Efficacy and safety of long-term losartan therapy demonstrated by a prospective observational study in Japanese patients with hypertension: The Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study.

PubMed

Naritomi, Hiroaki; Fujita, Toshiro; Ito, Sadayoshi; Ogihara, Toshio; Shimada, Kazuyuki; Shimamoto, Kazuaki; Tanaka, Heizo; Yoshiike, Nobuo

2008-02-01

The Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan Therapy (J-HEALTH) study is a nationwide, prospective, multicentered, observational study that was designed to enroll 30,000 hypertensive Japanese patients from more than 3,000 private practitioners. It is the first large-scale observational study to assess the efficacy and safety of losartan, an angiotensin II receptor antagonist, in Japan. Patients were enrolled between June 2000 and May 2002, and followed up to June 2005. The data from 29,850 patients were used for the analysis of safety and efficacy. These patients were treated with losartan mostly at a daily dose of 25-50 mg. The mean follow-up period was 2.9 years. The patients were aged 62.4+/-12.1 years (mean+/-SD) and their mean systolic/diastolic blood pressure was 165.3+/-17.2/94.3+/-11.7 mmHg (mean+/-SD). Mean blood pressure in patients who were evaluated for efficacy decreased from 165.8/94.8 mmHg (n=26,512) at baseline to 145.5/84.4 mmHg after 3 months (n=21,269) and 138.6/80.0 mmHg after 36 months of treatment (n=13,879). Blood pressure was well controlled during the study period by losartan alone or losartan-based combination therapy. In nearly half of the patients, blood pressure was reduced to less than 140/90 mmHg during the study period. In addition to its antihypertensive effect, losartan reduced the uric acid level in patients whose baseline uric acid level was > or =7 mg/dL. Losartan also prevented acceleration of proteinuria. Adverse drug reactions occurred in 1,081 of the 29,850 patients. Long-term losartan therapy was effective and well tolerated in Japanese clinical practice.

Association between control to target blood pressures and healthy lifestyle factors among Japanese hypertensive patients: longitudinal data analysis from Fukushima Research of Hypertension (FRESH).

PubMed

Yokokawa, Hirohide; Goto, Aya; Sanada, Hironobu; Watanabe, Tsuyoshi; Felder, Robin A; Jose, Pedro A; Yasumura, Seiji

2014-01-01

To determine success rates in controlling target blood pressures longitudinally by measuring several factors, including lifestyle characteristics associated with uncontrolled blood pressures for target treatment goals. This prospective observational cohort study (September 2008-September 2010) collected information on blood pressure control status and healthy lifestyle factors listed in Breslow's seven health practices through medical records and self-administered questionnaires from 884 of the 1264 Japanese hypertensive patients initially registered in the FRESH study. Multivariate analysis adjusted for associated factors was performed to estimate the association between lifestyle change and "uncontrolled blood pressures" at the final follow-up survey. Median age and proportion of men were 73 years and 39.1%, respectively. All survey failure rates were 37.6% among non-elderly patients (<65 years of age) without diabetes mellitus or chronic kidney disease, and 35.0% among patients with these diseases or myocardial infarction. Maintaining a healthy lifestyle was a protective factor against uncontrolled blood pressures in multivariate analysis. Obesity and smoking status were associated with uncontrolled blood pressures, and exercise frequency was borderline significance. The number of participants with healthy responses for these factors remained relatively low during follow up. Our study revealed low rates of controlled blood pressures, especially in non-elderly patients without diabetes mellitus or chronic kidney disease, and patients with these diseases or myocardial infarction. Our data indicate the need to maintain a healthy lifestyle, in particular, ideal body weight and adequate exercise frequency, for better hypertension management according to treatment guidelines. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Ethnic differences in the degree of morning blood pressure surge and in its determinants between Japanese and European hypertensive subjects: data from the ARTEMIS study.

PubMed

Hoshide, Satoshi; Kario, Kazuomi; de la Sierra, Alejandro; Bilo, Grzegorz; Schillaci, Giuseppe; Banegas, José Ramón; Gorostidi, Manuel; Segura, Julian; Lombardi, Carolina; Omboni, Stefano; Ruilope, Luis; Mancia, Giuseppe; Parati, Gianfranco

2015-10-01

Morning blood pressure (BP) surge has been reported to be a prognostic factor for cardiovascular events. Its determinants are still poorly defined, however. In particular, it is not clear whether ethnic differences play a role in determining morning surge (MS) size. Aim of our study was to explore whether differences exist in the size of MS between Japanese and Western European hypertensive patients. We included 2887 untreated hypertensive patients (age 62.3±8.8 years) from a European ambulatory BP monitoring database and 811 hypertensive patients from a Japanese database (Jichi Medical School Ambulatory Blood Pressure Monitoring WAVE1, age 72.3±9.8 years) following the same inclusion criteria. Their 24-hour ambulatory BP monitoring recordings were analyzed focusing on MS. Sleep-trough MS was defined as the difference between mean systolic BP during the 2 hours after awakening and mean systolic BP during the 1-hour night period that included the lowest sleep BP level. The sleep-trough MS was higher in Japanese than in European hypertensive patients after adjusting for age and 24-hour mean BP levels (40.1 [95% confidence interval 39.0-41.2] versus 23.0 [22.4-23.5] mm Hg; P<0.001). This difference remained significant after accounting for differences in night-time BP dipping. Age was independently associated with MS in the Japanese database, but not in the European subjects. Our results for the first time show the occurrence of substantial ethnic differences in the degree of MS. These findings may help in understanding the role of ethnic factors in cardiovascular risk assessment and in identifying possible ethnicity-related differences in the most effective measures to be implemented for prevention of BP-related cardiovascular events. © 2015 American Heart Association, Inc.

Safety and efficacy of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Japanese patients with hypertension and renal dysfunction

PubMed Central

Ito, Sadayoshi; Satoh, Minoru; Tamaki, Yuko; Gotou, Hiromi; Charney, Alan; Okino, Naoko; Akahori, Mizuki; Zhang, Jack

2015-01-01

This 8-week, multi-center, open-label study assessed the safety and efficacy of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Japanese patients with hypertension and renal dysfunction. Patients (n=32) with mean sitting systolic blood pressure (msSBP) ⩾140 mm Hg (after a 2–5-week washout of previous antihypertensive medications) and estimated glomerular filtration rate (eGFR) ⩾15 and <60 ml min−1 1.73 m−2 received LCZ696 100 mg with an optional titration to 200 and 400 mg in a sequential manner starting from Week 2 in patients with inadequate BP control (msSBP ⩾130 mm Hg and mean sitting diastolic blood pressure (msDBP) ⩾80 mm Hg) and without safety concerns. Safety was assessed by monitoring and recording all adverse events (AEs) and change in potassium and creatinine. Efficacy was assessed as change from baseline in msSBP/msDBP. The mean baseline BP was 151.6/86.9 mm Hg, urinary albumin/creatinine ratio (UACR) geometric mean was 7.3 mg mmol−1 and eGFR was ⩾30 and <60 in 25 (78.1%) patients and was ⩾15 and <30 in 7 (21.9%) patients. Fourteen (43.8%) patients reported at least one AE, which were mild in severity. No severe AEs or deaths were reported. There were no clinically meaningful changes in creatinine, potassium, blood urea nitrogen and eGFR. The geometric mean reduction in UACR was 15.1%, and the mean reduction in msSBP and msDBP was 20.5±11.3 and 8.3±6.3 mm Hg, respectively, from baseline to Week 8 end point. LCZ696 was generally safe and well tolerated and showed effective BP reduction in Japanese patients with hypertension and renal dysfunction without a decline in renal function. PMID:25693859

Effects of the endothelin receptor antagonist bosentan on hemodynamics and exercise capacity in Japanese patients with mildly symptomatic pulmonary arterial hypertension.

PubMed

Hatano, Masaru; Yamada, Hidehiro; Fukuda, Keiichi; Yoshioka, Koichiro; Funauchi, Masanori; Kuwana, Masataka; Sata, Masataka; Taniguchi, Mitsugu; Nakanishi, Norifumi; Saito, Takefumi; Saji, Tsutomu; Sasayama, Shigetake

2015-11-01

Pulmonary arterial hypertension (PAH) trial has mostly enrolled patients with World Health Organization functional class (WHO FC) III or IV. However, PAH is rapidly progressive in nature even in patients with less severe forms at diagnosis. Following the recent studies in Western population, here we assessed the efficacy of bosentan in Japanese patients with WHO FCII PAH. In this open-label trial, bosentan 125 mg twice daily was administered for 12 weeks in 16 patients, and a hemodynamic evaluation was performed. Treatment was continued for a further 12 weeks, where the effect on exercise capacity was assessed in 13 patients. In 16 patients, mean pulmonary arterial pressure decreased from 40.4 ± 10.4 to 35.6 ± 12.6 mmHg (p = 0.018) and cardiac index increased from 2.54 ± 0.73 to 2.96 ± 0.82 L/min/m(2) (p = 0.023). Thus, pulmonary vascular resistance decreased from 792 ± 565 to 598 ± 558 dyn·sec/cm(5) (p = 0.006). In 13 patients followed up for 24 weeks, 6-min walking distance increased from baseline at Week 12 (p = 0.003) and Week 24 (p = 0.011). All patients were mildly symptomatic at baseline with dyspnea index (Borg scale) of 2.50 ± 1.58 and the specific activity scale (SAS) of 5.0 ± 1.4 METs. These values remained unchanged throughout the study. These results suggest that bosentan treatment was beneficial for Japanese patients with WHO FC II PAH and treatment should be started in the early stage of the disease.

Anti-albuminuric effect of losartan versus amlodipine in hypertensive Japanese patients with type 2 diabetes mellitus: A prospective, open-label, randomized, comparative study

PubMed Central

Ohno, Yasuhiro; Nishimura, Akiyoshi; Iwai, Hiroshi; Hirota, Noriyuki; Yamauchi, Takaaki; Fujimoto, Mika; Miyatake, Toshiyuki; Arai, Hiroshi; Aoki, Norihiko

2007-01-01

Abstract Background The antiproteinuric effect of the angiotensin II receptor-antagonist losartan has been observed in patients with type 2 diabetes mellitus (T2DM). Proteinuria is considered to be a predictor of the progression of kidney disease. Objective The aims of the present study were to compare and examine the ability of losartan and amlodipine to ameliorate albuminuria in hypertensive Japanese patients (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) with T2DM and whether the change in albuminuria was associated with a change in glomerular filtration rate (GFR). Methods This prospective, open-label, randomized, comparative study was conducted over 3 months at the Kinki University School of Medicine, Osaka-Sayama, Japan. Hypertensive patients with T2DM were enrolled and randomly assigned to 1 of 2 study groups receiving either losartan (25–100 mg/d) or the calcium channel-blocker amlodipine (2.5–5 mg/d). Urinary albumin excretion (UAE), creatinine clearance, and GFR were recorded at study initiation (baseline) and study end (month 3). The GFR was measured from the fractional renal accumulation of 99mTc-diethylenetriaminepentaacetic acid. Adverse events (AEs) were monitored by a clinical research nurse during the examination. Results Fifty patients were asked to enroll and 38 returned the informed written consent. Thirty-five Japanese patients were included in the final study analysis. Seventeen patients were assigned to the losartan group (male sex, 10 [58.8%]; mean [SD] age, 58.1 [8.2] years) and 18 were assigned to the amlodipine group (male sex, 10 [55.6%]; mean [SD] age, 57.4 [8.9] years); no significant between-group difference in demographics was observed. A significant decrease from baseline to month 3 of mean (SD) UAE was observed in the losartan group (352.5 [556.6] mg/d vs 275.7 [466.1] mg/d; P = 0.048). No significant difference in mean (SD) UAE was observed in the amlodipine group for the same time period (298

Effects of triple combination therapy with azilsartan/amlodipine/hydrochlorothiazide on office/home blood pressure: a randomized-controlled trial in Japanese essential hypertensive patients.

PubMed

Rakugi, Hiromi; Shimizu, Kohei; Sano, Yuhei; Nishiyama, Yuya; Kinugawa, Yoshinobu; Terashio, Souhei

2018-04-01

The efficacy and safety of triple therapy with azilsartan (AZI), amlodipine besylate (AML), and hydrochlorothiazide (HCTZ) compared with dual therapy with AZI/AML or HCTZ monotherapy were evaluated in Japanese essential hypertensive patients in a double-blinded manner. A total of 353 patients with office blood pressure (BP) of at least 150/95 mmHg were randomized to a 10-week treatment with AZI/AML/HCTZ 20/5/12.5 mg, AZI/AML/HCTZ 20/5/6.25 mg, AZI/AML 20/5 mg, HCTZ 12.5 mg, or HCTZ 6.25 mg. The mean change from baseline in office diastolic/systolic BPs at week 10 was -25.9/-41.4, -24.9/-38.6, and -22.4/-34.5 mmHg in the AZI/AML/HCTZ 20/5/12.5 mg, AZI/AML/HCTZ 20/5/6.25 mg, and AZI/AML 20/5 mg groups, respectively. AZI/AML/HCTZ 20/5/12.5 mg led to a significantly greater reduction in diastolic and systolic BP than the dual therapy. In addition, the change in home diastolic BP measured with telemetry devices showed a significant difference between the two triple therapy groups. The incidences of adverse events except dizziness postural were similar among the treatment groups in the triple therapy groups. Triple therapy with AZI/AML/HCTZ 20/5/12.5 mg shows a greater antihypertensive effect than the dual therapy and has acceptable safety profiles for Japanese essential hypertensive patients. It was also observed that home BP measurement by automated telemetry could detect changes in BP that were not detected in office BP measurement, although further investigation is needed.

Concurrent variant type 3 autoimmune polyglandular syndrome and pulmonary arterial hypertension in a Japanese woman.

PubMed

Iijima, Toshie; Niitani, Takafumi; Tanaka, Seiichi; Yanagi, Kazunori; Jojima, Teruo; Suzuki, Kunihiro; Usui, Isao; Aso, Yoshimasa

2018-04-26

We describe a very rare case of concurrent variant type 3 autoimmune polyglandular syndrome (APS) and pulmonary arterial hypertension (PAH). A previously healthy 65-year-old Japanese woman was referred to our university hospital with a 2-month history of general fatigue and hyperglycemia. Laboratory tests revealed severe hyperglycemia (plasma glucose 543 mg/dL and HbA1c 10.7%) with ketonuria (3+). Glutamic acid decarboxylase (GAD) and IA-2 antibodies were positive, and the serum C peptide level was markedly decreased to 0.2 ng/mL. Accordingly, type 1 diabetes was diagnosed. Hashimoto's thyroiditis was also diagnosed because she had a diffuse goiter and a mild hypothyroidism (TSH 8.20 μU/mL, and FT4 0.80 ng/mL) with positive autoantibodies for thyroid peroxidase and thyroglobulin. There was neither adrenal insufficiency nor hypocalcemia. In addition, chest X ray showed a suspicious PAH by a dilation of both pulmonary arteries, especially right descending artery, and right heart catheterization confirmed the presence of PAH. HLA Class II genotyping revealed DRB1-DQB1*0901-*0303, a common susceptibility haplotype in Japanese patients with type 3 APS or acute-onset type 1 diabetes. The combination of variant type 3 APS and PAH is extremely rare and to the best of knowledge, this is the first case reported in a Japanese patient.

The effect of losartan and amlodipine on left ventricular diastolic function and atherosclerosis in Japanese patients with mild-to-moderate hypertension (J-ELAN) study.

PubMed

Yamamoto, Kazuhiro; Ozaki, Hitoshi; Takayasu, Ken; Akehi, Noriyuki; Fukui, Sugao; Sakai, Akihiko; Kodama, Mineo; Shimonagata, Tsuyoshi; Kobayashi, Keiji; Ota, Mitsushige; Horiguchi, Yasunori; Ebisuno, Shoji; Katsube, Yoshiki; Yamazaki, Tsutomu; Ohtsu, Hiroshi; Hori, Masatsugu

2011-03-01

This study was a prospective, randomized, open, blinded endpoint study to assess the effects of angiotensin II type 1 receptor blocker, losartan, compared with calcium channel blocker, amlodipine, on left ventricular (LV) diastolic function and atherosclerosis of the carotid artery in Japanese patients with mild-to-moderate hypertension, LV hypertrophy, diastolic dysfunction and preserved systolic function. Fifty-seven patients were randomly assigned to losartan- or amlodipine-based treatment groups and were followed up for 18 months. Blood pressure was similarly reduced by both regimens. Losartan shortened the transmitral E-wave deceleration time, and amlodipine reduced LV mass index; however, there was no significant difference in the percent changes of these indices between the two groups. Mean carotid intima-media thickness (mean IMT) as well as plaque score significantly increased in the amlodipine-based regimen (pre: 1.05±0.26 mm, follow-up: 1.23±0.33 mm, P=0.0015), but not in the losartan-based regimen (pre: 1.08±0.35 mm, follow-up: 1.16±0.52 mm, P=non-significant). The percent increase in mean IMT in the amlodipine-based regimen tended to be large compared with the losartan-based regimen (amlodipine: 19.8±23.7%, losartan: 6.9±23.3%, P=0.06). Under similar reduction of blood pressure, losartan is likely effective in protecting the progression of atherosclerosis of the carotid artery compared with amlodipine. Losartan may improve LV diastolic function, and amlodipine may attenuate LV hypertrophy; however, this study cannot make consecutive remarks about the superiority of either treatment regimen in the effects on cardiac function and geometry. This study has been registered at http://www.umin.ac.jp/ctr/listj/ (identifier C000000319). © 2011 The Japanese Society of Hypertension All rights reserved

Knowledge and awareness of hypertension among patients with systemic hypertension.

PubMed Central

Familoni, B. Oluranti; Ogun, S. Abayomi; Aina, A. Olutoyin

2004-01-01

BACKGROUND: In Nigeria, systemic hypertension is the commonest noncommunicable disease, and public awareness about hypertension and its determinants is poor. This study aims to assess the knowledge and level of awareness of the disease among hypertensive patients attending the medical outpatient clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH). METHODOLOGY: Hypertensive patients who attended the medical outpatient clinic during the one-year study period and gave their consent were recruited into the study. Response to a questionnaire on various aspects of hypertension was analyzed using the STATA for Windows software. RESULTS: There were 254 hypertensive patients, of which 111 were males and 143 were females, giving a male: female ratio of 1:1.3. The mean age (SD) of the patients was 51 years +/- 12.2; 52.4% of the participants were aware that hypertension was the commonest noncommunicable disease in Nigeria. About one in 10 patients (11.4%) was aware that "nil symptom" is the commonest symptom of hypertension, while 37% were not aware that hypertension could cause renal failure. Only about one-third (35.4%) of the patients knew that hypertension should ideally be treated for life, while 58.3% believed that antihypertensive drugs should be used only when there are symptoms. The remaining 6.3% believed that the treatment of hypertension should be for periods ranging from two weeks to five years but not for life. CONCLUSION: This study has demonstrated inadequate knowledge of hypertension in patients with hypertension in our study population. Conscious efforts should be made and time set aside to health educate hypertensive patients. Organization of "hypertensive club or society" could be encouraged. These will reduce dissemination of false or inaccurate information by hypertensive patients to the public and its attendant dangers. PMID:15160976

Evaluation of BAG3 levels in healthy subjects, hypertensive patients, and hypertensive diabetic patients.

PubMed

Derosa, Giuseppe; Maffioli, Pamela; Rosati, Alessandra; M, De Marco; Basile, Anna; D'Angelo, Angela; Romano, Davide; Sahebkar, Amirhossein; Falco, Antonia; Turco, Maria C

2018-03-01

BAG3 is a member of human BAG (Bcl-2-associated athanogene) proteins and plays a role in apoptosis, cell adhesion, cytoskeleton remodeling, and autophagy. The aim of this study was to evaluate BAG3 levels in healthy subjects, hypertensive patients, and hypertensive diabetic patients. We enrolled 209 Caucasian adults, of both sex, 18-75 years of age, 77 were healthy controls, 62 were affected by hypertension, and 70 were affected by hypertension and type 2 diabetes. All patients underwent an assessment that included medical history, physical examination, vital signs, a 12-lead electrocardiogram, measurements of systolic (SBP), and diastolic blood pressure (DBP), heart rate (HR), fasting plasma glucose (FPG), glycated hemoglobin (HbA 1c ), triglycerides (TG), transaminases, high sensitivity C-reactive protein (Hs-CRP), and BAG3. We observed higher blood pressure values in hypertensive, and hypertensive diabetic patients compared to controls. As expected, FPG and HbA 1c were higher in diabetic hypertensive patients, compared to the other two groups. No Tg levels differences were recorded among the three groups. Hs-CRP was higher in diabetic hypertensive patients compared to healthy subjects. Finally, BAG3 levels were higher in hypertensives, and hypertensive diabetic patients compared to controls. We observed higher levels of BAG3 in hypertensive patients compared to healthy controls, and even higher levels in hypertensive diabetic patients compared to healthy subjects. This paper could be the first of a long way to identify potential involvement of deregulated BAG3 levels in cardiometabolic diseases. © 2017 Wiley Periodicals, Inc.

Effect of Wave Reflection and Arterial Stiffness on the Risk of Development of Hypertension in Japanese Men.

PubMed

Tomiyama, Hirofumi; Komatsu, Shunsuke; Shiina, Kazuki; Matsumoto, Chisa; Kimura, Kazutaka; Fujii, Masatsune; Takahashi, Lisa; Chikamori, Taishiro; Yamashina, Akira

2018-05-08

We conducted analyses of repeated-measures data to examine whether pressure wave reflection acts additively or synergistically with arterial stiffness in the pathogenesis of hypertension. In 3172 middle-aged (42±9 years) healthy Japanese men without hypertension at the study baseline, systolic and diastolic blood pressures, brachial-ankle pulse wave velocity, and radial augmentation index were measured annually during a 9-year study period. Of these, 474 participants (15%) developed hypertension by the end of the study period. Binary logistic regression analysis demonstrated significant individual odds ratios for both baseline brachial-ankle pulse wave velocity and radial augmentation index for the development of hypertension. The rate of onset of hypertension during the study period was highest in the participant group with high values for both brachial-ankle pulse wave velocity and radial augmentation index at study baseline (262 of 965 participants: 27%). The generalized estimating equation analysis revealed that both radial augmentation index (estimate=0.06, SE=0.03, P =0.05) and brachial-ankle pulse wave velocity (estimate=0.07×10 -1 , SE=0.02×10 -1 , P <0.01) showed significant longitudinal association with new onset of hypertension, with no significant interaction. In Japanese men, abnormal wave reflection and increased arterial stiffness may be additively associated with the risk of new onset of hypertension. Abnormal wave reflection and elevated central blood pressure may be longitudinally associated with increase in arterial stiffness, and this longitudinal association may be a mechanism underlying the additive effect of these 2 variables on the risk of new onset of hypertension. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Evaluation of the efficacy and tolerability of fixed-dose combination therapy of azilsartan and amlodipine besylate in Japanese patients with grade I to II essential hypertension.

PubMed

Rakugi, Hiromi; Nakata, Emi; Sasaki, Emma; Kagawa, Tomoya

2014-05-01

Guidelines for the management of hypertension recommend using drugs with different mechanisms of action in antihypertensive regimens that include simple single-pill fixed-dose combination (FDC) products. The objective of this study was to compare the efficacy and tolerability of the FDC of azilsartan (AZI) and amlodipine besylate (AML) with those of AZI monotherapy and AML monotherapy in Japanese patients with grade 1 to 2 essential hypertension. This was a multicenter, randomized, double-blind, parallel-group study. After receiving placebo during a 4-week run-in period in a single-blind manner, patients were randomized to receive 1 of the following 5 treatments for 8 weeks: FDC containing AZI 20 mg and AML 5 mg (AZI/AML 20/5 mg), FDC containing AZI 20 mg and AML 2.5 mg (AZI/AML 20/2.5 mg), AZI 20 mg, AML 5 mg, or AML 2.5 mg once daily in a fasting or fed state. The primary end point was the change from baseline (week 0) in the seated trough diastolic blood pressure at week 8 (last observation carried forward [LOCF]), and the secondary end point was the change from baseline in the seated trough systolic blood pressure at week 8 (LOCF). Tolerability was assessed based on adverse events, vital signs, and physical examination findings. Of the 800 patients who provided informed consent, 603 were randomized to receive AZI/AML 20/5 mg (150 patients), AZI/AML 20/2.5 mg (151 patients), AZI 20 mg (151 patients), AML 5 mg (75 patients), or AML 2.5 mg (76 patients). The mean baseline systolic/diastolic blood pressure was 160.7/100.3 mm Hg. The mean change from baseline in seated blood pressure at week 8 (LOCF) was -35.3/-22.3 mm Hg in the AZI/AML 20/5 mg group and -31.4/-19.2 mm Hg in the AZI/AML 20/2.5 mg group, indicating a reduction significantly greater than that in corresponding monotherapy groups (-21.5/-13.9 mm Hg in the AZI 20 mg group, -26.4/-15.5 mm Hg in the AML 5 mg group, and -19.3/-11.6 mm Hg in the AML 2.5 mg group; p < 0.0001 for all contrast tests). No

Nationwide multicenter kidney biopsy study of Japanese patients with hypertensive nephrosclerosis.

PubMed

Furuichi, Kengo; Shimizu, Miho; Yuzawa, Yukio; Hara, Akinori; Toyama, Tadashi; Kitamura, Hiroshi; Suzuki, Yoshiki; Sato, Hiroshi; Uesugi, Noriko; Ubara, Yoshifumi; Hoshino, Junichi; Hisano, Satoshi; Ueda, Yoshihiko; Nishi, Shinichi; Yokoyama, Hitoshi; Nishino, Tomoya; Kohagura, Kentaro; Ogawa, Daisuke; Mise, Koki; Shibagaki, Yugo; Kimura, Kenjiro; Haneda, Masakazu; Makino, Hirofumi; Matsuo, Seiichi; Wada, Takashi

2018-06-01

Nephrosclerosis is an increasingly reason for dialysis in Japan. However, kidney biopsy specimens for hypertensive nephrosclerosis are very limited; thus, the pathologic evaluation of hypertensive nephrosclerosis currently remains unclear. Clinical and pathologic data of a total of 184 biopsy-confirmed hypertensive nephrosclerosis patients were collected from 13 centers throughout Japan. Seven pathological findings were assessed in this study. The outcomes of interest for this study were dialysis, composite kidney events, cardiovascular events, and all-cause mortality. The Green and Yellow (G&Y), Orange, and Red groups of the chronic kidney diseases (CKD) heat map contained 36, 57, and 91 cases, respectively. The mean observation period was 7.3 ± 5.2 (median, IQR; 6.1, 2.6-9.7) years. Global glomerulosclerosis (GScle), interstitial fibrosis and tubular atrophy (IFTA), arteriolar hyalinosis in Red exhibited higher scores than those in G&Y and Orange. The incidence rates of the composite kidney end points in 100 person-years for the G&Y, Orange, and Red groups were 1.42, 2.16, and 3.98, respectively. In the univariate Cox analysis for the composite kidney end points, GScle, IFTA and interstitial cell infiltration exhibited statistically significant high hazard ratios (1.18, 1.84, 1.69, respectively). However, after adjustment for clinical and medication data, the Red group in the CKD heat map category was risk factor for the composite kidney end points (HR 9.51). In summary, although pathologic findings had minor impacts on the prediction of composite outcomes in this study, the clinical stage of the CKD heat map is a good predictor of composite kidney events.

Daily life activity and the risk of developing hypertension in middle-aged Japanese men.

PubMed

Nakanishi, Noriyuki; Suzuki, Kenji

2005-01-24

Although previous studies suggest that physical activity may reduce the risk of hypertension, the role of daily life activity in the development of hypertension remains unclear. The study population included 2548 Japanese male office workers aged 35 to 59 years, who were without hypertension (systolic blood pressure [SBP] <140 mm Hg, diastolic blood pressure [DBP] <90 mm Hg, and no medication for hypertension) and had no history of cardiovascular disease. Daily life energy expenditure was estimated by a 1-day activity record during an ordinary weekday at study entry. Blood pressures were measured at periodic annual health examinations over 7 successive years. After controlling for potential predictors of hypertension (age, family history of hypertension, alcohol consumption, cigarette smoking, regular physical exercise at entry, and change in body mass index during the follow-up period), mean SBP and DBP in each follow-up year decreased as daily life energy expenditure increased. With additional adjustment for SBP at entry, the relative risk of hypertension (SBP > or =140 mm Hg and/or DBP > or =90 mm Hg or medication for hypertension) across quartiles of daily life energy expenditure (lowest to highest) were 1.00, 0.84, 0.75, and 0.54 (P<.001 for trend). Analyses by presence or absence of a risk factor demonstrated that the risk of hypertension was inversely related to daily life energy expenditure in men at either low or high risk of hypertension. Daily life energy expenditure was also associated with reduced risk of hypertension for subjects in all 3 categories of normotension: low normal, normal, and high normal. Increased daily life activity is effective for the prevention of hypertension, and this benefit applies to men at either low or high risk of hypertension.

Macrovascular Complications and Prevalence of Urgency Incontinence in Japanese Patients with Type 2 Diabetes Mellitus: The Dogo Study.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Kanzaki, Sayaka; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Onji, Morikazu; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2017-01-01

Objective Macrovascular diseases and urgency incontinence are common among Japanese patients with type 2 diabetes mellitus. However, little evidence exists regarding the association between stroke and urgency incontinence among patients with type 2 diabetes mellitus. We examined the associations between macrovascular complications and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Methods The study subjects were 818 Japanese patients with type 2 diabetes mellitus. Urgency incontinence was defined as present when a subject answered "once a week or more" to the question: "Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate?" We adjusted our analyses for sex, age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, dyslipidemia, glycated hemoglobin, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy. Results The prevalence of urgency incontinence was 9.2%. Stroke was independently positively associated with urgency incontinence, with an adjusted odds ratio of 2.34 (95% confidence interval: 1.03-4.95). The associations between ischemic heart disease or peripheral artery disease and the prevalence of urgency incontinence were not significant. Conclusion In Japanese patients with type 2 diabetes mellitus, stroke, but not ischemic heart diseases or peripheral artery disease, was independently positively associated with urgency incontinence.

Slightly increased BMI at young age is a risk factor for future hypertension in Japanese men

PubMed Central

Tamura, Yoshifumi; Kohmura, Yoshimitsu; Aoki, Kazuhiro; Kawai, Sachio; Daida, Hiroyuki

2018-01-01

Background Hypertension is developed easily in Asian adults with normal body mass index (BMI) (~23 kg/m2), compared with other ethnicities with similar BMI. This study tested the hypothesis that slightly increased BMI at young age is a risk factor for future hypertension in Japanese men by historical cohort study. Methods The study participants were 636 male alumni of the physical education school. They had available data on their physical examination at college age and follow-up investigation between 2007 and 2011. The participants were categorized into six categories: BMI at college age of <20.0 kg/m2, 20.0–21.0kg/m2, 21.0–22.0kg/m2, 22.0–23.0kg/m2, 23.0–24.0kg/m2, and ≥24.0kg/m2, and the incidence of hypertension was compared. Results This study covered 27-year follow-up period (interquartile range: IQR: 23–31) which included 17,059 person-years of observation. Subjects were 22 (22–22) years old at graduated college, and 49 (45–53) years old at first follow-up investigation. During the period, 120 men developed hypertension. The prevalence rates of hypertension for lowest to highest BMI categories were 9.4%, 14.6%, 16.1%, 17.5%, 30.3%, and 29.3%, respectively (p<0.001 for trend), and their hazard ratios were 1.00 (reference), 1.80 (95%CI: 0.65–4.94), 2.17 (0.83–5.64), 2.29 (0.89–5.92), 3.60 (1.37–9.47) and 4.72 (1.78–12.48), respectively (p<0.001 for trend). This trend was similar after adjustment for age, year of graduation, smoking, current exercise status and current dietary intake. Conclusion Slightly increased BMI at young age is a risk factor for future hypertension in Japanese men. PMID:29324821

Hypertension with diabetes mellitus: significance from an epidemiological perspective for Japanese.

PubMed

Tatsumi, Yukako; Ohkubo, Takayoshi

2017-09-01

The prevalence of both hypertension and diabetes mellitus is increasing worldwide. Both diseases lead to severe complications such as cardiovascular and chronic kidney diseases, which increase the risk of death over a long period of time. Therefore, the prevention and aggravation of hypertension and diabetes mellitus are major challenges. Because few review articles have focused on the epidemiological perspective of hypertension and diabetes mellitus, we reviewed major observational studies mainly from Japan and from Western countries that have reported on the prevalence of hypertension and diabetes mellitus, the binominal risk of hypertension and diabetes mellitus, and the risk of their coexistence. Our investigation found that approximately 50% of diabetic patients had hypertension, and approximately 20% of hypertensive patients had diabetes mellitus. Those with either hypertension or diabetes mellitus had a 1.5- to 2.0-fold higher risk of having both conditions. These results were similar for both Japan and Western countries. Although comparing the results between Japan and Western countries was difficult because the risks were estimated using widely varying statistical analyses, it was revealed that the coexistence of hypertension and diabetes mellitus certainly increased the risk of complications regardless of the country. The definition, prevalence and medical treatment of hypertension and diabetes mellitus will change in the future. For early intervention based on the latest evidence to prevent severe complications, it is important to accumulate epidemiological knowledge of hypertension and diabetes mellitus and to update the evidence for both Japan and other countries.

Pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension. An echographic study.

PubMed

Gurghean, Adriana V; Tudor, Ioana A

2017-01-01

The aim of the study is to determine the frequency of pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension, to determine the possibility of an accurate ultrasound diagnosis of the characteristics of this complication. 347 patients with liver cirrhosis consecutively hospitalized at Coltea Clinical Hospital were screened. 61 were excluded because of other possible causes of portal or pulmonary hypertension. All patients were investigated clinically and by abdominal and cardiac ultrasonography. Of the remaining 286 patients, 116 had portal hypertension, 27 of them (23%) having pulmonary hypertension. In this group we found a higher cardiac index and right atrial volume, higher pressures in the right atrium, suggesting a hyperdynamic state. Porto-pulmonary hypertension was found in only one patient. Echocardiography permits characterization of patients with cirrhosis and portal hypertension.

Comparison between valsartan and amlodipine regarding cardiovascular morbidity and mortality in hypertensive patients with glucose intolerance: NAGOYA HEART Study.

PubMed

Muramatsu, Takashi; Matsushita, Kunihiro; Yamashita, Kentaro; Kondo, Takahisa; Maeda, Kengo; Shintani, Satoshi; Ichimiya, Satoshi; Ohno, Miyoshi; Sone, Takahito; Ikeda, Nobuo; Watarai, Masato; Murohara, Toyoaki

2012-03-01

It has not been fully examined whether angiotensin II receptor blocker is superior to calcium channel blocker to reduce cardiovascular events in hypertensive patients with glucose intolerance. A prospective, open-labeled, randomized, controlled trial was conducted for Japanese hypertensive patients with type 2 diabetes mellitus or impaired glucose tolerance. A total of 1150 patients (women: 34%; mean age: 63 years; diabetes mellitus: 82%) were randomly assigned to receive either valsartan- or amlodipine-based antihypertensive treatment. Primary outcome was a composite of acute myocardial infarction, stroke, coronary revascularization, admission attributed to heart failure, or sudden cardiac death. Blood pressure was 145/82 and 144/81 mm Hg, and glycosylated hemoglobin was 7.0% and 6.9% at baseline in the valsartan group and the amlodipine group, respectively. Both of them were equally controlled between the 2 groups during the study. The median follow-up period was 3.2 years, and primary outcome had occurred in 54 patients in the valsartan group and 56 in the amlodipine group (hazard ratio: 0.97 [95% CI: 0.66-1.40]; P=0.85). Patients in the valsartan group had a significantly lower incidence of heart failure than in the amlodipine group (hazard ratio: 0.20 [95% CI: 0.06-0.69]; P=0.01). Other components and all-cause mortality were not significantly different between the 2 groups. Composite cardiovascular outcomes were comparable between the valsartan- and amlodipine-based treatments in Japanese hypertensive patients with glucose intolerance. Admission because of heart failure was significantly less in the valsartan group.

Cardiorespiratory Fitness is a Strong Predictor of the Cardio-ankle Vascular Index in Hypertensive Middle-aged and Elderly Japanese Men.

PubMed

Tanisawa, Kumpei; Ito, Tomoko; Sun, Xiaomin; Kawakami, Ryoko; Oshima, Satomi; Gando, Yuko; Cao, Zhen-Bo; Sakamoto, Shizuo; Higuchi, Mitsuru

2015-01-01

This study aimed to examine whether cardiorespiratory fitness (CRF) is associated with arterial stiffening, evaluated using the cardio-ankle vascular index (CAVI), independent of visceral fat (VF) in middle-aged and elderly Japanese men. We also examined whether the relationship between CRF and the CAVI is modified by age and/or hypertension. The CAVI was determined in 157 Japanese men (age range, 30-79 years), including 96 hypertensive subjects (61.1%). CRF was assessed by measuring the peak oxygen uptake (VO2peak). The subjects were divided into low- and high-CRF groups, and the VF area was assessed using magnetic resonance imaging. The VO2peak correlated with the CAVI following adjustment for age and body mass index in the middle-aged and elderly groups (all the subjects: r=-0.285, p＜0.001; middle-aged: r=-0.240, p=0.040; elderly: r=-0.225, p=0.049). VF also correlated with the CAVI (r=0.230, p=0.004). A multiple linear regression analysis revealed that age (β=0.406, p<0.001) and the VO2peak (β=-0.186, p=0.015) were associated with the CAVI independently of VF and the mean blood pressure. Two way ANCOVA adjusted for age demonstrated that the hypertensive individuals had higher CAVI values than the normotensive individuals in the low-CRF group, whereas no significant differences in the CAVI were observed in the high-CRF group (p for interaction <0.05). In the present study, CRF was found to be associated with the CAVI, independent of age and VF, in hypertensive middle-aged and elderly Japanese men.

Economic impact of switching to fixed-dose combination therapy for Japanese hypertensive patients: a retrospective cost analysis

PubMed Central

2013-01-01

Background The prescription of fixed-dose combinations (FDC) of antihypertensive drugs has increased rapidly since the relaxation of the prescription-term restriction. In this study, we used the opportunity of this policy change in Japan as an instrument to assess the causal impact of switching to FDC on hypertensive treatment costs. Methods Claims data from 64 community pharmacies located in Tokyo were used to identify hypertensive patients under continuous treatment with angiotensin-receptor blockers (ARBs). Patients switching to FDC between December 2010 and April 2011 were compared to patients who did not receive FDC (control group). Changes in annual antihypertensive drug costs were compared using a difference-in-differences approach to adjust for patient characteristics and use of concomitant medication. Subpopulation analyses were also performed, taking into account pre-index treatment patterns and prescribers’ characteristics. Results There were 542 patients who switched to FDC and 9664 patients in the control group. No significant differences were observed between the 2 groups, except for antihypertensive drug use patterns before the policy change and prescribers’ characteristics. The switch to FDC was associated with an annual saving of 10,420 yen (US$112.0) in antihypertensive drug costs. Approximately 20% of the FDC patients, however, switched from ARB alone, and their drug costs increased by 2376 yen (US$25.5). Conclusions For hypertensive patients who required ARB-based combination therapy, switching to FDC drugs had a significant cost-saving effect. However, the policy change of relaxing the prescription-term restriction could encourage aggressive treatment, i.e., switching to a combination therapy from monotherapy, regardless of medical conditions. Further research is required to evaluate the possible negative aspects of FDC drugs. PMID:23552327

Population pharmacokinetics of olmesartan following oral administration of its prodrug, olmesartan medoxomil: in healthy volunteers and hypertensive patients.

PubMed

Yoshihara, Kazutaka; Gao, Yuying; Shiga, Hiroshi; Wada, D Russell; Hisaoka, Masafumi

2005-01-01

Olmesartan medoxomil (CS-866) is a new orally active angiotensin II receptor antagonist that is highly selective for the AT1 receptor subtype. To develop a population pharmacokinetic model for olmesartan (RNH-6270), the active metabolite of olmesartan medoxomil, in healthy volunteers and hypertensive patients, and to evaluate effects of covariates on the apparent oral clearance (CL/F), with particular emphasis on the effect of race. Retrospective analysis of data from 12 phase I-III trials in the US, Europe and Japan. Eighty-nine healthy volunteers and 383 hypertensive patients. Nonlinear mixed-effects modelling was used to evaluate 7911 olmesartan plasma sample concentrations. The covariates included age, bodyweight, sex, race (Westerners [including Caucasians and Hispanics] versus Japanese), patient status (hypertensive patients versus healthy volunteers), serum creatinine level as an index of renal function and serum chemistry data as indices of hepatic function. The pharmacokinetic data of olmesartan were well described by a two-compartment linear model with first-order absorption and an absorption lag-time, parameterised in terms of CL/F (6.66 L/h for a typical male Western hypertensive patient), absorption rate constant (1.46h-1), elimination rate constant (0.193h-1), rate constant from the central to peripheral compartment (0.061h-1), rate constant from the peripheral to central compartment (0.079h-1) and absorption lag-time (0.427h). Analysis of covariates showed that age, bodyweight, sex, patient status and renal function were factors influencing the clearance of olmesartan. The population pharmacokinetic analysis of olmesartan showed that: (i) severe renal impairment (serum creatinine >265 micromol/L [approximately 3 mg/dL]) could cause a clearance decrease of > or =30%; (ii) older age, lower bodyweight and being female were determinants of lower clearance but their effects on olmesartan clearance were within 20%; (iii) no statistically significant

Smoking and prevalence of nocturia in Japanese patients with type 2 diabetes mellitus: a post-hoc analysis of The Dogo Study.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Kanzaki, Sayaka; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Onji, Morikazu; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2017-06-01

No evidence exists regarding the association between smoking status and nocturia among patients with type 2 diabetes mellitus. We evaluated this association among Japanese patients with type 2 diabetes mellitus by post-hoc analysis. Study subjects were 817 Japanese patients with type 2 diabetes mellitus. Study subjects were considered to have nocturia if they answered "once or more" to the question: "Within one week, how many times do you typically wake up to urinate from sleeping at night until waking in the morning?" We used the following three outcomes: (1) nocturia was ≥1 voids per night; (2) moderate nocturia was ≥2 voids per night; and (3) severe nocturia was ≥3 voids per night. Adjustments were made for age, sex, body mass index, hypertension, dyslipidemia, stroke, glycated hemoglobin, current drinking, use of anti-hypertensive agent, use of insulin, use of oral anti-hyperglycemic agent, and diabetic retinopathy. The prevalence values of one void per night, two voids per night, and three or more voids per night were 39.5%, 27.1%, and 14.8%, respectively. Current smoking was independently inversely associated with severe nocturia compared with never or former smoking; the adjusted PR was 0.47 (95%CI: 0.25-0.89). Among the 443 patients who had ever smoked, compared with former smoking, current smoking was independently inversely related to severe nocturia; the adjusted PR was 0.44 (95%CI: 0.24-0.82). In Japanese patients with type 2 diabetes mellitus, current smoking may be independently inversely associated with severe nocturia. © 2016 Wiley Periodicals, Inc.

[Hypertensive crisis in kidney patients].

PubMed

Scrivano, Jacopo; Giuliani, Anna; Pettorini, Laura; Punzo, Giorgio; Mene', Paolo; Pirozzi, Nicola

2011-01-01

The classification and management of hypertensive crisis have been recently reviewed in the context of both European and American guidelines. The key points for proper blood pressure control in severe arterial hypertension are: 1 - Distinction between urgent intervention and emergencies 2 - Choice of the best drug(s) 3 - Choice of the correct route of administration. In patients with renal disease, beside the common causes of hypertension/ hypertensive crises, kidney-specific causes should be taken into account such as renal parenchymal hypertension, renovascular hypertension, sclerodermic crises, and preeclampsia.

Cost-effectiveness analysis of hypertension treatment: controlled release nifedipine and candesartan low-dose combination therapy in patients with essential hypertension--the Nifedipine and Candesartan Combination (NICE-Combi) Study.

PubMed

Fujikawa, Keita; Hasebe, Naoyuki; Kikuchi, Kenjiro

2005-07-01

Societal interest in pharmaco-economic analysis is increasing in Japan. In this study, the cost-effectiveness of low-dose combination therapy with controlled release nifedipine plus candesartan and up-titrated monotherapy with candesartan was estimated, based on the results of the NICE-Combi study. The NICE-Combi study was a double-blind, parallel arm, randomized clinical trial to compare the efficacy of low-dose combination therapy of controlled release nifedipine (20 mg/day) plus candesartan (8 mg/day) vs. up-titrated monotherapy of candesartan (12 mg/day) on blood pressure control in Japanese patients with mild to severe essential hypertension who were not sufficiently controlled by the conventional dose of candesartan (8 mg/ day). The incremental cost effectiveness of each cohort during the 8-week randomization period was compared, from the perspective of a third-party payer (i.e., insurers). The average total cost per patient was 29,943 Japanese yen for the combination therapy group and 33,182 Japanese yen for the candesartan monotherapy group, while the rate of achievement of the target blood pressure was significantly higher in the combination therapy group than in the up-titrated monotherapy group. In the combination therapy group, higher efficacy and lower incremental treatment cost ("Dominance") were observed when compared to the monotherapy group. The sensitivity analyses also supported the results. In conclusion, these results suggest that combination therapy with controlled release nifedipine and low-dose candesartan (8 mg) is "dominant" to up-titrated candesartan monotherapy for the management of essential hypertension. This conclusion was robust to sensitivity analysis.

Short Sleep Duration is an Independent Predictor of Cardiovascular Events in Japanese Hypertensive Patients

PubMed Central

Eguchi, Kazuo; Pickering, Thomas G.; Schwartz, Joseph E.; Hoshide, Satoshi; Ishikawa, Joji; Ishikawa, Shizukiyo; Shimada, Kazuyuki; Kario, Kazuomi

2013-01-01

Context It is not known whether short duration of sleep is a predictor of future cardiovascular events in hypertensive patients. Objective To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD). Design, Setting, and Participants We performed ambulatory BP monitoring (ABPM) in 1255 subjects with hypertension (mean age: 70.4±9.9 years) and they were followed for an average of 50±23 months. Short sleep duration was defined as <7.5 hrs (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio (HR) and 95% CI for short sleep duration. A riser pattern was defined when average nighttime SBP exceeded daytime SBP. Main Outcome Measures The end point was cardiovascular events: stroke, fatal or non-fatal myocardial infarction (MI), and sudden cardiac death. Results In multivariable analyses, short duration of sleep (<7.5 hrs) was associated with incident CVD (HR=1.68; 1.06–2.66, P=.03). A synergistic interaction was observed between short sleep duration and the riser pattern (P=.089). When subjects were categorized on the basis of their sleep time and riser/non-riser patterns, the shorter sleep+riser group had a substantially and significantly higher incidence of CVD than the predominant normal sleep+non-riser group (HR=4.43;2.09–9.39, P<0.001), independent of covariates. Conclusions Short duration of sleep is associated with incident CVD risk, and the combination of riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of hypertensive patients. PMID:19001199

Dietary Sodium Consumption Predicts Future Blood Pressure and Incident Hypertension in the Japanese Normotensive General Population

PubMed Central

Takase, Hiroyuki; Sugiura, Tomonori; Kimura, Genjiro; Ohte, Nobuyuki; Dohi, Yasuaki

2015-01-01

Background Although there is a close relationship between dietary sodium and hypertension, the concept that persons with relatively high dietary sodium are at increased risk of developing hypertension compared with those with relatively low dietary sodium has not been studied intensively in a cohort. Methods and Results We conducted an observational study to investigate whether dietary sodium intake predicts future blood pressure and the onset of hypertension in the general population. Individual sodium intake was estimated by calculating 24-hour urinary sodium excretion from spot urine in 4523 normotensive participants who visited our hospital for a health checkup. After a baseline examination, they were followed for a median of 1143 days, with the end point being development of hypertension. During the follow-up period, hypertension developed in 1027 participants (22.7%). The risk of developing hypertension was higher in those with higher rather than lower sodium intake (hazard ratio 1.25, 95% CI 1.04 to 1.50). In multivariate Cox proportional hazards regression analysis, baseline sodium intake and the yearly change in sodium intake during the follow-up period (as continuous variables) correlated with the incidence of hypertension. Furthermore, both the yearly increase in sodium intake and baseline sodium intake showed significant correlations with the yearly increase in systolic blood pressure in multivariate regression analysis after adjustment for possible risk factors. Conclusions Both relatively high levels of dietary sodium intake and gradual increases in dietary sodium are associated with future increases in blood pressure and the incidence of hypertension in the Japanese general population. PMID:26224048

Pregnancy-induced hypertension is associated with an increase in the prevalence of cardiovascular disease risk factors in Japanese women.

PubMed

Watanabe, Kazushi; Kimura, Chiharu; Iwasaki, Ai; Mori, Toshitaka; Matsushita, Hiroshi; Shinohara, Koichi; Wakatsuki, Akihiko; Gosho, Masahiko; Miyano, Ichiro

2015-06-01

This study assessed whether pregnancy-induced hypertension (PIH) affects the prevalence of cardiovascular disease (CVD) risk factors in later life among Japanese women. Study participants were 1,185 women (mean [SD] age, 46.5 [5.6] y; range, 38-73 y) aged 40 years or older who underwent a health checkup at a periodic health examination facility between January 2012 and December 2013 and had experienced giving birth. Questionnaires were sent to potential participants, and they were encouraged to provide their Maternal and Child Health Handbook (handbook). We recruited 101 women with a history of PIH (PIH group) and 1,084 women with uncomplicated pregnancy at delivery (control group). Groupings were based on information from the handbook. We assessed the association between PIH and CVD in later life among Japanese women by focusing on hypertension, diabetes mellitus, and dyslipidemia as risk factors for CVD. Odds ratios (ORs) for the use of antihypertensive, diabetes mellitus, and dyslipidemic medications in the PIH group were determined. Women with PIH had increased risk of antihypertensive medication use compared with women without PIH (2.9% vs 13.9%; OR, 4.28; 95% CI, 2.14-8.57). Triglycerides were significantly higher and high-density lipoprotein cholesterol was significantly lower in the PIH group than in the control group. The OR for dyslipidemic medication use in the PIH group relative to the control group was 3.20 (95% CI, 1.42-7.22). Our findings suggest that a history of PIH may be associated with an increased risk of hypertension (a risk factor for CVD) in later life among Japanese women.

Clinical Characteristics, Management, and Outcomes of Japanese Patients Hospitalized for Heart Failure With Preserved Ejection Fraction　- A Report From the Japanese Heart Failure Syndrome With Preserved Ejection Fraction (JASPER) Registry.

PubMed

Nagai, Toshiyuki; Yoshikawa, Tsutomu; Saito, Yoshihiko; Takeishi, Yasuchika; Yamamoto, Kazuhiro; Ogawa, Hisao; Anzai, Toshihisa

2018-05-25

Despite the specific characteristics of heart failure with preserved ejection fraction (HFpEF) having been demonstrated predominantly from registries in Western countries, important international differences exist in terms of patient characteristics, management and medical infrastructure between Western and Asian countries.Methods and Results:We performed nationwide registration of consecutive Japanese hospitalized HFpEF patients with left ventricular EF ≥50% from 15 sites between November 2012 and March 2015. Follow-up data were obtained up to 2 years post-discharge. A total of 535 patients were registered. The median age was 80 years and 50% were female. The most common comorbid conditions were hypertension (77%) and atrial fibrillation (AF: 62%), but body mass index was relatively low. In-hospital mortality rate was 1.3% and the median length of hospitalization was 16 days. By 2 years post-discharge, 40.8% of patients had all-cause death or HF hospitalization. Approximately one-half of deaths had a cardiac cause. Lower serum albumin on admission was one of the strongest independent determinants of worse clinical outcome. Japanese HFpEF patients were less obese, but had a substantially higher prevalence of AF and lower incidence of subsequent events compared with previous reports. Our findings indicated that specific preventative and therapeutic strategies focusing on AF and nutritional status might need to be considered for Japanese hospitalized patients with HFpEF.

[The magnetotherapy of hypertension patients].

PubMed

Ivanov, S G; Smirnov, V V; Solov'eva, F V; Liashevskaia, S P; Selezneva, L Iu

1990-01-01

A study was made of the influence of the constant MKM2-1 magnets on patients suffering from essential hypertension. Continuous action of the magnetic field, created by such magnets, on the patients with stage II essential hypertension was noted to result in a decrease of arterial pressure without the occurrence of any side effects and in a simultaneous reduction of the scope of drug administration. Apart from that fact, magnetotherapy was discovered to produce a beneficial effect on the central hemodynamics and microcirculation. The use of the MKM2-1 magnets may be regarded as a feasible method of the treatment of essential hypertension patients at any medical institution.

[The leptin concentration in patients with primary arterial hypertension].

PubMed

Jołda-Mydłowska, Beata; Przewłocka-Kosmala, Monika; Zyśko, Dorota; Gajek, Jacek; Mazurek, Walentyna

2006-01-01

Leptin seems to play a role in the pathogenesis of arterial hypertension by activation of the sympathetic nervous system, influencing water - electrolyte balance and vascular remodeling. It is not known whether leptin is a factor participating in the pathogenesis of primary arterial hypertension or its higher concentration in patients with arterial hypertension reflects only the presence of other factors leading to increased blood pressure. The aim of the study was to try to estimate the leptin participation in the development of the arterial hypertension, to evaluate the concentration of leptin in blood serum of patients with mild, moderate and severe arterial hypertension and to determine the relationships between the observed leptin concentration, arterial hypertension degree according to WHO criteria and body mass. The investigations were performed on 74 untreated patients aged 19-74 years (mean 47 +/- 12 years ). In this group there were 33 women aged 35-74 years (mean 51 +/- 10 years) and 41 men aged 19-73 years (mean 45 +/- 14 years). The mild arterial hypertension was observed in 24 patients, moderate hypertension in 34 patients and severe hypertension in 16. The obesity, identified when BMI was equal or higher than 30 kg/m2, was observed in 4 patients with mild hypertension, in 9 with moderate hypertension and in 6 with severe hypertension. All patients had normal renal function. The leptin concentration was determined by the radioimmunological method using the Human Leptin RIA Kit by LINCO Research, Inc. (Cat# HL-81 K). The analysis of the obtained results was performed using Statistica for Windows PL.V5.0. The concentration of leptin in patients with mild hypertension was 3.61 +/- 2.22 ng/ml, in patients with moderate hypertension was 12.65 +/- 8.48 and in patients with severe hypertension 33.51 +/- 28.45 ng/ml. The concentration of leptin in obese patients was 24.83 +/- 26.60 and in patients without obesity was 10.57 +/- 11.99 ng/ml. 1. In patients with

Association of overtime work and hypertension in a Japanese working population: a cross-sectional study.

PubMed

Imai, Teppei; Kuwahara, Keisuke; Nishihara, Akiko; Nakagawa, Tohru; Yamamoto, Shuichiro; Honda, Toru; Miyamoto, Toshiaki; Kochi, Takeshi; Eguchi, Masafumi; Uehara, Akihiko; Kuroda, Reiko; Omoto, Daisuke; Nagata, Tomohisa; Pham, Ngoc Minh; Kurotani, Kayo; Nanri, Akiko; Akter, Shamima; Kabe, Isamu; Mizoue, Tetsuya; Sone, Tomofumi; Dohi, Seitaro

2014-12-01

Long working hours have been associated with an increased risk of cardiovascular disease, but its relationship with hypertension remains unclear. The objective of this study is to examine the relationship between overtime and presence of hypertension using data from a large-scale multi-company study in Japan. Participants were 52 365 workers of four companies that provided both health-checkup data and self-reported data on overtime worked. Hypertension was defined as systolic blood pressure ≥140 mmHg, diastolic blood pressure ≥90 mmHg, and/or the use of antihypertensive drug. Logistic regression analysis was performed to determine the odds ratio for hypertension for each category of overtime work (<45, 45-79, 80-99 or ≥100 h/month) with adjustments for age, sex, company, smoking status and body mass index. The prevalence of hypertension tended to decrease with increasing overtime work: 17.5, 12.0, 11.1 and 9.1% for the shortest (<45 h/month) through the longest overtime category (≥100 h/month). The age-, sex- and company-adjusted odds ratios (95% confidence interval) were 1.00 (reference), 0.81 (0.75-0.86), 0.73 (0.62-0.86), 0.58 (0.44-0.76), respectively (p for linear trend <0.001). In a sub-cohort, the inverse association remained statistically significant after an additional adjustment for other potential confounders. Results of the present large-scale study among Japanese workers suggest an inverse association between overtime work and presence of hypertension.

Screening for secondary endocrine hypertension in young patients.

PubMed

Trifanescu, Raluca; Carsote, Mara; Caragheorgheopol, Andra; Hortopan, Dan; Dumitrascu, Anda; Dobrescu, Mariana; Poiana, Catalina

2013-06-01

Secondary endocrine hypertension accounts for 5-12% of hypertension's causes. In selected patients (type 2 diabetes mellitus, sleep apnea syndrome with resistant hypertension, sudden deterioration in hypertension control), prevalence could be higher. To present etiology of endocrine secondary hypertension in a series of patients younger than 40 years at hypertension's onset. Medical records of 80 patients (39M/41F), aged 30.1 ± 8.2 years (range: 12-40 years), with maximum systolic blood pressure=190.4 ± 29.2 mm Hg, range: 145-300 mm Hg, maximum diastolic blood pressure=107.7 ± 16.9 mm Hg, range: 80-170 mm Hg) referred by cardiologists for endocrine hypertension screening were retrospectively reviewed. Cardiac and renal causes of secondary hypertension were previously excluded. In all patients, plasma catecholamines were measured by ELISA and plasma cortisol by immunochemiluminescence. Orthostatic aldosterone (ELISA) and direct renin (chemiluminescence) were measured in 48 patients. Secondary endocrine hypertension was confirmed in 16 out of 80 patients (20%). Primary hyperaldosteronism was diagnosed in 7 (4M/3F) out of 48 screened patients (14.6%). i.e. 8.75% from whole group: 5 patients with adrenal tumors (3 left/2 right), 2 patients with bilateral adrenal hyperplasia; all patients were hypokalemic at diagnostic (average nadir K+ levels = 2.5 ± 0.5 mmol/L); four patients were hypokalaemic on diuretic therapy (indapamidum); other 3 patients were hypokalaemic in the absence of diuretic therapy. Cushing's syndrome was diagnosed in 6 patients (7.5%): subclinical Cushing due to 4 cm right adrenal tumour - n = 1, overt ACTH-independent Cushing's syndrome due to: macronodular adrenal hyperplasia associated with primary hyperparathyroidism - n = 1; due to adrenal carcinoma - n = 1; due to adrenal adenomas - n = 2; Cushing's disease - n = 1). Pheochromocytomas were diagnosed in 3 patients (3.75%). Primary hyperaldosteronism was the most frequent cause of secondary

CPAP and hypertension in nonsleepy patients.

PubMed

Phillips, Barbara; Shafazand, Shirin

2013-02-01

Is continuous positive airway pressure (CPAP) therapy better than no therapy in reducing the incidence of hypertension or cardiovascular (CV) events in a cohort of nonsleepy patients with obstructive sleep apnea (OSA)? Randomized, controlled trial; no placebo CPAP used. ClinicalTrials.gov Identifier: NCT00127348. Randomization was performed using a computer generated list of random numbers in the coordinating center and results were mailed to participating centers in numbered opaque envelopes. Primary outcome was evaluated by individuals not involved in the study and who were blinded to patient allocation. Patients, investigators, and the statistician were not blinded. median 4 (interquartile range, 2.7-4.4) years. 14 academic medical centers in Spain. 725 adults (mean age 51.8 y, 14% women) who were diagnosed with OSA with apnea hypopnea index (AHI) ≥ 20 events per hour and Epworth sleepiness score (ESS) ≤ 10 were randomized. Subjects with previous CV events were excluded. However, patients with a history of hypertension were not excluded (50% of the sample were hypertensive at baseline). Patients were randomized to receive CPAP treatment or no active intervention. All participants received dietary counseling and advice about sleep hygiene. The primary outcome was the incidence of either systemic hypertension (among participants who were normotensive at baseline) or CV events (among all participants). The secondary outcome was the association between the incidence of hypertension or CV events (nonfatal myocardial infarction, nonfatal stroke, transient ischemic attack, hospitalization for unstable angina or arrhythmia, heart failure, and CV death) and the severity of OSA assessed by the AHI and oxygen saturation. The sample size was calculated assuming that the incidence of hypertension or new CV event in this population over a period of 3 years would be 10% annually; 345 patients per group were needed to detect a 60% reduction in incidence of new hypertension

Dietary Sodium Consumption Predicts Future Blood Pressure and Incident Hypertension in the Japanese Normotensive General Population.

PubMed

Takase, Hiroyuki; Sugiura, Tomonori; Kimura, Genjiro; Ohte, Nobuyuki; Dohi, Yasuaki

2015-07-29

Although there is a close relationship between dietary sodium and hypertension, the concept that persons with relatively high dietary sodium are at increased risk of developing hypertension compared with those with relatively low dietary sodium has not been studied intensively in a cohort. We conducted an observational study to investigate whether dietary sodium intake predicts future blood pressure and the onset of hypertension in the general population. Individual sodium intake was estimated by calculating 24-hour urinary sodium excretion from spot urine in 4523 normotensive participants who visited our hospital for a health checkup. After a baseline examination, they were followed for a median of 1143 days, with the end point being development of hypertension. During the follow-up period, hypertension developed in 1027 participants (22.7%). The risk of developing hypertension was higher in those with higher rather than lower sodium intake (hazard ratio 1.25, 95% CI 1.04 to 1.50). In multivariate Cox proportional hazards regression analysis, baseline sodium intake and the yearly change in sodium intake during the follow-up period (as continuous variables) correlated with the incidence of hypertension. Furthermore, both the yearly increase in sodium intake and baseline sodium intake showed significant correlations with the yearly increase in systolic blood pressure in multivariate regression analysis after adjustment for possible risk factors. Both relatively high levels of dietary sodium intake and gradual increases in dietary sodium are associated with future increases in blood pressure and the incidence of hypertension in the Japanese general population. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

eNOS Glu298Asp polymorphism and hypertension in a cohort study in Japanese.

PubMed

Kishimoto, Takuji; Misawa, Yumiko; Kaetu, Akihiko; Nagai, Maria; Osaki, Yoneatsu; Okamoto, Mikizoh; Yoshida, Soiti; Kurosawa, Yoichi; Fukumoto, Soji

2004-11-01

Some recent case-control association studies have suggested negative and positive relationship between Glu298Asp (the substitution of aspartic acid for glutamic acid at amino acid position 298) polymorphism of the endothelial nitric oxide synthase (eNOS) gene and hypertension. To investigate whether the Glu298Asp polymorphism of the eNOS gene affects the incidence of hypertension, a retrospective cohort study was performed. The baseline data among Japanese workers in Shimane Prefecture, Japan, were obtained at regular health examination in 1992, and a retrospective cohort study was performed to analyze the influence of Glu298Asp polymorphism on the incidence of hypertension in 1998. The incidences of Glu298Glu, Glu298Asp, and Asp298Asp genotypes in the subjects were 86.4%, 12.6% and 1.1%, respectively. The risk ratios of Glu298Asp and Asp298Asp against Glu298Glu for the incidence of hypertension by single variance analysis were 0.830 in total subjects [95% confidence interval (CI) 0.474-1.452], 0.596 in subjects 20-39 years old (95% CI; 0.207-1.717), and 0.915 in subjects 40-59 years old (95% CI; 0.464-1.805). The risk ratios of Glu298Asp and Asp298Asp against Glu298Glu for the incidence of hypertension by multiple variance analysis adjusted for sex, BMI, serum total cholesterol, serum high-density lipoprotein (HDL) cholesterol, fasting glucose, cigarette smoking, drinking habits, eating habits, and exercise in 1992 were 0.750 in total subjects (95% CI; 0.421-1.335), 0.505 in subjects 20-39 years old (95% CI; 0.170-1.496), and 0.873 in subjects 40-59 years old (95% CI; 0.434-1.757). These results suggested no association between the Glu298Asp gene polymorphism and the incidence of hypertension in this selected population.

[Microalbuminuria in diabetic and hypertensive patients: a study of 979 patients].

PubMed

Roberto Robles, Nicolás; Velasco, Joaquín; Mena, Cándido; Angulo, Enrique; Garrote, Timotea

2006-11-25

Microalbuminuria is a known complication of diabetes mellitus but it is also a cardiovascular risk factor commonly present among hypertensive (non diabetic) population. The prevalence of microalbuminuria is variable and it has been never estimated in our region. The aim of this study has been to determine the prevalence of microalbuminuria in hypertensive (non diabetic) and diabetic population in Extremadura (Spain). The study included diabetic patients and non-diabetic hypertensive ones randomly selected. Microalbuminuria was measured in every patient using albumin/creatinin reactive stick in fasting first morning urine. Whenever possible microalbuminuria was confirmed in laboratory by microalbuminuria/creatinina coefficient in first morning urine samples. A total of 979 patients (mean age [SD], 67.9 [10.8] years; 409 men and 570 women, 505 diabetics) were studied. The presence of microalbuminuria was found in 12.4% of hypertensive patients and in 21.4% of diabetic patients (p < 0.001). Hypertensives and normotensive diabetics showed a similar prevalence of microalbuminuria (13.3%, not significant), but it tripled in hypertensive diabetics (33.8; p < 0.01). Glicemic control was not different for microalbuminuric diabetic patients and non microalbuminuric ones. The patients receiving rennin-angiotensin axis blocking drugs do not showed less prevalence of microalbuminuria (hypertensives 10.5%, diabetics 23.5%). Microalbuminuria was confirmed in 65.4% of patients. The prevalence of microalbuminuria in Extremadura seems to be high either in diabetics or non diabetic hypertensive patients. The finding of microalbuminuria in diabetics patients correlates with hypertension but do not with glicemic control. The prevalence of microalbuminuria is high in spite of using rennin-angiotensin axis blocking drugs.

Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk.

PubMed

Okada, Sadanori; Morimoto, Takeshi; Ogawa, Hisao; Sakuma, Mio; Soejima, Hirofumi; Nakayama, Masafumi; Sugiyama, Seigo; Jinnouchi, Hideaki; Waki, Masako; Doi, Naofumi; Horii, Manabu; Kawata, Hiroyuki; Somekawa, Satoshi; Soeda, Tsunenari; Uemura, Shiro; Saito, Yoshihiko

2013-01-01

Benefit of low-dose aspirin for primary prevention of cardiovascular events in diabetes remains controversial. The American Diabetes Association (ADA), the American Heart Association (AHA), and the American College of Cardiology Foundation (ACCF) recommend aspirin for high-risk diabetic patients: older patients with additional cardiovascular risk factors. We evaluated aspirin's benefit in Japanese diabetic patients stratified by cardiovascular risk. In the JPAD trial, we enrolled 2,539 Japanese patients with type 2 diabetes and no history of cardiovascular disease. We randomly assigned them to aspirin (81-100 mg daily) or no aspirin groups. The median follow-up period was 4.4 years. We stratified the patients into high-risk or low-risk groups, according to the US recommendation: age (older; younger) and coexisting cardiovascular risk factors. The risk factors included smoking, hypertension, dyslipidemia, family history of coronary artery disease, and proteinuria. Most of the patients were classified into the high-risk group, consisting of older patients with risk factors (n=1,804). The incidence of cardiovascular events was higher in this group, but aspirin did not reduce cardiovascular events (hazard ratio [HR], 0.83; 95% confidence interval [CI]: 0.58-1.17). In the low-risk group, consisting of older patients without risk factors and younger patients (n=728), aspirin did not reduce cardiovascular events (HR, 0.55; 95% CI: 0.23-1.21). These results were unchanged after adjusting for potential confounding factors. Low-dose aspirin is not beneficial in Japanese diabetic patients at high risk.

Screening for Secondary Endocrine Hypertension in Young Patients

PubMed Central

TRIFANESCU, Raluca; CARSOTE, Mara; CARAGHEORGHEOPOL, Andra; HORTOPAN, Dan; DUMITRASCU, Anda; DOBRESCU, Mariana; POIANA, Catalina

2013-01-01

ABSTRACT Background: Secondary endocrine hypertension accounts for 5-12% of hypertension's causes. In selected patients (type 2 diabetes mellitus, sleep apnea syndrome with resistant hypertension, sudden deterioration in hypertension control), prevalence could be higher. Objectives: To present etiology of endocrine secondary hypertension in a series of patients younger than 40 years at hypertension's onset. Material and methods: Medical records of 80 patients (39M/41F), aged 30.1 ± 8.2 years (range: 12-40 years), with maximum systolic blood pressure=190.4 ± 29.2 mm Hg, range: 145-300 mm Hg, maximum diastolic blood pressure=107.7 ± 16.9 mm Hg, range: 80-170 mm Hg) referred by cardiologists for endocrine hypertension screening were retrospectively reviewed. Cardiac and renal causes of secondary hypertension were previously excluded. In all patients, plasma catecholamines were measured by ELISA and plasma cortisol by immunochemiluminescence. Orthostatic aldosterone (ELISA) and direct renin (chemiluminescence) were measured in 48 patients. Results: Secondary endocrine hypertension was confirmed in 16 out of 80 patients (20%). Primary hyperaldosteronism was diagnosed in 7 (4M/3F) out of 48 screened patients (14.6%). i.e. 8.75% from whole group: 5 patients with adrenal tumors (3 left/2 right), 2 patients with bilateral adrenal hyperplasia; all patients were hypokalemic at diagnostic (average nadir K+ levels = 2.5 ± 0.5 mmol/L); four patients were hypokalaemic on diuretic therapy (indapamidum); other 3 patients were hypokalaemic in the absence of diuretic therapy. Cushing's syndrome was diagnosed in 6 patients (7.5%): subclinical Cushing due to 4 cm right adrenal tumour – n = 1, overt ACTH-independent Cushing's syndrome due to: macronodular adrenal hyperplasia associated with primary hyperparathyroidism – n = 1; due to adrenal carcinoma – n = 1; due to adrenal adenomas – n = 2; Cushing's disease – n = 1). Pheochromocytomas were diagnosed in 3 patients (3

NADH Dehydrogenase Subunit-2 237 Leu/Met Polymorphism Modulates the Effects of Coffee Consumption on the Risk of Hypertension in Middle-Aged Japanese Men

PubMed Central

Kokaze, Akatsuki; Ishikawa, Mamoru; Matsunaga, Naomi; Karita, Kanae; Yoshida, Masao; Ohtsu, Tadahiro; Shirasawa, Takako; Sekii, Hideaki; Ito, Taku; Kawamoto, Teruyoshi; Takashima, Yutaka

2009-01-01

Background Habitual coffee consumption has been reported to lower blood pressure in the Japanese population. The NADH dehydrogenase subunit-2 237 leucine/methionine (ND2-237 Leu/Met) polymorphism is associated with longevity and modifies the effects of alcohol consumption on blood pressure in the Japanese population. The objective of this study was to determine whether this polymorphism also modifies the effects of coffee consumption on blood pressure or the risk of hypertension in middle-aged Japanese men. Methods A total of 398 men (mean age ± standard deviation, 53.8 ± 7.8 years) were selected from among individuals visiting the hospital for regular medical check-ups. Hypertension was defined as a systolic blood pressure ≥140 mm Hg, diastolic blood pressure ≥90 mm Hg, or antihypertensive drug treatment. Polymerase chain reaction-restriction fragment length polymorphism using the restriction enzyme AluI was performed to determine ND2-237 Leu/Met genotype. Results In subjects with ND2-237Leu, coffee consumption was significantly and negatively associated with diastolic blood pressure (P = 0.007). The odds ratio (OR) for hypertension was significantly lower in subjects with ND2-237Leu who consumed 2 or 3 cups of coffee per day than in those who consumed less than 1 cup of coffee per day (OR, 0.517; 95% confidence interval [CI], 0.276 to 0.968; P = 0.039). After adjustment, the OR remained significant (OR = 0.399; 95% CI, 0.184 to 0.869; P = 0.020). Moreover, after adjustment, the OR was significantly lower in subjects with ND2-237Leu who consumed more than 4 cups of coffee per day than in those who consumed less than 1 cup of coffee per day (OR, 0.246; 95% CI, 0.062 to 0.975; P = 0.046). However, the association between ND2-237Met genotype and hypertension did not depend on coffee consumption. Conclusions The present results suggest that the ND2-237 Leu/Met polymorphism modulates the effects of coffee consumption on hypertension risk in middle-aged Japanese

Short sleep duration as an independent predictor of cardiovascular events in Japanese patients with hypertension.

PubMed

Eguchi, Kazuo; Pickering, Thomas G; Schwartz, Joseph E; Hoshide, Satoshi; Ishikawa, Joji; Ishikawa, Shizukiyo; Shimada, Kazuyuki; Kario, Kazuomi

2008-11-10

It is not known whether short duration of sleep is a predictor of future cardiovascular events in patients with hypertension. To test the hypothesis that short duration of sleep is independently associated with incident cardiovascular diseases (CVD), we performed ambulatory blood pressure (BP) monitoring in 1255 subjects with hypertension (mean [SD] age, 70.4 [9.9] years) and followed them for a mean period of 50 (23) months. Short sleep duration was defined as less than 7.5 hours (20th percentile). Multivariable Cox hazard models predicting CVD events were used to estimate the adjusted hazard ratio and 95% confidence interval (CI) for short sleep duration. A riser pattern was defined when mean nighttime systolic BP exceeded daytime systolic BP. The end point was a cardiovascular event: stroke, fatal or nonfatal myocardial infarction (MI), and sudden cardiac death. In multivariable analyses, short duration of sleep (<7.5 hours) was associated with incident CVD (hazard ratio [HR], 1.68; 95% CI, 1.06-2.66; P = .03). A synergistic interaction was observed between short sleep duration and the riser pattern (P = .09). When subjects were classified according to their sleep time and a riser vs nonriser pattern, the group with shorter sleep duration plus the riser pattern had a substantially and significantly higher incidence of CVD than the group with predominant normal sleep duration plus the nonriser pattern (HR, 4.43; 95% CI, 2.09-9.39; P < .001), independent of covariates. Short duration of sleep is associated with incident CVD risk and the combination of the riser pattern and short duration of sleep that is most strongly predictive of future CVD, independent of ambulatory BP levels. Physicians should inquire about sleep duration in the risk assessment of patients with hypertension.

[Hypertension therapy and patient compliance].

PubMed

Rapi, Judit

2002-08-25

In the treatment of chronic disease like hypertension it is very important to achieve good patient compliance. One third of the patients however takes his medicament irregularly. The failure of the treatment is usually caused by the patient, who is not aware of his illness, he feels healthy that's why he does not go to see the doctor or he stops taking the medicine. The cause of bad compliance can also be the doctor who does not spend enough time and energy on his patients. Rarely the therapy is broken off because of the side effects of the medication. In the last year 100 patients with hypertension were asked with help of a questionnaire about their drug-taking habits and their knowledge about hypertension. From the answers we found out that one third of the patients takes his drugs irregularly. Less than half of the patients reaches the normotension. Most of the patients who have been treated for many years do not know the goal blood pressure, the possible complications of hypertension, the goal of the treatment. Often they do not even know the name of their medicine. Compliance is a complicated problem. Improvement could be reached by regular teaching of the patients, by teaching the patients how to measure blood pressure at home, by increasing the number of educational publications, by regular training of the doctors, by keeping the rules of the treatment, by using modern and long-term effective drugs. It would be important to start with teaching the healthy way of living already at a young age.

The role of comorbidities in patients' hypertension self-management.

PubMed

Fix, Gemmae M; Cohn, Ellen S; Solomon, Jeffrey L; Cortés, Dharma E; Mueller, Nora; Kressin, Nancy R; Borzecki, Ann; Katz, Lois A; Bokhour, Barbara G

2014-06-01

We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control].

PubMed

Benítez Camps, M; Egocheaga Cabello, M Isabel; Dalfó Baqué, A; Bajo García, J; Vara González, L; Sanchis Doménech, C; Martín Rioboo, E; Ureña Fernández, T; Domínguez Sardiña, M; Bonet Pla, A

2015-01-01

To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

Characteristics of MUTYH variants in Japanese colorectal polyposis patients.

PubMed

Takao, Misato; Yamaguchi, Tatsuro; Eguchi, Hidetaka; Tada, Yuhki; Kohda, Masakazu; Koizumi, Koichi; Horiguchi, Shin-Ichiro; Okazaki, Yasushi; Ishida, Hideyuki

2018-06-01

The base excision repair gene MUTYH is the causative gene of colorectal polyposis syndrome, which is an autosomal recessive disorder associated with a high risk of colorectal cancer. Since few studies have investigated the genotype-phenotype association in Japanese patients with MUTYH variants, the aim of this study was to clarify the clinicopathological findings in Japanese patients with MUTYH gene variants who were detected by screening causative genes associated with hereditary colorectal polyposis. After obtaining informed consent, genetic testing was performed using target enrichment sequencing of 26 genes, including MUTYH. Of the 31 Japanese patients with suspected hereditary colorectal polyposis, eight MUTYH variants were detected in five patients. MUTYH hotspot variants known for Caucasians, namely p.G396D and p.Y179D, were not among the detected variants.Of five patients, two with biallelic MUTYH variants were diagnosed with MUTYH-associated polyposis, while two others had monoallelic MUTYH variants. One patient had the p.P18L and p.G25D variants on the same allele; however, supportive data for considering these two variants 'pathogenic' were lacking. Two patients with biallelic MUTYH variants and two others with monoallelic MUTYH variants were identified among Japanese colorectal polyposis patients. Hotspot variants of the MUTYH gene for Caucasians were not hotspots for Japanese patients.

Changes of vasoactive polypeptides during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage.

PubMed

Wang, Zhi; Wang, Xue-feng; Wang, Chao; Luan, Wen-zhong

2007-12-05

Hypertensive crisis could be found after operation in patients with hypertensive intracerebral hemorrhage (HICH). The aim of this study was to explore the changes and the roles of some vasoactive polypeptides during postoperative hypertensive crisis in patients with HICH. A total of 31 patients, who were admitted for craniotomy, were enrolled into this study. After the operation, the patients were divided into three groups. Group I consisted of 9 patients with postoperative hypertensive crisis, and group II was composed of 13 patients without postoperative hypertensive crisis. Nine patients, who denied history of hypertension or HICH, were set as group III. The levels of some vasoactivators in the three groups were measured before and after the operation. The differences in the results among the groups were analyzed using the ANOVA. The data collected before and after the operation in the group I was compared by Wilcoxon test. The concentration of endothelin in group I was significantly higher than that in group III (P < 0.05). The level of thromboxane A2 and the ratio of thromboxane B2 to 6-keto-PGF1a in group I were significantly higher than those in the other two groups (P < 0.05). In group I, the levels of plasma renin activity, angiotensin II, aldosterone, catecholamine, and endothelin before the operation were significantly higher than those determined after the operation (P > 0.05). Postoperative hypertensive crisis may be due to the increased thromboxane A2 and relatively inadequate prostacyclin, especially 6-keto-PGF1a. The increased level of endothelin and intraoperative stimulation also play a certain role in the development of postoperative hypertensive crisis.

Genetic basis for childhood interstitial lung disease among Japanese infants and children.

PubMed

Hayasaka, Itaru; Cho, Kazutoshi; Akimoto, Takuma; Ikeda, Masahiko; Uzuki, Yutaka; Yamada, Masafumi; Nakata, Koh; Furuta, Itsuko; Ariga, Tadashi; Minakami, Hisanori

2018-02-01

BackgroundGenetic variants responsible for childhood interstitial lung disease (chILD) have not been studied extensively in Japanese patients.MethodsThe study population consisted of 62 Japanese chILD patients. Twenty-one and four patients had pulmonary hypertension resistant to treatment (PH) and hypothyroidism, respectively. Analyses of genetic variants were performed in all 62 patients for SFTPC and ABCA3, in all 21 PH patients for FOXF1, and in a limited number of patients for NKX2.1.ResultsCausative genetic variants for chILD were identified in 11 (18%) patients: SFTPC variants in six, NKX2.1 variants in three, and FOXF1 variants in two patients. No patients had ABCA3 variants. All three and two patients with NKX2.1 variants had hypothyroidism and developmental delay, respectively. We found six novel variants in this study.ConclusionMutations in SFTPC, NKX2.1, and FOXF1 were identified among Japanese infants and children with chILD, whereas ABCA3 mutations were rare.

Interdialytic ambulatory blood pressure in patients with intradialytic hypertension.

PubMed

Van Buren, Peter N; Toto, Robert; Inrig, Jula K

2012-01-01

Hypertension is common in hemodialysis patients and contributes to this population's high risk for cardiovascular morbidity and mortality. Patients with intradialytic hypertension, or increases in blood pressure during hemodialysis, have been shown to have the highest risk for these outcomes. The purpose of this review is to describe new findings that shed light on the epidemiology and pathophysiology of intradialytic hypertension and discuss how a better understanding of these mechanisms may lead to improved blood pressure management and outcomes in hemodialysis patients. Our laboratory demonstrated that intradialytic hypertension occurs at least sporadically in most hemodialysis patients, but in 25% of patients it occurs in over 31% of their hemodialysis treatments. We also identified that, compared with hemodialysis patients without intradialytic hypertension, those with intradialytic hypertension have worse endothelial cell function and have higher interdialytic ambulatory blood pressure. Pilot study data show that carvedilol reduces the frequency of intradialytic hypertension and improves endothelial cell dysfunction. Intradialytic hypertension is associated with increased morbidity and mortality, impaired endothelial cell function, and higher overall blood pressure burden. Further investigation is required to determine whether interventions aimed at preventing or treating intradialytic hypertension improve long-term outcomes.

Persistent Outpatient Hypertension Is Independently Associated with Spinal Cord Dysfunction and Imaging Characteristics of Spinal Cord Damage among Patients with Cervical Spondylosis.

PubMed

Kalb, Samuel; Zaidi, Hasan A; Ribas-Nijkerk, Juan C; Sindhwani, Maughan K; Clark, Justin C; Martirosyan, Nikolay L; Theodore, Nicholas

2015-08-01

Hypertension and cervical spondylosis are diseases of the adult population that are approaching near pandemic proportions. However, the interactions between these two disease processes are poorly understood. We set out to determine the associations among systemic hypertension, clinical status, and imaging findings of spinal cord damage for patients with cervical stenosis. A retrospective chart review was performed on patients with symptomatic cervical stenosis related to degenerative disease and divided on the basis of outpatient blood pressure control (normal <140/<90 mm Hg). Sagittal T2-weighted magnetic resonance imaging (MRI) of the cervical spine was analyzed to determine the degree of maximal canal stenosis (MCS; %), surface area of increased signal intensity (ISI; cm(2)), and signal intensity ratio (SIR). Functional status was evaluated using the modified Japanese Orthopaedic Association (mJOA) scale and the Nurick scale. One hundred twenty-two patients were identified (64 hypertensive, 58 nonhypertensive). Likelihood of ISI was higher in hypertensive patients (P < 0.05). Average ISI was significantly higher in patients with uncontrolled blood pressure (P = 0.02) despite MCS being identical between the two groups. The mJOA and Nurick scores were worse for patients with systemic hypertension (P < 0.02). Diabetes mellitus and smoking history did not affect these findings. Persistent hypertension in outpatients is associated with worsened clinical status and increased markers of spinal cord damage on MRI. Perioperative management of blood pressure may serve to improve clinical outcomes. Larger prospective trials are necessary to further validate these findings. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessment and Management of Hypertension in Patients on Dialysis

PubMed Central

Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

2014-01-01

Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

Risk factors for coronary artery calcification in Japanese patients.

PubMed

Shikada, Tomoki; Washio, Masakazu; Nishizaki, Akiko; Kakino, Takamori; Ooe, Kensuke; Ishibashi, Yuuji; Sagara, Shuuichirou; Morishige, Kunio; Tashiro, Hideki

2015-07-01

Because the prevalence of coronary artery calcification is lower among Japanese than among Western individuals, aspects of the Japanese lifestyle might be related to the development of calcification. We aimed to clarify the relationship between coronary artery calcium scores in Japanese patients and various lifestyle factors among the Japanese population. Study subjects were patients aged ≥20 years who underwent multidetector-row computed tomography. A total of 201 patients agreed to take part in this study and answered a questionnaire regarding lifestyle, medical history, and other factors. Old age, current and former smoking, sedentary work, short sleep time, coronary artery stenosis, treatment with statins, medical history of cerebrovascular disease, medical history of angina pectoris, medical history of ischemic heart disease, and medical history of dyslipidemia were associated with higher odds ratios than the other factors examined, while the Japanese-style breakfast (e.g. boiled rice, miso soup, grilled fish) was associated with lower odds ratios. In this study, smoking, sedentary work, short sleep time, and the Japanese-style breakfast were lifestyle factors related to coronary artery calcification. The lifestyle of Japanese people may be related to coronary calcification. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

The cardiovascular effects of mivacurium in hypertensive patients.

PubMed

Plaud, Benoît; Marty, Jean; Debaene, Bertrand; Meistelman, Claude; Pellissier, Daniel; LePage, Jean-Yves; Feiss, Pierre; Scherpereel, Philippe; Bouverne, Marie-Noëlle; Fosse, Sandrine

2002-08-01

Hypotension is common after mivacurium injection in healthy patients. This hemodynamic event had not been investigated in hypertensive patients characterized by more intense hemodynamic instability. In this open-label, multicenter, randomized, and controlled study, we sought to determine whether mean arterial blood pressure (MAP) and heart rate variations were larger in hypertensive versus normotensive patients after a bolus dose of mivacurium injected over 10 or 30 s. After the induction of anesthesia with fentanyl and etomidate, normotensive (n = 149) and hypertensive (n = 57) patients received a single dose of mivacurium 0.2 mg/kg injected over 10 or 30 s by random allocation. Heart rate and MAP were recorded electronically. The incidence of hypotension (defined as a 20% MAP decrease from the control value before mivacurium injection) was 21% and 36% (10-s injection) or 11% and 10% (30-s injection) in the Normotensive and Hypertensive groups, respectively. In Hypertensive patients, the maximum decrease in MAP was significantly greater when mivacurium was injected over 10 s compared with 30 s: 20% vs 11%, respectively (P = 0.002). This difference was not observed in Normotensive patients. Hypotension after rapid (e.g., 10 s) mivacurium injection was more frequent and more pronounced in Hypertensive than in Normotensive patients. When mivacurium (0.2 mg/kg) is injected rapidly (e.g., 10 s) the incidence and the intensity of hypotension are greater in hypertensive patients than in healthy patients.

Uric Acid Is a Strong Risk Marker for Developing Hypertension From Prehypertension: A 5-Year Japanese Cohort Study.

PubMed

Kuwabara, Masanari; Hisatome, Ichiro; Niwa, Koichiro; Hara, Shigeko; Roncal-Jimenez, Carlos A; Bjornstad, Petter; Nakagawa, Takahiko; Andres-Hernando, Ana; Sato, Yuka; Jensen, Thomas; Garcia, Gabriela; Rodriguez-Iturbe, Bernardo; Ohno, Minoru; Lanaspa, Miguel A; Johnson, Richard J

2018-01-01

Prehypertension frequently progresses to hypertension, a condition associated with high morbidity and mortality from cardiovascular diseases and stroke. However, the risk factors for developing hypertension from prehypertension remain poorly understood. We conducted a retrospective cohort study using the data from 3584 prehypertensive Japanese adults (52.1±11.0 years, 2081 men) found to be prehypertensive in 2004 and reexamined in 2009. We calculated the cumulative incidences of hypertension over 5 years, examined risk factors, and calculated odds ratios (ORs) for developing hypertension after adjustments for age, sex, body mass index, smoking and drinking habits, baseline systolic and diastolic blood pressure, pulse rate, diabetes mellitus, dyslipidemia, chronic kidney disease, and serum uric acid levels. The additional analysis evaluated whether serum uric acid (hyperuricemia) constituted an independent risk factor for developing hypertension. The cumulative incidence of hypertension from prehypertension over 5 years was 25.3%. There were no significant differences between women and men (24.4% versus 26.0%; P =0.28). The cumulative incidence of hypertension in subjects with hyperuricemia (n=726) was significantly higher than those without hyperuricemia (n=2858; 30.7% versus 24.0%; P <0.001). After multivariable adjustments, the risk factors for developing hypertension from prehypertension were age (OR, 1.023; P <0.001), female sex (OR, 1.595; P <0.001), higher body mass index (OR, 1.051; P <0.001), higher baseline systolic (OR, 1.072; P <0.001) and diastolic blood pressure (OR, 1.085; P <0.001), and higher serum uric acid (OR, 1.149; P <0.001). Increased serum uric acid is a strong risk marker for developing hypertension from prehypertension. Further studies are needed to determine whether treatment of hyperuricemia in prehypertensive subjects could impede the onset of hypertension. © 2017 American Heart Association, Inc.

Circulating odd-chain saturated fatty acids were associated with arteriosclerosis among patients with diabetes, dyslipidemia, or hypertension in Sri Lanka but not Japan.

PubMed

Kurotani, Kayo; Karunapema, Palitha; Jayaratne, Kapila; Sato, Masao; Hayashi, Takuya; Kajio, Hiroshi; Fukuda, Shoji; Hara, Hisao; Okazaki, Osamu; Jayatilleke, Achala Upendra; Nonaka, Daisuke; Noda, Mitsuhiko; Mizoue, Tetsuya

2018-02-01

The differences in the morbidity and mortality of cardiovascular diseases between Sri Lankan and Japanese populations might be explained by the differences in their diet, especially fat. To test the hypothesis that the fatty acid (FA) compositions differ between Sri Lankan and Japanese populations and that high concentrations of n-3 polyunsaturated FAs and linoleic acid are associated with a low level of arteriosclerosis, the authors compared the circulating FA compositions between Sri Lankan and Japanese populations and examined the association of the circulating FA composition with arterial stiffness in each population. The study participants were patients with diabetes, dyslipidemia, or hypertension in Sri Lanka (n = 100) or Japan (n = 236). Serum FA compositions were measured by gas chromatography. Arterial stiffness was measured using the cardio-ankle vascular index (CAVI). Analysis of covariance was used to compare the FA compositions between the populations. Multiple regression was used to assess the association between each FA and CAVI levels. The concentrations of myristic, γ-linolenic, dihomo-γ-linolenic, and arachidonic acids were higher in the Sri Lankan patients than in the Japanese patients. In contrast, the concentrations of linoleic, α-linolenic, and eicosapentaenoic acids were higher in the Japanese patients than in the Sri Lankan patients. Although no associations of n-3 polyunsaturated FAs and linoleic acid with CAVI were observed in both patient populations, odd-chain saturated FAs (pentadecanoic and heptadecanoic acids) were significantly inversely associated with CAVI levels in the Sri Lankan (P for trend = .03) but not the Japanese patients. The odd-chain saturated FAs might be inversely associated with atherosclerosis in this Sri Lankan population. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Genetic variation in the raptor gene is associated with overweight but not hypertension in American men of Japanese ancestry.

PubMed

Morris, Brian J; Carnes, Bruce A; Chen, Randi; Donlon, Timothy A; He, Qimei; Grove, John S; Masaki, Kamal H; Elliott, Ayako; Willcox, Donald C; Allsopp, Richard; Willcox, Bradley J

2015-04-01

The mechanistic target of rapamycin (mTOR) pathway is pivotal for cell growth. Regulatory associated protein of mTOR complex I (Raptor) is a unique component of this pro-growth complex. The present study tested whether variation across the raptor gene (RPTOR) is associated with overweight and hypertension. We tested 61 common (allele frequency ≥ 0.1) tagging single nucleotide polymorphisms (SNPs) that captured most of the genetic variation across RPTOR in 374 subjects of normal lifespan and 439 subjects with a lifespan exceeding 95 years for association with overweight/obesity, essential hypertension, and isolated systolic hypertension. Subjects were drawn from the Honolulu Heart Program, a homogeneous population of American men of Japanese ancestry, well characterized for phenotypes relevant to conditions of aging. Hypertension status was ascertained when subjects were 45-68 years old. Statistical evaluation involved contingency table analysis, logistic regression, and the powerful method of recursive partitioning. After analysis of RPTOR genotypes by each statistical approach, we found no significant association between genetic variation in RPTOR and either essential hypertension or isolated systolic hypertension. Models generated by recursive partitioning analysis showed that RPTOR SNPs significantly enhanced the ability of the model to accurately assign individuals to either the overweight/obese or the non-overweight/obese groups (P = 0.008 by 1-tailed Z test). Common genetic variation in RPTOR is associated with overweight/obesity but does not discernibly contribute to either essential hypertension or isolated systolic hypertension in the population studied. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Obstetric management in patients with severe pulmonary hypertension].

PubMed

Castillo-Luna, Rogelio; Miranda-Araujo, Osvaldo

2015-12-01

Pulmonary hypertension is a disease of poor prognosis when is associated with pregnancy. A maternal mortality of 30-56% and a neonatal survival of approximately 85% is reported. Surveillance of patients with severe pulmonary hypertension during pregnancy must be multidisciplinary, to provide information and optimal treatment during and after gestation. Targeted therapy for pulmonary arterial hypertension during pregnancy significantly reduces mortality. The critical period with respect to mortality, is the first month after birth. Propose an algorithm for management during pregnancy for patients with severe pulmonary hypertension who want to continue with it. The recommendations established with clinical evidence for patients with severe pulmonary hypertension and pregnancy are presented: diagnosis, treatment, obstetrics and cardiology management, preoperative recommendations for termination of pregnancy, post-partum care and contraception. The maternal mortality remains significantly higher in patients with severe pulmonary hypertension and pregnancy, in these cases should be performed multidisciplinary management in hospitals that have experience in the management of this disease and its complications.

Manifold implications of obesity in ischemic heart disease among Japanese patients according to covariance structure analysis: Low reactivity of B-type natriuretic peptide as an intervening risk factor.

PubMed

Tsutsumi, Joshi; Minai, Kosuke; Kawai, Makoto; Ogawa, Kazuo; Inoue, Yasunori; Morimoto, Satoshi; Tanaka, Toshikazu; Nagoshi, Tomohisa; Ogawa, Takayuki; Yoshimura, Michihiro

2017-01-01

Obesity is believed to be one of the major risk factors for cardiovascular disease in Western countries. However, the effects of obesity should be continuously examined in the Japanese population because the average bodily habitus differs among countries. In this study, we collectively examined the significance of obesity and obesity-triggered risk factors including the low reactivity of B-type natriuretic peptide (BNP), for ischemic heart disease (IHD) in Japanese patients. The study patients consisted of 1252 subjects (IHD: n = 970; non-IHD: n = 282). Multiple logistic regression analysis revealed that dyslipidemia, hypertension, diabetes, and the low reactivity of BNP were significant risk factors for IHD, but body mass index (BMI) was not. A theoretical path model was proposed by positioning BMI at the top of the hierarchical model. Exploratory factor analysis revealed that BMI did not play a causative role in IHD (P = NS). BMI was causatively linked to other risk factors (P<0.001 for hypertension; P<0.001 for dyslipidemia; P<0.001 for HbA1c; P<0.001 for LogBNP), and these factors played a causative role in IHD (P<0.001 for hypertension; P<0.001 for dyslipidemia; P<0.001 for HbA1c; P<0.001 for LogBNP). The intrinsic power of the low reactivity of BNP induced by high BMI on the promotion of IHD was fairly potent. This study demonstrated that obesity per se is not a strong risk factor for IHD in Japanese patients. However, several important risk factors triggered by obesity exhibited a causative role for IHD. The low reactivity of BNP is a substantial risk factor for IHD.

White-Coat Effect Is Uncommon in Patients With Refractory Hypertension.

PubMed

Siddiqui, Mohammed; Judd, Eric K; Oparil, Suzanne; Calhoun, David A

2017-09-01

Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure (BP) despite the use of ≥5 different antihypertensive agents, including chlorthalidone and spironolactone. Recent studies indicate that refractory hypertension is uncommon, with a prevalence of ≈5% to 10% of patients referred to a hypertension specialty clinic for uncontrolled hypertension. The prevalence of white-coat effect, that is, uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP <135/85 mm Hg, by awake ambulatory BP monitor in hypertensive patients overall is ≈30% to 40%. The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported. In this prospective evaluation, consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled. Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents, including chlorthalidone and spironolactone. Automated office BP measurements were based on 6 serial readings, done automatically with the use of a BpTRU device unobserved in the clinic. Out-of-office BP measurements were done by 24-hour ambulatory BP monitor. Thirty-four patients were diagnosed with refractory hypertension, of whom 31 had adequate ambulatory BP monitor readings. White-coat effect was present in only 2 patients, or 6.5% of the 31 patients with refractory hypertension, suggesting that white-coat effect is largely absent in patients with refractory hypertension. These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment. © 2017 American Heart Association, Inc.

Genetic Variation in the Raptor Gene Is Associated With Overweight But Not Hypertension in American Men of Japanese Ancestry

PubMed Central

Carnes, Bruce A.; Chen, Randi; Donlon, Timothy A.; He, Qimei; Grove, John S.; Masaki, Kamal H.; Elliott, Ayako; Willcox, Donald C.; Allsopp, Richard; Willcox, Bradley J.

2015-01-01

BACKGROUND The mechanistic target of rapamycin (mTOR) pathway is pivotal for cell growth. Regulatory associated protein of mTOR complex I (Raptor) is a unique component of this pro-growth complex. The present study tested whether variation across the raptor gene (RPTOR) is associated with overweight and hypertension. METHODS We tested 61 common (allele frequency ≥ 0.1) tagging single nucleotide polymorphisms (SNPs) that captured most of the genetic variation across RPTOR in 374 subjects of normal lifespan and 439 subjects with a lifespan exceeding 95 years for association with overweight/obesity, essential hypertension, and isolated systolic hypertension. Subjects were drawn from the Honolulu Heart Program, a homogeneous population of American men of Japanese ancestry, well characterized for phenotypes relevant to conditions of aging. Hypertension status was ascertained when subjects were 45–68 years old. Statistical evaluation involved contingency table analysis, logistic regression, and the powerful method of recursive partitioning. RESULTS After analysis of RPTOR genotypes by each statistical approach, we found no significant association between genetic variation in RPTOR and either essential hypertension or isolated systolic hypertension. Models generated by recursive partitioning analysis showed that RPTOR SNPs significantly enhanced the ability of the model to accurately assign individuals to either the overweight/obese or the non-overweight/obese groups (P = 0.008 by 1-tailed Z test). CONCLUSION Common genetic variation in RPTOR is associated with overweight/obesity but does not discernibly contribute to either essential hypertension or isolated systolic hypertension in the population studied. PMID:25249372

Symptomatic subsyndromal depression in hospitalized hypertensive patients.

PubMed

Chiaie, Roberto Delle; Iannucci, Gino; Paroli, Marino; Salviati, Massimo; Caredda, Maria; Pasquini, Massimo; Biondi, Massimo

2011-12-01

Clinicians generally agree on the association between depression and hypertension. Less clear is if the nature of the link is direct or indirect and if this should be considered confined only to syndromal forms or if it concerns also subsyndromal affective presentations. This study investigated the nature of the association between hypertension and subsyndromal depression in hospitalized hypertensive patients. 196 hypertensive and 96 non hypertensive inpatients underwent a SCID interview, to exclude patients positive for any Axis I or Axis II diagnosis. Symptomatic Subsyndromal Depression (SSD) was identified according to criteria proposed by Judd. Psychopathological assessment was performed with Anxiety Sensitivity Index (ASI) and Hopkins Symptom Checklist-90 (SCL-90). Clinical assessments included blood pressure measurement, evaluation of general health conditions and screening cardiovascular risk factors (smoke, alcohol, body weight, sedentary life style). Hypertensives met more frequently criteria for SSD. They also scored higher on ASI and SCL-90. However, those with more severe physical conditions, if compared with more healthy patients, did not show increased psychopathological severity. Similarly, psychopathological symptom severity did not differ among hypertensives positive for other cardiovascular risk factors, commonly more frequent among depressed subjects. Further analyses are needed to explore the potential advantage obtained on blood pressure control by treating SSD. Hospitalized hypertensives, more frequently satisfied criteria for Symptomatic Subsyndromal Depression. These milder affective forms are probably directly linked to the presence of hypertension, rather than being indirectly associated to physical impairment or to higher prevalence of other cardiovascular risk factors. Copyright © 2011. Published by Elsevier B.V.

[Relevance of diabetes in high cardiovascular risk hypertensive patients].

PubMed

Segura, Julián; de la Sierra, Alejandro; Fernández, Sandra; Ruilope, Luis M

2013-10-05

The aim of this cross-sectional study was to compare the prevalence of target organ damage (TOD) and established cardiovascular disease (CVD) in a cohort of nondiabetic hypertensive patients with 3 or more cardiovascular risk factors (CVRF) against a group of hypertensives with type 2 diabetes. We included 4,725 hypertensive patients, 62% male, mean age 64 (SD 12) years, with type 2 diabetes mellitus, independently of the number of associated CVRF (N=2,608), or non-diabetics, in which case we required the presence of 3 CVRF (N=2,117). The prevalence of established CVD (clinical interview) and TOD (left ventricular hypertrophy by electrocardiogram, microalbuminuria and estimated glomerular filtration rate) were estimated. Hypertensive patients with type 2 diabetes had an older age and more marked obesity. Furthermore, these patients showed a higher prevalence of micro- and macroalbuminuria, renal failure, left ventricular hypertrophy, atherosclerotic plaques in carotid arteries and CVD compared with nondiabetic hypertensive patients with 3 or more CVRF. Multivariate analysis showed that the risk of TOD or established CVD were associated independently with the presence of diabetes. Hypertensive patients with type 2 diabetes have a higher prevalence of LOD and CVD compared to nondiabetic hypertensive patients with 3 or more CVRF. Although both situations are included in the high cardiovascular risk stratum, it would be expected an increased incidence of cardiovascular complications in hypertensive diabetic patients. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Japanese Encephalitis Virus in Meningitis Patients, Japan

PubMed Central

Ito, Mikako; Takao, Shinichi; Shimazu, Yukie; Fukuda, Shinji; Miyazaki, Kazuo; Kurane, Ichiro; Takasaki, Tomohiko

2005-01-01

Cerebrospinal fluid specimens from 57 patients diagnosed with meningitis were tested for Japanese encephalitis virus. Total RNA was extracted from the specimens and amplified. Two products had highest homology with Nakayama strain and 2 with Ishikawa strain. Results suggest that Japanese encephalitis virus causes some aseptic meningitis in Japan. PMID:15757569

Disrupted white matter structure underlies cognitive deficit in hypertensive patients.

PubMed

Li, Xin; Ma, Chao; Sun, Xuan; Zhang, Junying; Chen, Yaojing; Chen, Kewei; Zhang, Zhanjun

2016-09-01

Hypertension is considered a risk factor of cognitive impairments and could result in white matter changes. Current studies on hypertension-related white matter (WM) changes focus only on regional changes, and the information about global changes in WM structure network is limited. We assessed the cognitive function in 39 hypertensive patients and 37 healthy controls with a battery of neuropsychological tests. The WM structural networks were constructed by utilizing diffusion tensor tractography and calculated topological properties of the networks using a graph theoretical method. The direct and indirect correlations among cognitive impairments, brain WM network disruptions and hypertension were analyzed with structural equation modelling (SEM). Hypertensive patients showed deficits in executive function, memory and attention compared with controls. An aberrant connectivity of WM networks was found in the hypertensive patients (P Eglob = 0.005, P Lp = 0.005), especially in the frontal and parietal regions. Importantly, SEM analysis showed that the decline of executive function resulted from aberrant WM networks in hypertensive patients (p = 0.3788, CFI = 0.99). These results suggest that the cognitive decline in hypertensive patients was due to frontal and parietal WM disconnections. Our findings highlight the importance of brain protection in hypertension patients. • Hypertension has a negative effect on the performance of the cognitive domains • Reduced efficiencies of white matter networks were shown in hypertension • Disrupted white matter networks are responsible for poor cognitive function in hypertension.

[Aerosolized iloprost therapy for pulmonary hypertensive crisis in 4 patients with idiopathic pulmonary arterial hypertension].

PubMed

Deng, Ke-wu; Zhou, Yu-jie; Xu, Xi-qi; Wu, Ming-ying; Wang, Guo-hong; Bian, Hong; Chen, Bo; Wang, Chun-bo

2012-10-01

To summary the efficacy and safety of aerosolized iloprost in patients with pulmonary hypertensive crisis. On the basis of conventional therapy, aerosolized iloprost (10 µg per time for 10 - 15 min in 2 hours interval, 8 times per day) was administered to four patients with idiopathic pulmonary arterial hypertension and pulmonary hypertensive crisis. Blood pressure, heart rate, systemic artery oxygen saturation, systolic pulmonary arterial pressure (sPAP) measured by echocardiography and the adverse events were analyzed. After aerosolized iloprost therapy, sPAP was significantly decreased and systemic artery oxygen saturation was improved. Adverse events (nausea, vomiting, diarrhea, dry cough) were observed in two patients, and the iloprost use was stopped in one patient due to severe vomiting and diarrhea. Aerosolized iloprost could significantly reduce the sPAP and improve the systemic artery oxygen saturation in patients with pulmonary hypertension crisis.

Deletion at 12p in a Japanese child with brachydactyly overlaps the assignment locus of brachydactyly with hypertension in a Turkish family

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baehring, S.; Toka, H.R.; Nitz, I.

1997-03-01

Positional cloning is occasionally facilitated by the identification of a chromosomal aberration. We are studying a Turkish family, first described by Bilginturan et al., who have a monogenic form of hypertension, and we have reason to believe that a chromosomal aberration in a Japanese child may facilitate our cloning of the responsible gene. The hypertension gene in our family is unique in that it causes, by as yet undefined mechanisms, increased peripheral vascular resistance. Pedigree analysis of the Turkish kindred allowed us to map the gene to 12p11-p12. The kindred has a second trait, brachyclactyly, which cosegregates with the hypertension.more » The brachyclactyly, which involves both hands and feet, features shortened metacarpals and phalanges, as well as cone-shaped epiphyses. 11 refs., 2 figs.« less

The spectrum of pheochromocytoma in hypertensive patients with neurofibromatosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalff, V.; Shapiro, B.; Lloyd, R.

We have found an appreciable number of pheochromocytomas in patients with neurofibromatosis and concurrent hypertension (ten of 18 cases). At diagnosis, the patient age range was 15 to 62 years, the clinical appearance of the neurofibromatosis did not predict who would and who would not have pheochromocytomas, but the age at diagnosis was helpful in that our younger patients tended to have causes of hypertension other than pheochromocytoma. However, several causes of hypertension may coexist. The biochemical findings were highly diagnostic. The pheochromocytomas secreted epinephrine as well as norepinephrine and resided in or next to the adrenal gland. Where pheochromocytomamore » is the cause of hypertension, its resection generally results in a better control of hypertension than that obtained in patients whose BPs were elevated from other unknown causes.« less

HYPEST study: profile of hypertensive patients in Estonia

PubMed Central

2011-01-01

Background More than one third of adult population in Estonia has problems with elevated blood pressure (BP). The Hypertension in Estonia (HYPEST) study represents the country's first hypertension-targeted sample collection aiming to examine the epidemiological and genetic determinants for hypertension (HTN) and related cardiovascular diseases (CVD) in Estonian population. The HYPEST subjects (n = 1,966) were recruited across Estonia between 2004-2007 including clinically diagnosed HTN cases and population-based controls. The present report is focused on the clinical and epidemiological profile of HYPEST cases, and gender-specific effects on the pathophysiology of hypertension. Methods Current analysis was performed on 1,007 clinically diagnosed HTN patients (617 women and 390 men) aged 18-85 years. The hypertensives were recruited to the study by BP specialists at the North Estonia Medical Center, Centre of Cardiology, Tallinn or at the Cardiology Clinic, Tartu University Hospital, Estonia. Longitudinal BP data was extracted retrospectively from clinical records. Current and retrospective data of patient's medical history, medication intake and lifestyle habits were derived from self-administrated questionnaire and each variable was examined separately for men and women. Eleven biochemical parameters were measured from fasting serum samples of 756 patients. Results The distribution of recruited men and women was 39% and 61% respectively. Majority of Estonian HTN patients (85%) were overweight (BMI ≥ 25 kg/m2) and a total of 79% of patients had additional complications with cardiovascular system. In men, the hypertension started almost 5 years earlier than in women (40.5 ± 14.5 vs 46.1 ± 12.7 years), which led to earlier age of first myocardial infarction (MI) and overall higher incidence rate of MI among male patients (men 21.2%, women 8.9%, P < 0.0001). Heart arrhythmia, thyroid diseases, renal tubulo-intestinal diseases and hyperlipidemia were more prevalent

Assessment and Management of Hypertension in Transplant Patients

PubMed Central

Burgess, Ellen D.; Cooper, James E.; Fenves, Andrew Z.; Goldsmith, David; McKay, Dianne; Mehrotra, Anita; Mitsnefes, Mark M.; Sica, Domenic A.; Taler, Sandra J.

2015-01-01

Hypertension in renal transplant recipients is common and ranges from 50% to 80% in adult recipients and from 47% to 82% in pediatric recipients. Cardiovascular morbidity and mortality and shortened allograft survival are important consequences of inadequate control of hypertension. In this review, we examine the epidemiology, pathophysiology, and management considerations of post-transplant hypertension. Donor and recipient factors, acute and chronic allograft injury, and immunosuppressive medications may each explain some of the pathophysiology of post-transplant hypertension. As observed in other patient cohorts, renal artery stenosis and adrenal causes of hypertension may be important contributing factors. Notably, BP treatment goals for renal transplant recipients remain an enigma because there are no adequate randomized controlled trials to support a benefit from targeting lower BP levels on graft and patient survival. The potential for drug-drug interactions and altered pharmacokinetics and pharmacodynamics of the different antihypertensive medications need to be carefully considered. To date, no specific antihypertensive medications have been shown to be more effective than others at improving either patient or graft survival. Identifying the underlying pathophysiology and subsequent individualization of treatment goals are important for improving long-term patient and graft outcomes in these patients. PMID:25653099

Dietary intake habits and the prevalence of nocturia in Japanese patients with type 2 diabetes mellitus.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2018-03-01

No reports have been published on the association between dietary intake habits and nocturia in the diabetes population. We therefore evaluated this issue among Japanese patients with diabetes mellitus. Study participants in the present study were 785 Japanese patients with type 2 diabetes mellitus. Self-administered questionnaires were used to assess each type of dietary intake habit. Vegetable intake habit was assessed by the following question: "Do you have vegetables or seaweed every day?" We used the following two outcomes: (i) nocturia: ≥2 voids per night; and (ii) severe nocturia: ≥3 voids per night. Adjustment was made for age, sex, body mass index, glycated hemoglobin, hypertension, dyslipidemia, smoking, drinking, exercise habit, stroke, ischemic artery disease, diabetic nephropathy, diabetic neuropathy and diabetic retinopathy. The prevalence of nocturia, severe nocturia, and vegetable intake habit was 39.9%, 14.4% and 67.3%, respectively. After adjusting for confounding factors, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted odds ratios were 0.67 (95% confidence interval [CI] 0.48-0.94) and 0.46 (95% CI 0.30-0.71), respectively. Among male patients, vegetable intake habit was independently inversely associated with severe nocturia, but not nocturia: the adjusted OR was 0.51 (95% CI 0.29-0.88). Among female patients, vegetable intake habit was independently inversely associated with nocturia and severe nocturia: the adjusted ORs were 0.44 (95% CI 0.24-0.79) and 0.34 (95% CI 0.15-0.78), respectively. We found an inverse association between vegetable intake habit and nocturia in Japanese patients with type 2 diabetes mellitus. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension

PubMed Central

Wang, Lei; Yao, Xiaoguang; Chang, Guijuan; Zhang, Delian; Heizhati, Mulalibieke; Wang, Menghui; Luo, Qin; Kong, Jianqiong

2017-01-01

Background Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Methods Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Results Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA) was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA) (5.8%) and PA + OSA (4.9%). Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing's syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Conclusion Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients. PMID:28691036

Detection of Secondary Causes and Coexisting Diseases in Hypertensive Patients: OSA and PA Are the Common Causes Associated with Hypertension.

PubMed

Wang, Lei; Li, Nanfang; Yao, Xiaoguang; Chang, Guijuan; Zhang, Delian; Heizhati, Mulalibieke; Wang, Menghui; Luo, Qin; Kong, Jianqiong

2017-01-01

Since the control rate of blood pressure is lower in mainland China, the aim of this study is to investigate the proportion of secondary causes and coexisting diseases of hypertension in hypertensive patients. Data on consecutive patients with hypertension who visited the Hypertension Center. Diseases were detected using an established strict screening protocol. Detection rate of secondary causes and coexisting diseases of hypertension was 39.5% among 3003 hypertensive patients. Obstructive sleep apnea (OSA) was the most common, accounting for 24.7% of patients, followed by primary aldosteronism (PA) (5.8%) and PA + OSA (4.9%). Endocrine hypertension accounted for 12.1% of patients, including 10.7% of patients with PA, 1.1% with hypothyroidism, 0.1% with pheochromocytoma, 0.1% with Cushing's syndrome, and 0.1% with hyperthyroidism, respectively. Those who smoke, those who are obese, and those who have diabetes accounted for 31.3%, 27.5%, and 16.6% of total patients, respectively. There were overlapping conditions in secondary causes and coexisting diseases of hypertension. OSA was the most common in each age- and BMI-stratified group. Findings from the current study suggest an increasing frequency of secondary forms of hypertension, highlighting the burden of OSA and PA in hypertensive patients.

Clinical characteristics of hypertensive encephalopathy in pediatric patients

PubMed Central

Ahn, Chang Hoon; Han, Seung-A; Kong, Young Hwa

2017-01-01

Purpose The aim of this study was to assess the clinical characteristics of hypertensive encephalopathy according to the underlying etiologies in children. Methods We retrospectively evaluated 33 pediatric patients who were diagnosed as having hypertensive encephalopathy in Chonbuk National University Children's Hospital. Among the patients, 18 were excluded because of incomplete data or because brain magnetic resonance imaging (MRI) was not performed. Finally, 17 patients were enrolled and divided into a renal-origin hypertension group and a non-renal-origin hypertension group according to the underlying cause. We compared the clinical features and brain MRI findings between the 2 groups. Results The renal group included renal artery stenosis (4), acute poststreptococcal glomerulonephritis (2), lupus nephritis (2), and acute renal failure (1); the nonrenal group included essential hypertension (4), pheochromocytoma (2), thyrotoxicosis (1), and acute promyelocytic leukemia (1). The mean systolic blood pressure of the renal group (172.5±36.9 mmHg) was higher than that of the nonrenal group (137.1±11.1 mmHg, P<0.05). Seizure was the most common neurologic symptom, especially in the renal group (P<0.05). Posterior reversible encephalopathy syndrome (PRES), which is the most typical finding of hypertensive encephalopathy, was found predominantly in the renal group as compared with the nonrenal group (66.6% vs. 12.5%, P<0.05). Conclusion We conclude that the patients with renal-origin hypertension had a more severe clinical course than those with non-renal-origin hypertension. Furthermore, the renal-origin group was highly associated with PRES on brain MRI. PMID:29042869

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus.

PubMed

Gun, Taylan; Özkan, Selçuk; Yavuz, Bunyamin

2018-04-23

Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus. This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1-5). This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Distribution pattern of urine albumin creatinine ratio and the prevalence of high-normal levels in untreated asymptomatic non-diabetic hypertensive patients.

PubMed

Ohmaru, Natsuki; Nakatsu, Takaaki; Izumi, Reishi; Mashima, Keiichi; Toki, Misako; Kobayashi, Asako; Ogawa, Hiroko; Hirohata, Satoshi; Ikeda, Satoru; Kusachi, Shozo

2011-01-01

Even high-normal albuminuria is reportedly associated with cardiovascular events. We determined the urine albumin creatinine ratio (UACR) in spot urine samples and analyzed the UACR distribution and the prevalence of high-normal levels. The UACR was determined using immunoturbidimetry in 332 untreated asymptomatic non-diabetic Japanese patients with hypertension and in 69 control subjects. The microalbuminuria and macroalbuminuria levels were defined as a UCAR ≥30 and <300 µg/mg·creatinine and a UCAR ≥300 µg/mg·creatinine, respectively. The distribution patterns showed a highly skewed distribution for the lower levels, and a common logarithmic transformation produced a close fit to a Gaussian distribution with median, 25th and 75th percentile values of 22.6, 13.5 and 48.2 µg/mg·creatinine, respectively. When a high-normal UACR was set at >20 to <30 µg/mg·creatinine, 19.9% (66/332) of the hypertensive patients exhibited a high-normal UACR. Microalbuminuria and macroalbuminuria were observed in 36.1% (120/336) and 2.1% (7/332) of the patients, respectively. UACR was significantly correlated with the systolic and diastolic blood pressures and the pulse pressure. A stepwise multivariate analysis revealed that these pressures as well as age were independent factors that increased UACR. The UACR distribution exhibited a highly skewed pattern, with approximately 60% of untreated, non-diabetic hypertensive patients exhibiting a high-normal or larger UACR. Both hypertension and age are independent risk factors that increase the UACR. The present study indicated that a considerable percentage of patients require anti-hypertensive drugs with antiproteinuric effects at the start of treatment.

Hypertensive crisis: clinical-epidemiological profile.

PubMed

Vilela-Martin, José Fernando; Vaz-de-Melo, Renan Oliveira; Kuniyoshi, Cristina Hiromi; Abdo, André Neder Ramires; Yugar-Toledo, Juan Carlos

2011-03-01

Hypertensive crisis (HC) stands out as one type of acute elevation in blood pressure (BP) and can manifest as hypertensive emergency (HE-with target-organ damage (TOD)) or hypertensive urgency (HU-without TOD), usually accompanied by levels of diastolic BP ≥120 mmHg. The aim of this study was to characterize the clinical-epidemiological profile of HC over the course of 1 year in a university reference hospital and perform a review of the literature. The study was a cross-sectional study, conducted over a period of 1 year (2006) in 362 patients who presented for treatment at the emergency hospital with HC, as described above. Among all patients examined, 231 individuals met the criteria for HE and 131 met the criteria for HU. Patients with HE were older (P<0.001) and more sedentary (P=0.026) than those with HU. Furthermore, fewer HE patients than HU patients had previously undergone antihypertensive treatment (P=0.006). The groups did not differ regarding BP levels, gender, smoking or body mass index. Dyspnea (41.1%), thoracic pain (37.2%) and neurological deficit (27.2%) were common signs/symptoms in those with HE. Meanwhile, in the group with HU, we most frequently found headache (42.0%), thoracic pain (41.2%) and dyspnea (34.3%). Among the forms of HE, we most frequently observed acute lung edema (30.7%), myocardial infarction/unstable angina (25.1%), and ischemic (22.9%) and hemorrhagic (14.8%) stroke. HC is a clinical entity associated with high morbidity in the emergency room. Individuals with HE are older and sedentary and have lower rates of antihypertensive treatment. Adequate control of BP should be pursued as a way to avoid this severe complication of hypertension. © 2011 The Japanese Society of Hypertension All rights reserved

Patterns of left ventricular remodeling among patients with essential and secondary hypertension.

PubMed

Radulescu, Dan; Stoicescu, Laurentiu; Buzdugan, Elena; Donca, Valer

2013-12-01

High blood pressure causes left ventricular hypertrophy, which is a negative prognostic factor among hypertensive patients. To assess left ventricular geometric remodeling patterns in patients with essential hypertension or with hypertension secondary to parenchymal renal disease. We analyzed data from echocardiograms performed in 250 patients with essential hypertension (150 females) and 100 patients with secondary hypertension (60 females). The interventricular septum and the left ventricular posterior wall thickness were measured in the parasternal long-axis. Left ventricular mass was calculated using the Devereaux formula. The most common remodeling type in females and males with essential hypertension were eccentric and concentric left ventricular hypertrophy (cLVH), respectively. Among patients with secondary arterial hypertension, cLVH was most commonly observed in both genders. The prevalence of left ventricular hypertrophy was higher among patients with secondary hypertension. The left ventricular mass index and the relative left ventricular wall thickness were higher in males and also in the secondary hypertension group. Age, blood pressure values and the duration of hypertension, influenced remodeling patterns. We documented a higher prevalence of LVH among patients with secondary hypertension. The type of ventricular remodeling depends on gender, age, type of hypertension, blood pressure values and the duration of hypertension.

Microvascular complications and prevalence of urgency incontinence in Japanese patients with type 2 diabetes mellitus: The dogo study.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Maruyama, Koutatsu; Ueda, Teruhisa; Senba, Hidenori; Todo, Yasuhiko; Torisu, Masamoto; Minami, Hisaka; Onji, Morikazu; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2016-11-01

Diabetes was significantly positively associated with urgency incontinence in several epidemiological studies. We examine the association between diabetic neuropathy, which we defined based on neuropathic symptoms, the absence of the Achilles reflex, and/or abnormal vibration perception, and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Study subjects were 742 Japanese patients with type 2 diabetes mellitus, aged 19-70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. Urgency incontinence was defined as present when a subject answered "once a week or more" to the question: "Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate ?". Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, the absence of the Achilles reflex, and/or abnormal vibration perception. Adjustment was made for sex, age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, insulin therapy, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. The prevalence of urgency incontinence was 8.6%. Diabetic neuropathy was independently positively associated with urgency incontinence: the adjusted OR was 2.20 (95%CI: 1.16-4.36). Associations between diabetic retinopathy or nephropathy and the prevalence of urgency incontinence were not significant. In Japanese patients with type 2 diabetes mellitus, only diabetic neuropathy was independently positively associated with urgency incontinence. Neurourol. Urodynam. 35:1024-1027, 2016. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Increased masked hypertension prevalence in patients with obesity.

PubMed

Özkan, Selçuk; Ata, Naim; Yavuz, Bunyamin

2018-02-08

Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index. The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients' height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level. Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight. This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.

[Clinical features of idiopathic restless legs syndrome in Japanese patients].

PubMed

Kume, Akito; Kume, Hideaki

2010-06-01

Little is known about the diagnosis and management of restless legs syndrome (RLS) in Japanese neurology clinics. To validate the diagnostic criteria of the International RLS Study Group (IRLSSG) and the treatment algorithm of the Mayo Clinic in a Japanese neurology clinic setting and to clarify the features of Japanese patients with idiopathic RLS. Patients with RLS symptoms were examined by a neurologist and the assessment included neurological examination, tests for periodic limb movements (PLM) and dopaminergic response, and the clinical diagnosis was made according to IRLSSG diagnostic criteria. Patients diagnosed with idiopathic RLS were treated with dopaminergic agents and the efficacy was evaluated. The study subjects were 151 Japanese patients who presented with RLS symptoms. Idiopathic RLS was diagnosed in 113 patients, secondary RLS in 16 and RLS mimics in 22. The cause of RLS mimics was either myelopathy, radiculopathy or neuropathy in 11 patients. The mean age of patients with idiopathic RLS was 50.1 (SD 20.0) years, 63% were woman, 97% had daily RLS, 31% had family history (40% of the early-onset subgroup), 86% reported unpleasant sensations in the lower legs, 43% had PLM in the daytime suggested immobilization test, 81% suffered from insomnia, 49% had limitations of work and activities, 71% reported impaired mood, 27% had consulted physicians about their symptoms, 4% had been diagnosed with RLS, 73% improved after dopaminergic treatments, and 33% experienced complete remission. The clinical features of Japanese patients with idiopathic RLS were identical to those reported in western countries, which suggests that IRLSSG diagnostic criteria and Mayo Clinic treatment algorism are valid in Japanese neurology clinics. Both patients and physicians were not fully aware of RLS in this country. Neurological examination was important in excluding RLS mimics and making a diagnosis of RLS.

Job strain and risk of cardiovascular events in treated hypertensive Japanese workers: hypertension follow-up group study.

PubMed

Uchiyama, Shuji; Kurasawa, Takashi; Sekizawa, Toshihiro; Nakatsuka, Hiroshi

2005-03-01

In Japan, Karoshi, which means "death from overwork", has become a focus of social concern. However, no previous study has examined long working hours and job strain simultaneously in relation to incidence of cardiovascular events (CVE) in Japanese workers. We prospectively evaluated the relation between job strain or long working hours and risk of CVE in treated hypertensives during the years 1994-2000. In this study, we followed a sample of 1,615 participants (908 men and 707 women) aged 40-65 yr who were working more than 5 working hours per day. Participants completed questions about work-related conditions and lifestyle variables at baseline, and were free of diagnosed cardiovascular disease, stroke or cancer. Job strain (the combination of job demands and job control) was assessed using a simple questionnaire developed with reference to Karasek's model. The main outcome measure was incidence of CVE. During the mean follow-up period of 5.6 yr, we documented 38 cases of initial CVE. Analyses were conducted using the Cox proportional hazard model. We found a significant association between incidence of CVE and job strain categories, but not long working hours. Multivariate relative risks for CVE in active jobs and high strain jobs overall were 2.89 (95% CI: 1.33-6.28) and 2.45 (95% CI: 0.87-6.93); for men 2.94 (95% CI: 1.29-6.73) and 1.86 (95% CI: 0.51-6.75), and for women 3.97 (95% CI: 0.34-46.88) and 9.05 (95% CI: 1.17-69.86), respectively. In conclusion, active jobs and high strain jobs were associated with increased risk of CVE for treated hypertensive workers.

Changes of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage.

PubMed

Wang, Zhi; Wang, Chao; Zhang, Weiguang; Wang, Laizang; Lei, Ting

2008-02-01

In order to explore the changes and the roles of TXA2 and PGI2 during postoperative hypertensive crisis in patients with hypertensive intracerebral hemorrhage, 31 cases subject to craniotomy were divided into three groups: group A, 9 patients with postoperative hypertensive crisis; group B, 13 patients without postoperative hypertensive crisis; and group C, 9 patients without history of hypertension and hypertensive intracerebral hemorrhage. TXA2, TXB2, 6-keto-PGF1 alpha and PGI2 were measured after operation in the three groups respectively. The postoperative blood pressure in group A, including SBP and DBP, was elevated more obviously than that in the other two groups. TXA2 and PGI2 in group A were significantly higher than those in other two groups (P<0.01). Moreover, the ratio of TXB2 to 6-keto-PGF1 alpha in group A was significantly higher than that in other two groups (P<0.05). The increase of TXA2 and the relative inadequacy of prostacyclin, especially 6-keto-PGF1 alpha, may play roles in the postoperative hypertensive crisis. And the increased value of TXB2 to 6-keto-PGF1 alpha could provide the basis for diagnosis of postoperative hypertensive crisis.

Community pharmacy--ideal location to screen and monitor hypertensive patients.

PubMed

Negru, Diana Simona; Diaconescu, Monica; Petculescu, Ana Maria; Bild, Veronica

2010-01-01

The goals of this study were (a) to create a patient electronic database by filling in the specially designed Patient Data Sheets (PDS) after interviewing hypertensive patients and (b) to evaluate pharmacists' opportunities for intervention in order to improve hypertensive patients' outcomes. Pharmacists from two Romanian chain community pharmacies interviewed all hypertensive patients that entered the pharmacies during the study period (November-December 2008) and selected 106 subjects using several selection criteria. Pharmacists recorded in specially designed Patient Data Sheet relevant information such as: demographic data, additional diagnostics (if any), lifestyle behaviors and therapeutic data. The records were then transferred into an electronic database and interpreted by the research team. Hypertension (HT) as a single disease was present in only 7 patients (6.6%), most of them being diagnosed with multiple illnesses (such as HT and cardiovascular disease (CVD) in 25 patients, HT and dyslipidemia (DL) in 20 patients). More than half of the subjects (61.3%) declared they have adopted at least one lifestyle modification component and almost 80% of the patients use two, three or more antihypertensive agents in their medication. The high incidence of complications among our hypertensive subjects justifies implementing blood pressure monitoring programs in community pharmacies and requires pharmacists' intervention for a better management of hypertension.

Validation of the Japanese disease severity classification and the GAP model in Japanese patients with idiopathic pulmonary fibrosis.

PubMed

Kondoh, Shun; Chiba, Hirofumi; Nishikiori, Hirotaka; Umeda, Yasuaki; Kuronuma, Koji; Otsuka, Mitsuo; Yamada, Gen; Ohnishi, Hirofumi; Mori, Mitsuru; Kondoh, Yasuhiro; Taniguchi, Hiroyuki; Homma, Sakae; Takahashi, Hiroki

2016-09-01

The clinical course of idiopathic pulmonary fibrosis (IPF) shows great inter-individual differences. It is important to standardize the severity classification to accurately evaluate each patient׳s prognosis. In Japan, an original severity classification (the Japanese disease severity classification, JSC) is used. In the United States, the new multidimensional index and staging system (the GAP model) has been proposed. The objective of this study was to evaluate the model performance for the prediction of mortality risk of the JSC and GAP models using a large cohort of Japanese patients with IPF. This is a retrospective cohort study including 326 patients with IPF in the Hokkaido prefecture from 2003 to 2007. We obtained the survival curves of each stage of the GAP and JSC models to perform a comparison. In the GAP model, the prognostic value for mortality risk of Japanese patients was also evaluated. In the JSC, patient prognoses were roughly divided into two groups, mild cases (Stages I and II) and severe cases (Stages III and IV). In the GAP model, there was no significant difference in survival between Stages II and III, and the mortality rates in the patients classified into the GAP Stages I and II were underestimated. It is difficult to predict accurate prognosis of IPF using the JSC and the GAP models. A re-examination of the variables from the two models is required, as well as an evaluation of the prognostic value to revise the severity classification for Japanese patients with IPF. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

Blood Pressure Control in Hypertensive Patients, Cardiovascular Risk Profile and the Prevalence of Masked Uncontrolled Hypertension (MUCH).

PubMed

Naser, Nabil; Dzubur, Alen; Durak, Azra; Kulic, Mehmed; Naser, Nura

2016-07-27

The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH). Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice. This is important because masked hypertension is associated with a high risk of cardiovascular events. This study was conducted to obtain more information about the association between hypertension and other CV risk factors, about office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients, also to define the prevalence and characteristics of masked uncontrolled hypertension (MUCH) among treated hypertensive patients in routine clinical practice. In this study 2514 male and female patients were included during a period of 5 years follow up. All patients have ambulatory blood pressure monitoring (ABPM) for at least 24h. We identified patients with treated and controlled BP according to current international guidelines (clinic BP, 140/90mmHg). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Masked uncontrolled hypertension (MUCH) was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130mmHg and/or 24-h diastolic BP ≥80mmHg). Patients had a mean age of 60.2+10 years, and the majority of them (94.6%) were followed by specialist physicians. Average clinic BP was 150.4+16/89.9+12 mmHg. About 70% of patients displayed a very high-risk profile. Ambulatory blood pressure monitoring (ABPM) was performed in all recruited

Hypertension and cardiovascular risk assessment in dialysis patients.

PubMed

Locatelli, Francesco; Covic, Adrian; Chazot, Charles; Leunissen, Karel; Luño, José; Yaqoob, Mohammed

2004-05-01

Cardiovascular (CV) disease is the main cause of morbidity and mortality in dialysis patients. Hypertension in patients affected by chronic renal insufficiency (CRI) has been recognized as one of the major classical CV risk factors in CRI from the very beginning of the dialysis era. However, its treatment is still unsatisfactory. A discussion is employed to achieve a consensus on key points relating to the epidemiological, pathophysiological and clinical characteristics of hypertension in renal patients, in the light of global CV risk assessment. CV disease is accelerated by CRI, in particular by uraemia-specific risk factors. This is reflected by the fact that general population-based equations for calculating CV risk underestimate the real CV risk in CRI and dialysis patients. Hypertension in dialysis patients is clearly a major CV risk factor. Isolated systolic hypertension with increased pulse pressure is the most prevalent blood pressure (BP) anomaly in dialysis patients, due to stiffening of the arterial tree. BP should be assessed by clinical measurements on a routine basis, leaving 24 h monitoring for selected cases. The targets of BP control should be those recommended by the present guidelines, i.e. <140/90 mmHg, or the lowest possible values that are well tolerated. The pathophysiological cornerstone of hypertension in dialysis patients is extra-cellular volume expansion, which is typically sodium-sensitive, given the loss of renal function. Therefore, the principles of hypertension treatment in dialysis are an achievement of dry body weight, proper dialysis prescription with respect to dialysis time and intra-dialytic sodium balance, and dietary sodium and water restriction. Pharmacological treatment should only be the second option, after the adequate and complete application of all other means. No comparative pharmacological trials have specifically addressed the issue of hypertension control in dialysis patients. Therefore, this workshop group had to

Effect of PUFA on patients with hypertension: A hospital based study

PubMed Central

Shantakumari, Nisha; Eldeeb, Rasha Ali; Mabrouk Ibrahim, Salwa Abdelzaher; Sreedharan, Jayadevan; Otoum, Sufian

2014-01-01

Introduction Hypertension affects more than a quarter of the global adult population. Studies conducted worldwide suggest an overall small, yet useful, role of omega-3 PUFAs in reducing blood pressure in hypertensive patients. However there is no substantial data in this regard from population based in Middle East and Asia. Objectives To determine the effects of (omega-3) PUFA supplementation on the blood pressure of hypertensive patient. To identify if male and female hypertensive patients respond differently to PUFA. To identify if response of hypertensive patients to PUFA varies with the duration of hypertension and co-existence of diabetes/dyslipidemia. Materials and methods This observational study was conducted among hypertensive patients visiting OPD of the Gulf Medical College Hospital, Ajman, UAE, during the period Jan–Dec 2012. A total of 100 hypertensive patients on treatment with their antihypertensive medications, 50 of whom were taking n-3 PUFA supplementation, were followed up for a period of 3 months. Comparisons were drawn between the BP recordings at the time of enrollment in the study and their follow up values 3 months after enrollment. Results There was a statistically significant reduction in both the systolic and diastolic blood pressures after 3 months of PUFA therapy. The BP lowering effect of PUFA was more in males. A statistically significant reduction in BP was noted in non-diabetic patients and patients with long standing hypertension. Conclusion Findings of the study suggest that omega-3 PUFA dietary supplements augment the benefits of pharmacotherapy in hypertension. PMID:25173198

Left atrial volume index is an independent predictor of hypertensive response to exercise in patients with hypertension.

PubMed

Lee, Sang-Eun; Youn, Jong-Chan; Lee, Hye Sun; Park, Sungha; Lee, Sang-Hak; Cho, In-Jeong; Shim, Chi Young; Hong, Geu-Ru; Choi, Donghoon; Kang, Seok-Min

2015-02-01

A hypertensive response to exercise (HRE) is known to be associated with higher risk of heart failure and future cardiovascular events in patients with hypertension. Left atrial volume index (LAVI) is associated with the diastolic dysfunction, indicating exercise intolerance. Therefore, we investigated whether LAVI is relevant to HRE during cardiopulmonary exercise test (CPET). We studied 118 consecutive hypertensive patients (61 men, 57±11 years) and 45 normotensive control subjects (16 men, 54±8 years). Clinical characteristics, CPET, echocardiographic and laboratory findings were assessed at the time of enrollment. HRE was defined as maximum systolic blood pressure (SBP)⩾210 mm Hg in men and ⩾190 mm Hg in women. HRE was more prevalent in hypertensive patients compared with normotensive control subjects (50.8% vs. 20.0%, P<0.001). Age and baseline SBP were shown to be associated with HRE in normotensive control subjects, as were baseline SBP and LAVI in hypertensive group. In multivariate analysis, LAVI was found to be an independent predictor of HRE in hypertensive patients (P=0.020) but not in normotensive control subjects (P=0.936) when controlled for age, sex, body mass index and peak oxygen consumption. Higher LAVI, reflecting the duration and severity of increased left atrial pressure is independently associated with HRE in hypertensive patients, but not in normotensive control subjects.

A randomised controlled trial for the evaluation of risk for type 2 diabetes in hypertensive patients receiving thiazide diuretics: Diuretics In the Management of Essential hypertension (DIME) study

PubMed Central

Ueda, Shinichiro; Morimoto, Takeshi; Ando, Shin-ichi; Takishita, Shu-ichi; Kawano, Yuhei; Shimamoto, Kazuaki; Ogihara, Toshio; Saruta, Takao

2014-01-01

Objectives Thiazide diuretics are one of the first choice antihypertensives but not optimally utilised because of concerns regarding their adverse effects on glucose metabolism. The Diuretics In the Management of Essential hypertension (DIME) study was designed, for the first time, to assess the risk for type 2 diabetes mellitus in patients with essential hypertension during antihypertensive treatment with low-dose thiazide diuretics compared to those not treated with diuretics. Design Multicentre, unblinded, pragmatic, randomised, controlled trial with blinded assessment of end points and intention-to-treat analysis that was started in 2004 and finished in 2012. Setting Hypertension clinics at 106 sites in Japan, including general practitioners’ offices and teaching hospitals. Participants Non-diabetic patients with essential hypertension. Interventions Antihypertensive treatment with low-dose thiazide diuretics at 12.5 mg/day of hydrochlorothiazide or equivalent (Diuretics group) or that without thiazide diuretics (No-diuretics group). Main outcome The primary outcome was new onset of type 2 diabetes diagnosed according to WHO criteria and the criteria of Japanese Society of Diabetes. Results 1130 patients were allocated to Diuretics (n=544) or No-diuretics group (n=586). Complete end point information was collected for 1049 participants after a median follow-up of 4.4 years. Diabetes developed in 25 (4.6%) participants in the Diuretics group, as compared with 29 (4.9%) in the No-diuretics group (HR 0.93; 95% CI 0.55 to 1.58; p=0.800). Conclusions Antihypertensive treatment with thiazide diuretics at low doses may not be associated with an increased risk for new onset of type 2 diabetes. This result might suggest safety of use of low doses of thiazide diuretics. Trial registration number ClinicalTrials.gov NCT00131846. PMID:25031188

2004 Japanese Society for Dialysis Therapy guidelines for renal anemia in chronic hemodialysis patients.

PubMed

Gejyo, Fumitake; Saito, Akira; Akizawa, Tadao; Akiba, Takashi; Sakai, Tatsuya; Suzuki, Masashi; Nishi, Shinichi; Tsubakihara, Yoshiharu; Hirakata, Hideki; Bessho, Masami

2004-12-01

The guideline committee of Japanese Society for Dialysis Therapy (JSDT), chaired by Professor F. Gejyo of Niigata University, now publishes an original Japanese guideline entitled 'Guidelines for Renal Anemia in Chronic Hemodialysis Patients'. It includes the re-evaluation of the usage of recombinant human erythropoietin (rHuEPO) with the medical and economical arguments regarding the prognosis and the quality of life of Japanese hemodialysis patients. This guideline consists of 7 sections. The first section comprises the general definition and the differential diagnosis of anemia. The hemoglobin (Hb) level of the Japanese population seemed to be low when compared with that of the European and American populations. The second section describes the target Hb level in hemodialysis patients. Multivariate analysis of the data that were collected from dialysis institutions throughout the country showed that an Hb level of 10-11 g/dL (Ht level 30-33%) at the first dialysis session in a week is the ideal range for chronic hemodialysis patients in terms of the 3-5 year survival rate. The supine position at blood sampling and the sampling timing at the first dialysis session in a week might affect the lower setting of target Hb hematocrit (Ht), compared to that of European and American guidelines. However, we particularly recommended that an Hb level of 11-12 g/dL (Ht level from 33 to 36%) at the first dialysis session in a week is desirable in relatively young patients. In the third section, the markers of iron deficiency are discussed. The Transferin saturation test (TSAT) and serum ferritin were emphasized as the standard markers. The routes of administration of rHuEPO and its dosages are written in the fourth section. The subcutaneous route was associated with the occurrence of secondary red cell aplasia due to anti-rHuEPO antibodies; however, secondary red cell aplasia was seldom observed in the venous injection. From this fact we recommend venous injection for chronic

Upper gastrointestinal tumours in Japanese familial adenomatous polyposis patients

PubMed Central

Yamaguchi, Tatsuro; Ishida, Hideyuki; Ueno, Hideki; Kobayashi, Hirotoshi; Hinoi, Takao; Inoue, Yasuhiro; Ishida, Fumio; Kanemitsu, Yukihide; Konishi, Tsuyoshi; Tomita, Naohiro; Matsubara, Nagahide; Watanabe, Toshiaki; Sugihara, Kenichi

2016-01-01

Objective The upper gastrointestinal characteristics in Japanese familial adenomatous polyposis patients have not yet been clarified. The aim of the present study was to elucidate these characteristics in Japanese familial adenomatous polyposis patients. Methods This study was conducted by the study group for familial adenomatous polyposis in the Japanese Society for Cancer of the Colon and Rectum. Familial adenomatous polyposis patients who underwent surgical resection from 2000 to 2012 were included in the study. Results In total, 303 familial adenomatous polyposis patients were enrolled, with 265 cases of classical familial adenomatous polyposis (≥100 adenomas) and 38 cases of attenuated familial adenomatous polyposis (<100 adenomas). Fundic gland polyps were significantly more common in classical familial adenomatous polyposis than in attenuated familial adenomatous polyposis; however, gastric cancer was significantly less common in classical familial adenomatous polyposis than in attenuated familial adenomatous polyposis. Gastric cancer and duodenal adenoma were significantly more common in familial adenomatous polyposis patients with gastric adenoma than in those without gastric adenoma. Duodenal cancer was detected in 7 of 72 familial adenomatous polyposis patients with duodenal adenoma. The median tumour risk in 50-year-old familial adenomatous polyposis patients was 55.3, 21.8, 3.8, 39.2 and 7.7% for fundic gland polyp, gastric adenoma, gastric cancer, duodenal adenoma and duodenal cancer, respectively. Conclusions Upper gastrointestinal tumours/polyps were frequently found in familial adenomatous polyposis patients, and their incidences were correlated; however, the frequency of gastric cancer in Japanese familial adenomatous polyposis patients was similar to that in the general population. PMID:26819281

Lipid and blood pressure control for the prevention of cardiovascular disease in hypertensive patients: a subanalysis of the OMEGA study.

PubMed

Teramoto, Tamio; Kawamori, Ryuzo; Miyazaki, Shigeru; Teramukai, Satoshi; Sato, Yuki; Okuda, Yasuyuki; Shirayama, Masayuki

2015-01-01

The aim of this analysis was to investigate the relationships between dyslipidemia, achieved blood pressure (BP) values and the lipid levels, as well as the control of four cardiovascular risk factors (BP, low-density lipoprotein: LDL cholesterol, hemoglobin A1c: HbA1c and smoking) and the incidence of cardiovascular disease (CVD), in Japanese patients receiving antihypertensive therapy. A total of 13,052 patients with no history of CVD were included in this subanalysis of the prospective observational OMEGA study in Japanese hypertensive patients treated with olmesartan. Multivariable Cox regression models were used to evaluate the relationship with the risk of CVD. The incidence of CVD during the 36-month study period was 5.59/1,000 patient-years among the patients with dyslipidemia (n = 6,297) and 5.57/1,000 patient-years among the patients without dyslipidemia (n = 6,755), with no significant differences between the two groups. Higher achieved BP values tended to be associated with an increased CVD risk in both the patients with and without dyslipidemia. In addition, the risk of CVD tended to be higher in the patients with an achieved LDL cholesterol level of ≥ 120 mg/dL than in those with an LDL level of ＜ 120 mg/dL (trend p = 0.0005) and in the patients with an achieved high-density lipoprotein cholesterol level of ＜ 60 mg/dL than in those with an HDL level of ≥ 60 mg/dL (trend p = 0.0017). Furthermore, the risk of CVD was higher among the patients with fewer controlled risk factors than among those with control of all four risk factors (trend p ＜ 0.0001). In order to prevent CVD in olmesartan-treated hypertensive patients with no history of CVD, it is important to control both the lipid and BP levels and aim for comprehensive risk factor control.

[Pregnancy in pulmonary arterial hypertension patients].

PubMed

Rosengarten, Dror; Kramer, Mordechai R

2013-09-01

Pulmonary arterial hypertension (PAH) is a disorder defined by elevated mean pulmonary arterial pressure. PAH can be idiopathic or associated with a variety of medical conditions such as scleroderma, congenital heart disease, left heart failure, lung disease or chronic pulmonary thromboembolism. This progressive disease can cause severe right heart failure and death. Normal physiologic changes that occur during pregnancy may produce fatal consequences in PAH patients. Current guidelines recommend that pregnancy be avoided or terminated early in women with PAH. During the past decade, new advanced therapies for PAH have emerged gathering reports of successful pregnancies in patients with pulmonary hypertension. Substantial risk still exists and current recommendations have not changed. Nevertheless, in selected cases, if a patient insists on continuing the pregnancy, being fully aware of the risks involved, an intensive treatment approach should be implemented in experienced centers. This is necessary in order to control pulmonary hypertension during pregnancy and reduce the risk so as to improve outcomes. This review will focus on the pathophysiology of PAH in pregnancy and appropriate management during pregnancy, delivery and the post-partum period.

Mitochondrial haplogroups associated with Japanese centenarians, Alzheimer's patients, Parkinson's patients, type 2 diabetic patients and healthy non-obese young males.

PubMed

Takasaki, Shigeru

2009-07-01

The relationships between five classes of Japanese people (i.e., 96 centenarians, 96 Alzheimer's disease (AD) patients, 96 Parkinson's disease (PD) patients, 96 type 2 diabetic (T2D) patients, and 96 healthy non-obese young males) and their mitochondrial single nucleotide polymorphism (mtSNP) frequencies at individual mtDNA positions of the entire mitochondrial genome were examined using the radial basis function (RBF) network and the modified method. New findings of mitochondrial haplogroups were obtained for individual classes. The five classes of people were associated with the following haplogroups: Japanese centenarians-M7b2, D4b2a, and B5b; Japanese AD patients-G2a, B4c1, and N9b1; Japanese PD patients-M7b2, B4e, and B5b; Japanese T2D patients-B5b, M8a1, G, D4, and F1; and Japanese healthy non-obese young males- D4g and D4b1b. From the points of common haplogroups among the five classes, the centenarians have the common haplogroups M7b2 and B5b with the PD patients and common haplogroup B5b with the T2D patients. In addition, the 112 Japanese semi-supercentenarians (over 105 years old) recently reported were also examined by the method proposed. The results obtained were the haplogroups D4a, B4c1a, M7b2, F1, M1, and B5b. These results are different from the previously reported haplogroup classifications. As the proposed analysis method can predict a person's mtSNP constitution and the probabilities of becoming a centenarian, AD patient, PD patient, or T2D patient, it may be useful in initial diagnosis of various diseases.

Perceptions of hypertension treatment among patients with and without diabetes.

PubMed

Anthony, Heymann; Valinsky, Liora; Inbar, Zucker; Gabriel, Chodick; Varda, Shalev

2012-03-26

Despite the availability of a wide selection of effective antihypertensive treatments and the existence of clear treatment guidelines, many patients with hypertension do not have controlled blood pressure. We conducted a qualitative study to explore beliefs and perceptions regarding hypertension and gain an understanding of barriers to treatment among patients with and without diabetes. Ten focus groups were held for patients with hypertension in three age ranges, with and without diabetes. The topic guides for the groups were: What will determine your future health status? What do you understand by "raised blood pressure"? How should one go about treating raised blood pressure? People with hypertension tend to see hypertension not as a disease but as a risk factor for myocardial infarction or stroke. They do not view it as a continuous, degenerative process of damage to the vascular system, but rather as a binary risk process, within which you can either be a winner (not become ill) or a loser. This makes non-adherence to treatment a gamble with a potential positive outcome. Patients with diabetes are more likely to accept hypertension as a chronic illness with minor impact on their routine, and less important than their diabetes. Most participants overestimated the effect of stress as a causative factor believing that a reduction in levels of stress is the most important treatment modality. Many believe they "know their bodies" and are able to control their blood pressure. Patients without diabetes were most likely to adopt a treatment which is a compromise between their physician's suggestions and their own understanding of hypertension. Patient denial and non-adherence to hypertension treatment is a prevalent phenomenon reflecting a conscious choice made by the patient, based on his knowledge and perceptions regarding the medical condition and its treatment. There is a need to change perception of hypertension from a gamble to a disease process. Changing the

An approach to the young hypertensive patient.

PubMed

Mangena, P; Saban, S; Hlabyago, K E; Rayner, B

2016-01-01

Hypertension is the leading cause of death worldwide. Globally and locally there has been an increase in hypertension in children, adolescents and young adults<40 years of age. In South Africa, the first decade of the millennium saw a doubling of the prevalence rate among adolescents and young adults aged 15-24 years. This increase suggests that an explosion of cerebrovascular disease, cardiovascular disease and chronic kidney disease can be expected in the forthcoming decades. A large part of the increased prevalence can be attributed to lifestyle factors such as diet and physical inactivity, which lead to overweight and obesity. The majority (>90%) of young patients will have essential or primary hypertension, while only a minority (<10%) will have secondary hypertension. We do not recommend an extensive workup for all newly diagnosed young hypertensives, as has been the practice in the past. We propose a rational approach that comprises a history to identify risk factors, an examination that establishes the presence of target-organ damage and identifies clues suggesting secondary hypertension, and a limited set of basic investigations. More specialised tests should be performed only where there is a clinical suspicion that a secondary cause for hypertension exists. There have been no randomised clinical trials on the treatment of hypertension in young patients. Expert opinion advises an initial emphasis on lifestyle modification. This can comprise a diet with reduced salt and refined carbohydrate intake, an exercise programme and management of substance abuse issues. Failure of lifestyle measures or the presence of target-organ damage should prompt the clinician to initiate pharmacotherapy. We recommend referral to a specialist practitioner in cases of resistant hypertension, where there is severe target-organ damage and when a secondary cause is suspected.

[Effectiveness of magnetotherapy in elderly hypertensive patients aging at different rates].

PubMed

Abramovich, S G; Koriakina, A V; Brodach, L N; Akhmedzianov, Iu A; Makarychkin, S P

2000-01-01

Effectiveness of general magnetotherapy was studied in 84 patients with essential hypertension and 36 patients with isolated systolic arterial hypertension of old age. It is thought necessary to determine biological age of the cardiovascular system in hypertensive patients over 60 years of age to specify indications and contraindications to physiotherapy.

[Factors for postoperative persistent hypertension in patients with aldosterone-producing adenoma].

PubMed

Liu, D; Zheng, C; Chen, Q

1997-07-01

We determined the factors for postoperative persistent hypertension in the patients with aldosterone-producing adrenal adenoma (APA) in 53 patients with APA who were followed up for average 3.1 years. All had normal serum potassium concentration postoperatively. Blood pressure was normal in 37 patients (69.8%) but 18.7/12.7 kPa or more in 16 patients (30.2%) with persistent hypertension. Also compared were sex, age, history of hypertension, effect of reducing blood pressure to antisterone, preoperative blood pressure, time of persistent hypertension, serum potassium concentration, aldosterone concentration in 24 hour urine, amount of PRA, and the type of operation. The results showed that an APA patient aged 50 years or more appears to have a great chance of persistent hypertension than an APA patient under age of 40 years, and the odds ratio is 3:1. There was a significant difference between the mean age for persistent hypertension and for normal blood pressure, and varioas response of reducing blood pressure to antisterone (P < 0.05). It is suggested that for an older APA patient and the patient without of reducing blood pressure to antisterone, there are other factors for hypertension such as renal veinlet change or renal interstitial lesions except for hyperaldosteronism. We recommend renal biopsy (using kidney puncture) at the operating table for those patients in order to understand pathological change and guide treatment after operation.

Experience of hypertensive patients with self-management of health care.

PubMed

Balduino, Anice de Fátima Ahmad; Mantovani, Maria de Fátima; Lacerda, Maria Ribeiro; Marin, Maria José Sanches; Wal, Marilene Loewen

2016-11-01

The aim of this study was to interpret how hypertensive patients experience health care self-management. Hypertension is one of the most prevalent chronic diseases worldwide. The involvement of individuals in the management of their health care to treat this disease is fundamental, with aid and advice from healthcare professionals, especially nurses, so that hypertensive patients can effectively self-manage their health care. Qualitative study. Hypertensive patients were recruited using theoretical sampling. The study sample consisted of 28 hypertensive patients aged 18-59 years who were registered in the e-Health programme of the Ministry of Health. Data were collected and analyzed between September 2012-October 2014 using a semi-structured interview based on the methodological framework of the constructivist grounded theory. The participants' statements depicted an outline of their experience with the disease: the beginning of the illness; understanding the disease process; incorporating behaviour for self-management of the disease; experiencing attitudes and actions in the control and treatment of the disease; and being treated in the public healthcare system. A central phenomenon emerged, namely hypertensive patients' experience of self-management of health care. This phenomenon has paths, actions and interactions. When patients discover that they have the disease and become aware of the disease process, they assume the identity of being hypertensive and become proactive in their health care and in living with their families and in communities. © 2016 John Wiley & Sons Ltd.

High Prevalence of Insecure Attachment in Patients with Primary Hypertension

PubMed Central

Balint, Elisabeth M.; Gander, Manuela; Pokorny, Dan; Funk, Alexandra; Waller, Christiane; Buchheim, Anna

2016-01-01

Hypertension is a major cardiovascular (CV) risk factor and is predicted by heightened CV reactivity to stress in healthy individuals. Patients with hypertension also show an altered stress response, while insecure attachment is linked to a heightened stress reactivity as well. This is the first study aiming to assess attachment representations in patients with primary hypertension and to investigate their CV responses when their attachment system is activated. We studied 50 patients (38 men, 12 women) with primary hypertension. The Adult Attachment Projective Picture System (AAP), a widely used and validated interview, was performed to measure the patients' attachment representations, and to activate their attachment system. Blood pressure and heart rate were measured after 10 min at rest prior to and directly after the AAP interview. Mood and state anxiety were assessed using the Multidimensional Mood State Questionnaire (MDBF) and the State Trait Anxiety Inventory-State (STAI-S) before and after the experiment. The prevalence of insecure attachment (dismissing, preoccupied, unresolved) in hypertensive patients was predominant (88%), while in non-clinical populations, only about 50% of individuals had insecure attachment patterns. Blood pressure (p < 0.001), heart rate (p = 0.016), and rate pressure product (p < 0.001) significantly increased in response to the attachment interview. Secure attached patients showed the highest rise in systolic blood pressure (p = 0.020) and the lowest heart rate compared to the other attachment groups (p = 0.043). However, attachment representation showed no significant group or interaction effects on diastolic blood pressure (DBP) and rate pressure product. Insecure attachment was highly over-represented in our sample of patients with primary hypertension. Additionally, a robust CV response to the attachment-activating stimulus was observed. Our data suggest that insecure attachment is significantly linked to primary hypertension

Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention

NASA Astrophysics Data System (ADS)

Aryfa Andra, Cut; Khairul, Andi; Aria Arina, Cut; Mukhtar, Zulfikri; Nyak Kaoy, Isfanuddin

2018-03-01

Contrast induced nephropathy (CIN) is the third lead cause of hospital acquired renal failure and was associated with significant morbidity and mortality. We hypothesized that hypertension is an independent risk factor for the development of CIN in patients undergoing elective percutaneous coronary intervention (PCI). The case-control method was used, 138 patients scheduled for elective PCI. We measured serum creatinine at baseline and after 24 hours of the procedure. CIN was defined as arising in serum creatinine of at least 44 μmol/l (0,5 mg/dl) or 25% rise from baseline. All patients received low osmolality nonionic contrast during PCI. Hypertension was defined as self-reported a history of treated or untreated diagnosed high blood pressure. One hundred thirty-eight patients (74,6%) were male, and 35 patients (25,4%) were female. Among the 138 patients, 86 (62,3%) were hypertensive patients whereas 52 (37,7%) were nonhypertensive patients. There was no difference in baseline serum creatinine levels and the amount of contrast media in patient with and without CIN. CIN developed in 42 patients, 39 patients (92,9%) were hypertensive compared to 3 patients (7,1%) without hypertension with p value < 0,05. (Odds ratio 16,8, 95% CI 4.542 - 62,412). This study showed that hypertension was a risk factor for the development of CIN

Management of Patients With Hypertensive Urgencies and Emergencies

PubMed Central

Cherney, David; Straus, Sharon

2002-01-01

BACKGROUND Hypertensive urgencies and emergencies are common clinical occurrences in hypertensive patients. Treatment practices vary considerably to because of the lack of evidence supporting the use of one therapeutic agent over another. This paper was designed to review the evidence for various pharmacotherapeutic regimens in the management of hypertensive urgencies and emergencies, in terms of the agents' abilities to reach predetermined “safe” goal blood pressures (BPs), and to prevent adverse events. METHODS medline was searched from 1966 to 2001, and the reference lists of all the articles were retrieved and searched for relevant references, and experts in the field were contacted to identify other relevant studies. The Cochrane Library was also searched. Studies that were eligible for inclusion in this review were systematic reviews of randomized control trials (RCTs) and individual RCTs, all-or-none studies, systematic reviews of cohort studies and individual cohort studies, and outcomes research. No language restrictions were used. RESULTS None of the trials included in this review identified an optimal rate of BP lowering in hypertensive emergencies and urgencies. The definitions of hypertensive emergencies and urgencies were not consistent, but emergencies always involved target end-organ damage, and urgencies were without such damage. Measures of outcome were not uniform between studies. The 4 hypertensive emergency and 15 hypertensive urgency studies represented 236 and 1,074 patients, respectively. The evidence indicated a nonsignificant trend toward increased efficacy with urapidil compared to nitroprusside for hypertensive emergencies (number needed to treat [NNT] for urapidil to achieve target BP, 12; 95% confidence interval [95% CI], number of patients needed to harm [NNH], 5 to NNT, 40 compared to nitroprusside). Several medications were efficacious in treating hypertensive urgencies, including: nicardipine (NNT for nicardipine compared to

Cost-effectiveness analysis: controlled-release nifedipine and valsartan combination therapy in patients with essential hypertension: the adalat CR and valsartan cost-effectiveness combination (ADVANCE-Combi) study.

PubMed

Saito, Ikuo; Fujikawa, Keita; Saruta, Takao

2008-07-01

As recommended by the guidelines such as JSH 2004, combination therapy with multiple agents is now being applied to many patients with hypertension. However, a pharmacoeconomic analysis of each therapy has not been fully undertaken in Japan, despite increasing societal interest. In this study, the cost-effectiveness of two calcium channel blockers, each coadministered with an angiotensin receptor blockade, was compared using data from the ADVANCE-Combi study. The ADVANCE-Combi study was a 16-week double-blind, randomized clinical trial to compare the efficacy and safety of two combination therapies (controlled-release nifedipine [nifedipine CR] plus valsartan vs. amlodipine plus valsartan) on blood pressure (BP) control in patients with moderate to severe essential hypertension. The incremental cost effectiveness of each cohort was compared from the perspective of insurers. The average total cost per patient was Japanese yen (JPY) 31,615 for the nifedipine CR treatment group and JPY 35,399 for the amlodipine treatment group (p < 0.001). The achievement rate of the target BP (SBP/DBP < 130/85 mmHg for patients aged under 60 years; SBP/DBP < 140/90 mmHg for those aged 60 years and over) was significantly higher in the nifedipine CR treatment group (61.2%) than in the amlodipine treatment group (34.6%) (p < 0.001), with no difference in the incidence of drug-related adverse events. Accordingly, the base case economic analysis demonstrated that the nifedipine CR treatment group was dominant (more efficacious and less costly) to the amlodipine treatment group. This result was supported by univariate and probabilistic sensitivity analyses. These results indicate that nifedipine CR-based combination therapy is superior to amlodipine-based combination therapy for the management of essential hypertension in the Japanese population.

The salt-taste threshold in untreated hypertensive patients.

PubMed

Kim, Chang-Yeon; Ye, Mi-Kyung; Lee, Young Soo

2017-01-01

The salt-taste threshold can influence the salt appetite, and is thought to be another marker of sodium intake. Many studies have mentioned the relationship between the sodium intake and blood pressure (BP). The aim of this study was to evaluate the relationship between the salt-taste threshold and urinary sodium excretion in normotensive and hypertensive groups. We analyzed 199 patients (mean age 52 years, male 47.3%) who underwent 24-h ambulatory BP monitoring (ABPM). Hypertension was diagnosed as an average daytime systolic BP of ≥135 mmHg or diastolic BP of ≥85 mmHg by the ABPM. We assessed the salt-taste threshold using graded saline solutions. The salt-taste threshold, 24-h urinary sodium and potassium excretion, and echocardiographic data were compared between the control and hypertensive groups. The detection and recognition threshold of the salt taste did not significantly differ between the control and hypertensive groups. The 24-h urinary sodium excretion of hypertensive patients was significantly higher than that of the control group (140.9 ± 59.8 vs. 117.9 ± 57.2 mEq/day, respectively, p  = 0.011). Also, the urinary sodium-potassium ratio was significantly higher in the hypertensive patients. There was no correlation between the salt-taste threshold and 24-h urinary sodium excretion. The salt-taste threshold might not be related to the BP status as well as the 24-h urinary sodium excretion.

Prevalence and Indicators of Portal Hypertension in Patients with Nonalcoholic Fatty Liver Disease

PubMed Central

Mendes, Flavia D.; Suzuki, Ayako; Sanderson, Schuyler O.; Lindor, Keith D.; Angulo, Paul

2012-01-01

Background & Aims Little is known about the prevalence and severity of portal hypertension in patients with non-alcoholic fatty liver disease (NAFLD). We investigated the prevalence and non-invasive predictors of portal hypertension in patients with NAFLD. Methods Signs of portal hypertension, including esophageal varices, splenomegaly, portosystemic encephalopathy, and ascites where investigated in 354 patients with NAFLD. Results One-hundred patients had portal hypertension at the time of NAFLD diagnosis (28.2%), 88 of these with septal fibrosis or cirrhosis (88%). Fibrosis stage correlated with presence (r=0.41, P<.0001) and number of findings (r=0.48, P=.006) of portal hypertension. Of the 204 patients with no or mild fibrosis (stages 0–2), 12 had portal hypertension (6%); they had a significantly higher grade of steatosis, based on biopsy analysis, compared to the 192 patients without portal hypertension (94%). Thrombocytopenia, hyperbilirubinemia, cirrhosis, and obesity were independently associated with portal hypertension. Esophageal varices were found in 57 of the 128 patients undergoing endoscopic screening (44.5%) and independently associated with thrombocytopenia, type 2 diabetes, and splenomegaly. Conclusions Signs of portal hypertension are present in 25% of patients at the time of diagnosis of NAFLD; most had advanced fibrosis or cirrhosis. Portal hypertension can occur in a small proportion of patients with mild or no fibrosis and is associated with the extent of steatosis. Features of advanced liver disease and insulin resistance might identify patients with NAFLD and portal hypertension, and those expected to derive the most benefit from endoscopic screening for esophageal varices. PMID:22610002

Cathepsin B expression in prostate cancer of native Japanese and Japanese-American patients: an immunohistochemical study.

PubMed

Sinha, Akhouri A; Morgan, Jenifer L; Betre, Konjit; Wilson, Michael J; Le, Chap; Marks, Leonard S

2008-01-01

Japanese-American (J-A) men who have immigrated to the U.S.A. and acquired the Western lifestyle usually have more invasive prostate cancer (PCa) than native Japanese (NJ) living in Japan. The specific reasons for these differences remain unknown. The objective of this study was to examine immunostainings of cathepsin B (CB) and its endogenous inhibitor stefin A (SA) in tissue microarray (TMA) and radical prostatectomy (RP) tissue sections in the hope of obtaining insights into the invasiveness of PCa in Japanese patients. TMA and RP sections were evaluated in 50 men (25 NJ and 25 J-A) for CB and SA reaction products. The CB and SA immunostainings were imaged directly from microscope slides to a computer using a high performance charge coupled device (CCD) digital camera, quantified using Metamorph software, analyzed using the two-sample t-test, and confirmed by multiple regression analysis. The CB and SA proteins were localized in the carcinomatous glands and isolated cancer cells in the TMA and RP sections. The Gleason scores and pre-surgery serum total prostate-specific antigen (PSA) levels did not differ significantly in the NJ and J-A patients (p = 0.14, p = 0.16, respectively). The Chi-square analysis of clinical stage versus place of birth showed that the NJ patients had significantly more T2a and T2b clinical stages than the J-A patients who had more advanced T2c and T3a stages (p = 0.003). The CB and SA immunostainings and their ratios in Gleason score 6 tumors did not show any difference, but the CB:SA ratios in score > or = 7 tumors approached significance levels. The overall matching of specimens according to the Gleason grade/score, pre-RP serum total PSA levels, clinical stage and age prior to evaluation of immunostainings greatly minimizes subjectivity associated with the evaluation of markers in this ethnic sub-population of PCa patients. CB and SA immunostaining is similar in Japanese patients who have organ-confined and moderately

Drug treatment of hypertension in older patients with diabetes mellitus.

PubMed

Yandrapalli, Srikanth; Pal, Suman; Nabors, Christopher; Aronow, Wilbert S

2018-05-01

Hypertension is more prevalent in the elderly (age>65 years) diabetic population than in the general population and shows an increasing prevalence with advancing age. Both diabetes mellitus (DM) and hypertension are independent risk factors for cardiovascular (CV) related morbidity and mortality. Optimal BP targets were not identified in elderly patients with DM and hypertension. Areas covered: In this review article, the authors briefly discuss the pathophysiology of hypertension in elderly diabetics, present evidence with various antihypertensive drug classes supporting the treatment of hypertension to reduce CV events in older diabetics, and then discuss the optimal target BP goals in these patients. Expert opinion: Clinicians should have a BP goal of less than 130/80 mm in all elderly patients with hypertension and DM, especially in those with high CV-risk. When medications are required for optimal BP control in addition to lifestyle measures, either thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers should be considered as initial therapy. Combinations of medications are usually required in these patients because BP control is more difficult to achieve in diabetics than those without DM.

Anti-Tribbles Homolog 2 Autoantibodies in Japanese Patients with Narcolepsy

PubMed Central

Toyoda, Hiromi; Tanaka, Susumu; Miyagawa, Taku; Honda, Yutaka; Tokunaga, Katsushi; Honda, Makoto

2010-01-01

Study Objectives: Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness and cataplexy. The association with human leukocyte antigen (HLA)-DQB1*0602 and T-cell receptor alpha locus suggests that autoimmunity plays a role in narcolepsy. A recent study reported an increased prevalence of autoantibodies against Tribbles homolog 2 (TRIB2) in patients with narcolepsy. To replicate this finding, we examined anti-TRIB2 autoantibodies in Japanese patients with narcolepsy. Design: We examined anti-TRIB2 autoantibodies against a full-length [35S]-labeled TRIB2 antigen in Japanese patients with narcolepsy-cataplexy (n = 88), narcolepsy without cataplexy (n = 18), and idiopathic hypersomnia with long sleep time (n = 11). The results were compared to Japanese healthy controls (n = 87). Thirty-seven healthy control subjects were positive for HLA-DRB1*1501-DQB1*0602. We also examined autoantibodies against another Tribbles homolog, TRIB3, as an experimental control. Measurements and Results: Autoantibodies against TRIB2 were found in 26.1% of patients with narcolepsy-cataplexy, a significantly higher prevalence than the 2.3% in healthy controls. We found that anti-TRIB3 autoantibodies were rare in patients with narcolepsy and showed no association with anti-TRIB2 indices. No significant correlation was found between anti-TRIB2 positivity and clinical information. Conclusions: We confirmed the higher prevalence and specificity of anti-TRIB2 autoantibodies in Japanese patients with narcolepsy-cataplexy. This suggests a subgroup within narcolepsy-cataplexy might be affected by an anti-TRIB2 autoantibody-mediated autoimmune mechanism. Citation: Toyoda H; Tanaka S; Miyagawa T; Honda Y; Tokunaga K; Honda M. Anti-Tribbles homolog 2 autoantibodies in Japanese patients with narcolepsy. SLEEP 2010;33(7):875-878. PMID:20614847

Patient-related barriers to hypertension control in a Nigerian population

PubMed Central

Okwuonu, Chimezie Godswill; Ojimadu, Nnamdi Ezekiel; Okaka, Enajite Ibiene; Akemokwe, Fatai Momodu

2014-01-01

Background Hypertension control is a challenge globally. Barriers to optimal control exist at the patient, physician, and health system levels. Patient-related barriers in our environment are not clear. The aim of this study was to identify patient-related barriers to control of hypertension among adults with hypertension in a semiurban community in South-East Nigeria. Methods This was a cross-sectional descriptive study of patients with a diagnosis of hypertension and on antihypertensive medication. Results A total of 252 participants were included in the survey, and comprised 143 males (56.7%) and 109 females (43.3%). The mean age of the participants was 56.6±12.7 years, with a diagnosis of hypertension for a mean duration of 6.1±3.3 years. Among these patients, 32.9% had controlled blood pressure, while 39.3% and 27.8%, respectively, had stage 1 and stage 2 hypertension according to the Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation of High Blood Pressure. Only 23.4% knew the consequences of poor blood pressure control and 64% were expecting a cure from treatment even when the cause of hypertension was not known. Furthermore, 68.7% showed low adherence to medication, the reported reasons for which included forgetfulness (61.2%), financial constraints (56.6%), high pill burden (22.5%), side effects of medication (17.3%), and low measured blood pressure (12.1%). Finally, knowledge and practice of the lifestyle modifications necessary for blood pressure control was inadequate among the participants. Conclusion Poor knowledge regarding hypertension, unrealistic expectations of treatment, poor adherence with medication, unawareness of lifestyle modification, and failure to apply these were identified as patient-related barriers to blood pressure control in this study. PMID:25061335

BPcontrol. A Mobile App to Monitor Hypertensive Patients.

PubMed

Carrera, Adrian; Pifarré, Marc; Vilaplana, Jordi; Cuadrado, Josep; Solsona, Sara; Mateo, Jordi; Solsona, Francesc

2016-12-07

Hypertension or high blood pressure is on the rise. Not only does it affect the elderly but is also increasingly spreading to younger sectors of the population. Treating this condition involves exhaustive monitoring of patients. The current mobile health services can be improved to perform this task more effectively. To develop a useful, user-friendly, robust and efficient app, to monitor hypertensive patients and adapted to the particular requirements of hypertension. This work presents BPcontrol, an Android and iOS app that allows hypertensive patients to communicate with their health-care centers, thus facilitating monitoring and diagnosis. Usability, robustness and efficiency factors for BPcontrol were evaluated for different devices and operating systems (Android, iOS and system-aware). Furthermore, its features were compared with other similar apps in the literature. BPcontrol is robust and user-friendly. The respective start-up efficiency of the Android and iOS versions of BPcontrol were 2.4 and 8.8 times faster than a system-aware app. Similar values were obtained for the communication efficiency (7.25 and 11.75 times faster for the Android and iOS respectively). When comparing plotting performance, BPcontrol was on average 2.25 times faster in the Android case. Most of the apps in the literature have no communication with a server, thus making it impossible to compare their performance with BPcontrol. Its optimal design and the good behavior of its facilities make BPcontrol a very promising mobile app for monitoring hypertensive patients.

Improvement in Retinal Capillary Rarefaction After Valsartan Treatment in Hypertensive Patients.

PubMed

Jumar, Agnes; Harazny, Joanna M; Ott, Christian; Kistner, Iris; Friedrich, Stefanie; Schmieder, Roland E

2016-11-01

Decreased capillary density influences vascular resistance and perfusion. The authors aimed to investigate the influence of the renin-angiotensin receptor blocker valsartan on retinal capillary rarefaction in hypertensive patients. Retinal vascular parameters were measured noninvasively and in vivo by scanning laser Doppler flowmetry before and after 4 weeks of treatment with valsartan in 95 patients with hypertension stage 1 or 2 and compared with 55 healthy individuals. Retinal capillary rarefaction was determined with the parameters intercapillary distance (ICD) and capillary area (CapA). In hypertensive patients, ICD decreased (23.4±5.5 μm vs 21.5±5.6 μm, P<.001) and CapA increased (1564±621 vs 1776±795, P=.001) after valsartan treatment compared with baseline. Compared with healthy normotensive controls (ICD 20.2±4.2 μm, CapA 1821±652), untreated hypertensive patients showed greater ICD (P<.001) and smaller CapA (P=.019), whereas treated hypertensive patients showed no difference in ICD (P=.126) and CapA (P=.728). Therapy with valsartan for 4 weeks diminished capillary rarefaction in hypertensive patients. © 2016 Wiley Periodicals, Inc.

The serum vaspin levels are reduced in Japanese chronic hemodialysis patients.

PubMed

Inoue, Junko; Wada, Jun; Teshigawara, Sanae; Hida, Kazuyuki; Nakatsuka, Atsuko; Takatori, Yuji; Kojo, Shoichirou; Akagi, Shigeru; Nakao, Kazushi; Miyatake, Nobuyuki; McDonald, John F; Makino, Hirofumi

2012-12-03

Visceral adipose tissue-derived serine proteinase inhibitor (vaspin) is an adipokine identified in genetically obese rats that correlates with insulin resistance and obesity in humans. Recently, we found that 7% of the Japanese population with the minor allele sequence (A) of rs77060950 exhibit higher levels of serum vaspin. We therefore evaluated the serum vaspin levels in Japanese chronic hemodialysis patients. Healthy Japanese control volunteers (control; n = 95, 49.9 ± 6.91 years) and Japanese patients undergoing hemodialysis therapy (HD; n = 138, 51.4 ± 10.5 years) were enrolled in this study, and serum samples were subjected to the human vaspin RIA system. The measurement of the serum vaspin levels demonstrated that a fraction of control subjects (n = 5) and HD patients (n = 11) exhibited much higher levels (> 10 ng/ml; Vaspin High group), while the rest of the population exhibited lower levels (< 3 ng/ml; Vaspin Low group). By comparing the patients in the Vaspin Low group, the serum vaspin levels were found to be significantly higher in the control subjects (0.87 ± 0.24 ng/ml) than in the HD patients (0.32 ± 0.15 ng/ml) (p < 0.0001). In the stepwise regression analyses, the serum creatinine and triglyceride levels were found to be independently and significantly associated with the vaspin concentrations in all subjects. The creatinine levels are negatively correlated with the serum vaspin levels and were significantly reduced in the Japanese HD patients in the Vaspin Low group.

Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

ERIC Educational Resources Information Center

Chintanadilok, Jirayos

2002-01-01

Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

[Power training for patients with arterial hypertension].

PubMed

Weisser, B; Richter, H; Siewers, M

2006-11-23

Nowadays, not only endurance training but also power training is recommended for patients with hypertension. In appropriately doses programs (no forced respiration), a number of studies have documented a blood pressure lowering effect. In the elderly hypertensive in particular, positive effects of power training that go beyond the simple lowering of elevated blood pressure may be expected.

The role of patients' explanatory models and daily-lived experience in hypertension self-management.

PubMed

Bokhour, Barbara G; Cohn, Ellen S; Cortés, Dharma E; Solomon, Jeffrey L; Fix, Gemmae M; Elwy, A Rani; Mueller, Nora; Katz, Lois A; Haidet, Paul; Green, Alexander R; Borzecki, Ann M; Kressin, Nancy R

2012-12-01

Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts. This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors. Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers. PARTICIPANTS (OR PATIENTS OR SUBJECTS): African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure. We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors. Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management. Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.

Neurocognitive disorder in hypertensive patients. Heart-Brain Study.

PubMed

Vicario, A; Cerezo, G H; Del Sueldo, M; Zilberman, J; Pawluk, S M; Lódolo, N; De Cerchio, A E; Ruffa, R M; Plunkett, R; Giuliano, M E; Forcada, P; Hauad, S; Flores, R

2018-02-15

The relation between hypertension and cognitive impairment is an undisputable fact. The aims of this study were to determine the prevalence of cognitive impairment in hypertensive patients, to identify the most affected cognitive domain, and to observe the association with different parameters of hypertension and other vascular risk factors. A multicentre study was carried out, and 1281 hypertensive patients of both genders and ≥21 years of age were included. Data on the following parameters were obtained: cognitive status (Minimal Cognitive Examination), behavioural status (Hospital Anxiety and Depression Scale), blood pressure, anthropometry, and biochemical profile. The average age was 60.2±13.5 years (71% female), and the educational level was 9.9±5.1 years. Global cognitive impairment was seen in 22.1%, executive dysfunction in 36.2%, and semantic memory impairment in 48.9%. Cognitive impairment was higher in males (36.8% vs. 30.06%) within both the 70-79-year-old and the ≥80-year-old (50% vs. 40%) age groups. Abnormal Clock Drawing Test results were related to high pulse pressure (p<0.0036), and abnormal Mini-Boston Naming Test results to both high systolic blood pressure (p<0.052) and pulse pressure (p<0.001). The treated/uncontrolled hypertensive group showed abnormal results both in the Mini Mental State Examination (OR, 0.73; p=0.036) and the Mini-Boston Naming Test (OR, 1.36; p=0.021). Among patients without cognitive impairment (MMSE >24), 29.4% presented executive dysfunction, and 41.5% semantic memory impairment. Cognitive impairment was higher in hypertensive patients than in the general population. Executive functions and semantic memory were the most affected cognitive domains. High systolic blood pressure and pulse pressure were associated with abnormal results in cognitive tests. Copyright © 2018 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Sexual function in hypertensive patients receiving treatment.

PubMed

Reffelmann, Thorsten; Kloner, Robert A

2006-01-01

In many forms of erectile dysfunction (ED), cardiovascular risk factors, in particular arterial hypertension, seem to be extremely common. While causes for ED are related to a broad spectrum of diseases, a generalized vascular process seems to be the underlying mechanism in many patients, which in a large portion of clinical cases involves endothelial dysfunction, ie, inadequate vasodilation in response to endothelium-dependent stimuli, both in the systemic vasculature and the penile arteries. Due to this close association of cardiovascular disease and ED, patients with ED should be evaluated as to whether they may suffer from cardiovascular risk factors including hypertension, cardiovascular disease or silent myocardial ischemia. On the other hand, cardiovascular patients, seeking treatment of ED, must be evaluated in order to decide whether treatment of ED or sexual activity can be recommended without significantly increased cardiac risk. The guideline from the first and second Princeton Consensus Conference may be applied in this context. While consequent treatment of cardiovascular risk factors should be accomplished in these patients, many antihypertensive drugs may worsen sexual function as a drug specific side-effect. Importantly, effective treatment for arterial hypertension should not be discontinued as hypertension itself may contribute to altered sexual functioning; to the contrary, alternative antihypertensive regimes should be administered with individually tailored drug regimes with minimal side-effects on sexual function. When phosphodiesterase-5 inhibitors, such as sildenafil, tadalafil and vardenafil, are prescribed to hypertensive patients on antihypertensive drugs, these combinations of antihypertensive drugs and phosphodiesterase 5 are usually well tolerated, provided there is a baseline blood pressure of at least 90/60 mmHg. However, there are two exceptions: nitric oxide donors and alpha-adrenoceptor blockers. Any drug serving as a nitric

Targeting hypertension in patients with cardiorenal metabolic syndrome.

PubMed

Rojas, Edward; Velasco, Manuel; Bermúdez, Valmore; Israili, Zafar; Bolli, Peter

2012-10-01

Diabetes mellitus coexisting with hypertension is greater than chance alone would predict. Hypertensive patients have been shown to have altered composition of skeletal muscle tissue, decreased blood flow to skeletal muscle and post-receptor signaling alterations in the IRS insulin pathway, all inducing insulin resistance states, which partially explains why blood pressure goals in DM patients are lower than in normoglycemic patients. Although optimal first-step antihypertensive drug therapy in type 2 DM or impaired fasting glucose levels (IFG) should be individualized for each patient, converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) have been demonstrated in some but not all studies to decrease the rate of development of proteinuria and diabetic renal disease. According to the ACCF/AHA 2011 Expert Consensus, elderly persons with diabetes, hypertension, and nephropathy should be initially treated with ACEIs or ARBs, although the choice of a specific antihypertensive may also depend on other associated comorbidities.

Cross-border movement of older patients: a descriptive study on health service use of Japanese retirees in Thailand.

PubMed

Miyashita, Yumiko; Akaleephan, Chutima; Asgari-Jirhandeh, Nima; Sungyuth, Channarong

2017-03-08

Thailand's policy to promote long-stay tourism encourages Japanese retirees to relocate to Thailand. One concern of such an influx is the impact of these elderly foreign residents on the Thai health system. This study aims to reveal the current use of and needs for health services amongst Japanese retirees residing in various locations in Thailand. In collaboration with nine Japanese self-help clubs in Bangkok, Chiang Mai, Chiang Rai, and Phuket, questionnaire surveys of Japanese long-stay retirees were conducted from January to March 2015. The inclusion criteria were being ≥ 50 years of age and staying in Thailand for ≥30 days in the previous 12 months while the main exclusion criteria included relocation by company, relocation due to marriage, or working migrants. The mean age of the 237 eligible participants was 68.8, with 79.3% of them being male, 57.8% having stayed in Thailand for ≥5 years, 63.3% having stayed in Thailand for ≥300 days in the previous 12 months and 33% suffering from chronic diseases or sequelae. Of the 143 who had health check-ups in the previous 12 months, 48.3% did so in Thailand. The top 3 diseases treated either in Thailand or Japan in the previous 12 months were dental diseases (50 patients), hypertension (44 patients), and musculoskeletal disorders (41 patients), with the rate of treatment in Thailand standing at 46.0, 47.7, and 65.9%, respectively. Of the 106 who saw a doctor in Thailand in the same period, 70.8% did so less than once a month. Only 23.2% of the participants preferred to receive medical treatment for serious conditions in Thailand. However, this number rose to 32.9% for long-term care (LTC) use. The usage of Thai health services amongst Japanese long-stay retirees is currently limited as they prefer going back to Japan for health screenings and treatment of chronic or serious diseases. However, the number of Japanese residents requiring health services including LTC and end-of-life care is expected

Vascular Smooth Muscle Cells From Hypertensive Patient-Derived Induced Pluripotent Stem Cells to Advance Hypertension Pharmacogenomics.

PubMed

Biel, Nikolett M; Santostefano, Katherine E; DiVita, Bayli B; El Rouby, Nihal; Carrasquilla, Santiago D; Simmons, Chelsey; Nakanishi, Mahito; Cooper-DeHoff, Rhonda M; Johnson, Julie A; Terada, Naohiro

2015-12-01

Studies in hypertension (HTN) pharmacogenomics seek to identify genetic sources of variable antihypertensive drug response. Genetic association studies have detected single-nucleotide polymorphisms (SNPs) that link to drug responses; however, to understand mechanisms underlying how genetic traits alter drug responses, a biological interface is needed. Patient-derived induced pluripotent stem cells (iPSCs) provide a potential source for studying otherwise inaccessible tissues that may be important to antihypertensive drug response. The present study established multiple iPSC lines from an HTN pharmacogenomics cohort. We demonstrated that established HTN iPSCs can robustly and reproducibly differentiate into functional vascular smooth muscle cells (VSMCs), a cell type most relevant to vasculature tone control. Moreover, a sensitive traction force microscopy assay demonstrated that iPSC-derived VSMCs show a quantitative contractile response on physiological stimulus of endothelin-1. Furthermore, the inflammatory chemokine tumor necrosis factor α induced a typical VSMC response in iPSC-derived VSMCs. These studies pave the way for a large research initiative to decode biological significance of identified SNPs in hypertension pharmacogenomics. Treatment of hypertension remains suboptimal, and a pharmacogenomics approach seeks to identify genetic biomarkers that could be used to guide treatment decisions; however, it is important to understand the biological underpinnings of genetic associations. Mouse models do not accurately recapitulate individual patient responses based on their genetics, and hypertension-relevant cells are difficult to obtain from patients. Induced pluripotent stem cell (iPSC) technology provides a great interface to bring patient cells with their genomic data into the laboratory and to study hypertensive responses. As an initial step, the present study established an iPSC bank from patients with primary hypertension and demonstrated an effective

Attitudes towards cross-border reproductive care among infertile Japanese patients.

PubMed

Hibino, Yuri; Shimazono, Yosuke; Kambayashi, Yasuhiro; Hitomi, Yoshiaki; Nakamura, Hiroyuki

2013-11-01

The attitudes towards cross-border reproductive care (CBRC) held by infertile Japanese patients have not been explored. The objective of the present study was to examine interest levels, preferred destinations, motivations, and sources of information related to CBRC. Our findings provide a general outline of CBRC and the future of reproduction and assisted reproductive technology (ART) in Japan. The study used a cross-sectional design. Data were collected from 2,007 infertile Japanese patients from 65 accredited ART clinics in Japan (response rate, 27.4 %) via anonymous questionnaires. Most of the infertile Japanese patients who responded denied using CBRC. However, by group, 171 (8.5 %) patients in non-donor in vitro fertilization, 150 (7.5 %) in egg donation, 145 (7.2 %) in pre-implantation genetic diagnosis, and 129 (6.4 %) in surrogacy said that, depending on the situation, they might travel abroad in the future. Older respondents were more likely to express an intention to travel overseas for egg donation in the future. The most popular destination for CBRC was the United States. Popular reasons for interest in CBRC among those considering or planning using this approach to third-party reproduction were that egg donation or surrogacy was unavailable or that obtaining ethical approval takes too long in Japan, whereas these processes are legal and affordable overseas. However, high cost was the most common reason for hesitancy regarding CBRC. Among the participants who were considering or planning to travel abroad for this purpose, TV, medical agencies, print media, and message boards on websites were popular sources of information, whereas doctors, friends, and patient self-help groups were not. Although CBRC among infertile Japanese patients is not at present common, the demand for and use of this approach may increase in the future in the context of the increasingly aging population. Lack of regulation and unavailability of third-party reproduction is a

Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes.

PubMed

Gorostidi, Manuel; de la Sierra, Alejandro; González-Albarrán, Olga; Segura, Julián; de la Cruz, Juan J; Vinyoles, Ernest; Llisterri, José L; Aranda, Pedro; Ruilope, Luis M; Banegas, José R

2011-11-01

Our aim was to assess the ambulatory blood pressure monitoring (ABPM) characteristics or patterns in hypertensive patients with diabetes compared with non-diabetic hypertensives. We performed a cross-sectional analysis of a 68,045 patient database from the Spanish Society of Hypertension ABPM Registry, a nation-wide network of >1200 primary-care physicians performing ABPM under standardized conditions in daily practice. We identified 12,600 (18.5%) hypertensive patients with diabetes. When compared with patients without diabetes, diabetic hypertensives exhibited higher systolic blood pressure (BP) levels in every ABPM period (daytime 135.4 vs. 131.8, and nighttime 126.0 vs. 121.0 mm Hg, P<0.001 for both) despite they were receiving more antihypertensive drugs (mean number 1.71 vs. 1.23, P<0.001). Consequently, diabetic patients suffered from lack of control of BP more frequently than non-diabetic subjects particularly during the night (65.5% vs. 57.4%, P<0.001). Prevalence of a non-dipping BP profile (64.2% vs. 51.6%, P<0.001) was higher in diabetic patients. In the other hand, prevalence of 'white-coat' hypertension in diabetic patients was 33.0%. We conclude that there was a remarkably high prevalence of alterations in ABPM in patients with diabetes. Abnormalities in systolic BP, particularly during the night, and in circadian BP pattern could be linked with the excess of BP-related cardiovascular risk of diabetes. A wider use of ABPM in diabetic patients should be considered.

[Hypertensive crisis: urgency and hypertensive emergency].

PubMed

Sobrino Martínez, Javier; Doménech Feria-Carot, Mónica; Morales Salinas, Alberto; Coca Payeras, Antonia

2016-11-18

Hypertensive crises lumped several clinical situations with different seriousness and prognosis. The differences between hypertensive urgency and hypertensive emergency depends on if this situation involves a vital risk for the patient. This risk is defined more by the severity of the organ damage than for the higher values of blood pressure. The hypertensive urgency not involves an immediately risk for the patient, for these reason, the treatment can be completed after discharged. Otherwise, the hypertensive emergency is a critical clinical condition that requires hospital assistance. Faced with a patient, with severe hypertension, asymptomatic or with unspecific symptoms we must be careful. First, we need to confirm the values of blood pressure, with several measures of blood pressure and investigate and treat factors, which triggered this situation. The objective of medical treatment for hypertensive urgency is to reduce blood pressure values (at least 20% of baseline values) but to avoid sudden reduction of these values. In hypertensive urgencies rapid acting drug should not be used because of the risk of ischemic stroke and use drugs with longer half-life. The cardiovascular risk of these patients is higher than that do not suffer hypertensive crisis. The treatment must be personalized in each hypertensive emergency and intravenous it’s the best route to treat these patients.

Association between in-hospital acute hypertensive episodes and outcomes in older trauma patients.

PubMed

Saliba, Lina; Stawicki, Stanislaw Peter; Thongrong, Cattleya; Bergese, Sergio Daniel; Papadimos, Thomas John; Gerlach, Anthony Thomas

2014-08-01

Although chronic hypertension is associated with long-term complications, few studies directly examine the effects of in-hospital acute hypertensive episodes in trauma patients. The aim was to determine whether there is an association between in-hospital acute hypertension and morbidity. We included trauma patients between 45 and 89 years who presented to a level I trauma center between January and September 2008. Patients were classified as either experiencing or not experiencing acute hypertensive episode(s) as defined by systolic blood pressure ≥180, or diastolic blood pressure ≥110 mmHg, or at least two readings of systolic blood pressure ≥160 or diastolic blood pressure ≥100 mmHg. The primary outcome was a composite endpoint of myocardial infarction, stroke, venous thromboembolism, new-onset atrial fibrillation, or acute kidney injury. At least one acute hypertensive episode occurred in 42.6% (69/162) of patients. A total of 10.5% patients developed the composite endpoint, 17.4% in the acute hypertensive episode group compared to 5.4% in the non-hypertensive group, p = 0.012. Patients in the acute hypertensive group were more likely to require an intensive care unit admission compared to the non-hypertensive group (33.3 versus 14.0%, p = 0.004). Of the 17 patients who developed an acute hypertensive episode and met the primary endpoint, 10 were on home antihypertensive medications. Of those, four were restarted on all medications initially, three on some, two were started on new medications, and one was not resumed on home medications. Development of acute hypertensive episode(s) in older trauma patients was associated with an increase in the composite endpoint. Prospective studies are needed.

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

PubMed

O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

2016-02-25

Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

[Arterial hypertension in elderly patients - from pathophysiology to rational treatment].

PubMed

Kucharska, Ewa

2013-01-01

According to the WHO, arterial hypertension is a major cause of death in adult populations all over the world, regardless of the socio-economic level of a specific population. In Poland, the presence of hypertension is estimated to be about 1/3 in the population of adult Poles. Although hypertension may occur in people of all ages, as the population is ageing, a large group of patients are those over 65. In this age group, the dominant form of arterial hypertension is the isolated systolic hypertension (ISH), in which increased systolic blood pressure is disclosed (higher than or equal to 140 mm Hg), with diastolic blood pressure values remaining within the normal range (<90 mm Hg). Even 15 years ago, the therapeutic approach to ISH in the elderly was a subject of a broad debate. Until the results of main clinical trials and meta-analyzes summarising these results were announced, it was not certain whether active treatment of these patients was beneficial. Moreover, the drug selection issue was hotly debated. The last major problem was the question concerning benefits resulting from the treatment of isolated systolic hypertension in patients aged 80 years and older.

Poor drug adherence and lack of awareness of hypertension among hypertensive stroke patients in Kampala, Uganda: a cross sectional study.

PubMed

Mugwano, Isaac; Kaddumukasa, Mark; Mugenyi, Levi; Kayima, James; Ddumba, Edward; Sajatovic, Martha; Sila, Cathy; DeGeorgia, Michael; Katabira, Elly

2016-01-02

Raised blood pressure (BP) remains an important risk factor for cardiovascular diseases such as stroke. Adherence to therapeutic recommendations especially antihypertensive drugs is important in BP control. The aim of the study was to assess the stroke risk factors and levels of adherence among hypertensive patients with stroke in Kampala Uganda. In a cross-sectional study we describe 112 hypertensive subjects with stroke from two Kampala city hospitals. A standardized pre-tested questionnaire was used to collect medical history, clinical details, radiological findings and laboratory data. A total of 112 hypertensive subjects with stroke were enrolled between May 2013 and April 2014. The median ages were 63.5 years (52.5-75.0) for the cases. Seventy percent (78/112) of the study participants had ischemic strokes. Only 17% were adherent to anti-hypertensive medications. The main cause of non-adherence appears to be lack of knowledge. Poor adherence of anti-hypertensive medications among hypertensive patients remains a big challenge in our setting. This has been attributed to lack of adequate knowledge and cost of the prescribed drugs. There is therefore an urgent need to promptly diagnose and educate hypertensive patients with emphasis on adherence to anti hypertensive drugs.

Endothelial dysfunction, platelet activation, thrombogenesis and fibrinolysis in patients with hypertensive crisis.

PubMed

van den Born, Bert-Jan H; Löwenberg, Ester C; van der Hoeven, Niels V; de Laat, Bas; Meijers, Joost C M; Levi, Marcel; van Montfrans, Gert A

2011-05-01

Hypertensive crisis is an extreme phenotype of hypertension and hypertension-related thrombotic complications. This is most evident in patients with hypertensive crisis having advanced retinopathy and thrombotic microangiopathy (TMA). We examined whether hypertensive crisis complicated by advanced retinopathy is associated with endothelial dysfunction, platelet activation, thrombin generation and decreased fibrinolytic activity. In addition, we tested the association between these procoagulant changes and the development of TMA and end-organ dysfunction. Several key mediators of coagulation were assessed in 40 patients with hypertensive crisis with and without retinopathy and compared with 20 age, sex and ethnicity-matched normotensive controls. In patients with hypertensive crisis, associations with markers of TMA and renal dysfunction were assessed by regression analysis. Soluble P-selectin levels were higher in patients with hypertensive crisis compared with controls regardless of the presence or absence of retinopathy (P<0.01). Levels of von Willebrand factor (VWF), VWF propeptide, prothrombin fragment 1+2 (F1+2) and plasmin-antiplasmin (PAP) complexes were significantly higher in hypertensive crisis with retinopathy compared with normotensive controls (P-values<0.01), whereas in patients without retinopathy only VWF propeptide was higher (P=0.04). VWF, VWF propeptide, soluble tissue factor, F1+2 and PAP were positively associated with markers of TMA and renal dysfunction (P≤0.05). Hypertensive crisis with retinopathy confers a prothrombotic state characterized by endothelial dysfunction, platelet activation and increased thrombin generation, whereas fibrinolytic activity is enhanced. The observed changes in prothrombotic and antithrombotic pathways may contribute to the increased risk of ischaemic and haemorrhagic complications in this extreme hypertension phenotype. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk of underdiagnosis of hypertension in schizophrenia patients.

PubMed

Castillo-Sánchez, Miguel; Fàbregas-Escurriola, Mireia; Bergè-Baquero, Daniel; Fernández-San Martín, MªIsabel; Boreu, Quintí Foguet; Goday-Arno, Albert

2018-01-01

Arterial hypertension requires proper screening and management, and its underdiagnosis in patients with schizophrenia (SZ) and/or antipsychotic treatment has been postulated. The objective of the study is to assess whether there are differences in the proportion of screened patients with a blood pressure >140/90 mmHg that are undiagnosed or not confirmed later (risk of underdiagnosis). Cross-sectional study of clinical records from SIDIAPQ (Spain) during the 2006-2011 period. Three groups were studied: SZ, no SZ but under antipsychotic treatment, and control groups. Patients with established hypertension, cardiovascular disease, dementia, or diagnosis of SZ or starting with antipsychotic treatment during this period were excluded. The SZ group had a lower risk of underdiagnosis than the control group (OR 0.91; 95% CI: 0.83-0.99; p < 0.05), at the expense of men (OR 0.8; 95% CI: 0.71-0.9; p < 0.001) and patients younger than 50 years of age (OR: 0.84; 95% CI: 0.74-0.93; p < 0.003). In the no SZ but under antipsychotic treatment group there were some differences, but not in the overall results. Preventive management of hypertension seemed to be sufficient for SZ and antipsychotic treatment patients. The lower prevalence of hypertension found in these groups may be due to other factors (blood pressure-lowering effect of psychoactive drugs or smoking) but these hypotheses must be evaluated with specific studies.

Validation of a Japanese version of the Scoliosis Research Society-22 Patient Questionnaire among idiopathic scoliosis patients in Japan.

PubMed

Hashimoto, Hideki; Sase, Takeshi; Arai, Yasuhisa; Maruyama, Toru; Isobe, Keijirou; Shouno, Yasuhiro

2007-02-15

A cross-sectional observational study to determine the response distribution, internal consistency, and construct, concurrent, and discriminative validities of The Scoliosis Research Society-22 (SRS-22) Patient Questionnaire translated into Japanese as compared with the other language versions. To validate the Japanese version of SRS22. The SRS-22 was translated into several languages but yet not into Japanese. The Japanese SRS-22 and Medical Outcomes Study Short Form 36 were simultaneously administered to 114 adolescent idiopathic scoliosis patients. Exploratory factor analysis revealed a 4-factor structure, though several items were not loaded as theoretically expected. The originally constructed Japanese SRS-22 subscales and the English version showed similar response distribution. Internal consistency was fair but lower than that of the English version. The concurrent validity of the translated version, except for the self-image subscale, was supported using Medical Outcomes Study Short Form 36 subscales as a reference. The function scale differed significantly by curve angle magnitude and treatment status. The self-image score was the highest in patients under observation when curve angle was < 40 degrees, while postsurgical patients marked the highest scores when the angle > or = 40 degrees, respectively. The Japanese SRS-22 is valid and may be useful for clinical evaluation of Japanese scoliosis patients, though the self-image subscale may need further assessment.

Reversible brain atrophy and cognitive impairment in an adolescent Japanese patient with primary adrenal Cushing's syndrome.

PubMed

Ohara, Nobumasa; Suzuki, Hiroshi; Suzuki, Akiko; Kaneko, Masanori; Ishizawa, Masahiro; Furukawa, Kazuo; Abe, Takahiro; Matsubayashi, Yasuhiro; Yamada, Takaho; Hanyu, Osamu; Shimohata, Takayoshi; Sone, Hirohito

2014-01-01

Endogenous Cushing's syndrome is an endocrine disease resulting from chronic exposure to excessive glucocorticoids produced in the adrenal cortex. Although the ultimate outcome remains uncertain, functional and morphological brain changes are not uncommon in patients with this syndrome, and generally persist even after resolution of hypercortisolemia. We present an adolescent patient with Cushing's syndrome who exhibited cognitive impairment with brain atrophy. A 19-year-old Japanese male visited a local hospital following 5 days of behavioral abnormalities, such as money wasting or nighttime wandering. He had hypertension and a 1-year history of a rounded face. Magnetic resonance imaging (MRI) revealed apparently diffuse brain atrophy. Because of high random plasma cortisol levels (28.7 μg/dL) at 10 AM, he was referred to our hospital in August 2011. Endocrinological testing showed adrenocorticotropic hormone-independent hypercortisolemia, and abdominal computed tomography demonstrated a 2.7 cm tumor in the left adrenal gland. The patient underwent left adrenalectomy in September 2011, and the diagnosis of cortisol-secreting adenoma was confirmed histologically. His hypertension and Cushingoid features regressed. Behavioral abnormalities were no longer observed, and he was classified as cured of his cognitive disturbance caused by Cushing's syndrome in February 2012. MRI performed 8 months after surgery revealed reversal of brain atrophy, and his subsequent course has been uneventful. In summary, the young age at onset and the short duration of Cushing's syndrome probably contributed to the rapid recovery of both cognitive dysfunction and brain atrophy in our patient. Cushing's syndrome should be considered as a possible etiological factor in patients with cognitive impairment and brain atrophy that is atypical for their age.

Idiopathic portal hypertension regarding thiopurine treatment in patients with inflammatory bowel disease.

PubMed

Suárez Ferrer, Cristina; Llop Herrera, Elba; Calvo Moya, Marta; Vera Mendoza, María Isabel; González Partida, Irene; González Lama, Yago; Matallana Royo, Virginia; Calleja Panero, José Luis; Abreu García, Luis

2016-02-01

The possibility of developing idiopathic portal hypertension has been described with thiopurine treatment despite compromises the prognosis of these patients, the fact its true prevalence is unknown. A cross-sectional study was conducted in a cohort of inflammatory bowel disease (IBD) patients followed at our unit, to determine the prevalence of diagnosis of idiopathic portal hypertension (IPH) and its relationship with thiopurine treatment. At the time of the analysis, 927/1,419 patients were under treatment with thiopurine drugs (65%). A total of 4 patients with IBD type Crohn's disease with idiopathic portal hypertension probably related to the thiopurine treatment were identified (incidence of 4.3 cases per 1,000). Seventy-five percent of patients started with signs or symptoms of portal hypertension. Only one patient was asymptomatic but the diagnosis of IPH because of isolated thrombocytopenia is suspected. However, note that all patients had thrombocytopenia previously. Abdominal ultrasound with fibroscan, hepatic vein catheterization and liver biopsy were performed on all of them as part of the etiology of portal hypertension. In the abdominal ultrasound, indirect portal hypertension data were observed in all patients (as splenomegaly) cirrhosis was also ruled out. The fibroscan data showed significant liver fibrosis (F2-F3). Idiopathic portal hypertension following thiopurine treatment in IBD patients is a rare occurrence, but it must be borne in mind in the differential diagnosis for early diagnosis, especially in patients undergoing thiopurine treatment over a long period. The presence of thrombocytopenia is often the only predictor of its development in the preclinical stage.

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I-II essential hypertension: a randomized, double-blind clinical study.

PubMed

Rakugi, Hiromi; Enya, Kazuaki; Sugiura, Kenkichi; Ikeda, Yoshinori

2012-05-01

Azilsartan is a novel angiotensin receptor blocker being developed for hypertension treatment. This 16-week, multicenter, randomized, double-blind study compared the efficacy and safety of azilsartan (20-40 mg once daily by forced titration) and its ability to provide 24-h blood pressure (BP) control, with that of candesartan cilexetil (candesartan; 8-12 mg once daily by forced titration) in 622 Japanese patients with grade I-II essential hypertension. Efficacy was evaluated by clinic-measured sitting BP, and by ambulatory BP monitoring (ABPM) at week 14. Participants (mean age: 57 years, 61% males) had a mean baseline sitting BP of 159.8/100.4 mm Hg. The mean change from baseline in sitting diastolic BP at week 16 (primary endpoint) was -12.4 mm Hg in the azilsartan group and -9.8 mm Hg in the candesartan group, demonstrating a statistically significant greater reduction with azilsartan vs. candesartan (difference: -2.6 mm Hg, 95% confidence interval (CI): -4.08 to -1.22 mm Hg, P=0.0003). The week 16 (secondary endpoint) mean change from baseline in sitting systolic BP was -21.8 mm Hg and -17.5 mm Hg, respectively, a significant decrease with azilsartan vs. candesartan (difference: -4.4 mm Hg, 95% CI: -6.53 to -2.20 mm Hg, P<0.0001). On ABPM, the week 14 mean changes from baseline in diastolic and systolic BP were also significantly greater with azilsartan over a 24-h period, and during the daytime, night-time and early morning. Safety and tolerability were similar among the two groups. These data demonstrate that once-daily azilsartan provides a more potent 24-h sustained antihypertensive effect than that of candesartan but with equivalent safety.

Comparison of the efficacy and safety of azilsartan with that of candesartan cilexetil in Japanese patients with grade I–II essential hypertension: a randomized, double-blind clinical study

PubMed Central

Rakugi, Hiromi; Enya, Kazuaki; Sugiura, Kenkichi; Ikeda, Yoshinori

2012-01-01

Azilsartan is a novel angiotensin receptor blocker being developed for hypertension treatment. This 16-week, multicenter, randomized, double-blind study compared the efficacy and safety of azilsartan (20–40 mg once daily by forced titration) and its ability to provide 24-h blood pressure (BP) control, with that of candesartan cilexetil (candesartan; 8–12 mg once daily by forced titration) in 622 Japanese patients with grade I–II essential hypertension. Efficacy was evaluated by clinic-measured sitting BP, and by ambulatory BP monitoring (ABPM) at week 14. Participants (mean age: 57 years, 61% males) had a mean baseline sitting BP of 159.8/100.4 mm Hg. The mean change from baseline in sitting diastolic BP at week 16 (primary endpoint) was −12.4 mm Hg in the azilsartan group and −9.8 mm Hg in the candesartan group, demonstrating a statistically significant greater reduction with azilsartan vs. candesartan (difference: −2.6 mm Hg, 95% confidence interval (CI): −4.08 to −1.22 mm Hg, P=0.0003). The week 16 (secondary endpoint) mean change from baseline in sitting systolic BP was −21.8 mm Hg and −17.5 mm Hg, respectively, a significant decrease with azilsartan vs. candesartan (difference: −4.4 mm Hg, 95% CI: −6.53 to −2.20 mm Hg, P<0.0001). On ABPM, the week 14 mean changes from baseline in diastolic and systolic BP were also significantly greater with azilsartan over a 24-h period, and during the daytime, night-time and early morning. Safety and tolerability were similar among the two groups. These data demonstrate that once-daily azilsartan provides a more potent 24-h sustained antihypertensive effect than that of candesartan but with equivalent safety. PMID:22278628

Characteristics of metabolic and lifestyle risk factors in young Japanese patients with coronary heart disease: a comparison with older patients.

PubMed

Azegami, Masako; Hongo, Minoru; Yanagisawa, Setsuko; Yamazaki, Akie; Sakaguchi, Kesami; Yazaki, Yoshikazu; Imamura, Hiroshi

2006-05-01

Coronary heart disease (CHD) is recognized as a lifestyle-related disease and is the second leading cause of death in Japan. However, the cardiac risk factor profile of young patients with CHD has not been clarified in suburban areas of Japan. Our study aimed to determine metabolic and lifestyle risk factors in young patients and compare them with older patients living in suburban areas of Nagano Prefecture. A multicenter study was conducted in 86 young (aged less than 40 years) and 91 older (aged 50 years and over) patients diagnosed with CHD from 1992 to 2002. There was a strong association between obesity and the occurrence of CHD events in young patients (odds ratio = 3.61, P = 0.006). Lifestyle in the young patients was characterized by a lack of physical activity and regular physical activity was found to decrease the risk of the CHD events in these patients (odds ratio = 0.31, P = 0.030). In older patients, hypertension was identified as an independent risk factor for CHD events. The results of the present study have demonstrated that obesity and a lack of regular physical exercise are independent risk factors for CHD events in younger patients. Thus, the data may be useful for the effective screening of high-risk individuals and the development of educational programs for the prevention of CHD, especially in younger Japanese.

Impact of dietary fiber intake on glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese patients with type 2 diabetes mellitus: the Fukuoka Diabetes Registry

PubMed Central

2013-01-01

Background Dietary fiber is beneficial for the treatment of type 2 diabetes mellitus, although it is consumed differently in ethnic foods around the world. We investigated the association between dietary fiber intake and obesity, glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese type 2 diabetic patients. Methods A total of 4,399 patients were assessed for dietary fiber intake using a brief self-administered diet history questionnaire. The associations between dietary fiber intake and various cardiovascular risk factors were investigated cross-sectionally. Results Body mass index, fasting plasma glucose, HbA1c, triglyceride and high-sensitivity C-reactive protein negatively associated with dietary fiber intake after adjusting for age, sex, duration of diabetes, current smoking, current drinking, total energy intake, fat intake, saturated fatty acid intake, leisure-time physical activity and use of oral hypoglycemic agents or insulin. The homeostasis model assessment insulin sensitivity and HDL cholesterol positively associated with dietary fiber intake. Dietary fiber intake was associated with reduced prevalence of abdominal obesity, hypertension and metabolic syndrome after multivariate adjustments including obesity. Furthermore, dietary fiber intake was associated with lower prevalence of albuminuria, low estimated glomerular filtration rate and chronic kidney disease after multivariate adjustments including protein intake. Additional adjustments for obesity, hypertension or metabolic syndrome did not change these associations. Conclusion We demonstrated that increased dietary fiber intake was associated with better glycemic control and more favorable cardiovascular disease risk factors including chronic kidney disease in Japanese type 2 diabetic patients. Diabetic patients should be encouraged to consume more dietary fiber in daily life. PMID:24330576

Shangaan patients and traditional healers management strategies of hypertension in Limpopo Province.

PubMed

Risenga, P R; Botha, A; Tjallinks, J E

2007-03-01

The study explored the cultural care beliefs, values and attitudes of Shangaans patients' and traditional healers' management strategies of hypertension in the Limpopo Province. The study aimed to describe the cultural values, beliefs and practices including taboos, rituals and religion within the world-view of the Shangaans. The study was undertaken in the Mopani region of the Greater Giyani area, with the purpose of recommending improvements to patient care in this area. Data collection was done by conducting focus groups and individual interviews. The following themes emerged. Hypertension. The traditional healer: the instrumental role. Traditional medicine versus Western medicine. Magico-religious healings. Cultural beliefs of Shangaans and hypertension. Experiences of hypertensive patients with regard to traditional healers and hypertension.

Determinants of left ventricular diastolic dysfunction in hypertensive patients.

PubMed

Nazário Leão, R; Marques da Silva, P; Marques Pocinho, R; Alves, M; Virella, D; Palma Dos Reis, R

2018-02-02

The progression of hypertensive heart disease leads to the left ventricular diastolic dysfunction (LVDD), which is associated with increased cardiovascular morbidity and mortality. The purpose of this analysis is to explore the determinants for LVDD in patients with hypertension. This is a secondary analysis of data of Impedance Cardiography in the Evaluation of Left Ventricular Diastolic Dysfunction in Patients with Arterial Hypertension (IMPEDDANS) Study. Mann-Whitney and Chi-square tests were used for univariable analysis. Multiple logistic regression was used to model for LVDD occurrence and discriminative capacity of the model assessed by the value of the area under the curve given by the receiver-operating characteristic curve. Older age (65 vs. 58 years, p<0.001), longer duration of hypertension (160 vs. 48 months, p<0.001), uncontrolled hypertension (59.8 vs. 15.9%, p<0.001), tobacco smoking (17.8 vs. 3.8%, p=0.016), higher systolic blood pressure (133 vs. 124mmHg, p=0.001) and slower heart rate (62 vs. 66bpm, p=0.023) were associated with LVDD. Multivariate model identified uncontrolled hypertension (AdjOR 36.90; 95% CI 7.94-171.58; p<0.001), smoking (AdjOR 6.66; 95% CI 1.63-27.26; p=0.008), eccentric hypertrophy (AdjOR 3.59; 95% CI 0.89-14.39; p=0.072), duration of hypertension (AdjOR 1.03; 95% CI 1.02-1.05; p<0.001) and concentric remodeling (AdjOR 0.19; 95% CI 0.04-0.93; p=0.041) as the more determinant for occurrence of LVDD. The discriminative capacity of the model was AUC=0.95 (95% CI 0.91-0.98). The occurrence of LVDD in hypertensive patients was strongly associated to long-lasting, uncontrolled hypertension, tobacco smoking, concentric remodeling and eccentric hypertrophy. Copyright © 2017 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Gastrointestinal Bleeding in Cirrhotic Patients with Portal Hypertension

PubMed Central

Biecker, Erwin

2013-01-01

Gastrointestinal bleeding related to portal hypertension is a serious complication in patients with liver cirrhosis. Most patients bleed from esophageal or gastric varices, but bleeding from ectopic varices or portal hypertensive gastropathy is also possible. The management of acute bleeding has changed over the last years. Patients are managed with a combination of endoscopic and pharmacologic treatment. The endoscopic treatment of choice for esophageal variceal bleeding is variceal band ligation. Bleeding from gastric varices is treated by injection with cyanoacrylate. Treatment with vasoactive drugs as well as antibiotic treatment is started before or at the time point of endoscopy. The first-line treatment for primary prophylaxis of esophageal variceal bleeding is nonselective beta blockers. Pharmacologic therapy is recommended for most patients; band ligation is an alternative in patients with contraindications for or intolerability of beta blockers. Treatment options for secondary prophylaxis include variceal band ligation, beta blockers, a combination of nitrates and beta blockers, and combination of band ligation and pharmacologic treatment. A clear superiority of one treatment over the other has not been shown. Bleeding from portal hypertensive gastropathy or ectopic varices is less common. Treatment options include beta blocker therapy, injection therapy, and interventional radiology. PMID:27335828

[Circulating endothelial progenitor cell levels in treated hypertensive patients].

PubMed

Maroun-Eid, C; Ortega-Hernández, A; Abad, M; García-Donaire, J A; Barbero, A; Reinares, L; Martell-Claros, N; Gómez-Garre, D

2015-01-01

Most optimally treated hypertensive patients still have an around 50% increased risk of any cardiovascular event, suggesting the possible existence of unidentified risk factors. In the last years there has been evidence of the essential role of circulating endothelial progenitor cells (EPCs) in the maintenance of endothelial integrity and function, increasing the interest in their involvement in cardiovascular disease. In this study, the circulating levels of EPCs and vascular endothelial growth factor (VEGF) are investigated in treated hypertensive patients with adequate control of blood pressure (BP). Blood samples were collected from treated hypertensive patients with controlled BP. Plasma levels of EPCs CD34+/KDR+ and CD34+/VE-cadherin+ were quantified by flow cytometry. Plasma concentration of VEGF was determined by ELISA. A group of healthy subjects without cardiovascular risk factors was included as controls. A total of 108 hypertensive patients were included (61±12 years, 47.2% men) of which 82.4% showed BP<140/90 mmHg, 91.7% and 81.5% controlled diabetes (HbA1c <7%) and cLDL (<130 or 100 mg/dL), respectively, and 85.2% were non-smokers. Around 45% of them were obese. Although patients had cardiovascular parameters within normal ranges, they showed significantly lower levels of CD34+/KDR+ and CD34+/VE-cadherin+ compared with healthy control group, although plasma VEGF concentration was higher in patients than in controls. Despite an optimal treatment, hypertensive patients show a decreased number of circulating EPCs that could be, at least in part, responsible for their residual cardiovascular risk, suggesting that these cells could be a therapeutic target. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

Pulmonary hypertension in patients with congenital portosystemic venous shunt: a previously unrecognized association.

PubMed

Ohno, Takuro; Muneuchi, Jun; Ihara, Kenji; Yuge, Tetsuji; Kanaya, Yoshiaki; Yamaki, Shigeo; Hara, Toshiro

2008-04-01

Pulmonary arterial hypertension has been reported to be observed in association with acquired portal hypertension. However, the contribution of congenital anomalies occurring in the portal system to the development of pulmonary arterial hypertension remains to be elucidated. Nine patients with congenital portosystemic venous shunt were studied from January 1990 through September 2005. Patent ductus venosus was detected in 5 patients, including 3 patients with an absence of the portal vein. The presence of either a gastrorenal or splenorenal shunt was evident in another 4 patients. Six patients had a history of hypergalactosemia with normal enzyme activities, as seen during neonatal screening. Six (66.7%) of the 9 patients were identified to have clinically significant pulmonary arterial hypertension (mean pulmonary artery pressure: 34-79 mm Hg; pulmonary vascular resistances: 5.12-38.07 U). The median age at the onset of pulmonary arterial hypertension was 12 years and 3 months. Histologic studies of lung specimens, which were available in 4 of the 9 patients with congenital portosystemic venous shunt, showed small arterial microthrombotic lesions in 3 patients. This characteristic finding was recognized even in the congenital portosystemic venous shunt patients without PAH. This study demonstrated thromboembolic pulmonary arterial hypertension to be a crucial complication in congenital portosystemic venous shunt, and this pathologic state may be latently present in patients with pulmonary arterial hypertension of unknown etiology.

Hypertension: are you and your patients up to date?

PubMed

Allu, Selina Omar; Bellerive, Jocelyne; Walker, Robin L; Campbell, Norm R C

2010-05-01

While there have been substantive efforts to improve treatment and control of hypertension in Canada, many individuals with hypertension remain unaware of their condition and many health care professionals are unaware of key hypertension management recommendations. The present article reviews the new Canadian strategic direction for increased knowledge translation and dissemination of information to patients and health care professionals by providing new, innovative and easily accessible resources for hypertension education in Canada. A multitude of resources that address the diverse learning needs of health care professionals and the general public are highlighted.

Body Mass Index (BMI) Is Associated with Microalbuminuria in Chinese Hypertensive Patients

PubMed Central

Liu, Xinyu; Liu, Yu; Chen, Youming; Li, Yongqiang; Shao, Xiaofei; Liang, Yan; Li, Bin; Holthöfer, Harry; Zhang, Guanjing; Zou, Hequn

2015-01-01

There is no general consensus on possible factors associated with microalbuminuria in hypertensive patients nor any reported study about this issue in Chinese patients. To examine this issues, 944 hypertensive patients were enrolled in a study based on a cross-sectional survey conducted in Southern China. Multivariate regression analyses were performed to identify the factors related with the presence of microalbuminuria and urinary excretion of albumin. The prevalence of microalbuminuria in hypertensive and non-diabetic hypertensive patients were 17.16% and 15.25%, respectively. Body mass index (BMI), but not waist circumference (WC), were independently associated with microalbuminuria and the values of urinary albumin to creatinine ratio (ACR) based on multiple regression analyses, even after excluding diabetic patients and patients taking inhibitors of the renin-angiotensin system from the analyses. Furthermore, patients with obesity (BMI ≥28) had higher levels of ACR, compared with those with normal weight (BMI <24 kg/m2) and overweight (24 kg/m2≤ BMI < 28). In conclusion, BMI, as a modifiable factor, is closely associated with microalbuminuria among Chinese hypertensive patients, which may provide a basis for future development of intervention approaches for these patients. PMID:25674785

[Quality of life in patients with Japanese cedar pollinosis: using the SF-8 health status questionnaire (Japanese version)].

PubMed

Fujii, Tsukasa; Ogino, Satoshi; Arimoto, Hiroe; Irifune, Morihiro; Iwata, Nobuko; Ookawachi, Ichiro; Kikumori, Hiroshi; Seo, Ritsu; Takeda, Mariko; Tamaki, Akiko; Baba, Kenji; Nose, Michihiro

2006-10-01

The number of patients with Japanese cedar pollinosis (JCP) is increasing, and now, has extended up to about 15% of the Japanese. It is reported that the QOL is an important outcome in the JCP treatment. This study aimed to evaluate the QOL in patients with JCP by means of the SF-8 Health Survey (Japanese Version), a new, even shorter generic health survey. 411 patients with JCP who visited 10 ENT clinics in Osaka from March 14 to March 26 (peak pollen season) were questioned, and 204 patients without any treatments in this season were engaged in this study as subjects. In this study, the QOL scores were evaluated using the SF-8. This is an 8-item version of the SF-36 that yields a comparable 8-dimension health profile and comparable estimates of summary scores for the physical and mental components of health. The QOL score depressed in the patients with JCP compared with healthy subjects (Japanese national norms). Both Mental Component Score (MCS) and Physical Component Score (PCS) scores decreased more in females than in males. In females, MCS were significantly lower than national norms. The older the patients were, the lower PCS scores were showed. The severity of nasal symptoms influenced the PCS scores. These results showed the tendency similar to the early studies using SF-36 questionnaire. The sensitivity of SF-8 in the individual is not better than that of other specific QOL questionnaires, but SF-8 can be answered in a short time compared with other questionnaires including SF-36. We suggested that SF-8 become a useful questionnaire in the future.

Interventional and surgical therapeutic strategies for pulmonary arterial hypertension: Beyond palliative treatments.

PubMed

Sandoval, Julio; Gomez-Arroyo, Jose; Gaspar, Jorge; Pulido-Zamudio, Tomas

2015-10-01

Despite significant advances in pharmacological treatments, pulmonary arterial hypertension remains an incurable disease with an unreasonably high morbidity and mortality. Although specific pharmacotherapies have shifted the survival curves of patients and improved exercise endurance as well as quality of life, it is also true that these pharmacological interventions are not always accessible (particularly in developing countries) and, perhaps most importantly, not all patients respond similarly to these drugs. Furthermore, many patients will continue to deteriorate and will eventually require an additional, non-pharmacological, intervention. In this review we analyze the role of atrial septostomy and Potts anastomosis in the management of patients with pulmonary arterial hypertension, we summarize the current worldwide clinical experience (case reports and case series), and discuss why these interventional/surgical strategies might have a therapeutic role beyond that of a "bridge" to transplantation. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients.

PubMed

Mattioli, A V; Farinetti, A; Miloro, C; Pedrazzi, P; Mattioli, G

2011-06-01

Coffee and caffeine are widely consumed in Western countries. Little information is available on the influence of coffee and caffeine consumption on atrial fibrillation (AF) in hypertensive patients. We sought to investigate the relationship between coffee consumption and atrial fibrillation with regard to spontaneous conversion of arrhythmia. A group of 600 patients presenting with a first known episode of AF was investigated, and we identified 247 hypertensive patients. The prevalence of nutritional parameters was assessed with a food frequency questionnaire. Coffee and caffeine intake were specifically estimated. Left ventricular hypertrophy was evaluated by electrocardiogram (ECG) and echocardiogram. Coffee consumption was higher in normotensive patients. High coffee consumers were more frequent in normotensive patients compared with hypertensive patients. On the other hand, the intake of caffeine was similar in hypertensive and normotensive patients, owing to a higher intake in hypertensive patients from sources other than coffee. Within normotensive patients, we report that non-habitual and low coffee consumers showed the highest probability of spontaneous conversion (OR 1.93 95%CI 0.88-3.23; p=0.001), whereas, within hypertensive patients, moderate but not high coffee consumers had the lowest probability of spontaneous conversion (OR 1.13 95%CI 0.67-1.99; p=0.05). Coffee and caffeine consumption influence spontaneous conversion of atrial fibrillation. Normotensive non-habitual coffee consumers are more likely to convert arrhythmia within 48h from the onset of symptoms. Hypertensive patients showed a U-shaped relationship between coffee consumption and spontaneous conversion of AF, moderate coffee consumers were less likely to show spontaneous conversion of arrhythmia. Patients with left ventricular hypertrophy showed a reduced rate of spontaneous conversion of arrhythmia. Copyright © 2009 Elsevier B.V. All rights reserved.

Patient autonomy preferences among hypertensive outpatients in a primary care setting in Japan.

PubMed

Nomura, Kyoko; Ohno, Maiko; Fujinuma, Yasuki; Ishikawa, Hirono

2007-01-01

To investigate autonomy preferences and the factors to promote active patient participation in a primary care setting in Japan. Ninety-two hypertensive outpatients who consecutively visited a Japanese hospital between January and May of 2005 in Tokyo, Japan. This cross-sectional study was conducted by using a self-administered questionnaire. The main outcome measures were patient preferences for autonomy (i.e., decision-making and information-seeking preferences), measured by the Autonomy Preference Index (API). The variables studied were patient sociodemographic characteristics, physician characteristics based on patient preference (i.e., ability to communicate, extent of clinical experience, qualifications, educational background, gender, and age), and the Multidimensional Health Locus of Control. On the API scale from 0 to 100, the patients had an intermediate desire for decision-making (median: 51) and a greater desire for information (median: 95). A multivariate regression model indicated that decision-making preference increased when patients were woman and decreased as physician age increased, and information-seeking preference was positively associated with good communication skills, more extensive clinical experience, physicians of middle age, and patient beliefs that they were responsible for their own health, and was negatively associated with a preference for man physicians. Physicians may need to understand that patient autonomy preferences pertain to physician age and gender, physician communication ability and extent of clinical experience, and patient beliefs about self-responsibility toward health, and could use the information to promote reliable patient-physician relationships.

Circulating osteoprotegerin is associated with chronic kidney disease in hypertensive patients.

PubMed

Bernardi, Stella; Toffoli, Barbara; Bossi, Fleur; Candido, Riccardo; Stenner, Elisabetta; Carretta, Renzo; Barbone, Fabio; Fabris, Bruno

2017-07-06

Osteoprotegerin (OPG) is a glycoprotein that plays an important regulatory role in the skeletal, vascular, and immune system. It has been shown that OPG predicts chronic kidney disease (CKD) in diabetic patients. We hypothesized that OPG could be a risk marker of CKD development also in non-diabetic hypertensive patients. A case-control study was carried out to measure circulating OPG levels in 42 hypertensive patients with CKD and in 141 hypertensive patients without CKD. A potential relationship between OPG and the presence of CKD was investigated and a receiver-operating characteristic (ROC) curve was designed thereafter to identify a cut-off value of OPG that best explained the presence of CKD. Secondly, to evaluate whether OPG increase could affect the kidney, 18 C57BL/6J mice were randomized to be treated with saline or recombinant OPG every 3 weeks for 12 weeks. Circulating OPG levels were significantly higher in hypertensive patients with CKD, and there was a significant inverse association between OPG and renal function, that was independent from other variables. ROC analysis showed that OPG levels had a high statistically predictive value on CKD in hypertensive patients, which was greater than that of hypertension. The OPG best cut-off value associated with CKD was 1109.19 ng/L. In the experimental study, OPG delivery significantly increased the gene expression of pro-inflammatory and pro-fibrotic mediators, as well as the glomerular nitrosylation of proteins. This study shows that OPG is associated with CKD in hypertensive patients, where it might have a higher predictive value than that of hypertension for CKD development. Secondly, we found that OPG delivery significantly increased the expression of molecular pathways involved in kidney damage. Further longitudinal studies are needed not only to evaluate whether OPG predicts CKD development but also to clarify whether OPG should be considered a risk factor for CKD.

Relevance of plasma malondialdehyde level and severity of portal hypertension in cirrhotic patients.

PubMed

Wang, Sheng-Lan; Zhu, Xin-Yan; Zhang, Dong-Wei; Zhang, Zhao-Jie; Gao, Heng-Jun; Yang, Chang-Qing

2015-01-01

Portal hypertension is one of the death reasons for the liver cirrhosis patients. The oxidative stress is related to the occurrence and development of portal hypertension in cirrhosis. Malondialdehyde (MDA), one of the lipid peroxides, increases substantially in cirrhotic patients. To evaluate the relevance between the MDA level and portal hypertension in cirrhotic patients. 60 liver cirrhotic patients and 30 healthy controls were enrolled. The plasma MDA level and general blood tests including ALT, AST, ALB, total bilirubin, and platelet were measured. All people enrolled accepted endoscopic examination and B-Ultrasound check to evaluate the severity of portal hypertension. The MDA plasma level of cirrhotic patients was significantly higher than the controls (P<0.001) and increased significantly accompanied by the severity of liver fibrosis and portal hypertension (P<0.01). Further, the plasma MDA level of cirrhotic patients was significantly correlated with Child-Pugh classification of cirrhosis (r=0.820, P<0.001), the degree of esophageal varices (r=0.857, P<0.001) and the width of portal vein (r=0.652, P<0.001). The ROC curve analyses showed that the plasma MDA level is a strong predictor of liver cirrhosis and portal hypertension. Plasma MDA level may correlate with the severity of portal hypertension in cirrhotic patients.

Bevacizumab-related arterial hypertension as a predictive marker in metastatic colorectal cancer patients.

PubMed

De Stefano, Alfonso; Carlomagno, Chiara; Pepe, Stefano; Bianco, Roberto; De Placido, Sabino

2011-11-01

Patients with metastatic colorectal cancer (mCRC) receiving all three active drugs (irinotecan, oxaliplatin, fluorouracil) achieve the best outcome. Bevacizumab added to chemotherapy further improves progression-free (PFS) survival and overall survival. As arterial hypertension has been reported in all studies involving bevacizumab, we retrospectively analysed the correlation between the modifications of arterial blood pressure and response rate (RR) and PFS in mCRC patients treated with bevacizumab. Patients with histologically proven mCRC receiving a first-line chemotherapeutic treatment were eligible. Arterial blood pressure was measured daily and hypertension graduated according to NCI-CTC V3.0 scale. Seventy-four patients were considered for the present analysis; median age was 57 years (range 31-80). Sixty-seven patients had undergone surgery on primary tumour and, of these, 19 patients had formerly received adjuvant chemotherapy for stage II-III tumours. Chemotherapeutic regimens for metastatic disease were FOLFIRI (61 patients), FOLFOXIRI (6 patients), XELOX (5 patients) and XELIRI (2 patients). Eighteen patients (24.3%) had basal hypertension. Thirteen patients (17.6%) developed G2-G4 arterial hypertension. Six complete (8.1%) and 31 partial (41.9%) responses were recorded. Among patients with induced arterial hypertension, 84.6% achieved a complete or partial response, as compared with 42.6% of patients who did not show this side effect (P = 0.006). Kaplan-Meier analysis showed a statistically significant improvement in median PFS for patients with induced arterial hypertension (15.1 vs. 8.3 months, P = 0.04). Our data suggest that bevacizumab-related arterial hypertension may represent a predictive factor of response and prolonged PFS in patients with mCRC receiving first-line bevacizumab.

Complementary and alternative medicine (CAM) use among hypertensive patients in Palestine.

PubMed

Ali-Shtayeh, Mohammed S; Jamous, Rana M; Jamous, Rania M; Salameh, Nihaya M Y

2013-11-01

To explore the frequency of CAM use among hypertensive patients in Palestine, determine demographic characteristics that may increase the likelihood of CAM use and to find out how benefits were perceived by patients. Across-sectional survey of patients attending outpatient hypertension clinics. The method was based on a semi-structured questionnaire. Of the 4575 hypertensive patients interviewed, 85.7% respondents used at least one type of CAM. Of the 3921 CAM users, 62.13% reported taking herbs. Most of these users were >50 years old, of low educational level, and had a family history of HTN, 62.9% claimed to have obtained the desired effect from taking these herbs; however, 68.1% did not disclose this fact to their health care providers, 83 plant taxa were reported by these patients, Allium sativum was the most commonly used herb. The use of CAM, particularly herbal therapies for hypertension treatment, is highly prevalent in Palestine. Copyright © 2013 Elsevier Ltd. All rights reserved.

Relationship of Hypertension to Coronary Atherosclerosis and Cardiac Events in Patients With Coronary Computed Tomographic Angiography.

PubMed

Nakanishi, Rine; Baskaran, Lohendran; Gransar, Heidi; Budoff, Matthew J; Achenbach, Stephan; Al-Mallah, Mouaz; Cademartiri, Filippo; Callister, Tracy Q; Chang, Hyuk-Jae; Chinnaiyan, Kavitha; Chow, Benjamin J W; DeLago, Augustin; Hadamitzky, Martin; Hausleiter, Joerg; Cury, Ricardo; Feuchtner, Gudrun; Kim, Yong-Jin; Leipsic, Jonathon; Kaufmann, Philipp A; Maffei, Erica; Raff, Gilbert; Shaw, Leslee J; Villines, Todd C; Dunning, Allison; Marques, Hugo; Pontone, Gianluca; Andreini, Daniele; Rubinshtein, Ronen; Bax, Jeroen; Jones, Erica; Hindoyan, Niree; Gomez, Millie; Lin, Fay Y; Min, James K; Berman, Daniel S

2017-08-01

Hypertension is an atherosclerosis factor and is associated with cardiovascular risk. We investigated the relationship between hypertension and the presence, extent, and severity of coronary atherosclerosis in coronary computed tomographic angiography and cardiac events risk. Of 17 181 patients enrolled in the CONFIRM registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) who underwent ≥64-detector row coronary computed tomographic angiography, we identified 14 803 patients without known coronary artery disease. Of these, 1434 hypertensive patients were matched to 1434 patients without hypertension. Major adverse cardiac events risk of hypertension and non-hypertensive patients was evaluated with Cox proportional hazards models. The prognostic associations between hypertension and no-hypertension with increasing degree of coronary stenosis severity (nonobstructive or obstructive ≥50%) and extent of coronary artery disease (segment involvement score of 1-5, >5) was also assessed. Hypertension patients less commonly had no coronary atherosclerosis and more commonly had nonobstructive and 1-, 2-, and 3-vessel disease than the no-hypertension group. During a mean follow-up of 5.2±1.2 years, 180 patients experienced cardiac events, with 104 (2.0%) occurring in the hypertension group and 76 (1.5%) occurring in the no-hypertension group (hazard ratios, 1.4; 95% confidence intervals, 1.0-1.9). Compared with no-hypertension patients without coronary atherosclerosis, hypertension patients with no coronary atherosclerosis and obstructive coronary disease tended to have higher risk of cardiac events. Similar trends were observed with respect to extent of coronary artery disease. Compared with no-hypertension patients, hypertensive patients have increased presence, extent, and severity of coronary atherosclerosis and tend to have an increase in major adverse cardiac events. © 2017 American Heart Association, Inc.

Resistant Hypertension, Patient Characteristics, and Risk of Stroke

PubMed Central

Hung, Chen-Ying; Wang, Kuo-Yang; Wu, Tsu-Juey; Hsieh, Yu-Cheng; Huang, Jin-Long; Loh, El-Wui; Lin, Ching-Heng

2014-01-01

Background Little is known about the prognosis of resistant hypertension (RH) in Asian population. This study aimed to evaluate the impacts of RH in Taiwanese patients with hypertension, and to ascertain whether patient characteristics influence the association of RH with adverse outcomes. Methods and Results Patients aged ≥45 years with hypertension were identified from the National Health Insurance Research Database. Medical records of 111,986 patients were reviewed in this study, and 16,402 (14.6%) patients were recognized as having RH (continuously concomitant use of ≥3 anti-hypertensive medications, including a diuretic, for ≥2 years). Risk of major adverse cardiovascular events (MACE, a composite of all-cause mortality, acute coronary syndrome, and stroke [included both fatal and nonfatal events]) in patients with RH and non-RH was analyzed. A total of 11,856 patients experienced MACE in the follow-up period (average 7.1±3.0 years). There was a higher proportion of females in the RH group, they were older than the non-RH (63.1 vs. 60.5 years) patients, and had a higher prevalence of cardiovascular co-morbidities. Overall, patients with RH had higher risks of MACE (adjusted HR 1.17; 95%CI 1.09–1.26; p<0.001). Significantly elevated risks of stroke (10,211 events; adjusted HR 1.17; 95%CI 1.08–1.27; p<0.001), especially ischemic stroke (6,235 events; adjusted HR 1.34; 95%CI 1.20–1.48; p<0.001), but not all-cause mortality (4,594 events; adjusted HR 1.06; 95%CI 0.95–1.19; p = 0.312) or acute coronary syndrome (2,145 events; adjusted HR 1.17; 95%CI 0.99–1.39; p = 0.070) were noted in patients with RH compared to those with non-RH. Subgroup analysis showed that RH increased the risks of stroke in female and elderly patients. However, no significant influence was noted in young or male patients. Conclusions Patients with RH were associated with higher risks of MACE and stroke, especially ischemic stroke. The risks were greater in female and

Depression and anxiety are associated with abnormal nocturnal blood pressure fall in hypertensive patients.

PubMed

Sunbul, Murat; Sunbul, Esra Aydin; Kosker, Selcen Dogru; Durmus, Erdal; Kivrak, Tarik; Ileri, Cigdem; Oguz, Mustafa; Sari, Ibrahim

2014-01-01

Previous studies have shown that depression and anxiety were independent risk factors for hypertension. Non-dipper hypertension is associated with higher cardiovascular mortality. The aim of this study was to evaluate the anxiety and depression scores in patients with dipper and non-dipper hypertension. The study sample consisted of 153 hypertensive patients. All patients underwent 24-h blood pressure monitoring. Patients were classified into two groups according to their dipper or non-dipper hypertension status. We evaluated results of the Hospital Anxiety and Depression Scale between groups. Seventy-eight patients (38 male, mean age: 51.6 ± 12.5 years) had dipper hypertension while 75 patients (27 male, mean age: 55.4 ± 14.1 years) had non-dipper hypertension (p = 0.141, 0.072, respectively). Clinical characteristics were similar for both groups. Patients with non-dipper hypertension had significantly higher depression and anxiety scores compared to patients with dipper hypertension. Dipper and non-dipper status significantly correlated with anxiety (p: 0.025, r: 0.181) and depression score (p: 0.001, r: 0.255). In univariate analysis, smoking, alcohol usage, presence of diabetes, hyperlipidemia, anxiety score >8 and depression score >7 were predictors of dipper versus non-dipper status. In multivariate logistic regression analyses only depression score >7 was independent predictor of dipper versus non-dipper status (odds ratio: 2.74, confidence intervals: 1.41-5.37). A depression score of 7 or higher predicted non-dipper status with a sensitivity of 62.7% and specificity of 62.8%. Non-dipper patients have significantly higher anxiety and depression scores compared to dipper patients. Evaluation of anxiety and depression in patients with hypertension might help to detect non-dipper group and hence guide for better management.

Population Pharmacokinetics of Hydroxychloroquine in Japanese Patients With Cutaneous or Systemic Lupus Erythematosus.

PubMed

Morita, Shigemichi; Takahashi, Toshiya; Yoshida, Yasushi; Yokota, Naohisa

2016-04-01

Hydroxychloroquine (HCQ) is an effective treatment for patients with cutaneous lupus erythematosus (CLE) or systemic lupus erythematosus (SLE) and has been used for these patients in more than 70 nations. However, in Japan, HCQ has not been approved for CLE or SLE. To establish an appropriate therapeutic regimen and to clarify the pharmacokinetics (PK) of HCQ in Japanese patients with CLE with or without SLE (CLE/SLE), a population pharmacokinetic (PopPK) analysis was performed. In a clinical study of Japanese patients with a diagnosis of CLE irrespective of the presence of SLE, blood and plasma drug concentration-time data receiving multiple oral doses of HCQ sulfate (200-400 mg daily) were analyzed using nonlinear mixed-effects model software. The blood and plasma concentrations of HCQ were analyzed using a high-performance liquid chromatography tandem mass spectrometry method. Model evaluation and validation were performed using goodness-of-fit (GOF) plots, visual predictive check, and a bootstrap. The PopPKs of HCQ in the blood and plasma of 90 Japanese patients with CLE/SLE were well described by a 1-compartment model with first-order absorption and absorption lag time. Body weight was a significant (P < 0.001) covariate of oral clearance of HCQ. The final model was assessed using GOF plots, a bootstrap, and visual predictive check, and this model was appropriate. Simulations based on the final model suggested that the recommended daily doses of HCQ sulfate (200-400 mg) based on the ideal body weight in Japanese patients with CLE/SLE were in the similar concentration ranges. The PopPK models derived from both blood and plasma HCQ concentrations of Japanese patients with CLE/SLE were developed and validated. Based on this study, the dosage regimens of HCQ sulfate for Japanese patients with CLE/SLE should be calculated using the individual ideal body weight.

Microalbuminuria in obese patients with or without hypertension.

PubMed

Valensi, P; Assayag, M; Busby, M; Pariès, J; Lormeau, B; Attali, J R

1996-06-01

To evaluate the prevalence in obese patients of an increased urinary albumin excretion rate (UAER) and the factors involved in this parameter. Two hundred and seven nondiabetic obese patients with BMI = 34.7 +/- 5.7 (SD) kg/m2. None had proteinuria or a history of nephropathy or uropathy. Fifty-two had moderate hypertension. A control group of 22 lean healthy subjects was also studied. The UAER was determined from 24-h urine samples by means of immunonephelemetry laser method. Creatinine clearance was calculated. Glycemia and plasma C peptide at fasting and 120 mine after glucose oral administration, HbA1c, serum fructosamine, plasma total cholesterol and triglycerides, HDL and LDL cholesterol were measured. Food intakes were determined by dietary history. Compared with the control group, the UAER was significantly higher in the obese patients (18.0 +/- 20.1 mg/24 h vs 3.2 +/- 2.8 mg/24 h, P < 0.0001). It was elevated (> 30 mg/24 h) in 25 obese patients (12.1%) and in particular, in 19.2% of the obese patients with hypertension. It was significantly higher in the patients with android or mixed (both android and gynoid) obesity than in those with gynoid obesity (p = 0.050). Log UAER correlated negatively with the duration of hypertension (p = 0.038) and was higher in the patients with familial hypertension than in those without (p = 0.002). Log UAER correlated strongly with log creatinine clearance (p < 0.0001) and fractional albumin clearance (p < 0.0001). It correlated significantly with fasting and 120 min after glucose plasma C peptide concentrations (p = 0.018 and p = 0.046, respectively). Creatinine clearance was significantly higher in the patients with android or mixed obesity than in those with gynoid obesity (p = 0.001). Log creatinine clearance correlated negatively with age (p = 0.046), and log LDL cholesterol (p = 0.025) and positively with log lipid caloric intake (p = 0.014). These results show the high prevalence of microalbuminuria in nondiabetic

Measurement of carotid pulse wave velocity using ultrafast ultrasound imaging in hypertensive patients.

PubMed

Li, Xiaopeng; Jiang, Jue; Zhang, Hong; Wang, Hua; Han, Donggang; Zhou, Qi; Gao, Ya; Yu, Shanshan; Qi, Yanhua

2017-04-01

The study aimed to assess the utility of ultrafast ultrasound imaging for evaluation of carotid pulse wave velocity (PWV) in newly diagnosed hypertension patients. This prospective non-randomized study enrolled 90 hypertensive patients in our hospital from September to December 2013 as a hypertension group. An age- and sex-matched cohort of 50 healthy adults in our hospital from September to December 2013 was also included in the study as a control group. Carotid PWV at the beginning and at the end of systole (PWV-BS and PWV-ES, respectively) and intima-media thickness (IMT) were measured by ultrafast ultrasound imaging technology. The associations of PWV-BS, PWV-ES, and IMT with hypertension stage were evaluated by Spearman correlation analysis. PWV-BS and PWV-ES in the hypertension group were significantly elevated compared with those in control group. Different hypertension stages significantly differed in PWV-BS and PWV-ES. PWV-BS and PWV-ES appeared to increase with the hypertension stage. Moreover, IMT, PWV-BS, and PWV-ES were positively correlated with the hypertension stage in hypertensive patients. Ultrafast ultrasound imaging was a valid and convenient method for the measurement of carotid PWV in hypertensive patients. Ultrafast ultrasound imaging might be recommended as a promising alternative method for early detection of arterial abnormality in clinical practice.

What Is in a Name? How Biomedical Language May Derail Patient Understanding of Hypertension.

PubMed

Bokhour, Barbara G; Kressin, Nancy R

2015-07-01

Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies. © 2015 American Heart Association, Inc.

Congenital abnormalities in Japanese patients with Menkes disease.

PubMed

Gu, Yan-Hong; Kodama, Hiroko; Kato, Tadaaki

2012-10-01

Menkes disease (MNK) is an X-linked recessive disorder. Incidence of live-born infants with MNK is 2.8 per million live births in Japan. The aim of this study was to observe congenital malformations (CMs) in MNK patients. Subjects comprised 35 Japanese male patients with classical MNK who received copper histidine treatment. Patient clinical data were obtained anonymously from medical records or medical record summaries by pediatrician's retrospective review through a survey. We observed 21 different CMs in 14 patients. Eight of these had a single CM, while six had multiple CMs. The most frequent CM was higher arched palate with other CMs found in five patients. There was no relationship between CMs and mutations in the ATP7A gene. Using Mann-Whitney U tests, age at death was also significantly lower in MNK patients with CMs (P<0.05), compared to those without CMs, even though there was no significant difference of age onset, age at diagnosis and age at start of treatment with copper histidine between both groups of patients. Sudden death occurred in three MNK patients with CMs only: two with congenital heart disease, and one with microphallus. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

[Subclinical and established kidney disease in recently diagnosed hypertensive patients].

PubMed

Gómez-Marcos, Manuel Angel; Martínez-Salgado, Carlos; Grandes, Gonzalo; Recio-Rodríguez, José Ignacio; Castaño Sánchez, Yolanda; Rodríguez Sánchez, Emiliano; García-Ortiz, Luis

2010-03-06

To estimate renal disease in recently diagnosed hypertensive patients, and to identify factors related to renal disease. Cross-sectional study, with 425 hypertensive patients recently diagnosed in primary health care; renal disease was estimated with serum creatinine, albumin/creatinine index and glomerular filtration rate (GFR). We analyzed cardiovascular risk factors (CRF), subclinical organ injury and cardiovascular disease following the criteria of the 2007 European Guide of Hypertension. Average age: 58,96 +/- 12,73 years old, 63,3% male. We found dyslipemia in 80%, abdominal obesity in 49% and metabolic syndrome in 36% patients. These patients showed increased serum creatinine 3,3%, a reduction in GFR 9,6%, hidden renal disease 6,4%, microalbuminuria 7,5% and nephropathy 2,4%. Hypertensive patients with renal disease (17,88%) were older, with higher systolic pressure, higher incidence of metabolic syndrome, abnormal carotid intima-media thickness and ankle-arm index, and presence of cardiovascular disease. Variables associated with renal disease were metabolic syndrome (odds ratio = 11,12) and ankle-arm index (odds ratio = 17,55). Variables related to creatinina were sex, ankle-arm index and metabolic syndrome; variables related to GFR were sex, age, ankle-arm index, metabolic syndrome and body mass index (BMI); variables related with albumin/creatinine index included diabetes mellitus. Renal disease is detected in about 2 out of 10 hypertensive patients, when, besides serum creatinina, we analyze albumin/creatinine index and GFR. Metabolic syndrome and ankle-arm index are the main variables associated with renal disease. Copyright 2009 Elsevier España, S.L. All rights reserved.

Safety and effectiveness of tadalafil in patients with pulmonary arterial hypertension: Japanese post-marketing surveillance data.

PubMed

Yamazaki, Hiroyoshi; Kobayashi, Noriko; Taketsuna, Masanori; Tajima, Koyuki; Murakami, Masahiro

2017-05-01

To evaluate the long-term safety and effectiveness of tadalafil in patients with pulmonary arterial hypertension (PAH) in real-world clinical practice. This prospective, multicenter, noninterventional, post-marketing surveillance included patients with PAH who were observed for up to 2 years after initiation of tadalafil. Safety was assessed by analyzing the frequency of adverse drug reactions (ADRs), discontinuations due to adverse events (AEs), and serious adverse drug reactions (SADRs). Effectiveness measurements included the assessment of the change in World Health Organization (WHO) functional classification of PAH, 6-minute walk test, cardiac catheterization, and echocardiography. Among 1676 patients analyzed for safety, the overall incidence of ADRs was 31.2%. The common ADRs (≥1.0%) were headache (7.0%), diarrhea (1.9%), platelet count decreased (1.8%), anemia, epistaxis, and nausea (1.6% each), flushing (1.3%), hepatic function abnormal (1.1%), hot flush, and myalgia (1.0% each). The common SADRs (≥0.3%) were cardiac failure (0.7%), interstitial lung disease, worsening of PAH, and platelet count decreased (0.3% each). Among 1556 patients analyzed for effectiveness, the percentages of patients with improvement of WHO functional class at 3 months, 1 year, and 2 years after the initiation of tadalafil, and last observation were 17.1%, 24.8%, 28.9%, and 22.5%, respectively. At all observation points (except pulmonary regurgitation pressure gradient at end diastole at 3 months), the mean 6-minute walk distance, cardiac catheterization, and echocardiogram measurements showed statistically significant improvement. This surveillance demonstrated that tadalafil has favorable safety and effectiveness profiles for long-term use in patients with PAH in Japan.

[Acute cerebrovascular disorder and arterial hypertension. Prospective study with 248 patients].

PubMed

Fonseca, T; Cortes, P; Monteiro, J; Salgado, V; Ferro, J; Franco, A S; Nogueira, J B; da Costa, J N

1996-01-01

To evaluate the hypertension associated to different types and sub-types of cerebrovascular disease (stroke), with particular reference to the frequency of hypertension, the values of blood pressure, the risk factors and the involvement of other target organs. Prospective study in 248 patients with acute stroke admitted to a Clinical Medicine Unit in three independent time periods. Internal Medicine Clinic of University Hospital in Lisbon. Medical, neurological and cardiologic examination were performed and all patients were also submitted to different complementary tests, including a computer tomography scan of the brain, and an echocardiogram. The values of blood pressure were measured in the admission at the urgent service and 24 h after in the the ward. We identified three sub-types of stroke: intracerebral hemorrhage (IH), ischaemic stroke (IS) and lacunes (L). For each sub-type and for those with hypertension or not, we evaluated: age, sex, duration of stay in hospital and mortality. We also compared for each sub-type the values of blood pressure, the risk factor and the repercussion on other target organs. Two hundred and forty eight patients (52% were men) with mean age 68.0 +/- 10.2 years, and ages among 40 and 92 years. Thirty-seven patients (15%) died. In the entire population (n = 248) hypertension were more prevalent in IH 83% and L 82% than in IS 59% (p < 0.0005). Hypertension was present in 172 patients (69%) and 81 (47%) were IS, 58 (34%) L and 33 (19%) IH. Sixty six percent of the 172 patients with hypertension had at least another risk factor and the most aged ones (> 65 years old) were more frequent in IS 75% than in HI 45% or L 58% (p < 0.001). For all subtypes blood pressure measurements were higher in admission than in ward and they were also higher in IH than in IS (p < 0.05). Hypertensive cardiopathy was more prevalent in IH 76% and L 61% than in IS 49% (p < 0.05). Renal failure was more frequent in IS 37% than in IH 28% and L 17% (p < 0

Secondary Intracranial Hypertension in Pediatric Patients With Leukemia.

PubMed

Fernández-García, Miguel Ángel; Cantarín-Extremera, Verónica; Andión-Catalán, Maitane; Duat-Rodríguez, Anna; Jiménez-Echevarría, Saioa; Bermejo-Arnedo, Ignacio; Hortigüela-Saeta, Montesclaros; Rekarte-García, Saray; Babín-López, Lara; Ruano Domínguez, David

2017-12-01

We investigated the clinical characteristics of a pediatric population with hemato-oncological disease and intracranial hypertension, analyze the therapeutic response and outcome, and compare its characteristics with respect to a control group with idiopathic intracranial hypertension. We retrospectively analyzed patients with hemato-oncological disease and secondary intracranial hypertension in our center during the past five years. We compared these individuals with a historical cohort with idiopathic intracranial hypertension from our institution (control group). We identified eight patients, all with leukemia, and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid was 35 cm H 2 O. All had headache, but only 28% complained of visual symptoms. Only 12.5% exhibited papilledema at the time of diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and all had a favorable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be difficult. Associated factors are diverse and do not show an obvious causal relationship. A high index of suspicion must be maintained for diagnosis, because a favorable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy and caused few side effects. Copyright © 2017 Elsevier Inc. All rights reserved.

Validation of behaviour measurement instrument of patients with diabetes mellitus and hypertension

NASA Astrophysics Data System (ADS)

Saputri, G. Z.; Akrom; Dini, S. M.

2017-11-01

Non-adherence to the treatment of chronic diseases such as hypertension and Diabetes Mellitus (DM) is a major obstacle in achieving patient therapy targets and quality of life of patients. A comprehensive approach involving pharmacists counselling has shown influences on changes in health behaviour and patient compliance. Behaviour changes in patients are one of the parameters to assess the effectiveness of counselling and education by pharmacists. Therefore, it is necessary to develop questionnaires of behaviour change measurement in DM-hypertension patients. This study aims to develop a measurement instrument in the form of questionnaires in assessing the behaviour change of DM-hypertension patients. Preparation of question items from the questionnaire research instrument refers to some guidelines and previous research references. Test of questionnaire instrument valid was done with expert validation, followed by pilot testing on 10 healthy respondents, and 10 DM-hypertension patients included in the inclusion criteria. Furthermore, field validation test was conducted on 37 patients who had undergone outpatient care at the PKU Muhammadiyah Yogyakarta City Hospital and The Gading Clinic in Yogyakarta. The inclusion criteria were male and female patients, aged 18-65, diagnosed with type 2 diabetes with hypertension who received oral antidiabetic drugs and antihypertensives, and who were not illiterate and co-operative. The data were collected by questionnaire interviews by a standardized pharmacist. The result of validation test using Person correlation shows the value of 0.33. The results of the questionnaire validation test on 37 patients showed 5 items of invalid questions with the value of r <0.33, e: questions 2, 3, 6, 10 and 11, while the other 10 questions show the value of Pearson correlation > 0.33. The reliability value is shown from the Cronbach's alpha value of 0.722 (> 0.6), implying that the questionnaire is reliable for DM-hypertension patients. This

Haptoglobin genotypes and refractory hypertension in type 2 diabetes mellitus patients.

PubMed

Wobeto, Vânia Pereira Albuquerque; Pinho, Paula da Cunha; Souza, José Roberto M; Zaccariotto, Tânia Regina; Zonati, Maria de Fátima

2011-10-01

It has been suggested that haptoglobin polymorphism may influence the pathogenesis of microvascular and macrovascular complications in diabetic patients. This cross sectional study was carried out to investigate the existence or not of an association between haptoglobin genotypes and prevalence of ischemic cardiovascular events (stable angina, unstable angina and acute myocardial infarction), systemic arterial hypertension, refractory hypertension, obesity and dyslipidemia in 120 type-2 diabetes mellitus patients followed up at Hospital de Clínicas da UNICAMP in Campinas, São Paulo state, southeastern Brazil. Haptoglobin genotyping was performed by allele-specific polymerase chain reactions. The frequencies of the haptoglobin genotypes were compared with the presence/absence of cardiovascular disease, systemic arterial hypertension, refractory hypertension, obesity and dyslipidemia; systolic and diastolic blood pressure measurements; plasma levels of glucose, cholesterol (total, high density lipoprotein-HDL and low density lipoprotein-LDL) and triglycerides; and serum creatinine levels. Although no association between haptoglobin genotype and the presence of cardiovascular disease could be identified, we found a significant excess of patients with Hp2-1 genotype among those with refractory hypertension, who also had higher systolic and diastolic blood pressure, and total and LDL cholesterol levels. Our results suggest that type-2 diabetes mellitus patients with the Hp2-1 genotype may have higher chances of developing refractory hypertension. Further studies in other diabetic populations are required to confirm these findings.

Comorbidity Analysis According to Sex and Age in Hypertension Patients in China.

PubMed

Liu, Jiaqi; Ma, James; Wang, Jiaojiao; Zeng, Daniel Dajun; Song, Hongbin; Wang, Ligui; Cao, Zhidong

2016-01-01

Hypertension, an important risk factor for the health of human being, is often accompanied by various comorbidities. However, the incidence patterns of those comorbidities have not been widely studied. Applying big-data techniques on a large collection of electronic medical records, we investigated sex-specific and age-specific detection rates of some important comorbidities of hypertension, and sketched their relationships to reveal the risk for hypertension patients. We collected a total of 6,371,963 hypertension-related medical records from 106 hospitals in 72 cities throughout China. Those records were reported to a National Center for Disease Control in China between 2011 and 2013. Based on the comprehensive and geographically distributed data set, we identified the top 20 comorbidities of hypertension, and disclosed the sex-specific and age-specific patterns of those comorbidities. A comorbidities network was constructed based on the frequency of co-occurrence relationships among those comorbidities. The top four comorbidities of hypertension were coronary heart disease, diabetes, hyperlipemia, and arteriosclerosis, whose detection rates were 21.71% (21.49% for men vs 21.95% for women), 16.00% (16.24% vs 15.74%), 13.81% (13.86% vs 13.76%), and 12.66% (12.25% vs 13.08%), respectively. The age-specific detection rates of comorbidities showed five unique patterns and also indicated that nephropathy, uremia, and anemia were significant risks for patients under 39 years of age. On the other hand, coronary heart disease, diabetes, arteriosclerosis, hyperlipemia, and cerebral infarction were more likely to occur in older patients. The comorbidity network that we constructed indicated that the top 20 comorbidities of hypertension had strong co-occurrence correlations. Hypertension patients can be aware of their risks of comorbidities based on our sex-specific results, age-specific patterns, and the comorbidity network. Our findings provide useful insights into the

Management of Hypertension in Patients with Chronic Kidney Disease in Asia.

PubMed

Huang, Qi-Fang; Hoshide, Satoshi; Cheng, Hao-Min; Park, Sungha; Park, Chang-Gyu; Chen, Chen-Huan; Kario, Kazuomi; Wang, Ji-Guang

2016-01-01

Hypertension is both a cause and consequence of chronic kidney disease (CKD). According to the Chinese national survey in 2007-2010, the prevalence of CKD was much higher in hypertensive patients (18.9%, n=16,691) than in the overall population sample (10.8%, n=47,204). CKD in hypertension confers risks to the kidneys as well as other organs. Probably because of high dietary salt intake, Asian hypertensive patients with CKD show high prevalence of non-dipping and reversed dipping blood pressure pattern, and may have even higher risks of cardiovascular disease. Therefore, out-of-office blood pressure evaluation and comprehensive cardiovascular evaluations are required. Most of current hypertension guidelines recommend intensive antihypertensive treatment in hypertensive patients with CKD. This is probably of particular relevance for cardiovascular prevention in Asia, because stroke, as a major complication of hypertension in Asia, is more closely related to blood pressure than coronary events. Intensive blood pressure control to 130/80 mmHg is often required to prevent CKD progression and cardiovascular complications. The inhibitors of the renin-angiotensin system (RAS) are recommended as the first line antihypertensive medications in patients with a glomerular filtration rate higher than 30 ml/min/1.73 m², which may more efficaciously prevent end-stage renal disease and cardiovascular events. Nonetheless, combination therapy of RAS inhibitors with other classes of antihypertensive drugs, such as calcium-channel blockers, diuretics, etc, is required to control blood pressure to the target. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

PubMed Central

Georgianos, Panagiotis I.

2016-01-01

Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin–converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third–line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area. PMID:27797886

Treatment strategies for osteoarthritis patients with pain and hypertension.

PubMed

Verdecchia, Paolo; Angeli, Fabio; Mazzotta, Giovanni; Martire, Paola; Garofoli, Marta; Gentile, Giorgio; Reboldi, Gianpaolo

2010-08-01

Out of 100 patients with osteoarthritis (OA), almost 40 have a concomitant diagnosis of hypertension. Nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors may trigger a rise in blood pressure (BP), which is more marked in patients with established hypertension. NSAIDs and COX-2 inhibitors attenuate the antihypertensive effect of several antihypertensive agents. Frequent BP controls are needed in treated hypertensive patients who are concomitantly receiving NSAIDs or COX-2 inhibitors because even a small increase in BP may be associated with an important rise in the risk of major cardiovascular complications. In meta-analyses, an increase in systolic BP of 5mmHg was associated with a 25% higher risk of cardiovascular events. These data have been confirmed in randomized studies with rofecoxib and celecoxib, where a modest increase in BP was associated with a significantly higher risk of cardiovascular disease. There is emerging evidence that the COX-inhibiting nitric oxide donator (CINOD) class is promising in the treatment of patients with OA. Naproxcinod, the first CINOD investigated in clinical trials, is composed of the traditional NSAID naproxen covalently bound to the nitric oxide (NO)-donating moiety butanediol mono-nitrate (BDMN). The molecule has the potential to provide a sustained release of NO. In clinical studies, naproxcinod prevented the BP rise in normotensive and hypertensive patients observed with naproxen. The BP benefit of naproxcinod over naproxen was greater in patients concomitantly receiving angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. These investigational data suggest that naproxcinod is a valuable alternative to NSAIDs and COX-2 inhibitors for treatment of OA patients.

Prospective direct comparison of antihypertensive effect and safety between high-dose amlodipine or indapamide in hypertensive patients uncontrolled by standard doses of angiotensin receptor blockers and amlodipine.

PubMed

Okamura, Keisuke; Shirai, Kazuyuki; Totake, Nao; Okuda, Tetsu; Urata, Hidenori

2018-01-01

When hypertension is uncontrolled by routine treatment with an angiotensin II receptor blocker (ARB) and the calcium channel blocker amlodipine (5 mg), the dose of amlodipine can be increased or a diuretic can be added. We investigated the more effective option in a prospective multicenter open-label study. Hypertensive patients were recruited if the target blood pressure (BP) in The Japanese Society of Hypertension 2009 guideline could not be achieved with standard-dose ARB therapy and amlodipine (5 mg). Patients were divided into three groups. Group-1 was switched to a combination of irbesartan (100 mg) and amlodipine (10 mg). Group-2A was changed to a combination of irbesartan (100 mg), amlodipine (5 mg), and indapamide, while Group-2B received a standard-dose ARB and amlodipine (5 mg) plus indapamide. Patients were assigned by their attending physicians and were followed for 6 months. The primary endpoint was the antihypertensive effect of each regimen. Group-1 contained 85 patients, Group-2A had 49 patients, and Group-2B had 4 patients. We only analyzed Group-1 and Group-2A due to the small size of Group-2B. In both groups, systolic BP and diastolic BP were significantly decreased up to 6 months (all p < 0.001). Reduction of systolic BP was greater in Group-1 than Group-2A after 1 month and 6 months (both p < 0.05). Uric acid was increased in Group-2A after 3 months, but not at 6 months. Although both regimens were effective for reducing BP, increasing amlodipine to 10 mg daily controlled hypertension without elevation of serum uric acid.

Medication adherence in patients with hypertension: Does satisfaction with doctor-patient relationship work?

PubMed

Mahmoudian, Ahmad; Zamani, Ahmadreza; Tavakoli, Neda; Farajzadegan, Ziba; Fathollahi-Dehkordi, Fariba

2017-01-01

It is assumed that doctor-patient relationship plays an effective role in patients' satisfaction, medication adherence, and health outcomes since exploring different aspects of this relationship, such as addressing medication adherence, has rarely been investigated. Therefore, the main aim of the present study was to assess the impact of patients' satisfaction derived from communicating with doctors on medication adherence in hypertensive patients. This cross-sectional survey was conducted on three hundred patients with hypertension, using multistage sampling technique in health care centers in Isfahan, Iran. Data were collected by two questionnaires comprised (1) patients' satisfaction derived from the relationship with doctors and (2) medication adherence named "Morisky Medication Adherence Scale" with 8 items. Multivariate logistic regression model was applied to test the odds ratio (OR) of patients' satisfaction resulting from the relationship with physicians in numerous aspects in two groups: appropriate and inappropriate medication adherence. A lower level of satisfaction derived from building the relationship (confidence interval [CI] =0.95, 0.06-0.71 and OR = 0.20) and empathy subscales (CI = 0.95, 13-0.80 and OR = 0.33) was associated with nonadherence to treatment after controlling the physicians' gender and patients' age, gender, education, and duration of disease. Patients' satisfaction resulting from building the relationship and empathy with physicians appeared to be associated with medication adherence among hypertensive patients.

EXPLANATORY MODELS OF HYPERTENSION AMONG NIGERIAN PATIENTS AT A UNIVERSITY TEACHING HOSPITAL

PubMed Central

Taylor, Kelly D.; Adedokun, Ayoade; Awobusuyi, Olugbenga; Adeniran, Peju; Onyia, Elochukwu; Ogedegbe, Gbenga

2013-01-01

Objective To elicit the explanatory models (EM) of hypertension among patients in a hospital-based primary care practice in Nigeria. Design Semi-structured in-depth individual interviews and focus groups were conducted with 62 hypertensive patients. Interviews and focus groups were audio-taped and transcribed verbatim. Data analysis was guided by phenomenology and content analysis using qualitative research software ATLAS.ti 5.0. Results Patients expressed four categories of EM of hypertension: 1) perceptions of hypertension, 2) consequences, 3) effect on daily life, and 4) perception of treatment. Focus group discussions and key informant interviews yielded a wide range of insights into the social and cultural factors influencing patients’ beliefs and health behavior. Participants were aware of the risks of hypertension. There was disagreement between participants’ own understanding of the serious nature of hypertension, the need for long-term treatment, and the desire to take medication long-term. Participants acknowledged the use of traditional medicine (e.g. teas and herbs) and healers. Different themes emerged for men versus women such that women often focused on family issues while men tended to discuss external stressors stemming from work as a cause of hypertension. Men were concerned with frequent urination, decreased libido and erectile dysfunction. Conclusion Knowledge gained will inform development of patient-centered treatment plans and targeted behavioral and educational interventions. PMID:23534506

Long-term renal outcome in patients with malignant hypertension: a retrospective cohort study

PubMed Central

2012-01-01

Background Malignant hypertension is frequently complicated by renal insufficiency. Although the survival of this hypertensive emergency has improved, recent data on renal outcome and its predictors are lacking. We assessed renal outcome and its predictors in patients with malignant hypertension. Methods Retrospective analysis of patients admitted with malignant hypertension in Amsterdam, the Netherlands between August 1992–January 2010. Follow-up data on vital status, renal function and blood pressure (BP) were obtained from the outpatient department and from general practitioners. The primary composite endpoint was end-stage renal disease (ESRD) defined as the start of kidney replacement therapy (KRT) or ≥ 50% decline of estimated glomerular filtration rate (eGFR). The secondary endpoint was all cause mortality. Results A total of 120 patients admitted with malignant hypertension were included. After a median follow-up period of 67 months (IQR 28 to 108 months) the primary endpoint was reached by 37 (31%) patients, whereas 18 patients (15%) reached the secondary endpoint. Twenty-nine (24%) patients started KRT and 8 patients (7%) had an eGFR decline ≥ 50%. After the acute phase (> 3 months after admission), initial serum creatinine and follow-up BP were the main predictors of future ESRD with hazard ratios of 6.1 (95% CI, 2.2–17) for patients with initial serum creatinine ≥ 175 μmol /L and 4.3 (95% CI, 1.4–14) for patients with uncontrolled hypertension. Conclusions Progressive renal function decline leading to ESRD remains a major threat to patients with malignant hypertension. BP control during follow-up was an important modifiable predictor of renal outcome. PMID:22846257

Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study.

PubMed

Omboni, Stefano; Aristizabal, Dagnovar; De la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Kahan, Thomas; Kantola, Ilkka; Kario, Kazuomi; Kawecka-Jaszcz, Kalina; Malan, Leoné; Narkiewicz, Krzysztof; Octavio, José A; Ohkubo, Takayoshi; Palatini, Paolo; Siègelovà, Jarmila; Silva, Eglé; Stergiou, George; Zhang, Yuqing; Mancia, Giuseppe; Parati, Gianfranco

2016-11-01

The Ambulatory blood pressure Registry TEleMonitoring of hypertension and cardiovascular rISk project was designed to set up an international registry including clinic blood pressure (CBP) and ambulatory blood pressure (ABP) measurements in patients attending hypertension clinics in all five continents, aiming to assess different daily life hypertension types. Cross-sectional ABP, CBP and demographic data, medical history and cardiovascular risk profile were provided from existing databases by hypertension clinics. Hypertension types were evaluated considering CBP (≥140/90 mmHg) and 24-h ABP (≥130/80 mmHg). Overall, 14 143 patients from 27 countries across all five continents were analyzed (Europe 73%, Africa 3%, America 9%, Asia 14% and Australia 2%). Mean age was 57 ± 14 years, men 51%, treated for hypertension 46%, cardiovascular disease 14%, people with diabetes 14%, dyslipidemia 33% and smokers 19%. The prevalence of hypertension was higher by CBP than by ABP monitoring (72 vs. 60%, P < 0.0001). Sustained hypertension (elevated CBP and ABP) was detected in 49% of patients. White-coat hypertension (WCH, elevated CBP with normal ABP) was more common than masked hypertension (elevated ABP with normal CBP) (23 vs. 10%; P < 0.0001). Sustained hypertension was more common in Europe and America and in elderly, men, obese patients with cardiovascular comorbidities. WCH was less common in Australia, America and Africa, and more common in elderly, obese women. Masked hypertension was more common in Asia and in men with diabetes. Smoking was a determinant for sustained hypertension and masked hypertension. Our analysis showed an unbalanced distribution of WCH and masked hypertension patterns among different continents, suggesting an interplay of genetic and environmental factors, and likely also different healthcare administrative and practice patterns.

Interleukin 17A and Toll-like Receptor 4 in Patients with Arterial Hypertension.

PubMed

Simundic, Tihana; Jelakovic, Bojan; Dzumhur, Andrea; Turk, Tajana; Sahinovic, Ines; Dobrosevic, Blazenka; Takac, Boris; Barbic, Jerko

2017-01-01

Immune responses are involved in arterial hypertension. An observational cross-sectional case control study was conducted to estimate the association between Toll-like receptor 4 (TLR4) expression and interleukin (IL)-17A serum levels in patients with controlled and non-controlled hypertension. We have enrolled 105 non-complicated otherwise healthy hypertensive patients: 53 with well-controlled blood pressure and 52 non-controlled. TLR4 peripheral monocytes expression and serum IL-17A levels were determined by flow cytometry and ELISA, respectively. Non-controlled patients exhibited higher TLR4 expression than well-controlled (25.60 vs. 21.99, P=0.011). TLR4 expression was lower in well-controlled patients who were prescribed beta blockers (18.9 vs. 22.6, P=0.005) and IL-17A concentration was higher in patients using diuretics in either group (1.41 vs. 2.01 pg/ml, P<0.001; well-controlled 1.3 vs. 1.8 pg/ml, P= 0.023; non-controlled 1.6 vs. 2.3 pg/ml, P=0.001). Correlation between IL-17A concentration and hypertension duration was observed in non-controlled patients (Spearman correlation coefficient . ρ=0.566, P<0.001) whereas in well-controlled patients a correlation was found between hypertension duration and TLR4 expression (ρ=0.322, P=0.020). Arterial hypertension stimulates the immune response regardless of blood pressure regulation status. Prolonged hypertension influences peripheral monocyte TLR4 expression and IL-17A serum levels. Anti-hypertensive drugs have different immunomodulatory effects: diuretics are associated with higher IL-17A concentration and beta-blockers with lower TLR4 expression. © 2017 The Author(s)Published by S. Karger AG, Basel.

Hunting for genes for hypertension: the Millennium Genome Project for Hypertension.

PubMed

Tabara, Yasuharu; Kohara, Katsuhiko; Miki, Tetsuro

2012-06-01

The Millennium Genome Project for Hypertension was started in 2000 to identify genetic variants conferring susceptibility to hypertension, with the aim of furthering the understanding of the pathogenesis of this condition and realizing genome-based personalized medical care. Two different approaches were launched, genome-wide association analysis using single-nucleotide polymorphisms (SNPs) and microsatellite markers, and systematic candidate gene analysis, under the hypothesis that common variants have an important role in the etiology of common diseases. These multilateral approaches identified ATP2B1 as a gene responsible for hypertension in not only Japanese but also Caucasians. The high blood pressure susceptibility conferred by certain alleles of ATP2B1 has been widely replicated in various populations. Ex vivo mRNA expression analysis in umbilical artery smooth muscle cells indicated that reduced expression of this gene associated with the risk allele may be an underlying mechanism relating the ATP2B1 variant to hypertension. However, the effect size of a SNP was too small to clarify the entire picture of the genetic basis of hypertension. Further, dense genome analysis with accurate phenotype data may be required.

Clinical practices, complications, and mortality in neurological patients with acute severe hypertension: the Studying the Treatment of Acute hyperTension registry.

PubMed

Mayer, Stephan A; Kurtz, Pedro; Wyman, Allison; Sung, Gene Y; Multz, Alan S; Varon, Joseph; Granger, Christopher B; Kleinschmidt, Kurt; Lapointe, Marc; Peacock, W Frank; Katz, Jason N; Gore, Joel M; O'Neil, Brian; Anderson, Frederick A

2011-10-01

To determine the demographic and clinical features, hospital complications, and predictors of 90-day mortality in neurologic patients with acute severe hypertension. Studying the Treatment of Acute hyperTension (STAT) was a multicenter (n=25) observational registry of adult critical care patients with severe hypertension treated with intravenous therapy. Emergency department or intensive care unit. A qualifying blood pressure measurement>180 mm Hg systolic or >110 mm Hg diastolic (>140/90 mm Hg for subarachnoid hemorrhage) was required for inclusion in the STAT registry. Patients with a primary neurologic admission diagnosis were included in the present analysis. All patients were treated with at least one parenteral (bolus or continuous infusion) antihypertensive agent. Of 1,566 patients included in the STAT registry, 432 (28%) had a primary neurologic diagnosis. The most common diagnoses were subarachnoid hemorrhage (38%), intracerebral hemorrhage (31%), and acute ischemic stroke (18%). The most common initial drug was labetalol (48%), followed by nicardipine (15%), hydralazine (15%), and sodium nitroprusside (13%). Mortality at 90 days was substantially higher in neurologic than in non-neurologic patients (24% vs. 6%, p<.0001). Median initial blood pressure was 183/95 mm Hg and did not differ between survivors and nonsurvivors. In a multivariable analysis, neurologic patients who died experienced lower minimal blood pressure values (median 103/45 vs. 118/55 mm Hg, p<.0001) and were less likely to experience recurrent hypertension requiring intravenous treatment (29% vs. 51%, p=.0001) than those who survived. Mortality was also associated with an increased frequency of neurologic deterioration (32% vs. 10%, p<.0001). Neurologic emergencies account for approximately 30% of hospitalized patients with severe acute hypertension, and the majority of those who die. Mortality in hypertensive neurologic patients is associated with lower minimum blood pressure values

Hypertension and arterial stiffness in heart transplantation patients

PubMed Central

de Souza-Neto, João David; de Oliveira, Ítalo Martins; Lima-Rocha, Hermano Alexandre; Oliveira-Lima, José Wellington; Bacal, Fernando

2016-01-01

OBJECTIVES: Post-transplantation hypertension is prevalent and is associated with increased cardiovascular morbidity and subsequent graft dysfunction. The present study aimed to identify the factors associated with arterial stiffness as measured by the ambulatory arterial stiffness index. METHODS: The current study used a prospective, observational, analytical design to evaluate a group of adult heart transplantation patients. Arterial stiffness was obtained by monitoring ambulatory blood pressure and using the ambulatory arterial stiffness index as the surrogate outcome. Multivariate logistic regression analyses were performed to control confounding. RESULTS: In a group of 85 adult heart transplantation patients, hypertension was independently associated with arterial stiffness (OR 4.98, CI 95% 1.06-23.4) as well as systolic and diastolic blood pressure averages and nighttime descent. CONCLUSIONS: Measurement of ambulatory arterial stiffness index is a new, non-invasive method that is easy to perform, may contribute to better defining arterial stiffness prognosis and is associated with hypertension. PMID:27652829

Macular microcirculation in hypertensive patients with and without branch retinal vein occlusion.

PubMed

Noma, Hidetaka; Funatsu, Hideharu; Sakata, Kumi; Harino, Seiyo; Mimura, Tatsuya; Hori, Sadao

2009-09-01

Our purpose was to determine whether a reduction in blood flow velocity (BFV) in the perifoveal capillaries is involved in the pathogenesis of branch retinal vein occlusion (BRVO) in patients with hypertension. Subjects included hypertensive patients with (n = 12) and without (n = 16) BRVO and healthy volunteers (n = 16). Perifoveal BFV was measured by the tracing method using fluorescein angiography and a scanning laser ophthalmoscope. Logistic regression analysis was performed to assess factors that influenced the presence or absence of BRVO. Mean BFV showed a significant decrease across the three groups (healthy controls: 1.49 +/- 0.11 mm/second; hypertensive patients without BRVO: 1.36 +/- 0.12 mm/second; hypertensive patients with BRVO: 1.16 +/- 0.24 mm/second; p(trend) < 0.001). Multivariate logistic regression analysis showed that BFV was a significant risk factor for the presence of BRVO. Perifoveal capillary BFV is reduced in hypertensive patients with and without BRVO. It is possible that a decrease in BFV may be involved in the occurrence of BRVO. Measurement of perifoveal capillary BFV may be useful for investigating the pathogenesis and progression of BRVO.

Nurse-led empowerment strategies for patients with hypertension: a questionnaire survey.

PubMed

Rasjö Wrååk, G; Törnkvist, L; Hasselström, J; Wändell, P E; Josefsson, K

2015-06-01

Hypertension is common and may lead to cerebrovascular and cardiovascular events and mortality. District nurses frequently encounter patients requiring blood pressure monitoring, lifestyle counsel and support. Empowerment as a method enables patients to both increase their control over their health and improve it. This study aims to describe the effects of the counsel and support from district nurses to patients with hypertension. A randomized controlled intervention trial. Questionnaires were answered by patients with hypertension before and after the intervention comprising district nurses' counsel and support based upon empowerment. A specially developed card for blood pressure monitoring was also used. Blood pressure decreased in intervention and the control groups. The intervention group experienced significantly improved health, with better emotional and physical health, and reduced stress. Living habits did not change significantly in either group. Satisfaction with knowledge of hypertension increased significantly in both groups. The intervention group reported that their care was based upon their health needs. Conducting large multi-centre studies with long follow-ups is complicated and results sometimes have a tendency to decline with time. A shorter follow-up might have shown a greater difference between the groups. Nursing interventions through district nurses' counsel and support with empowerment improved patients' health. More research is needed to evaluate nursing interventions' effect on hypertension. This study highlighted that district nurses' counsel and support increased patients' health and decreased stress by focusing on empowerment. © 2015 International Council of Nurses.

Restless Legs Syndrome in Patients with Hypertension and Diabetes Mellitus.

PubMed

Sabic, Adela; Sinanovic, Osman; Sabic, Dzevad; Galic, Gordan

2016-04-01

The aim of this study was to analyze frequency of restless legs syndrome (RLS) in patients with hypertension and diabetes mellitus. It was analyzed 120 subjects (from Health Center Živinice/Family Medicine Department) through a survey conducted in the period from March to June 2015, of which 30 (8 men/22 women). Subjects were 30 patients with longtime hypertension (HT)(18 men/12 women), 30 patients with diabetes mellitus (DM) type I or II (9 men/21 women), 30 patients with long standing DM type I or II and HT (12 men /18 women), and 30 control subjects (12 men/18 women). RLS were evaluated by questionnaire - International RLS Study Group Criteria. The average age of patients in the group with HT was 58.70 ± 9.07, in the group with DM 48.43 ± 15.37, and in the group of patients with HT and DM 63.90 ± 7.49 years. In the control group mean age was 52.76 ± 14.83 years. Statistical data were analyzed in Excel and SSPS statistical program. RLS was identified in 10 (30%) of those with HT; 7 (21%) in patients with DM, and 10 (30%) in patients with HT+DM. In the control group RLS was verified in 4 (12%) patients. Comparing the results, it was observed significant difference between the HT and the control group (p=0.0012) and HT+ DM and control group (p=0.0012). The frequency of RLS between DM and the control group was not significantly significant (p=0.107). RLS is frequent in patients with hypertension (30%), hypertension+ diabetes mellitus (30%), and patients with DM (21%).

[New American Guidelines on Hypertension: New Consequences for German Patients?

PubMed

Schrader, Bastian; Lüders, Stephan; Koziolek, Michael; Haller, Hermann; Schrader, Joachim

2018-06-01

Following the publication of the new US guidelines, especially the new classifications of hypertension and the general reduction in treatment targets were discussed worldwide. Applying the US guidelines to a recent German cohort study would in practice lead to a significant increase in the diagnosis of "hypertension" in untreated patients. The number of under-adjusted patients would also increase sharply, increasing more than those predicted in the US Guidelines. Affected by an intensified antihypertensive therapy would be particularly elderly patients, in which adverse drug reactions but also occur more frequently. It seems doubtful whether the massive increase in the diagnosis "hypertension" can improve the supply situation: the opposite effect of avoiding therapists and patients could occur. Determining the individual risk with suitable, evaluated instruments certainly makes sense to treat more targeted patients. More important than new blood pressure limits is a more accurate classification of blood pressure. Repeated self-measurements and ambulatory blood pressure measurement lead to a better selection of patients benefiting from a therapy. © Georg Thieme Verlag KG Stuttgart · New York.

Understanding untreated hypertension from patients' point of view: A qualitative study in rural Yogyakarta province, Indonesia.

PubMed

Rahmawati, Riana; Bajorek, Beata

2017-01-01

Objectives This study aimed to explore perspectives about hypertension from patients who do not take anti-hypertensive medications. Factors that shape their perspectives as well as patients' expectations were also canvassed. Method Individual, face-to-face interviews were conducted with 30 people (≥45 years old) living in rural villages, diagnosed with hypertension, who had not taken any anti-hypertensive medications for at least one year. Interviews were audiotaped, transcribed verbatim and thematically analysed. Results Four themes emerged: (1) alternative medicines for managing high blood pressure; (2) accessing health care services; (3) the need for anti-hypertensive medications; and (4) existing support and patients' expectations. Reluctance to take anti-hypertensive medications was influenced by patients' beliefs in personal health threats and the effectiveness of anti-hypertensive medications, high self-efficacy for taking alternative medicines, the lack of recommendation regarding hypertension treatment, and barriers to accessing supplies of medicines. Conclusion Despite their awareness of being diagnosed with hypertension, patients undervalued visiting a health professional to control their high blood pressure. Health strategies need to consider patients' beliefs, concerns and expectations. Providing an accessible, affordable and adequate supply of hypertension medication is also key to any programs designed to optimise hypertension management.

A potential protective effect in multilingual patients with semantic dementia: two case reports of patients speaking Taiwanese and Japanese.

PubMed

Liu, Yi-Chien; Yip, Ping-Keung; Fan, Yu-Ming; Meguro, Kenichi

2012-03-01

Several reports have suggested that multilingualism has a protective effect against semantic dementia. Here, we provide further evidence for this effect. The patient was a 75-year-old right-handed Taiwanese woman who had retired after working as a tailor. She was able to speak Taiwanese, Japanese and Mandarin Chinese fluently until 5 years ago. She gradually developed symptoms of profound anomia and difficulty with word-finding. Her mother tongue was Taiwanese and she had learned Japanese as her first symbolized language. She had used Mandarin Chinese for most of her life, but depended on Japanese to read and write (such as reading a newspaper and keeping accounts). However, she could now speak only very simple Taiwanese and Japanese, and could recognize only simple Japanese characters. SECOND: The patient was a 62-year-old right-handed man who had worked as an ironworker. He could speak Taiwanese and Mandarin Chinese fluently until 5 years ago. His mother tongue was Taiwanese. After 5 years of language deterioration, he was unable to communicate with his family members or recognize any characters, including numbers. SPECT RESULTS: Brain perfusion ECD SPECT (Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography) showed less perfusion in the multilingual patient (Case #1) than in the bilingual patient (Case #2). Neuropsychological tests also demonstrated a slower rate of degeneration in the multilingual patient. We speculate that reading and writing in Japanese had a greater impact on the semantic system in Case #1. Thus, this patient showed relatively less degeneration or functional inactivity, as shown by perfusion in the frontal lobe, and this might be due to the persistent activation involved in multilingualism.

Persistence with Antihypertensive Drugs in Patients with Hypertension and Dementia in Germany.

PubMed

Jacob, Louis; Adam-Schnepf, Leonie; Kostev, Karel

2017-01-01

Hypertension, a chronic disease resulting from aging and its related physiopathological dysregulations, is often associated with dementia. The goal was to analyze the persistence with antihypertensive drugs in patients affected by both hypertension and dementia in Germany. This study included hypertension patients who were initially treated with antihypertensive drugs in 1,262 general practices in Germany between January 2013 and December 2015 (index date). Patients with hypertension and comorbid dementia were matched (1 : 1) to patients without dementia by age, gender, type of residence (nursing home versus home-care setting), physician, and initial antihypertensive therapy, using a propensity score method. The primary outcome was the rate of patients without treatment discontinuation with antihypertensive drugs in cases and controls in the 12 months following the index date. Cox regressions were used to determine the impact of dementia on persistence with antihypertensive treatment. This study included 2,191 patients with hypertension and comorbid dementia and 2,191 patients with hypertension but without dementia. The mean age was 79.3 years (SD = 10.3 years) in both groups. Twelve months after initiation of antihypertensive therapy, 73.5% of cases and 69.5% of controls were persistent (p < 0.001). Dementia was associated with a significant decrease in the risk of non-persistence with antihypertensive drugs in the entire population (HR = 0.86, 95% CI: 0.79-0.93). This finding was corroborated in five different subgroups (age ≤60 years, age 61-70 years, men, women, and patients living in home-care settings). Dementia was found to be a protective factor for persistence with antihypertensive drugs in Germany.

Ambiguities in the Guidelines for the Management of Arterial Hypertension: Indian Perspective with a Call for Global Harmonization.

PubMed

Rehan, Harmeet Singh; Grover, Abhinav; Hungin, A P S

2017-02-01

Many medical professional societies have formulated guidelines to treat hypertension, but there existed differences with respect to diagnosis, blood pressure (BP) targets, pharmacotherapy of hypertension, and grades of evidence. A MEDLINE search for hypertension guidelines was performed to compare Indian guidelines for hypertension (IGH) with these guidelines. A majority of the guidelines had consensus on the cutoff value (140/90 mmHg, recorded twice) to diagnose hypertension. The Joint National Committee 8 (JNC 8), IGH, Japanese Society of hypertension (JSH), Canadian Hypertension Education Program (CHEP), and American Society of Hypertension/International Society of Hypertension (ASH/ISH) guidelines provide a higher BP target for the elderly hypertensive populations, while the National Institute for Health and Care Excellence (NICE) and European Society of Hypertension (ESH) guidelines provided a lower BP target for the elderly patients. However, a meta-analysis showed benefits of having a systolic BP target of <130 mmHg for all patients. Treatment of hypertension according to JNC 8, NICE, and ASH/ISH guidelines varies among the black and the non-black population which recommended thiazide or calcium channel blockers for the black population. There is no special mention of pharmacotherapy or BP targets for the South Asian population in various guidelines including IGH despite evidence of higher risk of hypertension-associated complications in this population. It is suggested that all the available guidelines should be harmonized with highest level of evidence available to minimize ambiguities associated with management of hypertension.

Can patients with pulmonary hypertension travel to high altitude?

PubMed

Luks, Andrew M

2009-01-01

With the increasing popularity of adventure travel and mountain activities, it is likely that many high altitude travelers will have underlying medical problems and approach clinicians for advice about ensuring a safe sojourn. Patients with underlying pulmonary hypertension are one group who warrants significant concern during high altitude travel, because ambient hypoxia at high altitude will trigger hypoxic pulmonary vasoconstriction and cause further increases in pulmonary artery (PA) pressure, which may worsen hemodynamics and also predispose to acute altitude illness. After addressing basic information about pulmonary hypertension and pulmonary vascular responses to acute hypoxia, this review discusses the evidence supporting an increased risk for high altitude pulmonary edema in these patients, concerns regarding worsening oxygenation and right-heart function, the degree of underlying pulmonary hypertension necessary to increase risk, and the altitude at which such problems may occur. These patients may be able to travel to high altitude, but they require careful pre-trip assessment, including echocardiography and, when feasible, high altitude simulation testing with echocardiography to assess changes in PA pressure and oxygenation under hypoxic conditions. Those with mean PA pressure > or =35 mm Hg or systolic PA pressure > or =50 mm Hg at baseline should avoid travel to >2000 m; but if such travel is necessary or strongly desired, they should use supplemental oxygen during the sojourn. Patients with milder degrees of pulmonary hypertension may travel to altitudes <3000 m, but should consider prophylactic measures, including pulmonary vasodilators or supplemental oxygen.

Comorbidity Analysis According to Sex and Age in Hypertension Patients in China

PubMed Central

Liu, Jiaqi; Ma, James; Wang, Jiaojiao; Zeng, Daniel Dajun; Song, Hongbin; Wang, Ligui; Cao, Zhidong

2016-01-01

Background: Hypertension, an important risk factor for the health of human being, is often accompanied by various comorbidities. However, the incidence patterns of those comorbidities have not been widely studied. Aim: Applying big-data techniques on a large collection of electronic medical records, we investigated sex-specific and age-specific detection rates of some important comorbidities of hypertension, and sketched their relationships to reveal the risk for hypertension patients. Methods: We collected a total of 6,371,963 hypertension-related medical records from 106 hospitals in 72 cities throughout China. Those records were reported to a National Center for Disease Control in China between 2011 and 2013. Based on the comprehensive and geographically distributed data set, we identified the top 20 comorbidities of hypertension, and disclosed the sex-specific and age-specific patterns of those comorbidities. A comorbidities network was constructed based on the frequency of co-occurrence relationships among those comorbidities. Results: The top four comorbidities of hypertension were coronary heart disease, diabetes, hyperlipemia, and arteriosclerosis, whose detection rates were 21.71% (21.49% for men vs 21.95% for women), 16.00% (16.24% vs 15.74%), 13.81% (13.86% vs 13.76%), and 12.66% (12.25% vs 13.08%), respectively. The age-specific detection rates of comorbidities showed five unique patterns and also indicated that nephropathy, uremia, and anemia were significant risks for patients under 39 years of age. On the other hand, coronary heart disease, diabetes, arteriosclerosis, hyperlipemia, and cerebral infarction were more likely to occur in older patients. The comorbidity network that we constructed indicated that the top 20 comorbidities of hypertension had strong co-occurrence correlations. Conclusions: Hypertension patients can be aware of their risks of comorbidities based on our sex-specific results, age-specific patterns, and the comorbidity network

Model-based dose selection for phase III rivaroxaban study in Japanese patients with non-valvular atrial fibrillation.

PubMed

Tanigawa, Takahiko; Kaneko, Masato; Hashizume, Kensei; Kajikawa, Mariko; Ueda, Hitoshi; Tajiri, Masahiro; Paolini, John F; Mueck, Wolfgang

2013-01-01

The global ROCKET AF phase III trial evaluated rivaroxaban 20 mg once daily (o.d.) for stroke prevention in atrial fibrillation (AF). Based on rivaroxaban pharmacokinetics in Japanese subjects and lower anticoagulation preferences in Japan, particularly in elderly patients, the optimal dose regimen for Japanese AF patients was considered. The aim of this analysis was dose selection for Japanese patients from a pharmacokinetic aspect by comparison of simulated exposure in Japanese patients with those in Caucasian patients. As a result of population pharmacokinetics-pharmacodynamics analyses, a one-compartment pharmacokinetic model with first-order absorption and direct link pharmacokinetic-pharmacodynamic models optimally described the plasma concentration and pharmacodynamic models (Factor Xa activity, prothrombin time, activated partial thromboplastin time, and HepTest), which were also consistent with previous works. Steady-state simulations indicated 15 mg rivaroxaban o.d. doses in Japanese patients with AF would yield exposures comparable to the 20 mg o.d. dose in Caucasian patients with AF. In conclusion, in the context of the lower anticoagulation targets in Japanese practice, the population pharmacokinetic and pharmacodynamic modeling supports 15 mg o.d. as the principal rivaroxaban dose in J-ROCKET AF.

Release of endothelial microparticles in patients with arterial hypertension, hypertensive emergencies and catheter-related injury.

PubMed

Sansone, Roberto; Baaken, Maximilian; Horn, Patrick; Schuler, Dominik; Westenfeld, Ralf; Amabile, Nicolas; Kelm, Malte; Heiss, Christian

2018-06-01

Circulating endothelial microparticles (EMPs) are increased in arterial hypertension. The role of physicomechanical factors that may induce EMP release in vivo is still unknown. We studied the relationship of EMPs and physicomechanical factors in stable arterial hypertension and hypertensive emergencies, and investigated the pattern of EMP release after mechanical endothelial injury. In a pilot study, 41 subjects (50% hypertensives) were recruited. EMPs were discriminated by flow-cytometry (CD31 + /41 - , CD62e + , CD144 + ). Besides blood pressure measurements, pulse-wave-analysis was performed. Flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), and wall-shear-stress (WSS) were measured ultrasonographically in the brachial artery; microvascular perfusion by laser-Doppler (Clinicaltrials.gov: NCT02795377). We studied patients with hypertensive emergencies before and 4 h after BP lowering by urapidil (n = 12) and studied the release of EMPs due to mechanical endothelial injury after coronary angiography (n = 10). Hypertensives exhibited increased EMPs (CD31 + /41 - , CD144 + , CD62e + ) as compared to normotensives and EMPs univariately correlated with systolic BP (SBP), augmentation index, and pulse wave velocity and inversely with FMD. CD31 + /41 - -EMPs correlated with diameter and inversely with WSS and NMD. CD62e + and CD144 + -EMPs inversely correlated with microvascular function. During hypertensive emergency, only CD62e + and CD144 + -EMPs were further elevated and FMD was decreased compared to stable hypertensives. Blood pressure lowering decreased CD62e + and CD144 + -EMPs and increased FMD. CD31 + /41 - EMPs, diameter, and WSS remained unaffected. Similar to hypertensive emergency, catheter-related endothelial injury increased only CD144 + and CD62e + -EMPs. EMP release in hypertension is complex and may involve both physicomechanical endothelial injury and activation (CD144 + , CD62e + ) and decreased wall shear stress (CD31

Aspirin for Stroke Prevention in Elderly Patients With Vascular Risk Factors: Japanese Primary Prevention Project.

PubMed

Uchiyama, Shinichiro; Ishizuka, Naoki; Shimada, Kazuyuki; Teramoto, Tamio; Yamazaki, Tsutomu; Oikawa, Shinichi; Sugawara, Masahiro; Ando, Katsuyuki; Murata, Mitsuru; Yokoyama, Kenji; Minematsu, Kazuo; Matsumoto, Masayasu; Ikeda, Yasuo

2016-06-01

The effect of aspirin in primary prevention of stroke is controversial among clinical trials conducted in Western countries, and no data are available for Asian populations with a high risk of intracranial hemorrhage. The objective of this study was to evaluate the effect of aspirin on the risk of stroke and intracranial hemorrhage in the Japanese Primary Prevention Project (JPPP). A total of 14 464 patients (age, 60-85 years) with hypertension, dyslipidemia, and diabetes mellitus participated and were randomized into 2 treatment groups: 100 mg of aspirin or no aspirin. The median follow-up period was 5.02 years. The cumulative rate of fatal or nonfatal stroke was similar for the aspirin (2.068%; 95% confidence interval [CI], 1.750-2.443) and no aspirin (2.299%; 95% CI, 1.963-2.692) groups at 5 years; the estimated hazard ratio was 0.927 (95% CI, 0.741-1.160; P=0.509). Aspirin nonsignificantly reduced the risk of ischemic stroke or transient ischemic attack (hazard ratio, 0.783; 95% CI, 0.606-1.012; P=0.061) and nonsignificantly increased the risk of intracranial hemorrhage (hazard ratio, 1.463; 95% CI; 0.956-2.237; P=0.078). A Cox regression adjusted by the risk factors for all stroke, which were age >70 years, smoking, and diabetes mellitus, supported the above result. Aspirin did not show any net benefit for the primary prevention of stroke in elderly Japanese patients with risk factors for stroke, whereas age >70 years, smoking, and diabetes mellitus were risk factors for stroke regardless of aspirin treatment. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00225849. © 2016 American Heart Association, Inc.

Sorafenib in Japanese Patients with Locally Advanced or Metastatic Medullary Thyroid Carcinoma and Anaplastic Thyroid Carcinoma.

PubMed

Ito, Yasuhiro; Onoda, Naoyoshi; Ito, Ken-Ichi; Sugitani, Iwao; Takahashi, Shunji; Yamaguchi, Iku; Kabu, Koki; Tsukada, Katsuya

2017-09-01

Therapeutic options for treating advanced or metastatic medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma (ATC) are still limited in Japan, even though vandetanib for MTC and lenvatinib for MTC and ATC have been approved. Sorafenib is an oral multikinase inhibitor approved for the treatment of patients with radioactive iodine-refractory differentiated thyroid cancer (DTC). An uncontrolled, open-label, multicenter, single-arm, Phase 2 clinical study was conducted to evaluate the safety and efficacy of sorafenib in Japanese patients with MTC and ATC. Japanese patients with histologically confirmed ATC and locally advanced or metastatic MTC were enrolled from April to September 2014. The primary endpoint was to evaluate the safety of sorafenib. Treatment efficacy variables including progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and maximum reduction in tumor size were evaluated as secondary endpoints. Patients received sorafenib 400 mg orally twice daily on a continuous basis and then continued treatment until the occurrence of disease progression, unacceptable toxicity, or withdrawal of consent. A total of 20 patients were screened, and 18 (8 with MTC and 10 with ATC) were enrolled. The most common drug-related adverse events were palmar-plantar erythrodysesthesia (72%), alopecia (56%), hypertension (56%), and diarrhea (44%). In the ATC patients, median PFS was 2.8 months [confidence interval 0.7-5.6], and median OS was 5.0 months [confidence interval 0.7-5.7]; ORR and DCR were 0% and 40%, respectively. In the MTC population, neither median PFS nor OS had been reached at the time of this analysis; ORR was 25% and DCR was 75%. The toxicities reported in this study were consistent with the known safety profile of sorafenib. Sorafenib seems to be effective in the treatment of advanced MTC but not ATC, and could be a new treatment option for locally advanced or metastatic MTC and

Individual patient's preferences for hypertension management: a Q-methodological approach.

PubMed

Morecroft, Charles; Cantrill, Judy; Tully, Mary P

2006-06-01

To systematically explore and elicit individual patient's preferences in the management of their hypertension using Q-methodology. Using Q-methodology, 120 patients ranking 42 statements according to their agreement or disagreement when considering appropriate hypertension management. The statements were derived from an earlier qualitative study. Factor analysis of the data was undertaken using PQMethod software to determine if any patterns were discernible. Ninety-two patients clustered to five factors, which all varied in the degree of involvement patients had, or wished to have, in their hypertension management. The 42 patients who loaded to factor 1 considered that appropriate antihypertensive treatment involved leaving medical decisions to their GPs and trusting their judgement in such matters. The patients (n = 31) who positively loaded to factor 2 suggested that an autonomous relationship with their healthcare professional(s) was an important issue when considering treatment. It is concluded that this study has successfully used Q-methodology to systematically investigate people's subjectivity and developed a novel approach to elicit the views of individual patients, as well as explore and differentiate between groups of patients. The formation of true partnerships between patients and healthcare professionals which will enhance individual patients' ability to self-manage chronic disease.

Prevalence of microalbuminuria in non-diabetic hypertensive patients attended by Portuguese GPs.

PubMed

Polónia, Jorge; Carmona, Jose; Mendes, Eduardo; Pisco, Luís

2007-06-01

To determine the prevalence of microalbuminuria in a sample of non-diabetic hypertensive patients and to correlate the presence of microalbuminuria with the patients' different clinical profiles. A descriptive, observational, cross-sectional and non-interventional enquiry based on strict respect for the standard general practitioner's medical practice and the physician-patient relationship. Portuguese general practitioners (GPs) who had participated in a preliminary opinion survey on evaluation of renal function in hypertensive patients. Non-diabetic uncontrolled and controlled hypertensive patients. Data were collected via written questionnaires completed by physicians at inclusion. Standard biochemical and microalbuminuria tests were performed by the laboratory chosen by each physician following the laboratory's usual practice. A Micral-Test"* to detect microalbuminuria was also performed on a spot morning urine collection. Between May and October 2003, 531 general practitioners recruited 1582 non-diabetic hypertensive patients (58% female) with a mean age of 60.4 +/- 11.3 years; 11% of them were physically active and 10% were smokers. Almost all the patients (>95%) were under antihypertensive medication; 44% were also taking statins and 19% aspirin. Of the 1582 subjects, 57% (n=906) and 41% (n=652) had uncontrolled and controlled hypertension respectively, and 34% (n=539) had markers of renal function damage such as proteinuria, hematuria, microalbuminuria or albuminuria. Data for the Micral-Test were obtained in 98% of the patients and 29% (n=458) had a positive test. The mean albuminuria level was 12.34 +/- 37.88 mg/l. Seventy-six per cent of the patients (n=1196) had a normal urine test. Microalbuminuria was significantly more frequent in patients with uncontrolled (29%) than in controlled (20%) hypertension (p < 0.01), with left ventricular hypertrophy (LVH) (33%) than without (24%) (p < 0.01), with ventricular arrhythmias (35%) than without (25%) (p < 0

Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.

PubMed

Zanchetti, Alberto; Liu, Lisheng; Mancia, Giuseppe; Parati, Gianfranco; Grassi, Guido; Stramba-Badiale, Marco; Silani, Vincenzo; Bilo, Grzegorz; Corrao, Giovanni; Zambon, Antonella; Scotti, Lorenza; Zhang, Xinhua; Wang, HayYan; Zhang, Yuqing; Zhang, Xuezhong; Guan, Ting Rui; Berge, Eivind; Redon, Josep; Narkiewicz, Krzysztof; Dominiczak, Anna; Nilsson, Peter; Viigimaa, Margus; Laurent, Stéphane; Agabiti-Rosei, Enrico; Wu, Zhaosu; Zhu, Dingliang; Rodicio, José Luis; Ruilope, Luis Miguel; Martell-Claros, Nieves; Pinto, Fernando; Schmieder, Roland E; Burnier, Michel; Banach, Maciej; Cifkova, Renata; Farsang, Csaba; Konradi, Alexandra; Lazareva, Irina; Sirenko, Yuriy; Dorobantu, Maria; Postadzhiyan, Arman; Accetto, Rok; Jelakovic, Bojan; Lovic, Dragan; Manolis, Athanasios J; Stylianou, Philippos; Erdine, Serap; Dicker, Dror; Wei, Gangzhi; Xu, Chengbin; Xie, Hengge; Coca, Antonio; O'Brien, John; Ford, Gary

2014-09-01

The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125  mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8  mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be

[Surgery in portal hypertension. Which patient and which operation?].

PubMed

Mercado, M A; Takahashi, T; Rojas, G; Prado, E; Hernández, J; Tielve, M; Orozco, H

1993-01-01

A prospective trial of a cohort of patients (N = 94) with portal hypertension and history of bleeding was selected for surgery based on strict clinical and laboratory criteria. All of them were treated with portal blood flow preserving procedures. The following selection criteria were used: good cardiopulmonary function without pulmonary hypertension and good liver function (Child-Pugh A). All patients were operated in an elective fashion and the operations performed were: selective shunts (N = 38) (distal splenorenal and splenocaval), low diameter mesocaval shunts (N = 13) and the esophagogastric devascularization with esophageal transection (Sugiura-Futagawa) (N = 43). Patients were selected for each operation according to their anatomical conditions. Sixty-one of the patients were cirrhotics. Operative mortality was 8% and rebleeding was observed in 5% of the cases. Postoperative encephalopathy was seen in seven patients (three selective shunts, two low diameter mesocaval shunts and two devascularizations). In 13 of 62 patients postoperatively evaluated by means of angiography, portal vein thrombosis was shown (seven selective shunts, two low diameter shunts and four devascularizations). Twenty-two patients with preoperative portal vein thrombosis (and treated with a Sugiura-Futagawa operation) were excluded from postoperative angiographic evaluation. Survival (Kaplan-Meier) was 85% at 60 months. Portal blood flow preserving procedures are the treatment of choice for patients with hemorrhagic portal hypertension and good liver function. The kind of operation is selected according to the individual anatomical status of the patient.

Evaluation and management of patients referred to a tertiary-level hypertension clinic in Cape Town, South Africa.

PubMed

Moosa, M S; Kuttschreuter, L S; Rayner, B L

2016-07-04

Hypertension remains a global health burden, with a high incidence of long-term morbidity and mortality. To evaluate blood pressure (BP) control, factors associated with poor BP control, target organ damage (TOD), white-coat hypertension, treatment-resistant hypertension and secondary hypertension in patients referred to a tertiary-level hypertension clinic. This was a prospective case-control study of patients referred for specialist hypertension management. Patient parameters recorded included age, gender, body mass index, uric acid, cholesterol, screening BP, follow-up BP, TOD and medications. We also recorded causes of secondary hypertension. Net BP change and the percentage achieving target BP were calculated in all patients followed up. A total of 175 patients were sampled (72 males and 103 females, mean age 46.5 years). Of the patients 16.6% had a normal screening BP; 62.9% of patients were followed up, and 43.6% of these achieved BP control. After intervention, there was a net drop of 13.2 mmHg (range 7.9 - 18.4) in systolic BP and of 3.8 mmHg (4.4 - 12.0) in diastolic BP. Of all the patients, 12.6% had resistant hypertension, 49.1% had evidence of left ventricular hypertrophy and 18.3% had microalbuminuria; 13.1% of the patients were diagnosed with secondary hypertension. Specialist intervention was useful in identifying patients with white-coat and secondary hypertension, as well as in improving hypertension control in patients with apparent treatment-resistant hypertension. However, a significant percentage of patients did not reach target BP, and further efforts are required to identify the underlying causes for this.

Metabolic syndrome in hypertensive patients: An unholy alliance

PubMed Central

Mulè, Giuseppe; Calcaterra, Ilenia; Nardi, Emilio; Cerasola, Giovanni; Cottone, Santina

2014-01-01

For many years, it has been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities including abdominal obesity, elevated triglycerides, reduced high-density lipoprotein cholesterol, glucose intolerance, insulin resistance and hyperuricemia. This constellation of various conditions has been transformed from a pathophysiological concept to a clinical entity, which has been defined metabolic syndrome (MetS). The consequences of the MetS have been difficult to assess without commonly accepted criteria to diagnose it. For this reason, on 2009 the International Diabetes Federation, the American Heart Association and other scientific organizations proposed a unified MetS definition. The incidence of the MetS has been increasing worldwide in parallel with an increase in overweight and obesity. The epidemic proportion reached by the MetS represents a major public health challenge, because several lines of evidence showed that the MetS, even without type 2 diabetes, confers an increased risk of cardiovascular morbidity and mortality in different populations including also hypertensive patients. It is likely that the enhanced cardiovascular risk associated with MetS in patients with high blood pressure may be largely mediated through an increased prevalence of preclinical cardiovascular and renal changes, such as left ventricular hypertrophy, early carotid atherosclerosis, impaired aortic elasticity, hypertensive retinopathy and microalbuminuria. Indeed, many reports support this notion, showing that hypertensive patients with MetS exhibit, more often than those without it, these early signs of end organ damage, most of which are recognized as significant independent predictors of adverse cardiovascular outcomes. PMID:25276291

Computer-Based Education for Patients with Hypertension: A Systematic Review

ERIC Educational Resources Information Center

Saksena, Anuraag

2010-01-01

Objective: To evaluate the benefits of using computer-based interventions to provide patient education to individuals with hypertension. Methods: MEDLINE, Web of Knowledge, CINAHL, ERIC, EMBASE, and PsychINFO were searched from 1995 to April 2009 using keywords related to "computers," "hypertension," "education," and "clinical trial." Additional…

Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan.

PubMed

Nakamura, Koshi; Okamura, Tomonori; Hayakawa, Takehito; Kanda, Hideyuki; Okayama, Akira; Ueshima, Hirotsugu

2010-08-01

Hypertension and smoking are major causes of disability and death, especially in the Asia-Pacific region, where there is a high prevalence of a combination of these two risk factors. We attempted to measure the medical expenditures of a Japanese male population with hypertension and/or a smoking habit over a 10-year period of follow-up. A cohort study was conducted that investigated the medical expenditures due to a smoking habit and/or hypertension during the decade of the 1990s using existing data on physical status and medical expenditures. The participants included 1708 community-dwelling Japanese men, aged 40-69 years, who were classified into the following four categories: 'neither smoking habit nor hypertension', 'smoking habit alone', 'hypertension alone' or 'both smoking habit and hypertension.' Hypertension was defined as a systolic blood pressure of > or =140 mm Hg, a diastolic blood pressure of > or =90 mm Hg or taking antihypertensive medications. In the study cohort, 24.9% had both a smoking habit and hypertension. During the 10-year follow-up period, participants with a smoking habit alone (18,444 Japanese yen per month), those with hypertension alone (21,252 yen per month) and those with both a smoking habit and hypertension (31,037 yen per month) had increased personal medical expenditures compared with those without a smoking habit and hypertension (17,418 yen per month). Similar differences were observed even after adjustment for other confounding factors (P<0.01). Japanese men with both a smoking habit and hypertension incurred higher medical expenditures compared with those without a smoking habit, hypertension or their combination.

Doppler echocardiographic analysis of left ventricular filling in treated hypertensive patients.

PubMed

Phillips, R A; Coplan, N L; Krakoff, L R; Yeager, K; Ross, R S; Gorlin, R; Goldman, M E

1987-02-01

Early detection and prevention of cardiac dysfunction is an important goal in the management of hypertensive patients. In this study, Doppler echocardiography was used to evaluate the pattern of left ventricular diastolic filling in 38 subjects: 18 treated hypertensive patients (blood pressure 141 +/- 17/83 +/- 10 mm Hg, mean +/- SD) without other coronary risk factors and 20 risk-free normotensive subjects of similar age (47 +/- 10 and 49 +/- 13 years, respectively). Peak velocity of late left ventricular filling due to the atrial contraction was greater in hypertensive compared with normotensive subjects (69 +/- 14 versus 52 +/- 13 cm/s; p less than 0.001). Peak velocity of late filling was significantly greater in hypertensive versus normotensive subjects in those aged 50 years or younger and those older than age 50 (65 +/- 12 versus 50 +/- 11; p less than 0.01 and 75 +/- 15 versus 56 +/- 15 cm/s; p less than 0.05, respectively). In hypertensive subjects, peak velocity of late filling did not correlate with routine indexes of hypertensive heart disease (including posterior wall thickness and left ventricular mass), systolic and diastolic blood pressure or duration of hypertension. These results indicate that increased velocity of late left ventricular filling may be independent of left ventricular hypertrophy and persist despite effective blood pressure control.

Hypertension and hyperlipidemia management in patients treated at community health centers.

PubMed

Kirchhoff, Anne C; Drum, Melinda L; Zhang, James X; Schlichting, Jennifer; Levie, Jessica; Harrison, James F; Lippold, Susan A; Schaefer, Cynthia T; Chin, Marshall H

2008-01-01

OBJECTIVE: Community health centers (HCs) provide care for millions of medically underserved Americans with disproportionate burdens of hypertension and hyperlipidemia. For both conditions, treatment guidelines recently became more stringent and quality improvement (QI) efforts have intensified. We assessed hypertension and hyperlipidemia management in HCs during this time of guideline revision and increased QI efforts. DESIGN: Cross-sectional chart review. SETTING AND PARTICIPANTS: Eleven Midwestern HCs for 2000 and 9 for 2002 provided audit data from 2,976 randomly chosen patients with hypertension and/or hyperlipidemia. MEASUREMENT: Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC VI/VII) and National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP III) guidelines were used to assess management of these conditions. RESULTS: Hypertension (2000, N=808; 2002, N=692) and hyperlipidemia (2000, N=774; 2002, N=702) outcomes improved for specific clinical subgroups. Hypertensive patients with 1 or more cardiovascular risk factors demonstrated significant improvement (34% vs. 45% controlled at <140/90 mm Hg, p=0.02). Hypertension control for persons with diabetes, renal failure and heart failure increased (16% vs. 28% controlled at <130/85 mm Hg, p=0.006). LDL control increased significantly for patients with 2 or more risk factors (39% vs. 58% controlled at <130 mg/dl, p=0.008). Other clinical subgroups showed trends toward better control, although there was insufficient power to detect significant differences for these groups. CONCLUSION: Hypertension and hyperlipidemia outcomes improved for some risk groups; however, ongoing QI is necessary.

Clinical Characteristics of Patients with Intradialytic Hypertension.

PubMed

Eftimovska-Otovic, Natasa; Grozdanovski, Risto; Taneva, Borjanka; Stojceva-Taneva, Olivera

2015-01-01

Intradialytic hypertension with a prevalence of 15% among hemodialysis patients is with unknown pathophysiology, demographic, laboratoiy and clinical characteristic of patients, and it's influence on longtenn clinical effects (cardiovascular morbidity and mortality, rate of hospitalization). The aim of the study is to present the clinical, laboratoiy and demographic characteristics of patients with intradialytic hypertension in our dialysis center. Out of 110 hemodialysis patients, 17 patients (15,45%) had intradialytic hypertension - started at a systolic pressure greater than 140 nun Hg or had an increase in systolic pressure more than 10 mm Hg during the session, and 17 patients were nonnotensive or had a drop in blood pressure dining the dialysis. HD were performed 3 times per week with a duration of 4-5 hours, on machines with controlled ultrafiltration and high flux syntetic membrane (polyetersulfon) sterilized with gamma rays. A dialysate with standard electrolytes content was used (Na(+) 138 mmol/L, K(+) 2,0 mmol/L, Ca(++) 1,5 mmol/L, Mg (+)1,0 mmol/L, CH(3)COO(-) 3,0 mmol/L, Cl -110 mmol/1, HCO(3)(-) 35 mmol/L). We analysed the following demographic and clinical characteristics: gender, age, BMI, dialysis vintage, vascular acces, cardiovascular comorbidity (cardiomyopathy, ischemic cardiac disease, peripheral artery disease, heart valve disease), number and type of antihypertensive drugs, weekly dose of erythropoesis - stimulating agent, standard monthly, three and six months laboratoiy analyzes, and sp Kt/V and PCR. Statistical analysis was performed using the statistical software SPSS 17.0. hi both groups men were predominant (IDH group 88.23%, control group 64.07%). The IDH group was older (59.00 ± 7.64 versus 49.00 ± 13.91, p = 0.314) and with lower BMI (p = 0.246) compared to the control group. The DDH patients had significantly lower serum sodium and higher sodium gradient (135.75 ± 2.03 versus 137.33 ± 1.97, p = 0.042; 2.25 ± 1.98 versus 0.66 �

Time-Dependent Changes in Psychosocial Distress in Japanese Patients with Implantable Cardioverter Defibrillators.

PubMed

Saito, Nao; Taru, Chiemi; Miyawaki, Ikuko

2016-12-02

This prospective study clarified changes in the mood states of Japanese patients with implantable cardioverter defibrillators as well as factors related to the mood states. Using a longitudinal repeated-measure design, 29 patients with implantable cardioverter defibrillators completed the Profile of Mood States-Short Form Japanese Version questionnaire before discharge and 1, 4, 7, and 13 months after implantation. One month after discharge, the mood states of the patients with implantable cardioverter defibrillators improved. From 7 to 13 months after discharge, moods deteriorated; 13 months after discharge, moods were equivalent to those at the time of discharge. No relationship with defibrillation experience was detected in this study, but employment, age, sex, and lack of experience of syncopal attack were factors related to poor mood states for patients with implantable cardioverter defibrillators. Therefore, Japanese patients with implantable cardioverter defibrillators with any factor deteriorating their mood state should be monitored so that their mood state does not deteriorate again between six months and one year after implantation.

Knowledge of hypertension and its management among hypertensive patients on chronic medicines at primary health care public sector facilities in South Africa; findings and implications.

PubMed

Rampamba, Enos M; Meyer, Johanna C; Helberg, Elvera; Godman, Brian

2017-08-01

There are high growing prevalence rates of hypertension in South Africa. Consequently, there is a need to assess knowledge and management among hypertensive patients receiving chronic medication from primary health care (PHC) facilities in South Africa as a basis for improving future management. This is important as South Africa seeks to improve its management of chronic diseases. Descriptive, quantitative study amongst chronic hypertensive patients in the chronic disease programme. Patients were interviewed face-to-face by trained pharmacists using a structured questionnaire. Data analysis included descriptive and inferential statistics. Half (53.7%) of the patients had uncontrolled blood pressure (BP). Less than a third of patients (27.7%) knew what hypertension is, the meaning of recorded BP numbers (4.5%), and what normal BP should be (19.9%). All patients who knew the meaning of BP numbers had formal education (p = 0.047). Only 15.6% of the 56.0% patients, who received hypertension information, received it on antihypertensive medicines specifically. The majority of the patients lacked hypertension specific knowledge and only half had controlled BP. Interventions to improve the control of high BP should be targeted at closing knowledge gaps as part of the current chronic treatment initiatives in South Africa to ensure the benefits of increased access to care are realized.

Differences in treatment and metabolic abnormalities between normo- and hypertensive patients with type 2 diabetes: the Skaraborg Hypertension and Diabetes Project.

PubMed

Ostgren, C J; Lindblad, U; Bøg-Hansen, E; Ranstam, J; Melander, A; Råstam, L

1999-03-01

To examine treatment and glucose control in type 2 diabetes patients with and without hypertension, and to explore differences in markers for insulin resistance and beta cell function. A community-based, cross-sectional observational study was carried out at the hypertension and diabetes outpatient clinic in primary health care, Skara, Sweden. The subjects were all the 400 patients with type 2 diabetes (202 men, 198 women) who underwent annual follow-up from May 1992 through September 1993; 204 of these also had hypertension. The patients with both type 2 diabetes and hypertension had a higher b.m.i. (mean; 28.9 kg m(-2) (s.d.; 4.4) vs. 27.4 kg m(-2)(4.6)), higher triglycerides (2.0 mmol l(-1)(1.1) vs. 1.7 mmol l(-1)(1.1)), higher LDL/HDL cholesterol ratio (4.3(1.4) vs. 4.1(1.2)) and higher fasting insulin (8.5 mU l(-1)(1.1) vs. 6.6 mU l(-1)(1.1)). Conversely, glucose levels were lower; HbA1c (6.4%(1.4) vs. 6.8%(1.6)) and fasting blood glucose (8.1 mmol l(-1)(2.3) vs. 8.9 mmol l(-1)(2.7)) than in patients with type 2 diabetes alone. By the homeostasis model assessment (HOMA), patients with type 2 diabetes alone had more impaired beta cell function. They also had a higher frequency of insulin treatment (20% vs. 12%) and were less often treated non-pharmacologically (33% vs. 50%). Patients with type 2 diabetes and hypertension constitute a high risk category with a more atherogenic risk factor profile related to the insulin resistance syndrome. Patients with type 2 diabetes without hypertension seem to constitute a subgroup of type 2 diabetes with predominately impaired beta cell function.

Performance on the Wechsler Adult Intelligence Scale-III in Japanese patients with schizophrenia.

PubMed

Fujino, Haruo; Sumiyoshi, Chika; Sumiyoshi, Tomiki; Yasuda, Yuka; Yamamori, Hidenaga; Ohi, Kazutaka; Fujimoto, Michiko; Umeda-Yano, Satomi; Higuchi, Arisa; Hibi, Yumiko; Matsuura, Yukako; Hashimoto, Ryota; Takeda, Masatoshi; Imura, Osamu

2014-07-01

Patients with schizophrenia have been reported to perform worse than non-schizophrenic populations on neuropsychological tests, which may be affected by cultural factors. The aim of this study was to examine the performance of a sizable number of patients with schizophrenia on the Japanese version of the Wechsler Adult Intelligence Scale-III (WAIS-III) compared with healthy controls. Performance on the WAIS-III was evaluated in 157 Japanese patients with schizophrenia and in 264 healthy control subjects. All IQ scores and four indices from the WAIS-III were impaired for patients with schizophrenia compared with healthy controls. Processing Speed was markedly disturbed, approximately 2 SD below that of the healthy control group. Among the 13 subtests, Comprehension (z = -1.70, d = 1.55), Digit Symbol Coding (z = -1.84, d = 1.88), and Symbol Search (z = -1.85, d = 1.77) were profoundly impaired relative to the healthy controls. These results indicate that the pattern and degree of impairment, as evaluated by the WAIS-III, in Japanese patients are similar to those previously reported in English-speaking patients and that the deficits of some neuropsychological domains relevant to functional outcomes are universally characteristic of schizophrenia. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

Alcohol consumption and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: Baseline data from the Dogo Study.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Maruyama, Koutatsu; Ueda, Teruhisa; Tanaka, Keiko; Senba, Hidenori; Todo, Yasuhiko; Torisu, Masamoto; Minami, Hisaka; Onji, Morikazu; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2016-09-01

Diabetes mellitus and heavy alcohol consumption are both associated with vascular disease, a category that includes erectile dysfunction (ED). However, the association between alcohol consumption and ED among patients with type 2 diabetes mellitus remains unclear. The aim of the present multicenter cross-sectional study was to investigate the relationship between drinking frequency, weekly alcohol consumption, daily alcohol consumption, and ED among Japanese patients with type 2 diabetes mellitus. Study subjects were 340 male Japanese patients with type 2 diabetes mellitus, aged 19-70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. The prevalence of ED was 43.2% (147/340). The frequency of alcohol consumption and weekly alcohol consumption were independently inversely associated with ED (p for trend p = 0.001 and 0.004, respectively). The relationship between daily alcohol consumption and ED was an inverted J-shaped curve: alcohol consumption of less than 60 g, but not 60 g or more, per day was independently related to a lower prevalence of ED (p for quadratic trend = 0.003). In Japanese men with type 2 diabetes mellitus, an inverted J-shaped relationship between daily alcohol consumption and ED was observed, while frequency of alcohol consumption and weekly alcohol consumption were significantly inversely associated with ED. Copyright © 2016 Elsevier Inc. All rights reserved.

The effect of spironolactone in patients with resistant arterial hypertension in relation to baseline blood pressure and secondary causes of hypertension.

PubMed

Vaclavik, Jan; Sedlak, Richard; Jarkovsky, Jiri; Kocianova, Eva; Taborsky, Milos

2013-03-01

There are currently limited data about whether the effect of spironolactone in patients with resistant arterial hypertension depends on baseline blood pressure and the presence of a secondary cause of hypertension. Patients with office systolic blood pressure (BP) >140 mmHg or diastolic BP >90 mmHg, despite treatment with at least 3 antihypertensive drugs including a diuretic, were randomly assigned to receive spironolactone or a placebo for 8 weeks in a double-blind, placebo-controlled, multicentre trial (ASPIRANT). Analyses were done with 55 patients treated with spironolactone. The degree of BP reduction after 8 weeks of spironolactone treatment did not differ significantly between the three tertiles of baseline systolic BP and patients with and without a secondary cause of hypertension. The reduction of office systolic, office diastolic BP and office pulse pressure was significantly lower in the highest tertile with baseline diastolic BP > 97 mmHg. Spironolactone treatment is effective to a similar extent both in patients with and without a secondary cause of hypertension and regardless of the baseline value of systolic BP. Less effect of spironolactone was found in patients with the highest baseline diastolic BP.

Cognitive emotion regulation questionnaire in hypertensive patients.

PubMed

Duan, Shu; Liu, Yiqun; Xiao, Jing; Zhao, Shuiping; Zhu, Xiongzhao

2011-06-01

To examine the reliability,validity,and practicability of Cognitive Emotion Regulation Questionnaire (CERQ) in hypertensive patients in China. Altogether 434 hypertensive patients and 462 healthy subjects were recruited. All the subjects were assessed with the CERQ-Chinese version (CERQ-C), Dysfunctional Attitude Scale (DAS), Mood and Anxiety Symptom Questionnaire-Short Form (MASQ-SF), and Center for Epidemiologic Studies Depression Scale (CES-D). We calculated the mean inter-item correlations for the total CERQ and for each of the subscales. Cronbach's alpha coefficient was used to analyze the inter-correlation and reliability, and confirmatory factor analysis was used to examine the 9-factor model. 1) Hypertension group reported significantly higher score than that of healthy ones on rumination (12.19 ± 2.51 vs. 11.51 ± 2.60, P<0.001), catastrophizing(8.82 ± 2.19 vs.8.11 ± 2.70,P<0.001),and blaming others(10.76 ± 2.11 vs. 9.88 ± 2.48,P<0.001), and had significantly lower score than that of healthy ones on positive reappraisal(13.80 ± 3.55 vs.14.71 ± 4.11,P<0.001).2)Reliability:In the hypertension group the Cronbach's alpha for the total CERQ was 0.80, and that for the 9 subscales ranged from 0.71 (self-blame) to 0.90 (rumination). In the healthy group the Cronbach's alpha for the total CERQ was 0.79, and that for the 9 subscales ranged from 0.71 (positive reappraisal) to 0.90 (rumination). The mean inter-item correlation coefficient for the 9 subscales was 0.21-0.42(the hypertension group)/0.19-0.32 (the healthy group). In the hypertension group,the test-retest reliability of the total scale was 0.82, the test-retest reliability of the 9 subscales ranged from 0.73 to 0.92. The confirmatory factor analysis showed that the 9 first-order factor data fitted both 2 samples well. CERQ meets the psychometric standard and it is reliable and valid for cognitive emotion regulation strategies, which may be regarded as an appropriate assessment tool.

Individual dose adjustment of riociguat in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension.

PubMed

Hill, Nicholas S; Rahaghi, Franck F; Sood, Namita; Frey, Reiner; Ghofrani, Hossein-Ardeschir

2017-08-01

Riociguat is a soluble guanylate cyclase stimulator that has been approved for the treatment of pulmonary arterial hypertension and inoperable chronic thromboembolic pulmonary hypertension or persistent/recurrent pulmonary hypertension following pulmonary endarterectomy. Riociguat is administered using an 8-week individual dose-adjustment scheme whereby a patient initially receives riociguat 1.0 mg three times daily (tid), and the dose is then increased every 2 weeks in the absence of hypotension, indicated by systolic blood pressure measurements and symptoms, up to a maximum dose of 2.5 mg tid. The established riociguat dose-adjustment scheme allows the dose of riociguat to be individually optimized in terms of tolerability and efficacy. The majority of patients in the phase III clinical trials and their long-term extension phases achieved the maximum riociguat dose, whereas some patients remained on lower doses. There is evidence that these patients may experience benefits at riociguat doses lower than 2.5 mg tid, with improvement in exercise capacity being observed after only 2-4 weeks of treatment in the phase III studies and in the exploratory 1.5 mg-maximum patient group of PATENT-1. This review aims to provide an overview of the rationale behind the riociguat dose-adjustment scheme and examine its application to both clinical trials and real-life clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Correlation of serum parathormone with hypertension in chronic renal failure patients treated with hemodialysis.

PubMed

Baradaran, Azar; Nasri, Hamid

2005-01-01

To consider the correlation of serum parathormone on severity of hypertension in end-stage renal disesase (ESRD) patients on hemodialysis (HD). A cross-sectional study was done on patients with ESRD on treatment with maintenance HD. Levels of serum calcium, phosphorus, alkaline phosphatase, albumin and intact parathormone (iPTH) were measured. Stratification of hypertensive patients was done from stages one to three. The total number of patients studied was 73 (Females=28, Males=45), consisting of 58 non-diabetic (F=22 M=36) and 15 diabetic patients (F=6 M=9). The mean age of the study patients was 46.5 +/- 16 years.The mean duration on HD of the study patients was 21.5 +/- 23.5 months. The mean serum PTH of the study patients was 309 +/- 349 pg/ml and the mean serum alkaline phosphatase was 413 +/- 348 IU/L. There was a significant positive correlation between the stage of hypertension and serum PTH levels (r =0.200 p=0.045). Also, there was a significant positive correlation between stage of hypertension and calcium-phosphorus product (r = 0. 231 p=0.027).There was no significant correlation between stage of hypertension and serum ALP (r =0.135 p=0.128). Relationship between serum PTH and severity of hypertension in patients on HD needs to be studied in more detail. Hypertention and secondary hyperparathyroidism interact in the process of accelerated atherosclerosis in HD patients thus warranting appropriate measures to control hyperparathyroidism vigorously.

Plasma ET-1 Concentrations are Elevated in Patients with Hypertension - Meta-Analysis of Clinical Studies.

PubMed

Xu, Mei; Lu, Yong-Ping; Hasan, Ahmed Abdallah; Hocher, Berthold

2017-01-01

A recent study revealed that global overexpression of ET-1 causes a slight reduction in systemic blood pressure. Moreover, heterozygous ET-1 knockout mice are hypertensive. The role of ET-1 in human hypertension was so far not addressed by a strict meta-analysis of published human clinical studies. We included studies published between January 1, 1990 and February 28, 2017. We included case control studies analyzing untreated essential hypertension or hypertensive patients where antihypertensive medication was discontinued for at least two weeks. Based on the principle of Cochrane systematic reviews, case control studies (CCSs) in PubMed (Medline) and Google Scholar designed to identify the role of endothelin-1 (ET-1) in the pathophysiological of hypertension were screened. Review Manager Version 5.0 (Rev-Man 5.0) was applied for statistical analysis. Mean difference and 95% confidence interval (CI) were shown in inverse variance (IV) fixed-effects model or IV random-effects models. Eleven studies fulfilling our in- and exclusion criteria were eligible for this meta-analysis. These studies included 450 hypertensive patients and 328 controls. Our meta-analysis revealed that ET-1 plasma concentrations were higher in hypertensive patients as compared to the control patients [mean difference between groups 1.57 pg/mL, 95%CI [0.47∼2.68, P = 0.005]. These finding were driven by patients having systolic blood pressure higher than 160 mmHg and diastolic blood pressure higher than 100 mmHg. This meta-analysis showed that hypertensive patients do have elevated plasma ET-1 concentrations. This finding is driven by those patients with high systolic/diastolic blood pressure. Given that the ET-1 gene did not appear in any of the whole genome association studies searching for hypertension associated gene loci, it is very likely that the elevated plasma ET-1 concentrations in hypertensive patients are secondary to hypertension and may reflect endothelial cell damage. © 2017 The

Beta blocker effects on plasma homocysteine levels in patients with hypertension.

PubMed

Atar, Ilyas; Korkmaz, Mehmet Emin; Demircan, Senol; Atar, Inci Asli; Bozbaş, Hüseyin; Aydinalp, Alp; Ozin, Bülent; Yildirir, Aylin; Müderrisoğlu, Haldun

2005-08-01

Recent studies have shown that hyperhomocysteinemia might play a role in the pathogenesis of hypertension. The effects of antihypertensive agents on plasma homocysteine levels have not been tested extensively. We investigated the effects of beta-blocker therapy on homocysteine levels in patients with hypertension. In the study, 120 patients with newly diagnosed hypertension were enrolled. All patients received metoprolol succinate 100 mg/day initially. If blood pressure was above normal on the 15th day of follow-up, the metoprolol dosage was doubled. Before initiation of the antihypertensive medication and after the fourth month of treatment, homocysteine levels were measured. Of the 120 patients enrolled, 39 could not complete the study. Homocysteine levels decreased significantly by the end of the fourth month when compared with basal values (13.5+/-4.5 micromol/l versus 12.4+/-4.9 micromol/l; P = 0.001). There was no relation between homocysteine level and blood pressure control. There was a significant decrease in homocysteine levels in the women treated in this study (P = 0.001); however, this effect was absent in men (P = 0.185). We demonstrate that metoprolol succinate treatment significantly decreases plasma homocysteine levels in patients with hypertension, especially in women.

Association of Clinical Features with Human Leukocyte Antigen in Japanese Patients with Ulcerative Colitis.

PubMed

Iwamoto, Taku; Yashima, Kazuo; Morio, Keiko; Ueda, Naoki; Ikebuchi, Yuichiro; Kawaguchi, Koichiro; Harada, Kenichi; Isomoto, Hajime

2018-03-01

The human leukocyte antigen (HLA) region has been found to be involved in the pathogenesis of inflammatory bowel disease (IBD), which is classified into ulcerative colitis (UC) and Crohn's disease (CD), by genome-wide association studies. The aim of this study was to confirm whether HLA-alleles confer susceptibility to UC and to determine whether HLA-allel1es are associated with the clinical phenotypes in Japanese patients with UC. In this study, HLA typing was performed by PCR-sequence-specific oligonucleotides (PCR-SSO) to confirm the correlation between UC and HLA alleles (for HLA-A, B, DRB1) in 45 Japanese UC patients. In addition, whether the HLA alleles are related to patient and clinical background characteristics was examined. Overall, 62.2%, and 66.7% of the 45 UC patients had HLA-B*52 and HLA-DRB1*15, respectively. These allele frequencies were significantly higher than in previously reported Japanese control persons ( P < 0.0001). The frequencies of extraintestinal manifestations [odds ratio (OR) = 0.12, P = 0.039] and a history of colectomy (OR = 0.18, P = 0.046) were lower in HLA-B*52-positive UC patients than in HLA-B*52 negative UC patients. The white blood cell (WBC) count was significantly higher in HLA-DRB1*15-positive patients (9430 ± 4592/μL) than in HLA-DRB1*15-negative patients (6729 ± 2160/μL). Thus, HLA-B*52 and DRB1*15 appear to be associated with disease features and severity in Japanese UC patients. These results indicate that HLA-B*52 and DRB1*15 are not only associated with overall UC susceptibility, but also with the clinical phenotypes in Japanese patients.

[Effect of ambulatory supervised cardiac training on arterial hypertension in patients with coronary artery disease and arterial hypertension].

PubMed

Kałka, Dariusz; Sobieszczańska, Małgorzata; Marciniak, Wojciech; Popielewicz-Kautz, Aleksandra; Markuszewski, Leszek; Chorebała, Arkadiusz; Korzeniowska, Joanna; Janczak, Jacek; Adamus, Jerzy

2007-01-01

Arterial hypertension is one of the most common health problems occurring in highly developed countries. It was proved that long-term and regular physical activity results in hypotensive effect. A goal of the present study was to assess an influence of six-month ambulatory cardiac rehabilitation on arterial pressure level in patients with coronary artery disease and hypertension as well as analysis of correlation between pressure values alterations and intensity of cardiac training. A study group comprised 103 patients (mean age: 61.2 +/- 0.8 years) manifesting coronary artery disease accompanied by arterial hypertension. A control group constituted 39 normotensive patients with coronary artery disease (mean age: 59.4 +/- 1.3 years). The both observed groups differ from each other only with values of left ventricle mass index and drug regimen established at least three months prior to the follow-up onset. During the rehabilitation cycle, no treatment corrections were made and no new preparations were added. The all patients were enrolled to the six-month cardiac rehabilitation program. The program comprised 45-minute training with cycle ergometer, three times a week, and generally improving gym exercises, two times a week. The analyses concerned systolic and diastolic pressure values, measured just before each training (resting pressure) and just after peak exercise interval (peak pressure), at the beginning and at the end of the rehabilitation cycle. At the initial stage, the patient group with hypertension demonstrated the higher pressure values (resting and peak), as compared with the control group. Cardiac rehabilitation performed in the examined patients caused a statistically significant reduction of the mean resting pressure, both systolic (p < 0.01) and diastolic (p < 0.01). As to the mean peak pressure in this group, systolic diminished slightly (NS), but diastolic was reduced significantly (p < 0.01). In the control group, after six-month rehabilitation

Alterations of carotid arterial mechanics preceding the wall thickening in patients with hypertension.

PubMed

Kim, Sung-Ai; Park, Sun-Hee; Jo, Sang-Ho; Park, Kyoung-Ha; Kim, Hyun-Sook; Han, Sang-Jin; Park, Woo-Jung; Ha, Jong-Won

2016-05-01

Carotid intima-media thickness (cIMT) is an established surrogate marker of atherosclerosis. However, cIMT may not reflect the whole arterial changes occurring in various pathologic conditions, such as hypertension. The aim of this study was to evaluate whether vascular properties of carotid artery (CA) in patients with hypertension differ from those of patients with diabetes and controls before the progression of cIMT. Vascular properties of CA were assessed in 402 consecutive asymptomatic subjects who have normal cIMT (131 with hypertension, 151 with diabetes mellitus, and 120 controls). Conventional carotid stiffness indices calculated from vessel diameter and blood pressure, and parameters from velocity-vector imaging (VVI), including vessel area, fractional area change (FAC), radial velocity, circumferential strain, and strain rate were measured to assess the differences between the groups. In univariate analysis, both patients with hypertension and diabetes showed higher elastic modulus, lower distensibility coefficients and FAC of VVI than those of controls. However, when adjusting for baseline covariates, only FAC (odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.70-0.97, p = 0.025) and vessel area (OR = 2.84, 95% CI = 1.64-4.91, p < 0.001) discriminated CA of patients with hypertension from those of controls. Also, patients with hypertension showed larger vessel area than diabetes (OR = 2.58, 95% CI = 1.75-3.80, p < 0.001) independent of baseline covariates. No significant vascular parameter was found to discriminate patients with diabetes from controls after adjustments. Despite normal cIMT, the CA of hypertensive patients was stiffer than those of controls and positive remodeling preceded the wall thickening independent of baseline covariates. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Traditional herbal medicine use among hypertensive patients in sub-Saharan Africa: a systematic review.

PubMed

Liwa, Anthony C; Smart, Luke R; Frumkin, Amara; Epstein, Helen-Ann B; Fitzgerald, Daniel W; Peck, Robert N

2014-06-01

Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Four hundred and eighty-one references were retrieved, and four articles from two countries met criteria for inclusion. The prevalence of THM use was 25-65% (average 38.6%). THM was the most common type of complementary and alternative medicines used by patients (86.7-96.6%). Among THM users, 47.5% concomitantly used both allopathic medicine and THM. Increased age (p<0.001), male sex (RR 2.58), belief in a supernatural cause of hypertension (RR 2.11), and family history of hypertension (OR 1.78) were positively associated with THM use, while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). More than one-third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa.

Traditional Herbal Medicine Use Among Hypertensive Patients in Sub-Saharan Africa: A Systematic Review

PubMed Central

Liwa, Anthony C.; Smart, Luke R.; Frumkin, Amara; Epstein, Helen-Ann B.; Fitzgerald, Daniel W.; Peck, Robert N.

2014-01-01

Background Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. Methods We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Results Four hundred eighty-one references were retrieved, and 4 articles from 2 countries met criteria for inclusion. The prevalence of THM use was 25-65% (average 38.6%). THM was the most common type of complementary and alternative medicines used by patients (86.7%-96.6%). Among THM users, 47.5% concomitantly used both allopathic medicine and THM. Increased age (p<0.001), male sex (RR 2.58), belief in a supernatural cause of hypertension (RR 2.11), and family history of hypertension (OR 1.78) were positively associated with THM use while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). Conclusion More than a third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa. PMID:24764197

Elevated urinary podocyte-derived extracellular microvesicles in renovascular hypertensive patients

PubMed Central

Kwon, Soon Hyo; Woollard, John R.; Saad, Ahmed; Garovic, Vesna D.; Zand, Ladan; Jordan, Kyra L.; Textor, Stephen C.

2017-01-01

ABSTRACT Background: An increased number of podocyte-derived extracellular vesicles (pEVs) may reflect podocyte injury in renal disease. Elevated glomerular pressure and other insults may injure podocytes, yet it remains unclear whether the numbers of pEVs are altered in hypertensive patients. We tested the hypothesis that urinary pEV levels would be elevated in patients with renovascular hypertension (RVH) compared with essential hypertension (EH) or healthy volunteers (HVs). Methods: We prospectively enrolled patients with EH (n = 30) or RVH (n = 31) to study renal blood flow (RBF) and cortical perfusion using multidetector computed tomography under controlled condition (regulated sodium intake and renin—angiotensin blockade). After isolation from urine samples, pEVs (nephrin and podocalyxin positive) were characterized by flow cytometry. Fourteen RVH patients were studied again 3 months after stenting or continued medical therapy. HVs (n = 15) served as controls. Results: The fraction of pEV among urinary EVs was elevated in RVH compared with HVs and EH (11.4 ± 6.4, 6.8 ± 3.4 and 6.3 ± 3.7%, respectively; P < 0.001) and remained unchanged after 3 additional months of therapy and after controlling for clinical parameters. However, eGFR- and age-adjusted pEV levels did not correlate with any clinical or renal parameters. Conclusions: In hypertensive patients under controlled conditions, urinary pEV levels are elevated in patients with RVH and low eGFR compared with patients with EH and relatively preserved renal function. These pEVs may reflect podocyte injury secondary to kidney damage, and their levels might represent a novel therapeutic target. PMID:27190371

Losartan/Hydrochlorothiazide: a review of its use in the treatment of hypertension and for stroke risk reduction in patients with hypertension and left ventricular hypertrophy.

PubMed

Keating, Gillian M

2009-06-18

Losartan/hydrochlorothiazide (HCTZ) [Hyzaar(R)] is a fixed-dose combination of the angiotensin II receptor antagonist (angiotensin receptor blocker [ARB]) losartan and the thiazide diuretic HCTZ. It is indicated for the treatment of hypertension (including as initial therapy in severe hypertension) and for stroke risk reduction in patients with hypertension and left ventricular hypertrophy (LVH). Losartan/HCTZ is an effective combination therapy, lowering blood pressure (BP) to a greater extent than losartan or HCTZ alone in patients with hypertension. Other ARB/HCTZ fixed-dose combinations generally lowered BP to a greater extent than losartan/HCTZ in patients with hypertension, although whether this translates into improvements in cardiovascular outcomes is not known. In the LIFE study, losartan-based therapy was associated with a lower incidence of cardiovascular morbidity and mortality than atenolol-based therapy, mainly as a result of a reduced risk of stroke; the incidence of new-onset diabetes mellitus was also lower with losartan-based therapy. Losartan/HCTZ is a well tolerated combination therapy. Thus, losartan/HCTZ remains an important option in the treatment of hypertension, as well as being indicated to reduce stroke risk in patients with hypertension and LVH.

Losartan/hydrochlorothiazide combination is safe and effective for morning hypertension in Very-Elderly patients.

PubMed

Uchiwa, Hiroki; Kai, Hisashi; Iwamoto, Yoshiko; Anegawa, Takahiro; Kajimoto, Hidemi; Fukuda, Kenji; Imaizumi, Tsutomu; Fukumoto, Yoshihiro

2018-01-01

Morning hypertension is an independent risk for cerebrovascular and cardiovascular events. Although the prevalence of morning hypertension increases with age, treatment of morning hypertension has not been established, particularly in Very-Elderly patients. We compared the safety and efficacy of a losartan/hydrochlorothiazide (HCTZ) combination in controlling morning hypertension between Very-Elderly (≥75 years) and Young/Elderly patients (<75 years). This study was a subanalysis of the Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy study, in which patients with morning hypertension (≥135/85 mmHg) received a 50-mg losartan/12.5-mg HCTZ combination tablet (combination therapy) or 100-mg losartan (high-dose therapy) for 3 months. High adherence rates and few adverse effects were observed in Very-Elderly patients receiving combination (n = 32) and high-dose (n = 34) therapies and in Young/Elderly patients receiving combination (n = 69) and high-dose (n = 66) therapies. Baseline morning systolic BP (SBP) was similar in both age groups receiving either therapy. Morning SBP was reduced by 20.2 and 18.1 mmHg with combination therapy and by 7.1 and 9.1 mmHg with high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Morning BP target (<135/85 mmHg) was achieved in 40.6% and 55.1% by combination therapy and in 14.7% and 24.2% by high-dose therapy in the Very-Elderly and Young/Elderly patients, respectively. Neither therapy changed renal function and serum potassium in Very-Elderly patients. In conclusion, the losartan/HCTZ combination was safe and effective in controlling morning hypertension in Very-Elderly as well as Young/Elderly patients. In addition, combination therapy was also superior to high-dose therapy for lowering morning SBP in Very-Elderly patients.

Wall shear stress in portal vein of cirrhotic patients with portal hypertension.

PubMed

Wei, Wei; Pu, Yan-Song; Wang, Xin-Kai; Jiang, An; Zhou, Rui; Li, Yu; Zhang, Qiu-Juan; Wei, Ya-Juan; Chen, Bin; Li, Zong-Fang

2017-05-14

To investigate wall shear stress (WSS) magnitude and distribution in cirrhotic patients with portal hypertension using computational fluid dynamics. Idealized portal vein (PV) system models were reconstructed with different angles of the PV-splenic vein (SV) and superior mesenteric vein (SMV)-SV. Patient-specific models were created according to enhanced computed tomography images. WSS was simulated by using a finite-element analyzer, regarding the blood as a Newtonian fluid and the vessel as a rigid wall. Analysis was carried out to compare the WSS in the portal hypertension group with that in healthy controls. For the idealized models, WSS in the portal hypertension group (0-10 dyn/cm 2 ) was significantly lower than that in the healthy controls (10-20 dyn/cm 2 ), and low WSS area (0-1 dyn/cm 2 ) only occurred in the left wall of the PV in the portal hypertension group. Different angles of PV-SV and SMV-SV had different effects on the magnitude and distribution of WSS, and low WSS area often occurred in smaller PV-SV angle and larger SMV-SV angle. In the patient-specific models, WSS in the cirrhotic patients with portal hypertension (10.13 ± 1.34 dyn/cm 2 ) was also significantly lower than that in the healthy controls ( P < 0.05). Low WSS area often occurred in the junction area of SV and SMV into the PV, in the area of the division of PV into left and right PV, and in the outer wall of the curving SV in the control group. In the cirrhotic patients with portal hypertension, the low WSS area extended to wider levels and the magnitude of WSS reached lower levels, thereby being more prone to disturbed flow occurrence. Cirrhotic patients with portal hypertension show dramatic hemodynamic changes with lower WSS and greater potential for disturbed flow, representing a possible causative factor of PV thrombosis.

Wall shear stress in portal vein of cirrhotic patients with portal hypertension

PubMed Central

Wei, Wei; Pu, Yan-Song; Wang, Xin-Kai; Jiang, An; Zhou, Rui; Li, Yu; Zhang, Qiu-Juan; Wei, Ya-Juan; Chen, Bin; Li, Zong-Fang

2017-01-01

AIM To investigate wall shear stress (WSS) magnitude and distribution in cirrhotic patients with portal hypertension using computational fluid dynamics. METHODS Idealized portal vein (PV) system models were reconstructed with different angles of the PV-splenic vein (SV) and superior mesenteric vein (SMV)-SV. Patient-specific models were created according to enhanced computed tomography images. WSS was simulated by using a finite-element analyzer, regarding the blood as a Newtonian fluid and the vessel as a rigid wall. Analysis was carried out to compare the WSS in the portal hypertension group with that in healthy controls. RESULTS For the idealized models, WSS in the portal hypertension group (0-10 dyn/cm2) was significantly lower than that in the healthy controls (10-20 dyn/cm2), and low WSS area (0-1 dyn/cm2) only occurred in the left wall of the PV in the portal hypertension group. Different angles of PV-SV and SMV-SV had different effects on the magnitude and distribution of WSS, and low WSS area often occurred in smaller PV-SV angle and larger SMV-SV angle. In the patient-specific models, WSS in the cirrhotic patients with portal hypertension (10.13 ± 1.34 dyn/cm2) was also significantly lower than that in the healthy controls (P < 0.05). Low WSS area often occurred in the junction area of SV and SMV into the PV, in the area of the division of PV into left and right PV, and in the outer wall of the curving SV in the control group. In the cirrhotic patients with portal hypertension, the low WSS area extended to wider levels and the magnitude of WSS reached lower levels, thereby being more prone to disturbed flow occurrence. CONCLUSION Cirrhotic patients with portal hypertension show dramatic hemodynamic changes with lower WSS and greater potential for disturbed flow, representing a possible causative factor of PV thrombosis. PMID:28566887

Nocturnal Polyuria and Hypertension in Patients with Lifestyle Related Diseases and Overactive Bladder.

PubMed

Yokoyama, Osamu; Nishizawa, Osamu; Homma, Yukio; Takeda, Masayuki; Gotoh, Momokazu; Kakizaki, Hidehiro; Akino, Hironobu; Hayashi, Koichi; Yonemoto, Koji

2017-02-01

The objective of this multicenter cross-sectional study was to investigate the relationship of nocturnal polyuria in patients with common lifestyle related diseases and overactive bladder, with special attention to hypertension. After baseline assessment, patients recorded 24-hour urinary frequency/volume, blood pressure and heart rate for 3 days. They were stratified into 4 groups based on mean blood pressure, including no hypertension, and controllable, untreated and uncontrolled hypertension, respectively. The 2,353 eligible patients, who had urinary urgency once or more per week and 1 or more nocturnal toilet visits, were enrolled from 543 sites in Japan. Of these patients complete data, including the 24-hour frequency volume chart, were collected from 1,271. Multivariable analyses showed a statistically significant association of nocturnal polyuria with increasing age (OR 1.04, 95% CI 1.02-1.05, p <0.001) and gender (women vs men OR 0.75, 95% CI 0.59-0.96, p = 0.02), and for controllable (OR 1.10, 95% CI 0.83-1.460), untreated (OR 2.62, 95% CI 1.55-4.45) and uncontrolled (OR 1.15, 95% CI 0.81-1.62) hypertension vs no hypertension (p = 0.005). However, when assessed separately in men and women, hypertension and heart rate were significantly associated with nocturnal polyuria in women alone (p = 0.01 and 0.03, respectively). Lower urinary tract symptoms suggestive of benign prostatic hyperplasia were significantly associated with nocturnal polyuria in men alone (p <0.001). The current study demonstrates that nocturnal polyuria was significantly associated with age, male gender, and untreated hypertension in patients with lifestyle related diseases and overactive bladder. The association between hypertension and nocturnal polyuria was significant in women alone. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Gastric mucosa in Mongolian and Japanese patients with gastric cancer and Helicobacter pylori infection

PubMed Central

Matsuhisa, Takeshi; Yamaoka, Yoshio; Uchida, Tomohisa; Duger, Davaadorj; Adiyasuren, Battulga; Khasag, Oyuntsetseg; Tegshee, Tserentogtokh; Tsogt-Ochir, Byambajav

2015-01-01

AIM: To investigate the characteristics of gastric cancer and gastric mucosa in a Mongolian population by comparison with a Japanese population. METHODS: A total of 484 Mongolian patients with gastric cancer were enrolled to study gastric cancer characteristics in Mongolians. In addition, a total of 208 Mongolian and 3205 Japanese consecutive outpatients who underwent endoscopy, had abdominal complaints, no history of gastric operation or Helicobacter pylori eradication treatment, and no use of gastric secretion inhibitors such as histamine H2-receptor antagonists or proton pump inhibitors were enrolled. This study was conducted with the approval of the ethics committees of all hospitals. The triple-site biopsy method was used for the histologic diagnosis of gastritis and H. pylori infection in all Mongolian and Japanese cases. The infection rate of H. pylori and the status of gastric mucosa in H. pylori-infected patients were compared between Mongolian and Japanese subjects. Age (± 5 years), sex, and endoscopic diagnosis were matched between the two countries. RESULTS: Approximately 70% of Mongolian patients with gastric cancer were 50-79 years of age, and approximately half of the cancers were located in the upper part of the stomach. Histologically, 65.7% of early cancers exhibited differentiated adenocarcinoma, whereas 73.9% of advanced cancers displayed undifferentiated adenocarcinoma. The infection rate of H. pylori was higher in Mongolian than Japanese patients (75.9% vs 48.3%, P < 0.0001). When stratified by age, the prevalence was highest among young patients, and tended to decrease in patients aged 50 years or older. The anti-East-Asian CagA-specific antibody was negative in 99.4% of H. pylori-positive Mongolian patients. Chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia scores were significantly lower in Mongolian compared to Japanese H. pylori-positive patients (P < 0.0001), with the exception of the intestinal

Gastric mucosa in Mongolian and Japanese patients with gastric cancer and Helicobacter pylori infection.

PubMed

Matsuhisa, Takeshi; Yamaoka, Yoshio; Uchida, Tomohisa; Duger, Davaadorj; Adiyasuren, Battulga; Khasag, Oyuntsetseg; Tegshee, Tserentogtokh; Tsogt-Ochir, Byambajav

2015-07-21

To investigate the characteristics of gastric cancer and gastric mucosa in a Mongolian population by comparison with a Japanese population. A total of 484 Mongolian patients with gastric cancer were enrolled to study gastric cancer characteristics in Mongolians. In addition, a total of 208 Mongolian and 3205 Japanese consecutive outpatients who underwent endoscopy, had abdominal complaints, no history of gastric operation or Helicobacter pylori eradication treatment, and no use of gastric secretion inhibitors such as histamine H2-receptor antagonists or proton pump inhibitors were enrolled. This study was conducted with the approval of the ethics committees of all hospitals. The triple-site biopsy method was used for the histologic diagnosis of gastritis and H. pylori infection in all Mongolian and Japanese cases. The infection rate of H. pylori and the status of gastric mucosa in H. pylori-infected patients were compared between Mongolian and Japanese subjects. Age (± 5 years), sex, and endoscopic diagnosis were matched between the two countries. Approximately 70% of Mongolian patients with gastric cancer were 50-79 years of age, and approximately half of the cancers were located in the upper part of the stomach. Histologically, 65.7% of early cancers exhibited differentiated adenocarcinoma, whereas 73.9% of advanced cancers displayed undifferentiated adenocarcinoma. The infection rate of H. pylori was higher in Mongolian than Japanese patients (75.9% vs 48.3%, P < 0.0001). When stratified by age, the prevalence was highest among young patients, and tended to decrease in patients aged 50 years or older. The anti-East-Asian CagA-specific antibody was negative in 99.4% of H. pylori-positive Mongolian patients. Chronic inflammation, neutrophil activity, glandular atrophy, and intestinal metaplasia scores were significantly lower in Mongolian compared to Japanese H. pylori-positive patients (P < 0.0001), with the exception of the intestinal metaplasia score of

Pulmonary arterial hypertension and portal hypertension in a patient with hereditary hemorrhagic telangiectasia.

PubMed

Pousada, Guillermo; Baloira, Adolfo; Valverde, Diana

2015-03-15

Pulmonary arterial hypertension (PAH) is a rare disease that could be inherited with an autosomal dominant pattern. Mutations in BMPR2 gene are described in over 70% of cases, although other genes are involved in lesser extend in PAH. Hereditary hemorrhagic telangiectasia (HHT) is another rare autosomal dominant disease. PAH is a rare complication of HHT that occurs in less than 1% of cases. Liver cirrhosis with portal hypertension is also associated with the presence of PAHs in 1-2% of cases. We present here a patient with HHT who developed PAH shortly after showing portal hypertension. Some genes (BMPR2, ACVRL1, ENG) seem to play an important role in PAH pathogenesis. We analyzed these genes, detecting mutations in BMPR2 gene (c.1021G>A (V341L), c.327G>A (p.Q109Q)), ACVRL1 (c.313+20C>A, c.1502+7A>G) and ENG (c.498G>A (Q166Q)). The patient also had 3 polymorphisms in the TRPC6 gene (c.1-361A>T, c.1-254C>G, c.1-218C>T). The study of these genes will help us to identify and track individuals susceptible for developing PAH associated with other diseases. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Why is cardiovascular risk stratification important in hypertensive patients?

PubMed

Coll-De-Tuero, Gabriel; Saez, Marc; Rodriguez-Poncelas, Antonio; Barceló-Rado, Antonia; Vargas-Vila, Susanna; Garre-Olmo, Josep; Sala, Victoria; Sieira, Angels; Gelada, Esther; Gelado-Ferrero, Jesús

2012-06-01

The aim is to evaluate whether cardiovascular (CV) risk stratification in newly diagnosed hypertensive patients according to the European Society of Hypertension (ESH) guidelines, can predict the evolution of target organ damage (TOD) using routine examinations in clinical practice during 1 year. Prospective study of recently diagnosed untreated hypertensives. At the moment of inclusion and 1 year later, urinary albumin excretion rate (UAER), blood analysis, electrocardiogram, retinography, self-monitored blood pressure (BP) and ambulatory BP measurement were performed. TOD was defined following the ESH guidelines and evaluated as having favorable or unfavorable evolution. Four hundred and seventy-nine hypertensive patients were included (58.8 years; 43.4% women). The baseline prevalence of TOD was: high UAER (2.4%), left ventricular hypertrophy (LVH) (20.7%), advanced lesion of the fundus oculi (FO) (10.2%). After 1 year, no differences were found between the final systolic and diastolic BP neither in the high/very high nor in the low/moderate CV risk groups. Patients with low/moderate CV risk had less unfavorable TOD evolution, LVH (9.2% vs 41.7%; p <0.001), FO advanced damage (0.99% vs 14.3%; p <0.001), high UAER (0.3% vs 5.1%; p <0.005) and amount of TOD (9.2% vs 44.0%; 0<0.001) than those with high/very high CV risk. The odds ratios of favorable TOD evolution adjusted for BP change and antihypertensive drug treatment were (low/moderate vs high/very high CV risk); 5.14 (95% confidence interval, CI, 3.99-6.64) for LVH; 12.42 (6.67-23.14) FO advanced damage; 10.71 (3.67-31.22) high UAER and 13.99 (10.18-19.22) for amount of TOD. It is possible to detect variations in TOD in hypertensive patients with a 1-year follow-up using the examinations available in routine clinic practice. The risk determined by the ESH guidelines predicts the evolution of TOD at 1 year.

Xeroderma pigmentosum complementation group F: Report of a case and review of Japanese patients.

PubMed

Tofuku, Yukari; Nobeyama, Yoshimasa; Kamide, Ryoichi; Moriwaki, Shinichi; Nakagawa, Hidemi

2015-09-01

Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder characterized by extraordinary sensitivity to sunlight, resulting in cutaneous malignant tumors. Among XP, XP-F presents relatively uniquely in Japanese. To clarify the characteristics of this group, we describe a case of XP-F and review Japanese cases previously reported. A 50-year-old Japanese woman was referred to us with multiple, variously sized, light- or dark-brown macules on the face and sunlight-exposed extremities. She had experienced bulla formation with approximately 10 min of sunlight exposure during her elementary school years. Her parents had been first cousins, and her mother and sister had photosensitivity. She showed no neurological or developmental abnormalities. Ultraviolet (UV) irradiation testing revealed normal levels for minimal erythema dose with UV-A and UV-B. Sensitivity to UV-C and DNA repair ability in the patient's fibroblasts were indicated between that in normal individuals and that in an XP-A patient. Complementation assay revealed that transfection of the XPF gene led most efficient DNA repair compared with the other XP genes. Therefore, the patient was diagnosed with XP-F. Twenty-three cases of Japanese patients (six males, 17 females) with XP-F have been reported, including the present case. Our review suggested a relatively high prevalence of 50% (11/22) for cutaneous malignant tumors. A significant difference was evident in the mean age at first medical consultation between patients with cutaneous malignant tumors (53.6 years) and patients without such tumors (30.8 years). This suggests that cutaneous malignant tumors could occur in the age range of 30-50 years in XP-F patients. © 2015 Japanese Dermatological Association.

[Predictors of cardiac arrhythmias in patients with arterial hypertension during exercise stress testing].

PubMed

Kolesnik, M Iu; Sokolova, M V

2014-02-01

Arterial hypertension is an important risk factor for atrial and ventricular arrhythmias. 203 male patients were examined in order to identify predictors of cardiac arrhythmias in patients with arterial hypertension during exercise stress testing. All participants were studied by 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, an ultrasound scan of the carotid arteries and treadmill test. 47,3% of patients presented cardiac arrhythmias during exercise stress testing. The left ventricular mass, diastolic function and carotid intima-media thickness were found to be independent predictors of exercise-induced arrhythmias. The use of the exercise stress testing may be reasonable for additional risk stratification in hypertensive patients.

[Antihypertensive treatment for patients with hypertension and diabetes type II--current clinical research].

PubMed

Rajzer, Marek; Kawecka-Jaszcz, Kalina; Wojciechowska, Wiktoria

2003-01-01

The frequency of arterial hypertension occurrence in polish population amounts to 30-40%, among diabetics is significantly higher-70%. According to the WHO/ISH Guidelines all hypertensive patients with diabetes are included into the "high risk group" independent of hypertension stage. Pharmacological treatment of hypertension is this group of patients has a particular meaning. Among hypertensive patients the degree of blood pressure lowering is more effective for cardiovascular risk reduction than choice of drug. This fact is well documented in clinical trials comparing antihypertensive efficacy of old and new antihypertensive drugs (for example UKPDS, STOP 2, INSIGHT). From the other point of view renal protection and metabolic benefits, as well as reduction of target organ damage are more advantageous for angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists than for diuretics and beta-blockers. Despite fast progress in clinical research on new antihypertensive drugs (especially AT1 receptor inhibitors) ACE-I seem to still remain still the "first choice" for hypertensive diabetics. Adequate blood pressure control among diabetic hypertensives is of special importance and usually needs appropriate combined antihypertensive therapy. Our review presents detailed information about treatment advantages and disadvantages of drugs from different antihypertensive classes in light of current clinical trials and international guidelines.

Intracranial hypertension in a dieting patient.

PubMed

Sirdofsky, M; Kattah, J; Macedo, P

1994-03-01

We report a case of encephalopathy with paranoid psychosis in association with intracranial hypertension. This occurred in a patient whose diet consisted almost solely of walnuts, ginseng tea, and vitamin A supplements. The patient was found to be severely iron- and vitamin B12-deficient. She was vitamin A toxic. Venous sinus thrombosis was also present. Symptoms remitted with serial lumbar punctures, normalization of diet, and repletion of vitamin B12 and iron stores. Physicians should be alerted to the possibility of a potentially confusing clinical presentation with coexistent and seemingly mutually exclusive neurologic conditions in patients with extremely restricted or fad diets.

The Japanese Histologic Classification and T-score in the Oxford Classification system could predict renal outcome in Japanese IgA nephropathy patients.

PubMed

Kaihan, Ahmad Baseer; Yasuda, Yoshinari; Katsuno, Takayuki; Kato, Sawako; Imaizumi, Takahiro; Ozeki, Takaya; Hishida, Manabu; Nagata, Takanobu; Ando, Masahiko; Tsuboi, Naotake; Maruyama, Shoichi

2017-12-01

The Oxford Classification is utilized globally, but has not been fully validated. In this study, we conducted a comparative analysis between the Oxford Classification and Japanese Histologic Classification (JHC) to predict renal outcome in Japanese patients with IgA nephropathy (IgAN). A retrospective cohort study including 86 adult IgAN patients was conducted. The Oxford Classification and the JHC were evaluated by 7 independent specialists. The JHC, MEST score in the Oxford Classification, and crescents were analyzed in association with renal outcome, defined as a 50% increase in serum creatinine. In multivariate analysis without the JHC, only the T score was significantly associated with renal outcome. While, a significant association was revealed only in the JHC on multivariate analysis with JHC. The JHC and T score in the Oxford Classification were associated with renal outcome among Japanese patients with IgAN. Superiority of the JHC as a predictive index should be validated with larger study population and cohort studies in different ethnicities.

Patient Portal Use and Blood Pressure Control in Newly Diagnosed Hypertension.

PubMed

Manard, William; Scherrer, Jeffrey F; Salas, Joanne; Schneider, F David

2016-01-01

Current evidence that patient portal use improves disease management is inconclusive. Randomized controlled trials have found no benefit of Web-based patient-provider communication for blood pressure (BP) control, but patients from these studies were not selected for uncontrolled hypertension, nor did measures of portal use occur in a real-world setting, as captured in the electronic medical record. This study determined whether patient portal use by patients with treated, incident hypertension was associated with achieving BP control. Between 2008 to 2010, 1571 patients with an incident hypertension diagnosis, ages 21 to >89 years, were identified from an academic medical center primary care patient data registry. Cox proportional hazard models were computed to estimate the association between portal use and incident BP control during follow-up (2011-2015), before and after adjusting for covariates. Covariates included sociodemographics, smoking, obesity and other physical and mental health comorbidities, and volume of health care utilization. After adjusting for age, portal users were more likely than nonusers to achieve BP control (hazard ratio, 1.24; 95% confidence interval, 1.06-1.45). After adjustment for sociodemographics, portal use was no longer associated with BP control (hazard ratio, 0.98; 95% confidence interval, 0.83-1.16). Patient sociodemographic factors, including race, sex, and socioeconomic status, account for the observation that portal use leads to BP control among persons with newly diagnosed hypertension. Further research is warranted to determine whether there are benefits of portal use for other chronic conditions. © Copyright 2016 by the American Board of Family Medicine.

New interventions to treat chronic thromboembolic pulmonary hypertension.

PubMed

Jenkins, David

2018-04-10

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as a type of precapillary pulmonary hypertension (PH) resulting from incomplete resolution of pulmonary embolism. Symptoms are exertional breathlessness and most patients come to a cardiologist's attention with a dilated right heart on echocardiography. Patients with suspected CTEPH should be referred for evaluation to a PH specialist centre to confirm the diagnosis. There are now three treatment options available, dependent on the anatomical level of the obstruction: pulmonary endarterectomy surgery, balloon pulmonary angioplasty and pulmonary arterial hypertension (PAH)-targeted drugs. All reduce pulmonary artery pressure and vascular resistance. Current guidelines recommend surgery as the definitive treatment in technically operable patients. The operation involves deep hypothermic circulatory arrest, but the in-hospital mortality is <5% and the 3-year survival is 90%. Large case series have demonstrated dramatic improvement in haemodynamic parameters with significant symptomatic and prognostic benefits. Balloon pulmonary angioplasty is the newest treatment that has been refined by Japanese cardiologists over the last 5 years. This technique is designed to target more distal subsegmental lesions in inoperable patients and in experienced centres has been shown to deliver equivalent haemodynamic improvement to surgery with low complication rates, but longer term outcome is still under evaluation. A recent randomised controlled trial has demonstrated a reduction in vascular resistance and increase in walk test distance with the PAH-targeted drug Riociguat in patients with inoperable CTEPH, and this drug is now licensed for these patients. It is likely that some patients will benefit from combinations of treatments. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly

Retrospective analysis of bevacizumab-induced hypertension and clinical outcome in patients with colorectal cancer and lung cancer.

PubMed

Nakaya, Aya; Kurata, Takayasu; Yokoi, Takashi; Iwamoto, Shigeyoshi; Torii, Yoshitaro; Katashiba, Yuichi; Ogata, Makoto; Hamada, Madoka; Kon, Masanori; Nomura, Shosaku

2016-07-01

Bevacizumab(Avastin(®) ), a humanized therapeutic monoclonal antibody that targets vascular endothelial growth factor, is widely used in cancer treatment. Patients who are treated with bevacizumab have an increased risk of developing systemic hypertension. However, the relationship between bevacizumab-induced hypertension and clinical outcome remains unclear. We aimed to evaluate the effect of bevacizumab-induced hypertension in terms of prognosis in patients with colorectal cancer and non-small cell lung cancer. The study included 632 patients, 317 patients with non-small cell lung cancer and 315 patients with colorectal cancer. All patients were treated with bevacizumab in combination with standard chemotherapy protocols, between April 2007 and December 2014. Blood pressure was measured before each treatment cycle. In the patient group with colorectal cancer, treated with bevacizumab, Grade 2-3 hypertension was present in 27.6%. In hypertensive patients with colorectal cancer, median overall survival was 42.6 months, compared with 20.6 months for normotensive patients in this group (P = 0.00071). In the patient group with non-small cell lung cancer, treated with bevacizumab, Grade 2-3 hypertension was present in 20.5%. In hypertensive patients with non-small cell lung cancer, median overall survival was 43.0 months, compared with 26.3 months for normotensive patients in this group (P = 0.00451). Patients who developed hypertension during treatment with bevacizumab for colorectal cancer and non-small cell lung cancer had significantly prolonged overall survival when compared with normotensive patients. Bevacizumab-induced hypertension may represent a biomarker for clinical benefit in cancer patients treated with bevacizumab. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Cortisol level and hemodynamic changes during tooth extraction at hypertensive and normotensive patients.

PubMed

Agani, Zana Bajrami; Benedetti, Alberto; Krasniqi, Vjosa Hamiti; Ahmedi, Jehona; Sejfija, Zana; Loxha, Mergime Prekazi; Murtezani, Arben; Rexhepi, Aida Namani; Ibraimi, Zana

2015-04-01

The patients that are subjects to oral-surgical interventions produce large amounts of steroids in comparison with healthy patients which are not a subject to any dental intervention. The aim of research was to determine the level of stress hormone cortisol in serum, arterial blood pressure and arterial pulse, and to compare the effectiveness of the usage of lidocaine with adrenalin in comparison with lidocaine without adrenalin during the tooth extraction. This clinical research includes patients with indication of tooth extraction divided in hypertensive and normotensive patients. There is no important statistical distinction between groups, for the cortisol levels before, during and after tooth extraction regardless of the type of anesthetic used, while we registered higher values of systolic and diastolic values at hypertensive patients, regardless of the type of anesthetic. There is significant systolic and diastolic blood pressure rise in both groups of patients hypertensive and normotensive patients, (regardless of anesthetic used with or without vasoconstrictor), who underwent tooth extraction. The special emphasize is attributed to hypertensive patients where these changes are more significant. As per cortisol level and pulse rate, our results indicate no significant statistical difference in between groups.

Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China

PubMed Central

Wang, Jiaojiao; Ma, Jian James; Liu, Jiaqi; Zeng, Daniel Dajun; Song, Cynthia; Cao, Zhidong

2017-01-01

Hypertension is a severe threat to human being's health due to its association with many comorbidities. Many research works have explored hypertension's prevalence and treatment. However, few considered impact of patient's socioeconomic status and geographical disparities. We intended to fulfill that research gap by analyzing the association of the prevalence of hypertension and three important comorbidities with various socioeconomic and geographical factors. We also investigated the prevalence of those comorbidities if the patient has been diagnosed with hypertension. We obtained a large collection of medical records from 29 hospitals across China. We utilized Bayes' Theorem, Pearson's chi-squared test, univariate and multivariate regression methods and geographical detector methods to analyze the association between disease prevalence and risk factors. We first attempted to quantified and analyzed the spatial stratified heterogeneity of the prevalence of hypertension comorbidities by q-statistic using geographical detector methods. We found that the demographic and socioeconomic factors, and hospital class and geographical factors would have an enhanced interactive influence on the prevalence of hypertension comorbidities. Our findings can be leveraged by public health policy makers to allocate medical resources more effectively. Healthcare practitioners can also be benefited by our analysis to offer customized disease prevention for populations with different socioeconomic status. PMID:28367080

Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China.

PubMed

Wang, Jiaojiao; Ma, Jian James; Liu, Jiaqi; Zeng, Daniel Dajun; Song, Cynthia; Cao, Zhidong

2017-01-01

Hypertension is a severe threat to human being's health due to its association with many comorbidities. Many research works have explored hypertension's prevalence and treatment. However, few considered impact of patient's socioeconomic status and geographical disparities. We intended to fulfill that research gap by analyzing the association of the prevalence of hypertension and three important comorbidities with various socioeconomic and geographical factors. We also investigated the prevalence of those comorbidities if the patient has been diagnosed with hypertension. We obtained a large collection of medical records from 29 hospitals across China. We utilized Bayes' Theorem, Pearson's chi-squared test, univariate and multivariate regression methods and geographical detector methods to analyze the association between disease prevalence and risk factors. We first attempted to quantified and analyzed the spatial stratified heterogeneity of the prevalence of hypertension comorbidities by q-statistic using geographical detector methods. We found that the demographic and socioeconomic factors, and hospital class and geographical factors would have an enhanced interactive influence on the prevalence of hypertension comorbidities. Our findings can be leveraged by public health policy makers to allocate medical resources more effectively. Healthcare practitioners can also be benefited by our analysis to offer customized disease prevention for populations with different socioeconomic status.

Trust in One’s Physician: The Role of Ethnic Match, Autonomy, Acculturation, and Religiosity Among Japanese and Japanese Americans

PubMed Central

Tarn, Derjung M.; Meredith, Lisa S.; Kagawa-Singer, Marjorie; Matsumura, Shinji; Bito, Seiji; Oye, Robert K.; Liu, Honghu; Kahn, Katherine L.; Fukuhara, Shunichi; Wenger, Neil S.

2005-01-01

PURPOSE Trust is a cornerstone of the physician-patient relationship. We investigated the relation of patient characteristics, religiosity, acculturation, physician ethnicity, and insurance-mandated physician change to levels of trust in Japanese American and Japanese patients. METHODS A self-administered, cross-sectional questionnaire in English and Japanese (completed in the language of their choice) was given to community-based samples of 539 English-speaking Japanese Americans, 340 Japanese-speaking Japanese Americans, and 304 Japanese living in Japan. RESULTS Eighty-seven percent of English-speaking Japanese Americans, 93% of Japanese-speaking Japanese Americans, and 58% of Japanese living in Japan responded to trust items and reported mean trust scores of 83, 80, and 68, respectively, on a scale ranging from 0 to 100. In multivariate analyses, English-speaking and Japanese-speaking Japanese American respondents reported more trust than Japanese respondents living in Japan (P values <.001). Greater religiosity (P <.001), less desire for autonomy (P <.001), and physician-patient relationships of longer duration (P <.001) were related to increased trust. Among Japanese Americans, more acculturated respondents reported more trust (P <.001), and Japanese physicians were trusted more than physicians of another ethnicity. Among respondents prompted to change physicians because of insurance coverage, the 48% who did not want to switch reported less trust in their current physician than in their former physician (mean score of 82 vs 89, P <.001). CONCLUSIONS Religiosity, autonomy preference, and acculturation were strongly related to trust in one’s physician among the Japanese American and Japanese samples studied and may provide avenues to enhance the physician-patient relationship. The strong relationship of trust with patient-physician ethnic match and the loss of trust when patients, in retrospect, report leaving a preferred physician suggest unintended

Impact of sildenafil on survival of patients with idiopathic pulmonary arterial hypertension.

PubMed

Zeng, Wei-Jie; Sun, Yun-Juan; Gu, Qing; Xiong, Chang-Ming; Li, Jian-Jun; He, Jian-Guo

2012-09-01

It has been reported that short-term sildenafil therapy is safe and effective for patients with pulmonary arterial hypertension. However, data regarding the impact of sildenafil on the survival of patients with idiopathic pulmonary arterial hypertension remain limited. The study was conducted on 77 patients with newly diagnosed idiopathic pulmonary arterial hypertension at Fu Wai Hospital between September 2005 and September 2009. Patients were divided into 2 groups: the sildenafil group and the conventional group. Nine patients treated with sildenafil were re-evaluated by right heart catheterization after 3 months. Our data demonstrated that the 6-minute walk distance, World Health Organization functional class, mixed venous oxygen saturation, and hemodynamics significantly improved after 3 months of sildenafil therapy (P < .05). The baseline characteristics of the sildenafil group were similar to those of the conventional group. The 1-, 2-, and 3-year survival rates in the sildenafil group were 88%, 72%, and 68% compared with 61%, 36%, and 27% in the conventional group (P < .001). The absence of sildenafil therapy, lower body mass index, and lower mixed venous oxygen saturation were found to be independent predictors of mortality. In conclusion, sildenafil therapy was found to be associated with improved survival in patients with idiopathic pulmonary arterial hypertension.

Target organ damage in hypertensive patients of different ethnic groups.

PubMed

Wolak, Talya; Anfanger, Sharon; Wolak, Arik; Furman, Tsilla; Abuara'ar, Touphic; Biton, Amnon; Pilpel, Dina; Paran, Esther

2007-03-20

Hypertension is associated with involvement of target organs which varies among the different ethnic groups. The multiplicity of the population in Israel offers an opportunity for evaluating target organ damage in hypertensive patients of different ethnic origins. Data were collected from the computerized medical files of hypertensive patients in primary care clinics. The analysis was done on 576 hypertensive patients: 138 Bedouins (Arab residents), 141 Sephardic Jews (immigrants from North Africa and the Middle East), 152 Asian-Indian Jews (immigrants from India) and 145 Ashkenazi Jews (immigrants from Europe and North and South America). In multivariable logistic regressions adjusted for known risk factors and ethnicity, the prevalence of cerebrovascular disease was the highest among the Asian-Indian Jews (OR=3.09, p value=0.009). Renal damage was highest among the Bedouins (OR=4.54, p value<0.0001) and Asian-Indian Jews (OR=2.88, p value=0.005). The differences in the prevalence of renal damage among the various ethnic groups were even more pronounced among patients without diabetes (OR=8.31, p value<0.0001 in Bedouins and OR=7.46, p value=0.001 in Asian-Indian Jews). The prevalence of ischemic heart disease did not differ significantly among the four ethnic groups. The prevalence of cerebrovascular and renal diseases are both significantly associated with ethnic origin of Asian-Indian Jews and Bedouins. However, the multivariate analysis shows that the prevalence of ischemic heart disease is not associated with ethnicity.

[Clinical, electrocardiographic and echocardiographic aspects in elderly hypertensive patients in Senegal].

PubMed

Sarr, Simon Antoine; Babaka, Kana; Mboup, Mouhamadou Cherif; Fall, Pape Diadie; Dia, Khadidiatou; Bodian, Malick; Ndiaye, Mouhamadou Bamba; Kane, Adama; Diao, Maboury; Ba, Serigne Abdou

2016-01-01

Arterial hypertension (HTA) in the elderly is an independent risk factor for cardiovascular disease. Our study aims to describe the clinical, electrocardiographic and echocardiographic aspects of Arterial hypertension in elderly patients. We conducted a descriptive, cross-sectional study from January to September 2013. Hypertensive patients =60 years treated in Outpatient Cardiology Department at the Principal Hospital in Dakar were included in the study. Statistical data were analyzed using Epi Info 7 software and a p-value < 0.05 was taken as significant. A total of 208 patients were enrolled in the study. The average age was 69.9 years with a female predominance (sex ratio 0.85). Average blood pressure was 162/90 mm Hg. HTA was under control in 13% of cases. The ECG showed evidence of rhythm disturbance (17.78%), left atrial enlargement (45.19%), left ventricular hypertrophy (28.85%) and complete atrioventricular block in 2 cases. Holter ECG revealed non-sustained ventricular tachycardia (Lown class IVb) in 4 cases, paroxysmal atrial fibrillation in 6 cases and paroxysmal atrial flutter in 1 case. Echocardiography performed in 140 patients showed mainly concentric left ventricular hypertrophy in 25 patients, occuring more frequently in males (p=0,04) and dilated left atrium in 56,42% of cases, occuring more frequently in elderly patients (p= 0,01). Electrocardiographic and echocardiographic aspects in elderly hypertensive population are characterized by concentric left ventricular hypertrophy and by the frequency of arrhythmias sometimes revealed by long-term continuous external electrocardiographic recording.

Blood Pressure Control in Hypertensive Patients in the "Hiperdia Program": A Territory-Based Study

PubMed Central

de Souza, Clarita Silva; Stein, Airton Tetelbom; Bastos, Gisele Alsina Nader; Pellanda, Lucia Campos

2014-01-01

Background Systemic hypertension is highly prevalent and an important risk factor for cardiovascular events. Blood pressure control in hypertensive patients enrolled in the Hiperdia Program, a program of the Single Health System for the follow-up and monitoring of hypertensive patients, is still far below the desired level. Objective To describe the epidemiological profile and to assess blood pressure control of patients enrolled in Hiperdia, in the city of Novo Hamburgo (State of Rio Grande do Sul, Brazil). Methods Cross-sectional study with a stratified cluster random sample, including 383 adults enrolled in the Hiperdia Program of the 15 Basic Health Units of the city of Porto Alegre, conducted between 2010 and 2011. Controlled blood pressure was defined as ≤140 mmHg × 90 mmHg. The hypertensive patients were interviewed and their blood pressure was measured using a calibrated aneroid device. Prevalence ratios (PR) with 95% confidence interval, Wald's χ2 test, and simple and multiple Poisson regression were used in the statistical analysis. Results The mean age was 63 ± 10 years, and most of the patients were females belonging to social class C, with a low level of education, a sedentary lifestyle, and family history positive for systemic hypertension. Diabetes mellitus (DM) was observed in 31%; adherence to the antihypertensive treatment in 54.3%; and 33.7% had their blood pressure controlled. DM was strongly associated with inadequate BP control, with only 15.7% of the diabetics showing BP considered as controlled. Conclusion Even for hypertensive patients enrolled in the Hiperdia Program, BP control is not satisfactorily reached or sustained. Diabetic hypertensive patients show the most inappropriate BP control. PMID:25004419

Oxidative stress in patients with essential hypertension: a comparison of dippers and non-dippers.

PubMed

Gönenç, Aymelek; Hacışevki, Aysun; Tavil, Yusuf; Çengel, Atiye; Torun, Meral

2013-03-01

Oxidative stress seems to play an important role in the pathophysiology of essential hypertension. We aimed to examine serum MDA, NO, 8-OHdG, ADMA, NT, CoQ10 and TAC as biomarkers of oxidative stress in dipper and non-dipper hypertensive patients. Eighteen dipper hypertensives, 20 non-dipper hypertensives and 22 healthy control subjects were included in the study. Clinical assessment and ambulatory blood pressure monitoring were performed in patients. Serum MDA, TAC and NO levels were measured by using spectrophotometric methods. CoQ10 levels were measured by HPLC method. 8-OHdG, ADMA and NT were quantitated by ELISA methods. MDA levels were significantly higher in dipper and non-dipper groups compared to controls (p<0.05 and p<0.01, respectively). TAC levels were found at low level in patients dipper and non-dipper patients compared to control group (p<0.01). Higher ADMA and NT levels but lower CoQ10 levels were found in non-dipper group compared to healthy controls (p<0.01, p<0.05, and p<0.05, respectively). ADMA levels were found higher in non-dipper group than those of dipper group (p<0.01). Increased ADMA, NT levels and decreased CoQ10 levels in non-dipper hypertensive patients might indicate more severe oxidative stres compared with dipper hypertensive patients, which plays an important role in the development of cardiovascular diseases. Increased MDA and reduced TAC levels might be considered as prospective prognostic markers of the development of cardiovascular diseases in dipper and non-dipper hypertensive patients. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Hypertensive crisis in a patient with thyroid cancer.

PubMed

Asha, H S; Seshadri, M S; Rajaratnam, Simon

2012-01-01

Phaeochromocytomas may be discovered incidentally when patients present with hypertensive crisis during general anaesthesia. A 49-year-old man underwent thyroidectomy 25 years ago and was diagnosed to have spindle cell carcinoma of the thyroid. He presented with recent onset of hoarseness of voice and was found to have a vocal cord nodule. He developed a hypertensive crisis during surgery. He was subsequently evaluated and found to have bilateral phaeochromocytoma. Further evaluation revealed a RET proto-oncogene mutation at codon 634 consistent with multiple endocrine neoplasia (MEN)-2A. Copyright 2012, NMJI.

Improving Hypertension Control and Patient Engagement Using Digital Tools.

PubMed

Milani, Richard V; Lavie, Carl J; Bober, Robert M; Milani, Alexander R; Ventura, Hector O

2017-01-01

Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available that transmitted data directly to the electronic medical record. Digital-medicine patients averaged 4.2 blood pressure readings per week. At 90 days, 71% of digital-medicine vs 31% of usual-care patients had achieved target blood pressure control. Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine, vs 4/2 mm Hg in usual care (P < .001). Excess sodium consumption decreased from 32% to 8% in the digital-medicine group (P = .004). Mean patient activation increased from 41.9 to 44.1 (P = .008), and the percentage of patients with low patient activation decreased from 15% to 6% (P = .03) in the digital-medicine group. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Pleiotropic Effects of Losartan in Hypertensive Patients with Dyslipidemia.

PubMed

Sivasubramaniam, Sivakumar; Kumarasamy, Banupriya

2017-09-01

In essential hypertension, the comorbidity of dyslipidemia is very common. In addition to hypertension, dyslipidemia is linked to cardiovascular disease, stroke and decline in renal function. Unlike other angiotensin receptor blockers, Losartan has been claimed to have unique pleiotropic property and thereby decreasing the risk of future cardiovascular complications. The present study was done to assess on the pleiotropic effect of losartan in newly diagnosed hypertensive patients with dyslipidemia. Fifty four hypertensive patients with dyslipidemia who fulfilled the eligible criteria and were willing to give informed consent were included in the study after getting Institutional Ethical Committee (IEC) approval. All the study participants were given tab. Losartan 50mg once daily for four weeks. At the end of 1st, 2nd, 3rd and 4th week, blood pressure control and compliance were monitored. At the end of 4th week all the baseline laboratory parameters like renal function test, liver function test, lipid prolife and random blood sugar were performed. The EQ-5D questionnaires were completed at two points during the study: at the patient's initial visit before enrollment in the study and after 4 weeks of Losartan therapy. Appropriate statistical methods were used to analyse the results.The primary endpoint was reduction in blood pressure and improvement in lipid profile and improvement in quality of life score from baseline after 4 weeks of losartan therapy. Four patients were withdrawn due to non-compliance and totally 50 patients completed the study. The mean systolic blood pressure was reduced from 154.54 mm Hg to 138.16 mm Hg with p<0.0001 and the mean diastolic blood pressure was reduced from 91.56 mm Hg to 82.44 mm Hg with p<0.0001. There was a significant reduction in the mean total cholesterol from 189.52 to 180.46 mg/dl, mean LDL from 110.50 to 101.32 mg/dl and mean triglygeride from 135.68 to 127.70 mg/dl with p<0.0001. Improvements in anxiety and depression

Clinical characteristics of Japanese patients with severe hypertriglyceridemia.

PubMed

Tada, Hayato; Kawashiri, Masa-Aki; Nakahashi, Takuya; Yagi, Kunimasa; Chujo, Daisuke; Ohbatake, Azusa; Mori, Yukiko; Mori, Shunsuke; Kometani, Mitsuhiro; Fujii, Hiroshi; Nohara, Atsushi; Inazu, Akihiro; Mabuchi, Hiroshi; Yamagishi, Masakazu; Hayashi, Kenshi

2015-01-01

Although of interest, few data exist on the clinical characteristics of Japanese patients with an extremely high triglyceride level (≥ 1000 mg/dL). We assessed the clinical characteristics of Japanese patients with an extremely high triglyceride level. We investigated the presence of coronary artery disease, history of pancreatitis, the presence of fatty liver, and the potential causes of elevated triglyceride in Japanese subjects with an extremely high level of fasting triglyceride (≥ 1000 mg/dL) among 70,368 subjects whose serum triglyceride was measured for any reason at Kanazawa University Hospital from April 2004 to March 2014. We identified 215 (0.31%) subjects (mean age, 46 years; male, 170, mean body mass index, 25 kg/m(2)) with severe hypertriglyceridemia. Among them, 4 (1.9%) subjects were classified as type I, 97 (45.1%) subjects were type IV, and 114 (53.0%) subjects were type V hyperlipidemia, according to Fredrickson's classification. Among 215 subjects, 116 subjects (54.0%) drank alcohol, 58 (27.0%) showed heavy intake (≥ 60 g/d), and 64 (29.8%) subjects had diabetes. In total, 59 (27.4%) subjects had transient severe hypertriglyceridemia caused by corticosteroids (N = 19), antidepressant (N = 18), l-asparaginase and steroids for acute lymphoid leukemia (N = 15), hormone replacement therapy for breast cancer (N = 9), β-blocker (N = 5), hypothyroidism (N = 4), pregnancy (N = 4), and panhypopituitarism (N = 2). As many as 119 (55.3%) subjects exhibited fatty liver. Moreover, 12 (5.6%) and 17 (7.9%) subjects had a history of pancreatitis and coronary artery disease, respectively. A variety of situations can cause severe hypertriglyceridemia. We suggest that potential secondary causes should be carefully assessed for such patients. Copyright © 2015 National Lipid Association. Published by Elsevier Inc. All rights reserved.

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension.

PubMed

Muela, Henrique C S; Costa-Hong, Valeria A; Yassuda, Mônica S; Moraes, Natália C; Memória, Claudia M; Machado, Michel F; Bor-Seng-Shu, Edson; Nogueira, Ricardo C; Mansur, Alfredo J; Massaro, Ayrton R; Nitrini, Ricardo; Macedo, Thiago A; Bortolotto, Luiz A

2018-01-01

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness. ©2017 Wiley Periodicals, Inc.

[Resistant arterial hypertension in Primary Care patients in Spain. PRESCAP Study 2010].

PubMed

Cinza-Sanjurjo, S; Alonso-Moreno, F J; Prieto-Díaz, M Á; Divisón-Garrote, J A; Rodríguez-Roca, G C; Llisterri-Caro, J L

2015-04-01

To determine the prevalence and clinical and epidemiological characteristics of Primary Care patients with resistant hypertension (RHT) in Spain. A cross-sectional multicenter study was conducted on hypertensive patients aged 18 or over and seen in a Primary Care clinic. RHT was considered as the presence of uncontrolled blood pressure in patients treated with at least 3 drugs, one of which is a diuretic. Of the 12,961 hypertensive patients in the PRESCAP 2010 study, 962 (7.4%) fulfilled criteria for RHT, of whom 51% were women, and with a mean age (SD) 68.8 [11.4] years. Patients with RHT were older (68.80 [10.69] years vs. 66.06 [11.44] years, P<.001), had a higher prevalence of obesity (55.2 vs. 38.6%, P<.001), a higher waist circumference (103.90 [13.89] vs. 99.32 [13.69] cm, P<.001), and a higher prevalence of DM (48.3 vs. 29.5%, P<.001). The prevalence of target organ damage (73.0 vs. 61.4%, P<.001) and cardiovascular disease (46.7 vs. 26.8%, P<.001) were higher in patients with resistant hypertension. The multivariate analysis showed that the variables associated with resistant hypertension were the presence of cardiovascular disease, diabetes mellitus, sedentary life style, microalbuminuria, body mass index, duration of AHT, and triglycerides. The prevalence of RHT in Primary Care patients is related to inappropriate lifestyles, the presence of target organ damage, and cardiovascular disease. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Applying Japanese management tips to patient accounts.

PubMed

Groenevelt, C J

1990-04-01

"Just in time," a Japanese management philosophy that has been applied successfully in manufacturing operations, also can be used to improve management of patient accounts departments. Under its principles, healthcare organizations would develop standardized procedures; involve workers in decision making; set up training and education programs aimed at creating a multi-skilled pool of workers; establish smooth production schedules; and foster cooperation and commitment to the philosophy throughout the organization.

Cortisol Level and Hemodynamic Changes During Tooth Extraction at Hypertensive and Normotensive Patients

PubMed Central

Agani, Zana Bajrami; Benedetti, Alberto; Krasniqi, Vjosa Hamiti; Ahmedi, Jehona; Sejfija, Zana; Loxha, Mergime Prekazi; Murtezani, Arben; Rexhepi, Aida Namani; Ibraimi, Zana

2015-01-01

Background: The patients that are subjects to oral-surgical interventions produce large amounts of steroids in comparison with healthy patients which are not a subject to any dental intervention. The aim of research was to determine the level of stress hormone cortisol in serum, arterial blood pressure and arterial pulse, and to compare the effectiveness of the usage of lidocaine with adrenalin in comparison with lidocaine without adrenalin during the tooth extraction. Patients and methods: This clinical research includes patients with indication of tooth extraction divided in hypertensive and normotensive patients. Results: There is no important statistical distinction between groups, for the cortisol levels before, during and after tooth extraction regardless of the type of anesthetic used, while we registered higher values of systolic and diastolic values at hypertensive patients, regardless of the type of anesthetic Conclusion: There is significant systolic and diastolic blood pressure rise in both groups of patients hypertensive and normotensive patients, (regardless of anesthetic used with or without vasoconstrictor), who underwent tooth extraction. The special emphasize is attributed to hypertensive patients where these changes are more significant. As per cortisol level and pulse rate, our results indicate no significant statistical difference in between groups. PMID:26005263

High incidence of secondary hypertension in patients referred for renal denervation--the Copenhagen experience.

PubMed

Olsen, Lene Kjær; Kamper, Anne-Lise; Svendsen, Jesper Hastrup; Bang, Lia Evi; Frimodt-Møller, Marie; Kelbæk, Henning; Sander, Mikael; Feldt-Rasmussen, Bo

2014-08-01

Percutaneous renal denervation is a new treatment option for patients with resistant hypertension and little is known about the eligibility of patients referred. 100 consecutive patients were referred for renal denervation from March 2011 through September 2012. Clinical data were prospectively extracted from letters and documents from referring clinics and from our physical examination. Of the 100 patients included, 68 were men and the mean age was 60 (± 12) years. Office blood pressure was 176 (± 28)/99 (± 19) mmHg and 24-h ambulatory blood pressure 156 (± 20)/88 (± 13) mmHg. The mean number of antihypertensive agents was 4.0 (± 1.6). Nearly four-fifths (82%) of the patients were categorized as having resistant hypertension based on the criteria stated by The American Heart Association's stated criteria. Nine patients declined interest in renal denervation before completing the clinical workup program. Thus, 91 patients were screened, and of those 51 were found to be candidates for renal denervation. Forty patients were not candidates, of which secondary hypertension was the most common cause (n = 10). Only 51% of patients referred for renal denervation were eligible for treatment. The prevalence of secondary hypertension was 10% of the referred population. Secondary hypertension should therefore be considered in the evaluation of candidates for renal denervation.

Correlates of serum lipids and lipoproteins in Congolese patients with arterial hypertension.

PubMed

Lepira, F B; M'Buyamba-Kabangu, J R; Kayembe, K P; Nseka, M N

2005-01-01

The purpose of this study was to assess the prevalence of dyslipidaemia and the correlates of serum lipids and lipoproteins among Congolese subjects with and without arterial hypertension. One hundred hypertensive patients attending the outpatient clinics at the University of Kinshasa Hospital, and 100 age- and sex-matched controls recruited among hospital personnel or blood donors entered the case-control study. Their blood pressure (BP), heart rate (HR), body mass index (BMI), waist-to-hip ratio (WHR), serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), plasma fibrinogen (only in patients) and fasting glucose, serum uric acid, creatinine and creatinine clearance (CrCl) were compared using the Student's t-test or Chi-square test as appropriate. Associations between continuous variables were assessed with Pearson correlation coefficients, and correlates of lipids and lipoproteins were determined using multiple linear-regression analysis. Compared to healthy controls, hypertensive patients had greater BMI (p hypertensives), LDL-C (3.46 +/- 1.16 mmol/l vs 3.36 +/- 1.32 mmol/l) and HDL-C (1.19 +/- 0.39 mmol/l vs 1.27 +/- 0.39 mmol/l) were similar and within the normal ranges, whereas TG in hypertensives (1.03 +/- 0.66 mmol/l) were significantly higher (p hypertensive patients (40%). Sixteen controls (16%) and 23 hypertensive patients (23%) had TC >or= 6.20 mmol/l. In hypertensive patients, TC (r = 0.24; p < 0.01) and LDL-C (r = 0.20; p < 0.05) were positively correlated to plasma fibrinogen. A positive correlation was also observed between TC and

Correlation between homocysteine and dyslipidemia in ischaemic stroke patients with and without hypertension

NASA Astrophysics Data System (ADS)

Aria Arina, Cut; Amir, Darwin; Siregar, Yahwardiah; Sembiring, Rosita J.

2018-03-01

Almost 80% of strokes are ischaemic and stroke is the third most common cause of death in developed countries, . The treatment of stroke still limited, the best approach to reduce mortality and morbidity is primary prevention through modification of acquired risk factors. Hypertension and dyslipidemia are one of the major risk factor for stroke while homocysteine is a less well-documented risk factor. The purpose of this study was to know the correlation between homocysteine and dyslipidemia in ischaemic stroke patients with and without hypertension. This study is a cross sectional study; the sample were taken consecutively. All sample matched with inclusion and exclusion criteria, demography data and blood sample were taken. Demography data was analyzed using descriptive statistic, to analyze the relation, we used Chi-Square test. p value <0,05 was significant. Of the 100 patients, were divided into two groups, with hypertension, and without hypertension, hyperhomocysteinemia was found in 62 patients (59 patients had mild hyperhomocysteinemia, three patients had moderate hyperhomocysteinemia) and dyslipidemia was found in 60 patients. There is a significant relation between homocysteine and dyslipidemia in ischaemic stroke patients with hypertension, p value = 0,009. A significant correlation between homocysteine and dyslipidemia might be because both of them have an important role in the acceleration of the atherosclerotic formation by activation platelet and thrombus, but we still need further study to get more explanation about the relation.

Can stories influence African-American patients' intentions to change hypertension management behaviors? A randomized control trial.

PubMed

Bokhour, Barbara G; Fix, Gemmae M; Gordon, Howard S; Long, Judith A; DeLaughter, Kathryn; Orner, Michelle B; Pope, Charlene; Houston, Thomas K

2016-09-01

Information-only interventions for hypertension management have limited effectiveness, particularly among disadvantaged populations. We assessed the impact of viewing African-American patients' stories of successfully controlling hypertension on intention to change hypertension management behaviors and engagement with educational materials. In a three-site randomized trial, 618 African-American Veterans with uncontrolled hypertension viewed an information-only DVD about hypertension (control) or a DVD adding videos of African-American Veterans telling stories about successful hypertension management (intervention). After viewing, patients were asked about their engagement with the DVD, and their intentions to change behavior. Mean scores were compared with two-sided t-tests. Results favored the Stories intervention, with significantly higher emotional engagement versus control (4.3 vs. 2.2 p<0.0001). Intervention patients reported significantly greater intentions to become more physically active (4.6 vs. 4.4, p=0.018), use salt substitutes (3.9 vs. 3.4, p=0.006), talk openly with their doctor about hypertension (4.6 vs. 4.5, p=0.049), and remember to take hypertension medication (4.8 vs. 4.6, p=0.04). Patients were more emotionally engaged and reported intentions to change behavior when watching real patient hypertension management success stories. Stories may be more influential than information alone, and represent a scalable approach to modifying behavioral intention. Published by Elsevier Ireland Ltd.

Self-reported sitting time and prevalence of erectile dysfunction in Japanese patients with type 2 diabetes mellitus: The Dogo Study.

PubMed

Furukawa, Shinya; Sakai, Takenori; Niiya, Tetsuji; Miyaoka, Hiroaki; Miyake, Teruki; Yamamoto, Shin; Kanzaki, Sayaka; Maruyama, Koutatsu; Tanaka, Keiko; Ueda, Teruhisa; Senba, Hidenori; Torisu, Masamoto; Minami, Hisaka; Tanigawa, Takeshi; Matsuura, Bunzo; Hiasa, Yoichi; Miyake, Yoshihiro

2017-01-01

No evidence exists regarding the association between sitting time and erectile dysfunction (ED) among patients with type 2 diabetes mellitus. The aim of this study was to evaluate the association between self-reported sitting time and ED among patients with type 2 diabetes mellitus. Study subjects were 430 male Japanese patients with type 2 diabetes mellitus (mean age, 60.5years). A self-administered questionnaire was used to collect information on the variables under study. The study subjects were asked about time spent sitting during typical 24-hour periods over the past 12months. Subjects were divided into four groups according to self-reported sitting time: 1) <5hours, 2) 5-7hours, 3) 7-9hours, and 4) ≥9hours. ED was defined as present when a subject had a Sexual Health Inventory for Men score <8. Adjustment was made for age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, coronary artery disease, stroke, glycated hemoglobin, walking habit, and diabetic neuropathy. The prevalence values of moderate to severe ED and severe ED were 36.1% and 49.8%. At least 9hours sitting was independently positively associated with severe ED but not moderate to severe ED; the adjusted OR was 1.84 (95% CI: 1.06-3.33). In the multivariate model, there was a statistically significant inverse exposure-response relationship between the self-reported sitting time and severe ED (p for trend=0.029). Self-reported sitting time may be positively associated with ED in Japanese patients with type 2 diabetes mellitus. Copyright © 2017 Elsevier Inc. All rights reserved.

Perceived involvement and preferences in shared decision-making among patients with hypertension.

PubMed

Mah, Hui Chin; Muthupalaniappen, Leelavathi; Chong, Wei Wen

2016-06-01

Shared decision-making (SDM) is an important component of patient-centred care. However, there is limited information on its implementation in Malaysia, particularly in chronic diseases such as hypertension. The objective of this study was to examine perceived involvement and role preferences of patients with hypertension in treatment decision-making. A cross-sectional survey was conducted among 210 patients with hypertension in a teaching hospital in Malaysia. The majority of respondents agreed that their doctor recognized that a decision needs to be made (89.5%) and informed them that different options are available (77.1%). However, respondents' perceived level of involvement in other aspects of treatment decision-making process was low, including in the selection of treatment and in reaching an agreement with their doctor on how to proceed with treatment. In terms of preferred decision-making roles, 51.4% of respondents preferred a collaborative role with their physicians, 44.8% preferred a passive role while only 1.9% preferred an active role. Age and educational level were found to be significantly related to patient preferences for involvement in SDM. Younger patients (<60 years) and those with higher educational level preferred SDM over passive decision-making (ρ < 0.01). Encouragement from health care providers was perceived as a major motivating factor for SDM among patients with hypertension, with 91% of respondents agreeing that this would motivate their participation in SDM. Preferences for involvement in decision-making among patients with hypertension are varied, and influenced by age and educational level. Physicians have a key role in encouraging patients to participate in SDM. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Hypertension management research priorities from patients, caregivers, and healthcare providers: A report from the Hypertension Canada Priority Setting Partnership Group.

PubMed

Khan, Nadia; Bacon, Simon L; Khan, Samia; Perlmutter, Sara; Gerlinsky, Carline; Dermer, Mark; Johnson, Lonni; Alves, Finderson; McLean, Donna; Laupacis, Andreas; Pui, Mandy; Berg, Angelique; Flowitt, Felicia

2017-11-01

Patient- and stakeholder-oriented research is vital to improving the relevance of research. The authors aimed to identify the 10 most important research priorities of patients, caregivers, and healthcare providers (family physicians, nurses, nurse practitioners, pharmacists, and dietitians) for hypertension management. Using the James Lind Alliance approach, a national web-based survey asked patients, caregivers, and care providers to submit their unanswered questions on hypertension management. Questions already answered from randomized controlled trial evidence were removed. A priority setting process of patient, caregiver, and healthcare providers then ranked the final top 10 research priorities in an in-person meeting. There were 386 respondents who submitted 598 questions after exclusions. Of the respondents, 78% were patients or caregivers, 29% lived in rural areas, 78% were aged 50 to 80 years, and 75% were women. The 598 questions were distilled to 42 unique questions and from this list, the top 10 research questions prioritized included determining the combinations of healthy lifestyle modifications to reduce the need for antihypertensive medications, stress management interventions, evaluating treatment strategies based on out-of-office blood pressure compared with conventional (office) blood pressure, education tools and technologies to improve patient motivation and health behavior change, management strategies for ethnic groups, evaluating natural and alternative treatments, and the optimal role of different healthcare providers and caregivers in supporting patients with hypertension. These priorities can be used to guide clinicians, researchers, and funding bodies on areas that are a high priority for hypertension management research for patients, caregivers, and healthcare providers. This also highlights priority areas for improved knowledge translation and delivering patient-centered care. ©2017 Wiley Periodicals, Inc.

Controlled release nifedipine and valsartan combination therapy in patients with essential hypertension: the adalat CR and valsartan cost-effectiveness combination (ADVANCE-combi) study.

PubMed

Saito, Ikuo; Saruta, Takao

2006-10-01

This study was designed to compare the clinical efficacy of two calcium channel blocker-based combination therapies with an angiotensin receptor blocker in Japanese patients with essential hypertension. A 16-week, double-blind, parallel-arm, randomized clinical trial was performed to compare the efficacy and safety of the combination therapy of controlled release nifedipine (nifedipine CR) plus valsartan vs. that of amlodipine plus valsartan. The primary endpoint was the target blood pressure achievement rate. Eligible patients were randomly allocated to nifedipine CR-based or amlodipine-based treatment groups. Patients were examined every 4 weeks to determine whether the blood pressure had reached the target level. When the target level was not achieved, the drug regimen was changed; when the target blood pressure was achieved, the same study medication was continued. A total of 505 patients were enrolled in the study (nifedipine CR group: 245 cases; amlodipine group: 260 cases). After 16 weeks of treatment, blood pressure was significantly reduced in both groups, but to a larger extent in the nifedipine CR group than in the amlodipine group (p < 0.01). The target blood pressure achievement rate was also significantly higher in the nifedipine CR group (p < 0.001). There was no significant difference in the incidence of drug-related adverse events between the groups. These results indicate that the nifedipine CR-based combination therapy was superior to the amlodipine-based therapy for decreasing blood pressure and achieving the target blood pressure in patients with essential hypertension.

Safety and Effectiveness of Mirabegron in Patients with Overactive Bladder in a Real-World Clinical Setting: A Japanese Post-Marketing Study.

PubMed

Nozawa, Yumiko; Kato, Daisuke; Tabuchi, Hiromi; Kuroishi, Kentarou

2018-05-01

To provide real-world data on Japanese patients with overactive bladder (OAB) initiating treatment with the β 3 -adrenoceptor agonist, mirabegron. This study examined prescribing patterns, adverse drug reaction (ADR) incidence, and treatment effectiveness. Full medical histories, including prior/concomitant drug use, were collected before initiating mirabegron treatment. After 12 weeks mirabegron, physicians assessed ADR incidence and treatment effectiveness. Residual urine volume was assessed and patients completed the Overactive Bladder Symptom Score (OABSS) and International Prostate Symptom Score-Quality of Life (I-PSS QoL) surveys at Baseline and 12 weeks. Data were collected between April 2012 and July 2014. Of 9795 OAB patients (46.8% male; 80.8% ≥65 years), 71.7% had coexisting disease [notably benign prostatic hyperplasia (BPH, 32.4%), hypertension (31.9%), and diabetes mellitus (9.4%)] and 53.4% reported concomitant drug use (27.8% α 1 -antagonists, 6.3% anticholinergics). The incidence of total ADRs was 6.07% [including constipation (0.97%), thirst (0.47%), and dysuria (0.44%)], of serious ADRs, 0.21%, of cardiovascular ADRs, 0.48% and of urinary retention, 0.31%. Incidence of total ADRs in patients with concomitant cardiovascular disease was 10.09% and of those related to urinary retention in men with untreated BPH, 0.88%. After 12 weeks treatment, physicians judged mirabegron as "effective" in 80.7% of patients, 63.6% of patients achieved the three-point minimal clinically important change from Baseline in the mean OABSS, and the I-PSS QoL decreased significantly from Baseline (-2.1 ± 1.77; P < 0.001). In the clinical setting, mirabegron is well tolerated, with no unanticipated ADRs, and is an effective treatment for Japanese patients with OAB. © 2016 Astellas Pharma Inc. LUTS: Lower Urinary Tract Symptoms published by John Wiley & Sons Australia, Ltd.

[Thermoregulation in hypertensive elderly patients during physiotherapy].

PubMed

Abramovich, S G

2002-01-01

Effects of therapeutic physical factors on thermoregulation and thermoreactivity of skin were studied in 222 elderly patients with hypertension. It is shown that sodium chloride half-baths, "dry" carbon dioxide baths and general magnetotherapy correct thermal asymmetry and normalize skin thermoreactivity, i.e. produce a positive effect on microcirculation.

Natural history of patients with non cirrhotic portal hypertension: Comparison with patients with compensated cirrhosis.

PubMed

Gioia, Stefania; Nardelli, Silvia; Pasquale, Chiara; Pentassuglio, Ilaria; Nicoletti, Valeria; Aprile, Francesca; Merli, Manuela; Riggio, Oliviero

2018-01-31

The knowledge of natural history of patients with portal hypertension (PH) not due to cirrhosis is less well known than that of cirrhotic patients. To describe the clinical presentation and the outcomes of 89 patients with non-cirrhotic PH (25 with non-cirrhotic portal hypertension, INCPH, and 64 with chronic portal vein thrombosis, PVT) in comparison with 77 patients with Child A cirrhosis. The patients were submitted to a standardized clinical, laboratory, ultrasonographic and endoscopic follow-up. Variceal progression, incidence of variceal bleeding, portal vein thrombosis, ascites and survival were recorded. At presentation, the prevalence of varices, variceal bleeding and ascites was similar in the 3 groups. During follow-up, the rate of progression to varices at risk of bleeding (p < 0.0001) and the incidence of first variceal bleeding (p = 0.02) were significantly higher in non-cirrhotic then in cirrhotic patients. A PVT developed in 32% of INCPH patients and in 18% of cirrhotics (p = 0.02). In the patients with non-cirrhotic PH variceal progression is more rapid and bleeding more frequent than in cirrhotics. Patients with INCPH are particularly prompt to develop PVT. This observational study suggests that the management of patients with non-cirrhotic PH should take into consideration the natural history of portal hypertension in these patients and cannot be simply derived by the observation of cirrhotic patients. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.

Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n =more » 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial

Evaluation of patients with chronic thromboembolic pulmonary hypertension for pulmonary endarterectomy

PubMed Central

Auger, William R.; Kerr, Kim M.; Kim, Nick H.; Fedullo, Peter F.

2012-01-01

Pulmonary hypertension as a result of chronic thromboembolic disease (CTEPH) is potentially curable with pulmonary endarterectomy surgery. Consequently, correctly diagnosing patients with this type of pulmonary hypertension and evaluating these patients with the goal of establishing their candidacy for surgical intervention is of utmost importance. And as advancements in surgical techniques have allowed successful resection of segmental-level chronic thromboembolic disease, the number of CTEPH patients that are deemed suitable surgical candidates has expanded, making it even more important that the evaluation be conducted with greater precision. This article will review a diagnostic approach to patients with suspected chronic thromboembolic disease with an emphasis on the criteria considered in selecting patients for pulmonary endarterectomy surgery. PMID:22837856

Association between SCO2 mutation and extreme myopia in Japanese patients.

PubMed

Wakazono, Tomotaka; Miyake, Masahiro; Yamashiro, Kenji; Yoshikawa, Munemitsu; Yoshimura, Nagahisa

2016-07-01

To investigate the role of SCO2 in extreme myopia of Japanese patients. In total, 101 Japanese patients with extreme myopia (axial length of ≥30 mm) OU at the Kyoto University Hospital were included in this study. Exon 2 of SCO2 was sequenced by conventional Sanger sequencing. The detected variants were assessed using in silico prediction programs: SIFT, PolyPhen-2 and MutationTaster. To determine the frequency of the mutations in normal subjects, we referred to the 1000 Genomes Project data and the Human Genetic Variation Database (HGVD) in the Human Genetic Variation Browser. The average age of the participants was 62.9 ± 12.7 years. There were 31 males (30.7 %) and 70 females. Axial lengths were 31.76 ± 1.17 mm OD and 31.40 ± 1.07 mm OS, and 176 eyes (87.6 %) out of 201 eyes had myopic maculopathy of grade 2 or more. Among the 101 extremely myopic patients, one mutation (c.290 C > T;p.Ala97Val) in SCO2 was detected. This mutation was not found in the 1000 Genomes Project data or HGVD data. Variant type of the mutation was nonsynonymous. Although the SIFT prediction score was 0.350, the PolyPhen-2 probability was 0.846, thus predicting its pathogenicity to be possibly damaging. MutationTaster PhyloP was 1.268, suggesting that the mutation is conserved. We identified one novel possibility of an extreme myopia-causing mutation in SCO2. No other disease-causing mutation was found in 101 extremely myopic Japanese patients, suggesting that SCO2 plays a limited role in Japanese extreme myopia. Further investigation is required for better understanding of extreme myopia.

Ambulatory blood pressure monitoring can unmask hypertension in patients with psoriasis vulgaris

PubMed Central

Bacaksiz, Ahmet; Erdogan, Ercan; Sonmez, Osman; Sevgili, Emrah; Tasal, Abdurrahman; Onsun, Nahide; Topukcu, Bugce; Kulaç, Beytullah; Uysal, Omer; Goktekin, Omer

2013-01-01

Background Psoriasis vulgaris is one of the most prevalent chronic, inflammatory skin disorders. Patients with psoriasis have excess risk of essential hypertension. Masked hypertension (MH), defined as normal office blood pressure (BP) with elevated ambulatory BP (ABPM), has been drawing attention recently due to its association with increased risk of developing sustained hypertension, cardiovascular morbidity, and mortality. The aim of this study was to investigate the prevalence of MH in psoriatic patients. Material/Methods On hundred and ten middle-aged, normotensive, non-obese patients with psoriasis vulgaris and 110 age- and sex-matched normotensive controls were included in the study. ABPM was performed in all participants over a 24-h period. The clinical severity of the disease was determined according to current indexes. Results The prevalence of MH among subjects with psoriasis vulgaris was 31.8% and increased compared to control subjects (p<0.01). Predictors of MH in patients with psoriasis vulgaris were detected as male sex, smoking, obesity-related anthropometric measures, and disease activity. Male sex, waist circumference, and diffuse psoriatic involvement were detected as independent predictors of MH. Conclusions MH is prevalent in patients with psoriasis vulgaris. Assessment with ABPM and close follow-up for development of hypertension is reasonable. PMID:23800996

Smartphone apps for improving medication adherence in hypertension: patients' perspectives.

PubMed

Morrissey, Eimear C; Casey, Monica; Glynn, Liam G; Walsh, Jane C; Molloy, Gerard J

2018-01-01

Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients' perspectives on smartphone apps to improve medication adherence in hypertension. This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients' perspectives on smartphone apps to improve medication adherence in hypertension: "development of digital competence," "rules of engagement," and "sustainability" of these technologies. These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by "ambivalence."

Hla-B genotype in Japanese patients with Crohn's disease.

PubMed

Kinouchi, Yoshitaka; Matsumoto, Keisuke; Negoro, Kenichi; Takagi, Sho; Takahashi, Seiichi; Hiwatashi, Nobuo; Shimosegawa, Tooru

2003-10-01

The HLA-B gene is one of the susceptibility genes for inflammatory bowel disease. Previous association studies of HLA-B showed several associated alleles and haplotypes of HLA-B in patients with ulcerative colitis, and among the associated alleles HLA-B*52 is well known to be strongly associated with ulcerative colitis in Japanese patients. However, there are no convincing reports about HLA-B including the B*52 allele in patients with Crohn's disease. The purpose of this study was to determine if HLA-B, especially the B*52 allele, confers susceptibility to Crohn's disease or determines the disease phenotype of Crohn's disease. A total of 195 patients with Crohn's disease (49 ileitis, 106 ileocolitis, 34 colitis, 6 uncertain) and 185 healthy controls were studied in this case-controlled study. All patients and healthy controls were Japanese. Genotyping of the HLA-B gene was performed by a polymerase chain reaction, sequence-specific primer that can classify the gene into 23 allele groups. Allele frequencies were compared between patients with Crohn's disease and healthy controls with chi-squared test using a 2 x 2 contingency table. P value was corrected by the number of allele groups (n = 23) observed in the Japanese population or the number of clinical subgroups. Corrected P values of <0.05 were considered to be statistically significant. Before the correction for multiple testing, B*4001 and B*44 were associated with patients with Crohn's disease, positively and negatively, respectively. However, after the correction there were no significant differences in any HLA-B alleles between patients with Crohn's disease and healthy controls. In the subgroup analysis according to clinical phenotypes (disease location, anal lesion, age at diagnosis, need for surgery), none of the HLA-B alleles except B*52 showed any disease phenotype-genotype associations. The allele frequency of B*52 in the colitis type (16.2 percent; corrected P = 0.011) was significantly higher than

Effects of Bariatric Surgery in Obese Patients With Hypertension

PubMed Central

Bersch-Ferreira, Angela Cristine; Santucci, Eliana Vieira; Oliveira, Juliana Dantas; Torreglosa, Camila Ragne; Bueno, Priscila Torres; Frayha, Julia Caldas; Santos, Renato Nakagawa; Damiani, Lucas Petri; Noujaim, Patricia Malvina; Halpern, Helio; Monteiro, Frederico L.J.; Cohen, Ricardo Vitor; Uchoa, Carlos H.; de Souza, Marcio Gonçalves; Amodeo, Celso; Bortolotto, Luiz; Ikeoka, Dimas; Drager, Luciano F.; Cavalcanti, Alexandre Biasi; Berwanger, Otavio

2018-01-01

Background: Recent research efforts on bariatric surgery have focused on metabolic and diabetes mellitus resolution. Randomized trials designed to assess the impact of bariatric surgery in patients with obesity and hypertension are needed. Methods: In this randomized, single-center, nonblinded trial, we included patients with hypertension (using ≥2 medications at maximum doses or >2 at moderate doses) and a body mass index between 30.0 and 39.9 kg/m2. Patients were randomized to Roux-en-Y gastric bypass plus medical therapy or medical therapy alone. The primary end point was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm Hg and 90 mm Hg, respectively, at 12 months. Results: We included 100 patients (70% female, mean age 43.8±9.2 years, mean body mass index 36.9±2.7 kg/m2), and 96% completed follow-up. Reduction of ≥30% of the total number of antihypertensive medications while maintaining controlled blood pressure occurred in 41 of 49 patients from the gastric bypass group (83.7%) compared with 6 of 47 patients (12.8%) from the control group with a rate ratio of 6.6 (95% confidence interval, 3.1–14.0; P<0.001). Remission of hypertension was present in 25 of 49 (51%) and 22 of 48 (45.8%) patients randomized to gastric bypass, considering office and 24-hour ambulatory blood pressure monitoring, respectively, whereas no patient submitted to medical therapy was free of antihypertensive drugs at 12 months. A post hoc analysis for the primary end point considering the SPRINT (Systolic Blood Pressure Intervention Trial) target reached consistent results, with a rate ratio of 3.8 (95% confidence interval, 1.4–10.6; P=0.005). Eleven patients (22.4%) from the gastric bypass group and none in the control group were able to achieve SPRINT levels without antihypertensives. Waist circumference, body mass index, fasting plasma glucose, glycohemoglobin, low-density lipoprotein

Microalbuminuria and plasma aldosterone levels in nondiabetic treatment-naïve patients with hypertension.

PubMed

Catena, Cristiana; Colussi, GianLuca; Martinis, Flavia; Novello, Marileda; Sechi, Leonardo A

2017-12-01

Identification of factors that contribute to urinary albumin losses in hypertensive nephropathy is crucial for prevention of renal deterioration. The aim of this study was to investigate the relationship of low-grade albuminuria with plasma aldosterone levels in treatment-naïve hypertensive patients free of additional comorbidities that might affect renal function. In 242 newly diagnosed patients with uncomplicated primary hypertension, we obtained duplicate 24-h urine collections for measurement of urinary albumin/creatinine ratio (UACR) and measured plasma aldosterone levels. Patients with diabetes, overt proteinuria (>300 mg/day), glomerular filtration rate less than 30 ml/min per 1.73 m, and previous renal diseases were excluded. Increasing UACR was associated with significantly and progressively higher blood pressure (BP), HDL-cholesterol, and plasma aldosterone levels, and with lower glomerular filtration. Microalbuminuria (30-300 mg/day) was detected in 41 (17%) of 242 hypertensive patients, and these patients had significantly higher BP and plasma aldosterone levels (178 ± 113 vs. 128 ± 84 pg/ml; P = 0.001), and lower glomerular filtration than patients without microalbuminuria. UACR was directly and independently correlated with BP and plasma aldosterone levels. In a logistic regression model, presence of microalbuminuria was associated with plasma aldosterone levels independently of glomerular filtration and demographic, anthropometric, and metabolic variables. In nondiabetic, treatment-naïve patients with hypertension, low-grade albuminuria is independently associated with elevated plasma aldosterone. These findings suggest a contribution of aldosterone to the early glomerular changes occurring in hypertensive nephropathy.

Nitro-oxidative stress, VEGF and MMP-9 in patients with cirrhotic and non-cirrhotic portal hypertension.

PubMed

Muti, Leon Adrian; Pârvu, Alina Elena; Crăciun, Alexandra M; Miron, Nicolae; Acalovschi, Monica

2015-01-01

Nitro-oxidative stress may have pathophysiological consequences. The study aimed to assess the nitro-oxidative stress, the vascular growth factor, and metalloproteinase-9 levels in patients with noncirrohic and cirrhotic portal hypertension. Patients with noncirrhotic portal hypertension (n=50) and cirrhotic portal hypertension (n=50) from the 3rd Medical Clinic in Cluj-Napoca Romania were prospectively enrolled between October 2004 and October 2006. A control group of healthy volunteers (n=50) was also evaluated. Nitro-oxidative stress was assessed by measuring serum concentration of nitrites and nitrate, 3-nitrotyrosine, total oxidative status, total antioxidant reactivity, and oxidative stress index. Serum vascular growth factor and matrix metalloproteinase-9 were also determined. Serum nitrites and nitrate levels significantly increased in both noncirrhotic (p<0.001) and cirrhotic portal hypertension (p=0.057). 3-nitrotyrosine also increased in noncirrhotic (p=0.001) and cirrhotic portal hypertension patients (p=0.014). Total oxidative status showed a significant increase in noncirrhotic (p<0.001) and in cirrhotic portal hypertension (p<0.001), but total antioxidant reactivity did not change significantly. The oxidative stress index increased in both noncirrhotic (p <0.001) and cirrhotic portal hypertension (p<0.001), as well as the serum vascular growth factor (p=0.005 and p=0.01, respectively). In NCPHT patients serum MMP-9 was significantly lower than in the healthy controls (p=0.03) and CPHT patients (p=0.05). In patients with noncirrhotic and cirrhotic portal hypertension a significant systemic nitro-oxidative stress was found, correlated with an increase of VEGF. MMP-9 decreased in noncirrhotic portal hypertension.

Telemanagement of hypertension: A qualitative assessment of patient and physician preferences

PubMed Central

Halifax, Nancy VD; Cafazzo, Joseph A; Irvine, M Jane; Hamill, Melinda; Rizo, Carlos A; McIsaac, Warren J; Rossos, Peter G; Logan, Alexander G

2007-01-01

BACKGROUND: Prevalence surveys have consistently found that the blood pressure control rate among people with hypertension is less than 25%. Studies of telemedicine as a means of providing care to hypertensive patients have shown that this approach is effective in lowering blood pressure. Major design flaws and high operating costs, however, have hindered its adoption by physicians and patients. OBJECTIVES: In the present commentary, the field of telemedicine, as it pertains to hypertension management, is reviewed, and the investigators’ experiences in developing a new telemedicine system are outlined. METHODS: An applied qualitative case study approach was used to determine the information needs for the design of a telemedicine system. Opinions were elicited separately from type 2 diabetic patients with hypertension (n=24) and family practitioners in active clinical practice (n=18). RESULTS: Physician and patient focus group meetings provided key information that led to changes in the prototype system. The low level of computer and Internet use by patients in everyday life and by physicians in practice-related activities precluded their inclusion in the design of the system for information retrieval and receiving clinical alerts. For patients, the mobile phone appeared to be an acceptable alternative. The only practical, automated means to disseminate reports and alerts to physicians was by fax, which was the most universally available device in a doctor’s office. CONCLUSION: This tightly focused qualitative study led to the development of design principles for a prototype system, increasing the likelihood of user acceptance and improving its effectiveness. PMID:17534469

Correlation Between Severity Of Portal Hypertensive Gastropathy And Size Of Oesophageal Varices In Cirrhotic Hepatitis-C Patients.

PubMed

Saleem, Khurram; Baig, Faisal Amin; Nida, Mahwish; Javed, Munaza

2018-01-01

Portal hypertension can lead to oesophageal varices (EV) and portal hypertensive gastropathy (PHG). The aim of this study is to determine the relationship between severity of Portal hypertensive gastropathy and size of oesophageal varices. One hundred and ninety-five patients of hepatitis C positive chronic liver disease having oesophageal varices were assessed for severity of portal hypertensive gastropathy. Mild Portal Hypertensive Gastropathy was observed in 16 (8.2 %), moderate in 54 (27.7 %) and severe in 120 (61.6 %) patients. Grade 1 Oesophageal Varices were present in 79 (40.5%) patients, grade 2 in 44 (21.9%) patients, grade 3 in 62 (31.8%) and grade 4 in 10 (5.2%) patients. No significant correlation was observed between grades of gastropathy and size of varices. The frequency of portal hypertensive gastropathy was 97.5% in Hepatitis C positive cirrhotic patients having oesophageal varices. Severity of gastropathy is not related to the grade or size of oesophageal varices.

Prevalence of and risk factors for primary aldosteronism among patients with resistant hypertension in China.

PubMed

Sang, Xiaojing; Jiang, Yiran; Wang, Weiqing; Yan, Li; Zhao, Jiasheng; Peng, Yongde; Gu, Wei; Chen, Gang; Liu, Wei; Ning, Guang

2013-07-01

It is estimated that there are more than 16 million adults with drug-resistant hypertension in China. Nevertheless, the prevalence of and risk factors for primary aldosteronism, a highly curable condition among adults with drug-resistant hypertension, has not been fully investigated. Between January 2010 and October 2011, a multicenter epidemiologic study was conducted among 1656 patients with resistant hypertension in 11 provinces of China. Serum aldosterone and plasma renin activity were measured in every participant and aldosterone-to-renin ratio (ARR) was calculated. Patients with ARR more than 20 underwent an intravenous (i.v.) sodium infusion test, and diagnosis of primary aldosteronism was established by the presence of unsuppressed postinfusion aldosterone (>8 ng/dl). Patients with biochemically proved primary aldosteronism then underwent adrenal computed tomography (CT) scanning and adrenal vein sampling (AVS) for subtype classification. Among the 1656 patients, 494 (29.8%) had ARR greater than 20 and underwent i.v. sodium infusion. Of these 494, 118 were diagnosed as primary aldosteronism, yielding a prevalence of 7.1% (95% confidential interval 5.9-8.3%). Seventy of the 118 patients were categorized into unilateral (39) and bilateral (31) by AVS. Generalized additive regression analysis revealed that among all the factors investigated (age of hypertension onset, BMI, family history of hypertension, cigarette smoking, alcohol consumption, diabetes, serum potassium, hyperlipidemia, and creatinine), only age of hypertension onset and serum potassium were independently associated with the presence of primary aldosteronism. The prevalence of primary aldosteronism among Chinese patients with resistant hypertension is relatively lower than that reported previously for other ethnic populations. The screening for primary aldosteronism should be focused on those with early onset hypertension and/or hypokalemia.

Social support and psychological and physical states among Japanese patients with breast cancer and their spouses prior to surgery.

PubMed

Makabe, Reiko; Nomizu, Tadashi

2006-05-03

To assess social support and psychological and physical states among Japanese patients with breast cancer and their spouses prior to surgery. Descriptive, comparative, and correlational. A general hospital in northern Japan. 38 Japanese patients with breast cancer and their spouses (N = 76). The Japanese versions of three questionnaires were used to collect data before surgery: the Interpersonal Relationship Inventory, the General Health Questionnaire, and the Physical States Interview Form. Social support (support, conflict, and reciprocity), social network, and psychological and physical states. Significant differences were found in support and reciprocity between patients and their spouses. However, no significant differences were found in social network, conflict, or psychological states between patients and their spouses. Moreover, some significant correlations were found in the variables of conflict, social network, and psychological and physical states. Japanese patients with breast cancer perceived more support and reciprocity than their spouses before their breast surgery. Conflict was significantly correlated with psychological states among Japanese women with breast cancer and their spouses. Healthcare professionals need to consider social support as an important factor to help Japanese patients with breast cancer and their spouses cope with the disease.

Baseline Antihypertensive Drug Count and Patient Response to Hypertension Medication Management.

PubMed

Crowley, Matthew J; Olsen, Maren K; Woolson, Sandra L; King, Heather A; Oddone, Eugene Z; Bosworth, Hayden B

2016-04-01

Telemedicine-based medication management improves hypertension control, but has been evaluated primarily in patients with low antihypertensive drug counts. Its impact on patients taking three or more antihypertensive agents is not well-established. To address this evidence gap, the authors conducted an exploratory analysis of an 18-month, 591-patient trial of telemedicine-based hypertension medication management. Using general linear models, the effect of medication management on blood pressure for patients taking two or fewer antihypertensive agents at study baseline vs those taking three or more was compared. While patients taking two or fewer antihypertensive agents had a significant reduction in systolic blood pressure with medication management, those taking three or more had no such response. The between-subgroup effect difference was statistically significant at 6 months (-6.4 mm Hg [95% confidence interval, -12.2 to -0.6]) and near significant at 18 months (-6.0 mm Hg [95% confidence interval, -12.2 to 0.2]). These findings suggest that baseline antihypertensive drug count may impact how patients respond to hypertension medication management and emphasize the need to study management strategies specifically in patients taking three or more antihypertensive medications. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Mortality among patients with hypertension from 1995 to 2005: a population-based study

PubMed Central

Tu, Karen; Chen, Zhongliang; Lipscombe, Lorraine L.

2008-01-01

Background We have reported that the prevalence of diagnosed hypertension increased by 60% from 1995 to 2005 in Ontario. In the present study, we asked whether this increase is explained by a decrease in the mortality rate. Methods We performed a population-based cohort study using linked administrative data for Ontario, a Canadian province with over 12 million residents. We identified prevalent cases of hypertension using a validated case-definition algorithm for hypertension, and we examined trends in mortality from 1995 to 2005 among adults aged 20 years and older with hypertension. Results The age-and sex-adjusted mortality among patients with hypertension decreased from 11.3 per 1000 people in 1995 to 9.6 per 1000 in 2005 (p < 0.001), which is a relative reduction of 15.5%. We found that the relative decrease in age-adjusted mortality was higher among men than among women (–22.2% v. –7.3%, p < 0.001). Interpretation Mortality rates among patients with hypertension have decreased. Along with an increasing incidence, decreased mortality rates may contribute to the increased prevalence of diagnosed hypertension. Sex-related discrepancies in the reduction of mortality warrant further investigation. PMID:18490639

Mortality among patients with hypertension from 1995 to 2005: a population-based study.

PubMed

Tu, Karen; Chen, Zhongliang; Lipscombe, Lorraine L

2008-05-20

We have reported that the prevalence of diagnosed hypertension increased by 60% from 1995 to 2005 in Ontario. In the present study, we asked whether this increase is explained by a decrease in the mortality rate. We performed a population-based cohort study using linked administrative data for Ontario, a Canadian province with over 12 million residents. We identified prevalent cases of hypertension using a validated case-definition algorithm for hypertension, and we examined trends in mortality from 1995 to 2005 among adults aged 20 years and older with hypertension. The age- and sex-adjusted mortality among patients with hypertension decreased from 11.3 per 1000 people in 1995 to 9.6 per 1000 in 2005 (p < 0.001), which is a relative reduction of 15.5%. We found that the relative decrease in age-adjusted mortality was higher among men than among women (-22.2% v. -7.3%, p < 0.001). Mortality rates among patients with hypertension have decreased. Along with an increasing incidence, decreased mortality rates may contribute to the increased prevalence of diagnosed hypertension. Sex-related discrepancies in the reduction of mortality warrant further investigation.

Histological Spectrum of Idiopathic Noncirrhotic Portal Hypertension in Liver Biopsies From Dialysis Patients.

PubMed

Lee, Hwajeong; Ainechi, Sanaz; Singh, Mandeep; Ells, Peter F; Sheehan, Christine E; Lin, Jingmei

2015-09-01

Liver biopsy is performed for various indications in dialysis patients. Being a less-common subset, the hepatic pathology in renal dialysis is not well documented. Idiopathic noncirrhotic portal hypertension (INCPH) is a clinical entity associated with unexplained portal hypertension and/or a spectrum of histopathological vascular changes in the liver. After encountering INCPH and vascular changes of INCPH in 2 renal dialysis patients, we sought to further investigate this noteworthy association. A random search for patients on hemodialysis or peritoneal dialysis with liver biopsy was performed. Hematoxylin and eosin, reticulin, trichrome, and CK7 stains were performed on formalin-fixed, paraffin-embedded tissue sections. Histopathological features were reviewed, and the results were correlated with clinical findings. In all, 13 liver biopsies were retrieved. The mean cumulative duration of dialysis was 50 months (range = 17 months to 11 years). All patients had multiple comorbidities. Indications for biopsy were a combination of abnormal liver function tests (6), portal hypertension (4), ascites (3), and possible cirrhosis (3). Two patients with portal hypertension underwent multiple liver biopsies for diagnostic purposes. All (100%) biopsies showed some histological features of INCPH, including narrowed portal venous lumen (9), increased portal vascular channels (8), shunt vessels (3), dilated sinusoids (9), regenerative nodule (5), and features of venous outflow obstruction (3). No cirrhosis was identified. Liver biopsies from patients on dialysis demonstrate histopathological vascular changes of INCPH. Some (31%) patients present with portal hypertension without cirrhosis. The histological changes may be reflective of underlying risk factors for INCPH in this group. © The Author(s) 2015.

Management of patients with severe hypertension in emergency department, Maharaj Nakorn Chiang Mai hospital.

PubMed

Sruamsiri, Kamphee; Chenthanakij, Boriboon; Wittayachamnankul, Borwon

2014-09-01

Management of patients with severe hypertension without progressive target organ damage remains controversial. Some guidelines mentioned oral anti-hypertensive medication as a treatment to reduce blood pressure in the emergency department, while others recommended against such treatment. To review the management ofpatients with severe hypertension without progressive target organ damage in the emergency department, Maharaj Nakorn Chiang Mai hospital. In a retrospective descriptive analysis study, medical records ofadult patients diagnosed with severe hypertension without progressive target organ damage between January 2011 and December 2012 were reviewed. Patient demographics, data on management including investigation sent and treatment given were collected. Statistical analysis was done by using descriptive statistics and Kruskal-Wallis one-way analysis of variance test. One hundred fifty one medical records were reviewed. Four oral anti-hypertensive medication were used to reduce blood pressure, Amlodipine, Captopril, Hydralazine, and Nifedipine. There were no significant diference between each medication in terms of their effect on bloodpressure reduction (p = 0.513). No side effect or other complications from the use of oral anti-hypertensive medication were recorded The choice of medication used for the treatment of hypertensive urgency ranged from Amlodipine, Captopril, Hydralazine, and Nifedipine, which varied in dosage. However their efficacies were the same when compared with each other and none produced any notable side effects.

[Economic efficiency of renal denervation in patients with resistant hypertension: results of Markov modeling].

PubMed

Kontsevaia, A V; Suvorova, E I; Khudiakov, M B

2014-01-01

Aim of this study was to evaluate the cost-effectiveness of renal denervation (RD) in resistant arterial hypertension (AH) in Russia. Modeling of Markov conducted economic impact of RD on the Russian population of patients with resistant hypertension in combination with optimal medical therapy (OMT) compared with OMT using a model developed by American researchers based on the results of international research. The model contains data on Russian mortality, and costs of major complications of hypertension. The simulation results showed a significant reduction in relative risk reduction of adverse outcomes in patients with resistant hypertension for 10 years (risk of stroke is reduced by 30%, myocardial infarction - 32%). RD saves 0.9 years of quality-adjusted life (QALY) by an average of 1 patient with resistant hypertension. Costs for 1 year stored in the application of quality of life amounted to RD 203 791.6 rubles. Which is below the 1 gross domestic product and therefore indicates the feasibility of this method in Russia.

[Non-pharmacologic treatment of arterial hypertension in hemodialysis patients].

PubMed

Chazot, C; Charra, B

2007-10-01

High blood pressure in dialysis patients is related to extracellular volume excess and the related increase of systemic vascular resistances. Scribner has early described the treatment of hypertension with ultrafiltration and low salt diet, without any drugs. The dry weight method relies on the progressive reduction of the postdialysis body weight until blood pressure is normalized. Additional measures are needed such as low salt diet, neutral sodium balance during dialysis treatment, stop of antihypertensive drugs, adequate length of the dialysis session, and patient education. It may exist a lag time between the normalization of the extracellular volume and blood pressure. It is related to the correction of the hemodynamic consequences of the extracellular volume overload. Moreover, the dry weight may potentially vary in patients undergoing catabolic intercurrent events. The complications of these changes (severe hypertension, pulmonary oedema) must be anticipated by the nephrologist and the staff to avoid additional morbidity to the patient.

FLG mutation p.Lys4021X in the C-terminal imperfect filaggrin repeat in Japanese patients with atopic eczema.

PubMed

Nemoto-Hasebe, I; Akiyama, M; Nomura, T; Sandilands, A; McLean, W H I; Shimizu, H

2009-12-01

Mutations in the gene encoding filaggrin (FLG) have been shown to predispose to atopic eczema (AE). Further to establish population genetics of FLG mutations in the Japanese population and to elucidate effects of FLG mutations to filaggrin biosynthesis in skin of patients with AE. We searched for FLG mutations in 19 newly recruited Japanese patients with AE. We then screened 137 Japanese patients with AE and 134 Japanese control individuals for a novel mutation identified in the present study. In addition, we evaluated FLG mRNA expression by real-time reverse transcription-polymerase chain reaction and profilaggrin/filaggrin protein expression by immunohistochemical staining in the epidermis of the patients carrying the novel mutation. We identified a novel FLG nonsense mutation c.12069A>T (p.Lys4021X) in one patient with AE. Upon further screening, p.Lys4021X was identified in four patients with AE (2.9% of all the patients with AE). In total, there are at least eight FLG variants in the Japanese population. Here we show that about 27% of patients in our Japanese AE case series carry one or more of these eight FLG mutations and these variants are also carried by 3.7% of Japanese general control individuals. There is a significant statistical association between the eight FLG mutations and AE (chi(2) P = 6.50 x 10(-8)). Interestingly, the present nonsense mutation is in the C-terminal incomplete filaggrin repeat and is the mutation nearest the C-terminal among previously reported FLG mutations. Immunohistochemical staining for filaggrin revealed that this nonsense mutation leads to remarkable reduction of filaggrin protein expression in the patients' epidermis. We clearly demonstrated that FLG mutations are significantly associated with AE in the Japanese population. The present results further support the hypothesis that the C-terminal region is essential for proper processing of profilaggrin to filaggrin.

Association between angiotensin II type 1 receptor gene polymorphism and essential hypertension: the Ohasama Study.

PubMed

Sugimoto, Ken; Katsuya, Tomohiro; Ohkubo, Takayoshi; Hozawa, Atsushi; Yamamoto, Koichi; Matsuo, Akiko; Rakugi, Hiromi; Tsuji, Ichiro; Imai, Yutaka; Ogihara, Toshio

2004-08-01

Gene targeting approaches have suggested that the angiotensin II type 1 receptor (AT1R) is involved in blood pressure (BP) regulation and modulation of the effect of angiotensin II. The A1166C polymorphism of the AT1 receptor gene (AT1R/A1166C) is associated with hypertension in Caucasians, but not in Japanese. The goal of this study, the Ohasama Study, was to examine the association between AT1R/A1166C and hypertension, especially home BP, in the Japanese general population. The Ohasama Study was a cohort study based on Japanese rural residents of Ohasama Town in the northern part of Japan. Subjects who gave informed consent to the study protocol and genetic analysis were recruited. Home BP was measured twice in the morning within 1 h of waking up and in the evening just before going to bed. The TaqMan polimerase chain reaction (PCR) method clearly determined AT1R/A1166C genotypes (n =1,207). The genotype distribution of AT1R/A1166C was as follows: AA 84%; AC 15%; CC 1%. There was almost no difference in baseline characteristics among the AT1R genotypes (AA, AC, CC). In the subjects not receiving antihypertensive medication (n =817), both casual BP and home BP were not different among the AT1R genotypes after adjusting for confounding factors (age, sex, body mass index, current smoking habit and current alcohol consumption). The frequency of hypertension showed no difference among AT1R genotypes after adjusting for confounding factors, though the AC and CC genotypes were more frequent in hypertensives than in normotensives. Our data suggested that the AT1R/A1166C polymorphism is not a major genetic predisposing factor for hypertension in Japanese.

Phase I study of single-agent ribociclib in Japanese patients with advanced solid tumors.

PubMed

Doi, Toshihiko; Hewes, Becker; Kakizume, Tomoyuki; Tajima, Takeshi; Ishikawa, Norifumi; Yamada, Yasuhide

2018-01-01

The cyclin D-CDK4/6-INK4-Rb pathway is frequently dysregulated in cancers. Ribociclib, an orally available, selective CDK4/6 inhibitor, showed preliminary clinical activity in a phase I study in the USA and Europe for patients with solid tumors and lymphomas. The present study aimed to determine the single-agent maximum tolerated dose (MTD) and recommended dose for expansion (RDE) in Japanese patients with advanced solid tumors. Ribociclib safety, tolerability, pharmacokinetic profile, and preliminary antitumor activity were also assessed. Japanese patients with solid tumors that had progressed on prior therapies received escalating doses of single-agent ribociclib on a 3-weeks-on/1-week-off schedule. Treatment continued until the development of toxicity or disease progression. A dose escalation was planned for patients with esophageal cancer. In the dose-escalation phase, 4 patients received 400 mg ribociclib and 13 patients received 600 mg ribociclib. Four patients experienced dose-limiting toxicities, 3 of whom were in the 600 mg group. The RDE was declared to be 600 mg, and the MTD was not determined. The most frequent adverse events were hematologic and gastrointestinal. Four patients achieved stable disease at the 600 mg dose; no patients achieved complete or partial response. All patients discontinued the study, the majority due to disease progression. No patients discontinued due to adverse events. Dose escalation was not pursued due to lack of observed efficacy in esophageal cancer. At the RDE of 600 mg/d on a 3-weeks-on/1-week-off schedule, ribociclib showed acceptable safety and tolerability profiles in Japanese patients with advanced solid tumors. © 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

Comparison of valsartan and amlodipine on ambulatory blood pressure variability in hypertensive patients.

PubMed

Eguchi, Kazuo; Imaizumi, Yuki; Kaihara, Toshiki; Hoshide, Satoshi; Kario, Kazuomi

We tested the hypothesis that calcium channel blockers (CCBs: amlodipine group, n = 38)) are superior to angiotensin receptor blockers (ARBs: valsartan group, n = 38) against ambulatory blood pressure variability (BPV) in untreated Japanese hypertensive patients. Both drugs significantly reduced ambulatory systolic and diastolic BP values. With regard to BPV, standard deviation (SD) in SBP did not change with the administration of either drug, but the ARB significantly increased SD in awake DBP (12 ± 4-14 ± 4 mmHg). The ARB also significantly increased the coefficients of variation (CVs)in awake and 24-h SBP/DBP (all P < 0.05), but amlodipine did not change the CV. CCB significantly reduced the maximum values of awake SBP (193 ± 24-182 ± 27 mmHg, P = 0.02), sleep SBP (156 ± 18-139 ± 14 mmHg, P < 0 .001), and awake and sleep DBP (P < 0.01 in both cases), but the ARB did not change the maximum BP values. In conclusion, a once-daily morning dose of CCB amlodipine was more effective at controlling ambulatory BPV than ARB valsartan, especially in reducing maximum BP levels.

Medication adherence among hypertensive patients of primary health clinics in Malaysia

PubMed Central

Ramli, Azuana; Ahmad, Nur Sufiza; Paraidathathu, Thomas

2012-01-01

Purpose Poor adherence to prescribed medications is a major cause for treatment failure, particularly in chronic diseases such as hypertension. This study was conducted to assess adherence to medications in patients undergoing hypertensive treatment in the Primary Health Clinics of the Ministry of Health in Malaysia. Factors affecting adherence to medications were studied, and the effect of nonadherence to blood pressure control was assessed. Patients and methods This was a cross-sectional study to assess adherence to medications by adult patients undergoing hypertensive treatment in primary care. Adherence was measured using a validated survey form for medication adherence consisting of seven questions. A retrospective medication record review was conducted to collect and confirm data on patients’ demographics, diagnosis, treatments, and outcomes. Results Good adherence was observed in 53.4% of the 653 patients sampled. Female patients were found to be more likely to adhere to their medication regime, compared to their male counterparts (odds ratio 1.46 [95% confidence intervals [CI]: 1.05–2.04; P < 0.05]). Patients in the ethnic Chinese were twice as likely (95% CI: 1.14–3.6; P < 0.05) to adhere, compared to those in the Indian ethnic group. An increase in the score for medicine knowledge was also found to increase the odds of adherence. On the other hand, increasing the number of drugs the patient was taking and the daily dose frequencies of the medications prescribed were found to negatively affect adherence. Blood pressure control was also found to be worse in noncompliers. Conclusion The medication adherence rate was found to be low among primary care hypertensive patients. A poor adherence rate was found to negatively affect blood pressure control. Developing multidisciplinary intervention programs to address the factors identified is necessary to improve adherence and, in turn, to improve blood pressure control. PMID:22969292

Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo.

PubMed

Kika, T M; Lepira, F B; Kayembe, P K; Makulo, J R; Sumaili, E K; Kintoki, E V; M'Buyamba-Kabangu, J R

Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare. The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.

Long-term multiple risk factor interventions in Japanese elderly diabetic patients: the Japanese Elderly Diabetes Intervention Trial--study design, baseline characteristics and effects of intervention.

PubMed

Araki, Atsushi; Iimuro, Satoshi; Sakurai, Takashi; Umegaki, Hiroyuki; Iijima, Katsuya; Nakano, Hiroshi; Oba, Kenzo; Yokono, Koichi; Sone, Hirohito; Yamada, Nobuhiro; Ako, Junya; Kozaki, Koichi; Miura, Hisayuki; Kashiwagi, Atsunori; Kikkawa, Ryuichi; Yoshimura, Yukio; Nakano, Tadasumi; Ohashi, Yasuo; Ito, Hideki

2012-04-01

To evaluate long-term, multiple risk factor intervention on physical, psychological and mental prognosis, and development of complications and cardiovascular disease in elderly type 2 diabetes patients. Our randomized, controlled, multicenter, prospective intervention trial included 1173 elderly type 2 diabetes patients who were enrolled from 39 Japanese institutions and randomized to an intensive or conservative treatment group. Glycemic control, dyslipidemia, hypertension, obesity, diabetic complications and atherosclerotic disease were measured annually. Instrumental activity of daily living, cognitive impairment, depressive symptoms and diabetes burden were assessed at baseline and 3 years. There was no significant difference in clinical or cognitive parameters at baseline between the two groups. The prevalence of low activities of daily living, depressive symptoms and cognitive impairment was 13%, 28% and 4%, respectively, and was similar in the two groups. A small, but significant difference in HbA1c between the two groups was observed at 1 year after the start of intervention (7.9% vs 8.1%, P < 0.05), although this significant difference was not observed after the second year. With the exception of coronary revascularization, there was no significant difference in fatal or non-fatal events between the two groups. Composite events were also similar in the two groups. This study showed no significant differences in fatal or non-fatal events between intensive and conventional treatment. The present study might clarify whether treatment of risk factors influences function and quality of life in elderly diabetic patients. © 2012 Japan Geriatrics Society.

[Blood pressure lowering therapy for mild hypertensive patients with a history of stroke].

PubMed

Ishikawa, Eiichi; Ibayashi, Setsuro

2008-08-01

Hypertension is the primary and one of the major risk factors for stroke. Many hypertensive patients with a history of stroke might have mild to moderate hypertension at the same time. In order to prevent recurrence of cardiovascular diseases including stroke, we should lower their blood pressure levels, carefully and slowly below less than 140/90 mmHg or much lower. Additionally, the patients having any occlusion or stenoses in their carotid and/or intracranial arteries, or even in old-old patients with atherosclerosis, might need further consideration for the cerebral blood flow insufficiency in the course of blood pressure lowering therapy. Although the advantages of inhibitors of renin-angiotensin system are lionized these days (advertisement based medicine: ABM), we should never forget to select more favorable antihypertensive drugs for each patient in case by case (individual based medicine: IBM), to get the definite blood pressure lowering effects without worsening any complications. We also need further gathering of many evidences in a net-work-meta-analysis way, on blood pressure lowering therapy in those hypertensive patients with a history of stroke (evidence based medicine: EBM).

Valsartan combination therapy in the management of hypertension – patient perspectives and clinical utility

PubMed Central

Nash, David T; McNamara, Michael S

2009-01-01

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy should include a RAAS inhibitor. Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of antihypertensive therapy. In this article, we discuss two ARB combinations (valsartan/hydrochlorothiazide [HCTZ] and amlodipine/valsartan), both of which are indicated for the treatment of hypertension in patients not adequately controlled on monotherapy and as initial therapy in patients likely to need multiple drugs to achieve BP goals. Randomized, double-blind studies that have assessed the antihypertensive efficacy and safety of these combinations in the first-line treatment of hypertensive patients are reviewed. Both valsartan/HCTZ and amlodipine/valsartan effectively lower BP and are well tolerated in a broad range of patients with hypertension, including difficult-to-treat populations such as those with severe BP elevations, prediabetes and diabetes, patients with the cardiometabolic syndrome, and individuals who are obese, elderly, or black. Also discussed herein are patient-focused perspectives related to the use of valsartan/HCTZ and amlodipine/valsartan, and the rationale for use of single-pill combinations as one approach to enhance patient compliance with antihypertensive therapy. PMID:21949614

Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension.

PubMed

De Groote, Katya; Devos, Daniël; Van Herck, Koen; Demulier, Laurent; Buysse, Wesley; De Schepper, Jean; De Wolf, Daniël

2015-09-01

Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology.

[Estimation of the consumption frequency of high glucose corn syrup by patients with hypertension].

PubMed

Semków-Pochwatko, Aneta; Stolarz-Skrzypek, Katarzyna; Czarnecka, Danuta

Hypertension is a major health problem in modern times, due to its high prevalence. This is an important risk factor for cardiovascular disease, which are the main cause of death in developed countries. The component of prevention and non-pharmacological treatment of hypertension is a proper diet. More and more often an adequate supply of sugars in the diet is emphasized. In recent years particular attention was paid to the consumption of HFCS (high fructose corn syrup), which is present in many processed foods. The aim of this study was to estimate the frequency of consumption of HFCS products among patients with hypertension. The study involved 108 people diagnosed with hypertension, who attended to the Hypertensive Clinic in Krakow. The study was conducted in the form of Food Frequency Questionnaire (FFQ) of 24 selected beverages and solid products, which are a source of HFCS. In addition, the survey included 6 questions about nutrition knowledge on HFCS. The examination took place from October 2014. to March 2015. The vast majority of patients indicated consumption of products with HFSC. The most popular products proved to be sweets (especially chocolate bars, wafers) and fruit drinks and nectars. Frequent consumption of cola drinks was also observed, which were more often chosen by men than women. Younger respondents (<55 years old) more often than respondents over 55. years old chose sweets. At the same time our survey indicated unsatisfactory level of nutritional knowledge on HFCS among patients. The consumption of HFCS in patients with hypertension is common, at low knowledge of its harmful effects on health. Therefore there is apparent need for dietary education of patients with hypertension in this area.

Patient-tailored self-management intervention for older adults with hypertension in a nursing home.

PubMed

Park, Yeon-Hwan; Chang, HeeKyung; Kim, JinShil; Kwak, Jin Sang

2013-03-01

This study was to evaluate the effects of a patient-tailored self-management intervention on (1) blood pressure control and (2) self-care behaviour, exercise self-efficacy and medication adherence among Korean older hypertensive patients in a nursing home.   Little is known about whether a patient-tailored self-management for nursing home residents with hypertension is likely to advance the care of this growing population worldwide. A non-equivalent comparison group design. Forty-seven patients (23 and 24 in the intervention and comparison groups, respectively) participated in the study. No one withdrew during the eight-week study period. Hypertensive patients in the intervention group received health education and tailored individual counselling for eight weeks to enhance the self-management. The mean age of patients was 77·4 years. Patients were on hypertensive medications for 11·8 years; only 36 of them took medications without assistance. The baseline comparisons of the patients with and without 8-week intervention did not differ for clinical and demographic variables and outcome measures. Blood pressure decreased when comparing the baseline to eight weeks later from baseline; moreover, blood pressure was significantly reduced only in patients who received the intervention. Self-care behaviour and exercise self-efficacy significantly increased over time only in those who were in the intervention group. However, no significant difference was observed in medication adherence between the two groups. Patient-tailored self-management intervention was a practical approach for decreasing blood pressure and increasing self-care behaviour in older hypertensive patients in a nursing home. Further studies are needed to validate these findings using a larger sample with long-term follow-up. A patient-tailored intervention is feasible not only to empower nursing home residents with hypertension for their care, but also to offer a qualified training and guidelines to

Screening for major depressive episodes in Japanese patients with epilepsy: validation and translation of the Japanese version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E).

PubMed

Tadokoro, Yukari; Oshima, Tomohiro; Fukuchi, Toshihiko; Kanner, Andres M; Kanemoto, Kousuke

2012-09-01

We validated and translated into Japanese the English version of the screening instrument Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) to identify major depressive episodes in patients with epilepsy. A total of 159 Japanese subjects with epilepsy underwent a psychiatric structured interview with the Japanese version of the Mini International Neuropsychiatric Interview (M.I.N.I.-J) followed by completion of the Japanese version of NDDI-E (NDDI-E-J). Twelve participants met the M.I.N.I.-J criteria of current major depressive episode. Participants had no difficulties completing the NDDI-E-J. Its Cronbach's alpha coefficient was 0.83 and a cut-off score greater than 16 provided a sensitivity of 0.92, a specificity of 0.89, and a negative predictive value of 0.99. The NDDI-E-J appears to be useful for primary care clinicians to screen for major depressive episodes in epilepsy patients. Routine use of this brief and self-administered instrument in busy clinical settings will likely improve management of depression in Japanese individuals with epilepsy. Copyright © 2012 Elsevier Inc. All rights reserved.

Coherence: A Novel Nonpharmacological Modality for Lowering Blood Pressure in Hypertensive Patients

PubMed Central

2012-01-01

This study examined the efficacy of teaching emotional self-regulation techniques supported by heart rhythm coherence training (emWave Personal Stress Reliever) as a means to quickly lower blood pressure (BP) in patients diagnosed with hypertension. Previous studies have demonstrated systemic reductions in BP in both high stress populations and patients diagnosed with hypertension using this approach, but to the best of our knowledge, an investigation of their ability to produce immediate reductions in BP had not been published in the medical literature. The study was a randomized controlled design with 62 hypertensive participants who were divided into three groups. Group 1 was taking hypertensive medication, was taught self-regulation technique, and used heart rate variability coherence (HRVC) training devices. Group 2 was not yet taking medication and was trained in the same intervention. Group 3 was taking hypertensive medication but did not receive the intervention and was instructed to relax between the BP assessments. An analysis of covariates was conducted to compare the effectiveness of three different interventions on reducing the participants' BP. The use of the self-regulation technique and the HRVC-monitoring device was associated with a significantly greater reduction in mean arterial pressure in the two groups who used the intervention as compared with the relaxation-plus-medication group. Additionally, the group not taking medication that used the intervention also had a significantly greater reduction in systolic BP than the relaxation- plus-medication group. These results suggest that self-regulation techniques that incorporate the intentional generation of positive emotions to facilitate a shift into the psychophysiological coherence state are an effective approach to lowering BP. This approach to reducing BP should be considered a simple and effective approach that can easily be taught to patients to quickly lower their BP in stressful

A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients.

PubMed

Cooper, Lisa A; Roter, Debra L; Carson, Kathryn A; Bone, Lee R; Larson, Susan M; Miller, Edgar R; Barr, Michael S; Levine, David M

2011-11-01

African Americans and persons with low socioeconomic status (SES) are disproportionately affected by hypertension and receive less patient-centered care than less vulnerable patient populations. Moreover, continuing medical education (CME) and patient-activation interventions have infrequently been directed to improve the processes of care for these populations. To compare the effectiveness of patient-centered interventions targeting patients and physicians with the effectiveness of minimal interventions for underserved groups. Randomized controlled trial conducted from January 2002 through August 2005, with patient follow-up at 3 and 12 months, in 14 urban, community-based practices in Baltimore, Maryland. Forty-one primary care physicians and 279 hypertension patients. Physician communication skills training and patient coaching by community health workers. Physician communication behaviors; patient ratings of physicians' participatory decision-making (PDM), patient involvement in care (PIC), reported adherence to medications; systolic and diastolic blood pressure (BP) and BP control. Visits of trained versus control group physicians demonstrated more positive communication change scores from baseline (-0.52 vs. -0.82, p = 0.04). At 12 months, the patient+physician intensive group compared to the minimal intervention group showed significantly greater improvements in patient report of physicians' PDM (β = +6.20 vs. -5.24, p = 0.03) and PIC dimensions related to doctor facilitation (β = +0.22 vs. -0.17, p = 0.03) and information exchange (β = +0.32 vs. -0.22, p = 0.005). Improvements in patient adherence and BP control did not differ across groups for the overall patient sample. However, among patients with uncontrolled hypertension at baseline, non-significant reductions in systolic BP were observed among patients in all intervention groups-the patient+physician intensive (-13.2 mmHg), physician intensive/patient minimal (-10.6 mmHg), and the patient intensive

The Prevalence of Japanese Outpatients with Hypertension Who Meet the Definition of Treatment Resistant Hypertension and Are Eligible for Enrolment in Clinical Trials of Endovascular Ultrasound Renal Denervation.

PubMed

Okamura, Keisuke; Shirai, Kazuyuki; Okuda, Tetsu; Urata, Hidenori

2018-01-01

Objective A clinical trial (REQUIRE) was started to investigate the use of an ultrasound renal denervation system in the treatment of resistant hypertension (RHT). We analyzed the prevalence of patients who were eligible for inclusion in this cross-sectional study at the time of screening. Methods Nine-hundred ninety-nine consecutive hypertension (HT) patients who were treated in our hospital as outpatients were classified into the following categories: patients treated with at least 3 types of antihypertensive drugs including diuretic agents who were eligible for enrolment in SYMPLICITY HTN-Japan (SH-J) with an office systolic blood pressure (SBP) of ≥160 mmHg, who were ≤80 years of age, and an estimated glomerular filtration rate (eGFR) of ≥45 mL/min/1.73 m 2 (RHT-S); and patients who were treated similar medications and who were eligible for enrolment in REQUIRE, with an SBP of ≥150 mmHg, ≤75 years of age, and an eGFR of ≥40 mL/min/1.73 m 2 (RHT-R). We investigated the proportion of patients in each category. We also investigated HT patients (1,423 cases) who were enrolled in the Chikushi Anti-Hypertension Trial (CHAT), a research network that includes general practitioners. Results Eleven patients (1.1%) with RHT-S and 18 patients (1.8%) with RHT-R were identified. After the exclusion of patients with secondary HT and a diastolic blood pressure (DBP) of <90 mmHg (applied in REQUIRE), 5 patients (0.5%) with RHT-S and 4 patients (0.4%) with RHT-R remained. In the analysis of the CHAT study, only 2 (0.1%) patients with RHT-R remained. Conclusion The number of eligible patients in the REQUIRE trial was decreased, largely due to the strict age restriction and the new DBP limitation. The prevalence of eligible patients in REQUIRE was estimated to be approximately 0.5 to 0.8 times that in SH-J. Since patient enrollment will be difficult, drastic measures may be required to recruit eligible patients.