli's equation. Transpulmonary peak systolic gradient calculated by Doppler examination ranged from 9 to 159 mm Hg (mean 54.8 +/- 34.5 mm Hg) and correlated well with values obtained at cardiac catheterization (r = 0.94, P less than 0.001). Thus our study shows that accurate quantification of pulmonary valve stenosis can be reliably undertaken non-invasively utilizing Doppler echocardiography.     

Balloon valvoplasty in calcific aortic stenosis: a therapeutic alternative

Percutaneous balloon valvoplasty was used to treat calcific aortic stenosis in 3 women aged 73, 67 and 61 years, respectively. We approached through the left brachial artery in the first case and the right femoral artery in the other two. An 18 mm balloon was used in all cases, the systolic gradient being reduced from 50, 180 and 48 to 7, 50 and 35 mm Hg, respectively. A mild and transitory systemic embolization was observed in one case. Aortic regurgitation was not present in two patients either before or after valvoplasty. In the other case, a grade 1/6 murmur indicative of regurgitation prior to the procedure increased to a grade 2/6 afterwards. A small and localized aortic dissection was present in one case but disappeared in the control angiography performed 11 days later.     

Balloon dilatation of a porcine bioprosthetic valve in aortic position

We describe a case of percutaneous balloon valvoplasty of a stenotic Hancock bioprosthesis in aortic position. The procedure reduced the peak systolic gradient from 110 to 25 mm Hg. The calculated area of the orifice increased from 0.59 to 1.07 cm2. A cineaortogram performed after the procedure showed trivial aortic regurgitation and the subsequent immediate course was uneventful. The mechanism of dilatation and the risks of the procedure are discussed.     

瓣叶增补法在主动脉瓣成形术中的应用

目的 探讨瓣叶增补技术在主动脉瓣成形术中应用的效果.方法 2007年1月至2009年12月,应用瓣叶增补法完成主动脉瓣成形术26例,患者平均年龄11.5岁.术前四肢动脉压差58～103 mm Hg.主动脉瓣病变包括瓣叶脱垂或感染性心内膜炎造成的瓣叶损害;彩色多普勒显示主动脉瓣有中-重度反流.全组均在病变瓣叶边缘缝合心包片增补瓣叶形成正常瓣兜,使三个瓣叶边缘对合良好.结果 全组无手术及术后早期死亡.术后全组均无心力衰竭发生,动脉压差36～51 mm Hg.彩色超声心动图提示主动脉瓣无明显反流5例,有微少反流12例、轻度反流9例.随访3～38个月,复查超声心动图显示主动脉瓣无反流加重者.结论 瓣叶增补技术能有效地减少或避免主动脉瓣反流.     

Aortic balloon dilatation for congenital aortic stenosis: report of 90 cases (1986-98)

OBJECTIVE—To review 12 years of experience of balloon aortic valvoplasty in childhood.
DESIGN—Early and mid-term clinical and instrumental evaluation of 104 consecutive balloon aortic valvoplasties performed from 1986 to 1998.
SETTING—A tertiary referral centre for congenital heart disease.
PATIENTS—90 patients with congenital aortic stenosis: 20 neonates (group 1), 16 infants (group 2), and 54 children (group 3).
INTERVENTIONS—Balloon aortic valvotomy.
MAIN OUTCOME MEASURES—Doppler and peak to peak aortic gradient before and after valvoplasty, degree of aortic regurgitation before and after valvoplasty, early and late mortality, need for repeat intervention or surgery.
RESULTS—Balloon aortic valvoplasty produced a gradient reduction of > 50% in 59 patients, 12 having a residual peak to peak gradient of > 50 mm Hg. Early mortality included three procedure related and six procedure unrelated deaths. There were no intraprocedural deaths. Grade III aortic regurgitation occurred in 20 patients. Five non-lethal complications occurred. At a mean follow up of 5.1 (group 1), 5.7 (group 2), and 7.6 years (group 3), survival was 75%, 88%, and 96%, respectively. Redilatation was performed in three patients in group 1, one in group 2, and 10 in group 3. Surgery was necessary for six in group 1, one in group 2, and eight in group 3. Freedom from events at last follow up was 50%, 75%, and 64%, respectively. There was a residual maximum Doppler gradient of < 30 mm Hg in 22 patients and > 60 mm Hg in 23; 50 patients have mild to moderate aortic regurgitation.
CONCLUSIONS—Balloon aortic valvoplasty is effective and repeatable and offers good palliation for congenital aortic stenosis in childhood.


Keywords: aortic valve disease; paediatric cardiology; percutaneous valvotomy; interventional catheterisation     

Balloon valvoplasty in infants with tetralogy of Fallot: effects on oxygen saturation and growth of the pulmonary arteries.

Balloon valvoplasty was undertaken in 27 patients with tetralogy of Fallot for first-stage palliation. Indications were arterial saturation of oxygen < 80%, hypoxic spells and duct-dependant pulmonary perfusion. The dilation was performed following diagnostic heart catheterization. Saturations improved from 75% +/- 8.5 before valvoplasty to 85% +/- 8.4 after the procedure, and worsened little to 83% +/- 9.6 at follow-up after 3.4 months. The pulmonary valvar orifice was hypoplastic in most patients (Z = -3.3 +/- 1.2), and did not change after the procedure. The cross-sectional area of the pulmonary arteries was diminished initially, reflected by a Nakata index of 186 +/- 95 mm2/m2. After valvoplasty, we found widening of the vessels (Nakata index 225 +/- 100 mm2/m2). At follow-up no further growth of the arteries was observed (Nakata index 209 +/- 109 mm2/m2). The procedure was complicated by hypoxic spells in three patients which were controlled by intravenous propranolol, and deep venous thrombosis in four patients. Our data demonstrate that balloon valvoplasty is feasible for initial palliation in patients with tetralogy of Fallot. It does not, however, produce growth of the pulmonary arteries or of the pulmonary valve.     

Doppler ultrasound in the prediction of transvalvar pressure gradients in patients with valvar pulmonary stenosis

Good correlation between Doppler-derived and catheterization-measured pulmonary valvar pressure gradients has previously been reported. The purpose of this paper was to present two groups of patients who did not show such correlation, namely those with very severe stenosis and those measured immediately following balloon pulmonary valvoplasty. Twenty-two patients, aged 4 months to 20 years, in whom Doppler and catheterization pressure gradients were measured within 24 hours of each other were included in the study. There were 35 pairs of such data. The correlation coefficient for the entire group was 0.61 which improved to 0.91 when the five patients with severe stenosis (gradients of 94 to 190 mm Hg) and one patient with severe right ventricular infundibular stenosis immediately following balloon valvoplasty were excluded from analysis. Although the possibility exists, technical aspects of Doppler recording did not appear to be causing this lack of correlation. Cone-shaped spray formation rather than a focused jet in patients with extremely severe pulmonary stenosis may be postulated to be responsible for poor prediction by Doppler of catheterization gradient. Once these two groups of patients are excluded, there is excellent correlation between Doppler and catheterization gradients in patients with pulmonic stenosis.     

Efficacy of aortic balloon valvoplasty: direct measurement of orificial area in a model with pulsatile flow

The efficacy of balloon valvoplasty of calcific aortic stenosis remains controversial. We studied, therefore, 5 human aortic valves obtained at necropsy in a positive-displacement pulse duplicator which delivered stroke volumes of 40-100 ml with a quasiphysiological waveform of flow. All valves had three leaflets without commissural fusion and were preserved in antibiotic solution before study. Orificial area was planimetered from videotape of opening of the valve and varied with flow in all cases. Valvoplasty with a 20 mm diameter balloon had no effect on the orifice of the normal valve but increased the orifice of 2 mildly calcified valves from 0.70-1.77 cm2 (range) at baseline to 1.06-1.95 cm2. In 2 valves with severe calcification of the leaflets, the orifice was increased from 0.31-0.82 cm2 to 0.73-1.07 cm2. Dual balloon valvoplasty achieved a variable but small further increase in orificial area. No valve showed tears of the leaflets or fracture of calcific deposits after valvoplasty. We conclude that balloon valvoplasty can acutely increase orificial area, independently of any change in stroke volume. In valves without commissural fusion, its mechanism appears to be an increase in the pliability of the leaflets which does not require macroscopic fracture of calcific deposits.     

Laser valvotomy with balloon valvoplasty for pulmonary atresia with intact ventricular septum: five years' experience.

OBJECTIVE: To assess immediate and medium term results of transcatheter laser valvotomy with balloon valvoplasty in selected infants with pulmonary atresia and intact ventricular septum. DESIGN: Prospective study. SETTING: Tertiary cardiac unit. PATIENTS: All infants with pulmonary atresia and intact septum with no more than minor tricuspid valve hypoplasia referred between November 1990 and June 1995. Laser valvotomy was attempted in nine infants of median age 4-5 days and median weight 3.6 kg. INTERVENTION: The pulmonary valve was perforated using a 0.018 inch fibreoptic guidewire attached to a NdYag laser and introduced through a catheter positioned beneath the valve. After perforation the valve was dilated with progressively larger balloons. MAIN OUTCOME MEASURES: Successful laser valvotomy and balloon dilatation, complications, pulse oximetry, right ventricular outflow velocities, and need for surgical treatment. RESULTS: Valvotomy was successful in all but one case, the failure being due to laser breakdown. After perforation the valve was dilated to 6-8 mm diameter. Prostaglandin E was withdrawn immediately in six of the eight duct dependent infants, and 28 and 49 days later in two. No patient required an aortopulmonary shunt. Two patients had repeat valvoplasty at 20 days and three months of age, respectively; one required infundibular resection and closure of the atrial septum at age four and one is awaiting similar treatment. CONCLUSIONS: Laser valvotomy with balloon valvoplasty is safe and effective treatment for selected patients with pulmonary atresia and intact ventricular septum and should be considered as first line treatment in place of surgical valvotomy.     

Hemodynamic effects of contrast media during coronary angiography: a comparison of three nonionic agents to Hypaque-76

Coronary angiography with standard ionic contrast media is associated with marked alterations in cardiac hemodynamics because of the depressant effects of the contrast media on cardiac contractility. Nonionic contrast media have been reported to produce less hemodynamic alteration than standard ionic contrast media. However, there is no information on how one nonionic media compares to another. Thus we compared the hemodynamic effects of three nonionic contrast media, Iopamidol (IOP), Iohexol (IOH), and Ioversol (IOV) to each other as well as to the standard ionic contrast media Hypaque-76 (H76). In 20 closed-chest anesthetized dogs, we recorded the maximal change in left ventricular systolic pressure (LVSP), mean aortic pressure, left ventricular diastolic pressure (LVDP), and left ventricular dp/dt during 10-cc left main coronary artery injections of H76, IOP, IOH, and IOV. The mean aortic pressure and LVSP decreased 36 +/- 17 mm Hg and 46 +/- 21 mm Hg with H76 but only 5 +/- 5 mm Hg and 6 +/- 5 mm Hg with IOP, 5 +/- 4 mm Hg and 6 +/- 6 mm Hg with IOH, and 5 +/- 4 mm Hg and 7 +/- 6 mm Hg with IOV (P less than 0.001). The LVDP increased 6 +/- 5.0 mm Hg with H76 but only 0.2 +/- 0.5 mm Hg with IOP, 0.2 +/- 0.3 mm Hg with IOH, and 0.5 +/- 1.0 mm Hg with IOV (P less than 0.001). The LV dp/dt decreased 545 +/- 261 mm Hg/sec with H76 but increased 886 +/- 477 mm Hg/sec with IOP, 910 +/- 96 mm Hg/sec with IOH, and 473 +/- 335 mm Hg/sec with IOV (P less than 0.001). Whereas each nonionic agent produced significantly less hemodynamic abnormalities than H76, there was no significant difference between any of the nonionic agents on any hemodynamic parameter. Thus, as compared to H76, these nonionic contrast media produced only trivial alterations in hemodynamics and LV dp/dt. These agents may be preferable in patients with LV dysfunction.     

Normal values of blood pressure self-measurement in view of the 1999 World Health Organization-International Society of Hypertension guidelines

New guidelines for the management of hypertension have been published in 1999 by the World Health Organization (WHO) and the International Society of Hypertension (ISH). The WHO/ISH Committee has adopted in principle the definition and classification of hypertension provided by the JNC VI (1997). The new classification defines a blood pressure of 120/80 mm Hg as optimal and of 130/85 mm Hg as the limit between normal and high-normal blood pressure. It is unclear which self-measured home blood pressure values correspond to these office blood pressure limits. In this study we reevaluated data from our Dübendorf study to determine self-measured blood pressure values corresponding to optimal and normal office blood pressure using the percentiles of the (office and home) blood pressure distributions of 503 individuals (age, 20 to 90 years; mean age, 46.5 years; 265 men, 238 women). Self-measured blood pressure values corresponding to office values of 130/85 mm Hg and 120/80 mm Hg were 124.1/79.9 mm Hg and 114.3/75.1 mm Hg. Thus, we propose 125/80 mm Hg as a home blood pressure corresponding to an office blood pressure of 130/85 mm Hg (WHO 1999: normal) and 115/75 mm Hg corresponding to 120/80 mm Hg (optimal).     

Pulmonary regurgitation after percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis in childhood

OBJECTIVES: A retrospective study was undertaken to determine the degree of pulmonary regurgitation following percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis. BACKGROUND: Percutaneous balloon valvoplasty is the recognised treatment of choice in pulmonary valvar stenosis with effective relief of gradient. Few studies have reviewed the degree of pulmonary regurgitation after the balloon valvoplasty. METHODS: We reviewed all patients with isolated pulmonary valvar stenosis undergoing percutaneous balloon valvoplasty at a tertiary centre between December 1984 and August 1996. Those with an associated haemodynamically insignificant atrial septal defect or patent oval foramen were also included. Their medical records, echocardiograms and angiograms were studied. Colour flow Doppler was used as a semi-quantitative way of assessing the pulmonary incompetence. RESULTS: Over the period of review, 57 procedures had been performed in 49 patients. The median age at the time of the procedure was 1.08 years, with a range from 0.01 to 13.3 years. The median period of follow-up was 5.64 years, with a range from 3.00 to 14.26 years. Immediately following the dilation of the pulmonary valve, the peak-to-peak instantaneous systolic pressure gradient was significantly reduced. Seven patients required a second dilation of the valve. Their median age at the first valvoplasty, at 0.49 year, was significantly lower than those who required only one procedure, at a median of 1.50 years. Following the valvoplasty, mild pulmonary incompetence was noted in 26 out of 42 patients the day after the procedure, but only 7% had moderate incompetence. On follow-up, there was an increase in the number of patients with moderate to severe pulmonary incompetence, from 7% to 29%. Those patients in whom the procedure was performed at a younger age had more significant pulmonary incompetence. Neither the initial gradient across the pulmonary valve, nor the size of the balloon used, were related with statistical significance to the subsequent development of pulmonary incompetence. CONCLUSIONS: The majority of the patients with congenital isolated pulmonary valvar stenosis had only a mild increase in the degree of pulmonary incompetence following a single pulmonary valvoplasty. Patients who required the procedure early in life were more likely to develop significant pulmonary incompetence. The ratio of the size of the balloon to the diameter of the valve did not significantly affect the outcome. We suggest that those patients who had more severe stenosis because of a more abnormal pulmonary valve, and hence required early intervention, were more likely to develop greater pulmonary incompetence after the valvoplasty.     

Prevalence and persistence of masked hypertension in treated hypertensive patients

BACKGROUND: Masked hypertension (MH) is defined as a normal blood pressure in the physician's office and an elevated blood pressure when measured out-of-office. The cause of MH may be termed the masked hypertension effect (MHE), and is not restricted to blood-pressure (BP) values around the thresholds for normal BP. We investigated the prevalence and persistence of MH and MHE in patients who were being treated for high BP and who had been followed for a period of 1 year. METHODS: One hundred and sixty-one treated hypertensive patients underwent office blood-pressure measurements (OBPMs) at seven visits and self-performed blood-pressure measurements (SBPMs) for 1 week before each visit over a period of 1 year. All measurements were performed with the same type of automatic device. At each visit, MH was determined according to the European Society of Hypertension definition (OBPM, <140/90 mm Hg; SBPM, >/=135 mm Hg or 85 mm Hg). In addition, we determined prevalences of MHE at 5/3 mm Hg (SBPM exceeds OBPM by 5 mm Hg systolic and 3 mm Hg diastolic), and MHE at 10/6 mm Hg (SBPM exceeds OBPM by 10 mm Hg systolic and 6 mm Hg diastolic), respectively. RESULTS: During the entire study, 50% of the patients had MH, and 40% had MHE at 5/3 mm Hg at least once. At four sequential OBPM visits, 2% consistently had MH, and 3% had MHE at 5/3 mm Hg or MHE at 10/6 mm Hg. The prevalence of MH increased with lower OBPM levels but remained rather constant for MHE at 5/3 mm Hg and MHE at 10/6 mm Hg. The persistence of MH and the MHE over time in individual patients was low. CONCLUSIONS: We conclude that MH and MHE at 5/3 mm Hg and MHE at 10/6 mm Hg commonly occur in treated patients, but are not persistent phenomena and probably result from an accidentally low OBPM value on one particular occasion.     

Effects of aliskiren-based therapy on ambulatory blood pressure profile, central hemodynamics, and arterial stiffness in nondiabetic mild to moderate hypertensive patients

J Clin Hypertens (Greenwich). 2012;00:000–000. ©2012 Wiley Periodicals, Inc. Aliskiren is a direct renin inhibitor that exerts its effect at the rate‐limiting step of the renin‐angiotensin system. This study was performed to examine the beneficial effects of aliskiren‐based antihypertensive therapy on the ambulatory blood pressure (BP) profile, central hemodybamics, and arterial stiffness in untreated Japanese patients with mild to moderate hypertension. Twenty‐one Japanese nondiabetic patients with untreated mild to moderate essential hypertension were initially given aliskiren once daily at 150 mg, and the dose was titrated up to 300 mg as needed. After 12 weeks of aliskiren‐based therapy, the clinic, ambulatory, and central BP values as well as brachial‐ankle pulse wave velocity (baPWV) were all significantly decreased compared with baseline (clinic systolic BP, 151±11 mm Hg vs 132±11 mm Hg; clinic diastolic BP, 91±13 mm Hg vs 82±9 mm Hg; 24‐hour systolic BP, 144±12 mm Hg vs 133±11 mm Hg; 24‐hour diastolic BP, 88±8 mm Hg vs 81±9 mm Hg; central BP, 162±16 mm Hg vs 148±14 mm Hg; baPWV, 1625±245 cm/s vs 1495±199 cm/s; P<.05). These results show that aliskiren, as a first‐line regimen, improves the ambulatory BP profile and may have protective vascular effects in Japanese nondiabetic patients with untreated mild to moderate essential hypertension.