苅尾 七臣

Objectives There has been no report investigating the impact of the arterial stiffness reduction induced by antihypertensive medications on the improvement of target organ damage in hypertension. The aim of this study was to assess the association of the change in pulse wave velocity (PWV) with that in urinary albumin excretion as a measure of renal damage. Methods We studied 404 treated hypertensive patients (mean age, 70.5 +/- 9.5 years), who were allocated to either an active treatment group (doxazosin and atenolol when needed) or a control group. Blood pressure, urinary albumin-to-creatinine ratio (UACR), and brachial-ankle PWV (baPWV) were measured at baseline and after 6 months of treatment. Results In the total population, home/office SBP, UACR, and baPWV decreased significantly from the baseline. In multivariate regression analyses, Delta baPWV was significantly associated with Delta UACR, independent of Delta home SBP (beta=0.21, P<0.001). When the patients were divided into a group with Delta baPWV of at least 0 cm/s (positive Delta PWV) and a group with Delta baPWV of less than 0 cm/s (negative Delta PWV), the reduction of UACR was greater in the latter group, even after adjustment for the covariates including the change in home SBP. These results were essentially the same when office SBP was entered in place of home SBP, and similar both in the active treatment group and the control group. Conclusion These findings suggest that the arterial stiffness reduction induced by antihypertensive medications is associated with the improvement of renal damage, independent of home/office SBP reduction. J Hypertens 28: 1752-1760 (c) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Objectives To study the impact of the dosing time of an angiotensin II receptor blocker (ARB) titrated by self-measured home blood pressure (HBP) on cardiorenal damage in hypertensives. Methods We conducted an open-label multicenter trial, the J-TOP study, that enrolled 450 hypertensives with self-measured systolic HBP more than 135 mm Hg. The study patients were stratified into three groups according to the difference between their morning and evening SBPs difference: a morning hypertension group (morning and evening difference at least 15 mm Hg; n=170), a morning and evening hypertension group (0 mm Hg <= morning and evening difference <15 mm Hg; n=198), and an evening hypertension group (morning and evening difference <0 mm Hg; n=82). Individuals were then randomly allocated to receive bedtime dosing or awakening dosing of candesartan (+/-diuretic as needed) titrated to achieve a target systolic HBP less than 135 mm Hg. The 6-month change in the urinary albumin/creatinine ratio (UACR) was assessed. Results In total patients, the UACR was more markedly reduced in the bedtime-dosing group than in the awakening-dosing group (-45.7 vs. -34.5%, P=0.02), whereas there were no differences in the reduction of any of the HBPs including the sleep blood pressures (BPs) between the two groups. Among the three subgroups stratified by the morning and evening difference, the difference in the UACR reduction between the bedtime-dosing and awakening-dosing groups was only significant in the morning hypertension group (-50.6 vs. -31.3%, P=0.02). Conclusion In HBP-guided antihypertensive treatment in hypertensives, bedtime dosing of an ARB may be superior to awakening dosing for reducing microalbuminuria. J Hypertens 28: 1574-1583 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Background: It is reported that blood pressure (BP) variability increases with aging, and cognitive dysfunction may be related to BP variability; however, there are no data showing that exaggerated BP variability is associated with cognitive dysfunction or quality of life (QOL) in the older elderly. We investigated the relationships and the differences between ambulatory BP variability and cognitive function or QOL in younger elderly and very elderly. Methods: We recruited both 101 very elderly (aged >= 80 years) and 101 younger elderly (aged 61 to 79 years). Twenty-four-hour ambulatory blood pressure monitoring, mini-mental state examinations (MMSE), and Medical Outcome Study Short-Form 36 Items Health Survey (SF-36) were performed for all subjects. Results: The mean standard deviation (SD) of daytime systolic BP in young elderly was 17.2 +/- 4.6 mm Hg (mean SD SD of mean SD), and that in very elderly was 21.2 +/- 4.3 mm Hg. The MMSE score significantly decreased with the tertile of SD of daytime systolic BP in very elderly (P = .004) and young elderly (P = .03). In very elderly, there was no significant association between the SD of daytime systolic BP and each of eight SF-36 categories. On the other hand, in younger elderly, two of eight SF-36 categories decreased with the tertile of SID of daytime systolic BP (P = .001 for Vitality and P = .003 for Role emotion). Conclusions: Very elderly had larger BP variability than younger elderly. Exaggerated ambulatory BP variability was related to cognitive dysfunction in the elderly, especially in the very elderly, and was related to lower QOL in the younger elderly. Am J Hypertens 2007;20: 720-727 (c) 2007 American Journal of Hypertension, Ltd.

Background: Masked hypertension (MHT: normal office blood pressure [BP] + elevated BP out of the office) is a significant predictor of target organ damage and cardiovascular disease. The purpose of this study was to investigate the subclinical arterial damage in unmedicated subjects with MHT detected by home BP measurement. Methods: We recruited 282 subjects not taking antihypertensive medication, who had at least one of the following five cardiovascular risk factors: high BP, hyperlipidemia, diabetes mellitus, current smoking, and chronic kidney disease. Furthermore, we classified them into four groups (normotension [NT], white-coat hypertension [WCHT], MHT, and sustained hypertension [SHT]) by office BP (140/90 mm Hg) and home BP (135/85 mm Hg) measurements. Arterial damage was evaluated by measuring carotid intima-media thickness (IMT) and brachial-ankle pulse wave velocity (baPWV). Results: Subjects with MHT had a higher prevalence of habitual alcohol drinkers than the other groups, and higher pulse rates at home than those with NT and WCHT. After adjustment for covariates, carotid IMT was the highest in MHT among the four groups (mean: 1.01 v 0.83 mm for NT, 0.86 mm for WCHT, and 0.91 mm for SHT, all P<.01). The baPWV was also significantly higher in MHT than NT and WCHT (mean: 1940 v 1663 and 1733 cm/sec, all P<.01), whereas the difference between MHT and SHT (2023 cm/sec) was not significant. Conclusions: This study shows that masked hypertensives detected by home BP are at higher risk for increased arterial damage than normotensives or white-coat hypertensives, and potentially than sustained hypertensives.