基本情報
研究キーワード
4経歴
1-
2009年 - 現在
学歴
2-
- 1987年
-
- 1987年
委員歴
11受賞
12論文
293-
Hypertension research : official journal of the Japanese Society of Hypertension 44(11) 1363-1372 2021年11月Blood pressure (BP) exhibits seasonal variation, with an elevation of daytime BP in winter and an elevation of nighttime BP in summer. The wintertime elevation of daytime BP is largely attributable to cold temperatures. The summertime elevation of nighttime BP is not due mainly to temperature; rather, it is considered to be related to physical discomfort and poor sleep quality due to the summer weather. The winter elevation of daytime BP is likely to be associated with the increased incidence of cardiovascular disease (CVD) events in winter compared to other seasons. The suppression of excess seasonal BP changes, especially the wintertime elevation of daytime BP and the summertime elevation of nighttime BP, would contribute to the prevention of CVD events. Herein, we review the literature on seasonal variations in BP, and we recommend the following measures for suppressing excess seasonal BP changes as part of a regimen to manage hypertension: (1) out-of-office BP monitoring, especially home BP measurements, throughout the year to evaluate seasonal variations in BP; (2) the early titration and tapering of antihypertensive medications before winter and summer; (3) the optimization of environmental factors such as room temperature and housing conditions; and (4) the use of information and communication technology-based medicine to evaluate seasonal variations in BP and provide early therapeutic intervention. Seasonal BP variations are an important treatment target for the prevention of CVD through the management of hypertension, and further research is necessary to clarify these variations.
-
Journal of Clinical Hypertension 23(10) 1872-1878 2021年10月1日The authors investigated the reproducibility of nighttime home blood pressure (BP) measured by a wrist-type BP monitoring device. Forty-six hypertensive patients (mean 69.0±11.6 years, 56.5% male) self-measured their nighttime BP hourly using simultaneously worn wrist-type and upper arm-type nocturnal home BP monitoring devices at home on two consecutive nights. Using the average 7.4±1.3 measurements on the first night and the average 7.0 ± 1.8 measurements on the second night, the authors assessed the reliability and the reproducibility of nighttime BP measured on the two nights. The difference between nights in systolic BP (SBP) measured by the wrist-device was not significant (1.6±7.0 mmHg, p =.124), while the difference in diastolic BP (DBP) was marginally significant (1.4±4.9 mmHg, p =.050). The intraclass correlation coefficients (ICCs) for agreement between nights were high both in SBP and DBP average (SBP: 0.835, DBP: 0.804). Averaging only three points of SBP resulted in lower ICC values, but still indicated good correlations (ICC > 0.6). On the other hand, the correlations of the standard deviation and average real variability of SBP between nights were low, with ICCs of 0.220 and 0.436, respectively. In conclusion, the average SBP values measured on the first night were reliable even when averaging only three readings. The reproducibility of nighttime BP variability seemed inferior to that of BP average it might be better to measure nighttime BP over multiple nights to assess BP variability. However, this hypothesis needs verification in other study population. In addition, our study population had well-controlled BP, which limits the generalizability of this findings to all hypertensive patients.
-
Journal of the American College of Cardiology 78(10) 1028-1038 2021年9月7日Background: Sham-controlled trials demonstrated safety and efficacy of renal denervation (RDN) to lower blood pressure (BP). Association of baseline heart rate with BP reduction after RDN is incompletely understood. Objectives: The purpose of this analysis was to evaluate the impact of baseline heart rate on BP reduction without antihypertensive medications in the SPYRAL HTN-OFF MED (Global Clinical Study of Renal Denervation With the Symplicity Spyral Multi-electrode Renal Denervation System in Patients With Uncontrolled Hypertension in the Absence of Antihypertensive Medications) Pivotal trial. Methods: Patients removed from any antihypertensive medications were enrolled with office systolic blood pressure (SBP) ≥150 and < 180 mm Hg and randomized 1:1 to RDN or sham control. Patients were separated according to baseline office heart rate < 70 or ≥70 beats/min. BP changes from baseline to 3 months between treatment arms were adjusted for baseline SBP using analysis of covariance. Results: Scatter plots of 3-month changes in 24-hour and office SBP illustrate a wide range of changes in SBP for different baseline heart rates. Treatment difference at 3 months between RDN and sham control with baseline office heart rate ≥70 beats/min for 24-hour SBP was −6.2 mm Hg (95% CI: −9.0 to −3.5 mm Hg) (P < 0.001) and for baseline office heart rate < 70 beats/min it was −0.1 mm Hg (−3.8 to 3.6 mm Hg) (P = 0.97) with an interaction P value of 0.008. Results were similar for changes in office, daytime, and nighttime SBP at 3 months, with a greater reduction in SBP with baseline office heart rate ≥70 beats/min. Conclusions: Reduction in mean office, 24-hour, daytime, and nighttime SBP for RDN at 3 months was greater with baseline office heart rate ≥70 than < 70 beats/min, suggesting an association between baseline heart rate and BP reduction after RDN. (SPYRAL PIVOTAL—SPYRAL HTN-OFF MED Study NCT02439749)
-
Hypertension Research 44(9) 1138-1146 2021年9月1日We tested our hypothesis that the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiovascular disease (CVD) events is mediated in part by a pathway of increased nighttime blood pressure (BP) that involves volume overload. We used the data from the Japan Morning Surge-Home Blood Pressure (J-HOP) Nocturnal BP Study, which targeted 2476 Japanese participants who had a history of or risk for CVD (mean age 63.8 ± 10.2 years), along with their measured nighttime BP values assessed by a home BP device (measured at 2:00, 3:00 and 4:00 a.m.) and NT-proBNP levels. At baseline, elevated daytime (average of morning and evening) and nighttime home systolic BP (SBP) were independently associated with log-transformed NT-proBNP levels after adjustment for cardiovascular risk factors. During a median follow-up of 7.2 years, 150 participants experienced a CVD event (62 stroke events and 88 coronary artery disease events). After adjustment for cardiovascular risk factors and nighttime SBP, increased log-transformed NT-proBNP levels were independently associated with CVD events (hazard ratio [HR] per 1 unit, 1.67 95% confidence interval [CI]: 1.16–2.40). Elevated nighttime home SBP was also independently associated with CVD events after adjustment for cardiovascular risk and log-transformed NT-proBNP (HR per standard deviation, 1.22 95% CI: 1.001–1.50). The percentage of the association between NT-proBNP and CVD events mediated by nighttime home SBP was 15%. Our findings indicate a physiological pathway in which increased nighttime SBP contributes to the impact of elevated NT-proBNP levels on the incidence of CVD.
-
Heart and Vessels 36(9) 1275-1282 2021年9月1日Hemodialysis (HD) patients tend to have sarcopenia and malnutrition, and both conditions are related to poor prognosis in the cardiovascular disease that often accompanies HD. However, the impact of sarcopenia or malnutrition on the long-term prognosis of HD patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) remains unclear. We analyzed 1,605 consecutive patients with ACS who had undergone PCI at a single center between January 2009 and December 2014. We evaluated all-cause mortality and prognosis-associated factors, including sarcopenia/malnutrition-related factors such as the Geriatric Nutritional Risk Index (GNRI), and Skeletal Muscle Mass Index (SMI). After exclusions, 1461 patients were enrolled, and 58 (4.0%) were on HD. The HD group had lower levels of SMI and GNRI than non-HD group, and had worse in-hospital prognosis. Moreover, HD group had a significant higher mortality in the long-term follow-up [median follow-up period: 1219 days Hazard Ratio (HR) = 4.09, p < 0.001]. After adjusting the covariates, SMI and GNRI were the factors associated with all-cause mortality in all patients [SMI: adjusted HR (aHR) = 2.39, p = 0.036 GNRI: aHR = 2.21, p = 0.006] however, these findings were not observed among HD patients with ACS, and only diabetes was significantly associated with all-cause mortality (diabetes: aHR = 3.50, p = 0.031). HD patients with ACS had a significantly higher rate of in-hospital and long-term mortality than non-HD patients. Although sarcopenia and malnutrition were related to mortality and were more common in HD patients, sarcopenia and malnutrition had a lower impact than diabetes on the long-term prognosis of HD patients with ACS.
-
American journal of hypertension 34(7) 729-736 2021年8月9日BACKGROUND: The incidence of cardiovascular disease (CVD) increases during winter. The risk that elevated home blood pressure (BP) poses for CVD events that occur in each of 4 seasons is unclear. We conducted a post hoc analysis using the dataset from a nationwide cohort, the Japan Morning Surge-Home Blood Pressure (J-HOP) study, to assess the association between home BP and winter-onset CVD events. METHODS: J-HOP participants who had cardiovascular risks conducted morning and evening home BP measurements for a 14-day period and were followed-up for the occurrence of CVD events. RESULTS: We analyzed 4,258 participants (mean age 64.9 years; 47% male; 92% hypertensives) who were followed-up for an average of 6.2 ± 3.8 years (26,295 person-years). We divided the total of 269 CVD events (10.2/1,000 person-years) by the season of onset as follows: 82 in the winter and 187 in the other seasons (spring, summer, and autumn). In the Cox models adjusted for covariates and the season when home BPs were measured at baseline, morning home systolic BP (SBP) was associated with both winter-onset and other season-onset CVD events: hazard ratio (HR) for winter 1.22, 95% confidence interval (CI) 1.06-1.42 per 10 mm Hg; HR for other seasons 1.11, 95% CI 1.00-1.23. Evening home SBP was associated with the other season-onset CVD events (HR 1.20, 95% CI 1.08-1.33 per 10 mm Hg), but not with the winter-onset CVD events. CONCLUSIONS: Our findings indicate that compared with evening home BP, morning home BP might be a superior predictor of winter-onset CVD events.
-
Journal of Clinical Hypertension 23(8) 1529-1537 2021年8月1日This study sought to investigate whether the relation between increased blood pressure (BP) variability and increased arterial stiffness confers a risk for cardiovascular disease (CVD) events. We analyzed 2648 patients from a practitioner-based population (mean ± SD age 64.9 ± 11.4 years: 75.8% taking antihypertensive medication) with at least one cardiovascular risk factor who underwent home BP monitoring in the Japan Morning Surge-Home Blood Pressure Study. The standard deviation (SDSBP), coefficient of variation (CVSBP), and average real variability (ARVSBP) were assessed as indexes of day-by-day home systolic BP (SBP) variability. The authors assessed arterial stiffness by brachial-ankle pulse wave velocity (baPWV) and divided patients into lower (< 1800 cm/s, n = 1837) and higher (≥1800 cm/s, n = 811) baPWV groups. During a mean follow-up of 4.4 years, 95 cardiovascular events occurred (8.1 per 1000 person-years). In Cox proportional hazard models adjusted for traditional cardiovascular risk factors including average home SBP, the highest quartiles of SDSBP (hazard ratio [HR], 2.30 95% confidence interval [CI], 1.23-4.32), CVSBP (HR, 2.89 95%CI, 1.59-5.26) and ARVSBP (HR, 2.55 95%CI, 1.37-4.75) were predictive of CVD events compared to the other quartiles in the higher baPWV group. Moreover, 1SD increases in SDSBP (HR, 1.44 95%CI, 1.13-1.82), CVSBP (HR, 1.49 95%CI, 1.16-1.90) and ARVSBP (HR, 1.37 95%CI, 1.09-1.73) were also predictive of CVD events. These associations remained even after N-terminal pro-brain natriuretic peptide was added to the models. However, these associations were not observed in the lower baPWV group. We conclude that arterial stiffness contributes to the association between home BP variability and CVD incidence.
-
American journal of hypertension 34(6) 609-618 2021年6月22日BACKGROUND: Little is known about seasonal variation in nighttime blood pressure (BP) measured by a home device. In this cross-sectional study, we sought to assess seasonal variation in nighttime home BP using data from the nationwide, practice-based Japan Morning Surge-Home BP (J-HOP) Nocturnal BP study. METHODS: In this study, 2,544 outpatients (mean age 63 years; hypertensives 92%) with cardiovascular risks underwent morning, evening, and nighttime home BP measurements (measured at 2:00, 3:00, and 4:00 am) using validated, automatic, and oscillometric home BP devices. RESULTS: Our analysis showed that nighttime home systolic BP (SBP) was higher in summer than in other seasons (summer, 123.3 ± 14.6 mmHg vs. spring, 120.7 ± 14.8 mmHg; autumn, 121.1 ± 14.8 mmHg; winter, 119.3 ± 14.0 mmHg; all P<0.05). Moreover, we assessed seasonal variation in the prevalence of elevated nighttime home SBP (≥120 mmHg) in patients with non-elevated daytime home SBP (average of morning and evening home SBP <135 mmHg; n = 1,565), i.e., masked nocturnal hypertension, which was highest in summer (summer, 45.6% vs. spring, 27.2%; autumn, 28.8%; winter, 24.9%; all P<0.05). Even in intensively controlled morning home SBP (<125 mmHg), the prevalence of masked nocturnal hypertension was higher in summer (summer, 27.4% vs. spring, 14.2%; autumn, 8.9%; winter, 9.0%; all P<0.05). The urine albumin-creatinine ratio in patients with masked nocturnal hypertension tended to be higher than that in patients with non-elevated both daytime and nighttime SBP throughout each season. CONCLUSIONS: The prevalence of masked nocturnal hypertension was higher in summer than other seasons and the difference proved to be clinically meaningful.
-
Journal of the American College of Cardiology 77(23) 2909-2919 2021年6月15日Background: The renin-angiotensin-aldosterone system plays a key role in blood pressure (BP) regulation and is the target of several antihypertensive medications. Renal denervation (RDN) is thought to interrupt the sympathetic-mediated neurohormonal pathway as part of its mechanism of action to reduce BP. Objectives: The purpose of this study was to evaluate plasma renin activity (PRA) and aldosterone before and after RDN and to assess whether these baseline neuroendocrine markers predict response to RDN. Methods: Analyses were conducted in patients with confirmed absence of antihypertensive medication. Aldosterone and PRA levels were compared at baseline and 3 months post-procedure for RDN and sham control groups. Patients in the SPYRAL HTN-OFF MED Pivotal trial were separated into 2 groups, those with baseline PRA ≥0.65 ng/ml/h (n = 110) versus < 0.65 ng/ml/h (n = 116). Follow-up treatment differences between RDN and sham control groups were adjusted for baseline values using multivariable linear regression models. Results: Baseline PRA was similar between RDN and control groups (1.0 ± 1.1 ng/ml/h vs. 1.1 ± 1.1 ng/ml/h p = 0.37). Change in PRA at 3 months from baseline was significantly greater for RDN compared with control subjects (−0.2 ± 1.0 ng/ml/h p = 0.019 vs. 0.1 ± 0.9 ng/ml/h p = 0.14), p = 0.001 for RDN versus control subjects, and similar differences were seen for aldosterone: RDN compared with control subjects (−1.2 ± 6.4 ng/dl p = 0.04 vs. 0.4 ± 5.4 ng/dl p = 0.40), p = 0.011. Treatment differences at 3 months in 24-h and office systolic blood pressure (SBP) for RDN versus control patients were significantly greater for patients with baseline PRA ≥0.65 ng/ml/h versus < 0.65 ng/ml/h, despite similar baseline BP. Differences in office SBP changes according to baseline PRA were also observed earlier at 2 weeks post-RDN. Conclusions: Plasma renin activity and aldosterone levels for RDN patients were significantly reduced at 3 months when compared with baseline as well as when compared with sham control. Higher baseline PRA levels were associated with a significantly greater reduction in office and 24-h SBP. (SPYRAL PIVOTAL - SPYRAL HTN-OFF MED Study NCT02439749)
-
Journal of Clinical Hypertension 23(6) 1144-1149 2021年6月1日We investigated the optimal nighttime home blood pressure (BP) measurement schedule for wrist BP monitoring. Fifty hypertensive patients (mean age 68.9 ± 11.3 years) self-measured their nighttime BP hourly using a wrist-type nocturnal home BP monitoring device at home on two consecutive nights. Using the average 7.2 ± 1.5 measurements per night, we compared the clock-based index (average of three measurements at 2:00, 3:00, and 4:00 a.m.) and the bedtime-based index (average of three measurements at 2, 3, and 4 h after bedtime). The clock-based average was significantly higher than the bedtime-based average for both systolic BP (2.7 ± 8.2 mmHg, P =.002) and diastolic BP (1.9 ± 5.1 mmHg, P < .001). Compared to the average of all measurements throughout a night (the same definition of ambulatory BP monitoring, ie, from the time point of going to bed to awakening), the clock-based average was comparable (systolic/diastolic BP: −0.5 ± 5.5/−0.2 ± 3.7), whereas the bedtime-based average was significantly lower (−3.3 ± 5.0/−2.1 ± 3.6). Thus, the repeated measurement of wrist-measured nighttime BP at three clock-based time points per night provided reliable values. Further prospective studies of larger populations are required to confirm the optimal nighttime BP measurement schedule for wrist BP monitoring for the prediction of cardiovascular events.
-
Journal of Clinical Hypertension 23(5) 1085-1088 2021年5月1日The authors evaluated the diagnostic accuracy of a new algorithm for detecting atrial fibrillation (AF) using a home blood pressure (BP) monitor. Three serial BP values were measured in 205 subjects with sinus rhythm and 75 subjects with AF confirmed by electrocardiogram. Irregular pulse peak (IPP) 15 was defined as follows: |interval of pulse peak - the average of the interval of the pulse peak| ≥ the average of the interval of the pulse peak × 15%. Irregular heartbeat (IHB) was defined as follows: beats of IPP ≥ total pulse × 20%. The sensitivities of IPP15 for diagnosing AF defined as two or three IHBs of three readings were 1.0 and 0.99, and the corresponding specificities were 0.97 and 0.99, respectively. The algorithm using two or more IHBs of three readings in the setting of IPP15 had the highest diagnostic accuracy for AF.
-
Clinical Research in Cardiology 110(5) 725-731 2021年5月1日Background: Catheter-based renal denervation (RDN) reduces blood pressure (BP) throughout the 24-h period, as reported in several randomized sham-controlled trials. Reduction of BP in the early morning hours is especially important due to increased cardiovascular risks during that time. Objective: In this report, we examine the impact of RDN on systolic BP (SBP) and diastolic BP (DBP) during the critical morning surge period in a post-hoc analysis of patients in the SPYRAL HTN-ON MED trial. Methods and results: Ambulatory BP measurements were collected at baseline and 6 months for treatment and control patient groups over 24-h periods. Average morning BP surge is the difference between average morning BP and average nighttime BP, and the morning surge slope reflects the rate of change of BP from nighttime to morning. Mean morning DBP surge slopes were significantly lower for RDN vs. control groups at 6 months (1.1 vs. 3.6 mmHg/h p = 0.029). In the RDN group, morning DBP surge slopes were significantly lower at 6 months compared to baseline (1.1 vs. 4.1 mmHg/h p = 0.006). Similar patterns were observed for mean morning SBP surge slope but did not reach statistical significance. Conclusions: This decrease in the morning DBP surge slope, an index of the sympathetically-mediated morning BP surge, thus indicates a drop in late morning BP relative to early morning/nocturnal BP in the RDN group. Thus, RDN appears effective in attenuating the slope of morning surge in DBP that might indicate possible benefits in a high-risk hypertensive population. Clinical trial registration: https://www.clinicaltrials.gov (NCT02439775), registered May 12, 2015.
-
American Journal of Hypertension 34(4) 377-382 2021年4月1日BACKGROUND: Psychological stress contributes to blood pressure (BP) variability, which is a significant and independent risk factor for cardiovascular events. We compared the effectiveness of a recently developed wearable watch-type BP monitoring (WBPM) device and an ambulatory BP monitoring (ABPM) device for detecting ambulatory stress-induced BP elevation in 50 outpatients with 1 or more cardiovascular risk factors. METHODS: The WBPM and ABPM were both worn on the subject's nondominant arm. ABPM was measured automatically at 30-minute intervals, and each ABPM measurement was followed by a self-measured WBPM measurement. We also collected self-reported information about situational conditions, including the emotional state of subjects at the time of each BP measurement. We analyzed 642 paired BP readings for which the self-reported emotional state in the corresponding diary entry was happy, calm, anxious, or tense. RESULTS: In a mixed-effect analysis, there were significant differences between the BP values measured during negative (anxious, tense) and positive (happy, calm) emotions in both the WBPM (systolic BP [SBP]: 9.3 ± 2.1 mm Hg, P < 0.001 diastolic BP [DBP]: 8.4 ± 1.4 mm Hg, P < 0.001) and ABPM (SBP: 10.7 ± 2.1 mm Hg, P < 0.001 DBP: 5.6 ± 1.4 mm Hg, P < 0.001). The absolute BP levels induced by emotional stress self-measured by the WBPM were similar to those automeasured by the ABPM (SBP, WBPM: 141.1 ± 2.7 mm Hg ABPM: 140.3 ± 2.7 mm Hg P = 0.724). The subject's location at the BP measurement was also significantly associated with BP elevation. CONCLUSIONS: The self-measurement by the WBPM could detect BP variability induced by multiple factors, including emotional stress, under ambulatory conditions as accurately as ABPM.
-
Journal of Clinical Hypertension 23(4) 860-869 2021年4月1日Elderly diabetic patients are likely to have uncontrolled nocturnal hypertension, which confers higher risks of cardiovascular events and heart failure. To investigate the efficacy and safety of empagliflozin in elderly patients with type 2 diabetes (T2DM), a sub-analysis was performed of data from the SGLT2 inhibitor and Angiotensin receptor blocker Combination theRapy in pAtients with diabetes and uncontrolled nocturnal hypertension (SACRA) study, a multi-center, double-blind, randomized, parallel study of T2DM patients who were treated with empagliflozin for 12 weeks. In the present analysis, we compared efficacy and safety outcomes in participants aged < 75 and ≥75 years. At baseline, 44 participants were ≥75 years and 87 were < 75 years. Nighttime ambulatory systolic blood pressure (SBP) decreased by 4.2 mm Hg in the ≥75-year-old group and by 7.9 mm Hg in the < 75-year-old group (p =.884 for the between-age group difference in the change between baseline and week 12) [primary endpoint]. Empagliflozin, but not placebo, significantly reduced mean 24-h SBP (−8.7 mm Hg in ≥75-year-olds vs. −11.0 mm Hg in < 75-year-olds) and daytime SBP (−10.8 mm Hg in ≥ 75-year-olds vs. −12.3 mm Hg in < 75-year-olds) between baseline and week 12, with no significant differences between the groups. In addition, there were significant reductions in glycated hemoglobin, body weight, and uric acid during 12 weeks of empagliflozin treatment in the two age groups. The incidences of hypoglycemic episodes, hypotension, and metabolic adverse events were similar in the two groups. Thus, empagliflozin was effective and well tolerated in elderly diabetic patients with uncontrolled nocturnal hypertension when administered for 12 weeks.
-
日本循環器学会学術集会抄録集 85回 SS22-3 2021年3月
-
日本循環器学会学術集会抄録集 85回 OJ88-1 2021年3月
-
Journal of Clinical Hypertension 23(3) 687-691 2021年3月1日We tested our hypothesis that, in hypertensive patients with higher nocturnal home systolic blood pressure (HSBP) at baseline, a valsartan/cilnidipine (80/10 mg) combination would reduce nocturnal HSBP more markedly than a valsartan/hydrochlorothiazide (80/12.5 mg) combination. Patients measured their nocturnal HSBP over three nights prior to study randomization and at the end of treatment. Sixty-three and 66 patients comprised the valsartan/cilnidipine and valsartan/hydrochlorothiazide groups their respective baseline nocturnal HSBP values were 124.3 ± 15.6 and 125.8 ± 15.2 mm Hg (P =.597). Nocturnal HSBPs were significantly reduced from baseline in both groups. Although the valsartan/hydrochlorothiazide group exhibited a significantly greater reduction in nocturnal HSBP compared to the valsartan/cilnidipine group (−5.0 vs. −10.0 mm Hg, P =.035), interaction between the treatment groups and the baseline nocturnal HSBP levels for the changes in nocturnal HSBP after the treatment periods was significant (P =.047). The BP-lowering effect of valsartan/cilnidipine was more dependent on baseline nocturnal HSBP than that of valsartan/hydrochlorothiazide.
-
Journal of Clinical Hypertension 23(3) 665-671 2021年3月1日The impacts of atrial fibrillation (AF) and home blood pressure (BP) on the cardiovascular prognosis of obese individuals have not been clarified. We analyzed the differences in the prognosis (including the effect of the home BP of AF patients with/without obesity) in a Japanese population with cardiovascular risk factors. We enrolled 3,586 patients from the J-HOP study who had at least one cardiovascular risk factor. We conducted 12-lead electrocardiography, and the group of AF patients was determined as those whose electrocardiography revealed AF. Obesity was defined as a body mass index > 25 kg/m2. The primary end points were fatal/nonfatal cardiovascular events (myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection). Among the obese patients, those with AF (n = 36) suffered more significantly cardiovascular events (log rank 7.17, p =.007) compared to the patients with sinus rhythm (n = 1,282), but among the non-obese patients, the rates of cardiovascular events were similar (log rank 0.006, p =.94) in the AF patients (n = 48) and sinus rhythm patients (n = 2220). After adjusting for age, sex, office/home BP, smoking, diabetes, and creatinine level, AF was an independent predictor of cardiovascular events in the obese group (hazard ratio [HR] 3.05, 95%CI: 1.17-7.97, p =.023). Home systolic BP was also a predictor of cardiovascular events in the obese group independent of the risk of AF (per 10 mm Hg: HR 1.36, 95%CI: 1.02-1.83, p =.039). In conclusion, AF was an independent predictor of cardiovascular events in obese patients after adjusting for home BP.
-
Journal of Clinical Hypertension 23(3) 614-620 2021年3月1日Ethnic differences in the profiles of hypertension and cardiovascular risk have been reported between Asians and Westerners. However, blood pressure (BP) profiles and the risk factors for cardiovascular disease might differ even among different Asian populations because of the diversity of cultures, foods, and environments. We retrospectively examined differences in 24-h BP profiles between 1051 Japanese (mean age, 62.5 ± 12.4 years medicated hypertension, 75.7%) and 804 Thai (mean age, 56.9 ± 18.5 years medicated hypertension, 65.6%) by using the Japanese and Thai ambulatory BP monitoring (ABPM) databases, in order to check the BP control status in treated hypertensives and to inform the clinical diagnosis of hypertension. The two populations had similar office systolic BP (SBP) (142.7 ± 20.0 vs 142.3 ± 20.6 mm Hg, p =.679). However, the Japanese population had higher 24-hr average and daytime SBP, and the Thai population had higher nighttime SBP even after adjusting for cardiovascular risk factors (all p < .05). Greater morning BP surge was observed in Japanese (31.2 vs 22.8 mm Hg, p < .001). Regarding nocturnal BP dipping status, the prevalence of riser status (higher nighttime than daytime SBP) was higher in the Thai population (30.5% vs 10.9%). These findings suggest that a substantial difference in 24-hr BP profiles exists between even neighboring countries in Asia.
-
Journal of Clinical Hypertension 23(2) 382-388 2021年2月1日The relationship between lean and cardiovascular events has been shown to vary with age, but the relationship between age-related lean and cardiovascular events in Asia has not been established. We divided patients enrolled in the J-HOP (Japan Morning Surge-Home Blood Pressure) study with one or more cardiovascular disease risks into three groups based on their body mass index (BMI): lean (BMI < 21), normal-weight (21 ≤ BMI < 27), and obese (BMI ≥ 27). We stratified the risk of cardiovascular events of lean and obesity compared to normal weight into the patients < 65 years old and those aged ≥ 65 years. A total of 286 cardiovascular disease events were observed during the follow-up period (73 ± 46 months). Regarding the relationship between BMI and cardiovascular disease risk, both lean and obesity were independent prognostic factors: lean: hazard ratio (HR) 1.43, 95% confidence interval (CI): 1.02-2.01, p =.040 obesity: HR 1.55, 95%CI: 1.13-2.12, p =.006. In patients < 65 years old, the risk of cardiovascular disease of the lean patients was lower than that of the normal-weight patients (HR 0.39, 95%CI: 0.12-1.29, p =.124) and the risk of obesity patients was significantly higher (HR 1.77, 95%CI: 1.08-2.92, p =.024). In the patients aged ≥ 65 years, lean was a significant independent factor of cardiovascular events compared to normal-weight (lean: HR 1.70, 95%CI: 1.18-2.47, p =.005). In conclusion, lean was an independent predictor of cardiovascular events in patients aged ≥ 65 years.
-
Journal of Clinical Hypertension 23(2) 301-308 2021年2月1日A prolonged P-wave in electrocardiography (ECG) reflects atrial remodeling and predicts the development of atrial fibrillation (AF). The authors enrolled 810 subjects in the Japan Morning Surge Home Blood Pressure (J-HOP) study who had ≥1 cardiovascular (CV) risk factor. The duration of P-wave was automatically analyzed by standard 12-lead electrocardiogram. Left atrial (LA) enlargement and left ventricular hypertrophy (LVH) were measured on echocardiography. The primary end points were fatal/nonfatal cardiac events: myocardial infarction, sudden death, and hospitalization for heart failure. The maximum P-wave duration (Pmax) from the 12 leads was selected for analysis. The authors compared four prolonged P-wave cutoffs (Pmax = 120, 130, 140, 150 ms) and cardiac events. LA diameter and left ventricular mass index (LVMI) were significantly associated with Pmax (r = 0.08, P =.02 and r = 0.17, P < .001, respectively). When the cutoff level was Pmax 120 or 130 ms, prolonged P-wave was not associated with cardiac events (P =.45 and P =.10), but when a prolonged P-wave was defined as Pmax ≥ 140 ms (n = 50) or Pmax ≥ 150 ms (n = 19), the patients in those groups had significantly higher incidence of cardiac events than others (P < .001 and P =.03). A Cox proportional hazards model including age, gender, body mass index, smoking, regular drinker, hypertension, dyslipidemia, diabetes, office systolic blood pressure, heart rate, LA enlargement, and LVH revealed that prolonged P-wave defined as Pmax ≥ 140 ms was independently associated with cardiac events (hazard ratio: 4.23 95% confidence interval: 1.30–13.77 P =.02). In conclusion, the automatically assessed prolonged P-wave was associated with cardiac events independently of LA enlargement and LVH in Japanese patients with CV risks.
-
Journal of Clinical Hypertension 23(2) 272-280 2021年2月1日Whether marked nocturnal blood pressure (BP) reduction is associated with cardiovascular disease (CVD) is still controversial. In addition, no report has yet discussed the relationship between lower nocturnal BP and CVD, involving modification by nighttime hypoxia. We evaluated 840 patients who had one or more cardiovascular risk factors by measuring their high-sensitivity cardiac troponin T (Hs-cTnT), N-terminal pro-B-type natriuretic peptide (NT-pro BNP), and nighttime saturation levels and performing ambulatory BP monitoring. The lowest tertile in nighttime diastolic BP (DBP) (≤66 mmHg) had increased likelihood of the presence of ≥0.014 ng/ml of Hs-cTnT compared with the second tertile (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.01–3.63), and the lowest tertile of minimum blood oxygen saturation (≤81%) had increased likelihood of the presence of ≥0.014 ng/ml of Hs-cTnT compared with the third tertile (OR 2.15, 95% CI 1.13–4.10). Additionally, the patients with both lowest tertile of nighttime DBP and minimum SpO2 showed increased likelihood of the presence of ≥0.014 ng/ml of Hs-cTnT compared with those without this combination (OR 2.93, 95% CI 1.40–6.16). On the other hand, these associations were not found in the presence of ≥125 pg/ml of NT-pro BNP. In the clinical population, each of lower nocturnal DBP and nighttime hypoxia was associated with asymptomatic myocardial injury, which was represented as higher Hs-cTnT, and coexisting lower nocturnal DBP and nighttime hypoxia had an additive effect on the risk of myocardial injury.
-
Hypertension Research 2021年
-
Hypertension 840-850 2021年We assessed the relationship between maximum mean home blood pressure (HBP) and incident cardiovascular disease risks in the general practice population of the J-HOP study (Japan Morning Surge-Home Blood Pressure), which recruited 4231 patients with cardiovascular risk factors (mean [SD] age: 65 [11] years 53% women 79% on antihypertensive medications) who measured their HBP in the morning and evening for 14 days. The first day's HBPs were excluded. The average of morning and evening (the average of morning and evening value [MEave]) BP was defined as the average of all HBP values. The maximum mean HBP was defined as the highest value of mean HBP on one occasion. The variability independent of the mean of MEave BP was assessed. The MEave BP was 134/76 mm Hg the maximum mean HBP was 156/88 mm Hg. Over a median 3.9-year follow-up (16 762 person-years), 72 stroke, and 76 coronary heart disease events occurred. A Cox regression analysis showed that the hazard ratios of a 1-SD increase in maximum mean home systolic BP (SBP 95% CI) for incident stroke events were (1) 1.89 (1.23-2.89) including MEave SBP and (2) 1.68 (1.33-2.14) including the variability independent of the mean of MEave SBP. These significant associations were not observed for coronary heart disease events. Adding the maximum mean home SBP to the stroke prediction model significantly improved the discrimination: (1) MEave SBP: C statistics difference (95% CI), 0.019 (0.002-0.038) and (2) variability independent of the mean of MEave SBP: 0.031 (0.008-0.056). The maximum mean HBP could be a useful marker for evaluating the stroke risk of patients. Registration: URL: https://upload.umin.ac.jp Unique identifier: UMIN000000894.
-
Hypertension Research 2021年There is a lack of data on how nighttime blood pressure (BP) might modify the relationship between sleep duration and cardiovascular disease (CVD) risk. Self-reported sleep duration data were available for 2253/2562 patients from the J-HOP Nocturnal BP study of these, 2236 had complete follow-up data (mean age 63.0 years, 83% using antihypertensive drugs). CVD outcomes included stroke, coronary artery disease (CAD), and atherosclerotic CVD (ASCVD [stroke + CAD]). Associations between sleep duration and nighttime home BP (measured using a validated, automatic, oscillometric device) were determined. During a mean follow-up of 7.1 ± 3.8 years, there were 133 ASCVD events (52 strokes and 81 CAD events). Short sleep duration (< 6 versus ≥6 and < 9 h/night) was significantly associated with the risk of ASCVD (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.07–3.22), especially stroke (HR 2.47, 95% CI 1.08–5.63). When nighttime systolic BP was < 120 mmHg, those with a sleep duration < 6 versus ≥6 and < 9 h/night had a significantly higher risk of ASCVD and CAD events (HR [95% CI] 3.46 [1.52–7.92] and 3.24 [1.21–8.69], respectively). Even patients with “optimal” sleep duration (≥6 and < 9 h/night) were at significantly higher risk of stroke when nighttime systolic BP was uncontrolled (HR [95% CI] 2.76 [1.26–6.04]). Adding sleep duration and nighttime BP to a base model with standard CVD risk factors significantly improved model performance for stroke (C-statistic 0.795, 95% CI 0.737–0.856 p = 0.038). These findings highlight the importance of both optimal sleep duration and control of nocturnal hypertension for reducing the risk of CVD, especially stroke. Clinical Trial registration: URL: http://www.umin.ac.jp/icdr/index.html. Unique identifier: UMIN000000894.
-
Journal of Clinical Hypertension 23(1) 53-60 2021年1月1日The effects of elevations in blood pressure (BP) on worksite stress as an out-of-office BP setting have been evaluated using ambulatory BP monitoring but not by self-measurement. Herein, we determined the profile of self-measured worksite BP in working adults and its association with organ damage in comparison with office BP and home BP measured by the same home BP monitoring device. A total of 103 prefectural government employees (age 45.3 ± 9.0 years, 77.7% male) self-measured their worksite BP at four timepoints (before starting work, before and after a lunch break, and before leaving the workplace) and home BP in the morning, evening, and nighttime (at 2, 3, and 4 a.m.) each day for 14 consecutive days. In the total group, the average worksite systolic BP (SBP) was significantly higher than the morning home SBP (129.1 ± 14.3 vs. 124.4 ± 16.4 mmHg, p =.026). No significant difference was observed among the four worksite SBP values. Although the average worksite BP was higher than the morning home BP in the study participants with office BP < 140/90 mmHg (SBP: 121.4 ± 9.4 vs. 115.1 ± 10.4 mmHg, p < .001, DBP: 76.0 ± 7.7 vs. 72.4 ± 8.4 mmHg, p =.013), this association was not observed in those with office BP ≥ 140/90 mmHg or those using antihypertensive medication. Worksite SBP was significantly correlated with the left ventricular mass index evaluated by echocardiography (r = 0.516, p < .0001). The self-measurement of worksite BP would be useful to unveil the risk of hypertension in working adults who show normal office and home BP.
-
Journal of Clinical Hypertension 22(12) 2214-2220 2020年12月1日Several guidelines recommend measuring home blood pressure (BP) and lowering blood pressure than ever before. But several studies reported that lowering diastolic blood pressure (DBP) increased the incidence of coronary artery disease (CAD). We analyzed 3605 individuals who underwent both home and office BP monitoring over 14 days and baseline Hs-cTnT measurement and identified follow-up data of the Japan Morning Surge-Home Blood Pressure (J-HOP) study who had a history of or risk factors for cardiovascular disease. During a mean follow-up period of 6.4 years (23 173 person-years), 114 coronary artery disease and 81 stroke events occurred. Elevated Hs-cTnT (≥0.014 ng/mL) was observed in 298 patients (8.3%). In the group with non-elevated Hs-cTnT (< 0.014 ng/mL, n = 3307), an adjusted Cox hazard model showed that home systolic BP (SBP) was associated with a risk of stroke incidence (hazard ratio [HR] per 1 SD, 1.62 95% confidence interval [CI], 1.29-2.03). This association was also observed in office SBP (HR per 1 SD, 1.43 95%CI, 1.07-1.91). There was no association between office or home BP and CAD events in the group with non-elevated Hs-cTnT. In the group with elevated Hs-cTnT, an adjusted Cox hazard model showed that home DBP was associated with a risk of CAD incidence (HR per 1 SD, 0.54 95%CI, 0.30-0.99). However, this association was not observed in office DBP. In patients with elevated Hs-cTnT, which is a marker of subclinical myocardial ischemia, excessive lowering of home DBP may be associated with a risk of incident CAD.
-
Journal of Clinical Hypertension 22(11) 2137-2140 2020年11月1日Hypertension guidelines recommend isometric handgrip exercise (IHG) as a non-pharmacological treatment. The aim of this study was to investigate whether IHG is safe for hypertensive patients. The participants were mostly middle-aged to elderly patients with hypertension. Participants wore a pedometer for 4 weeks and were then divided into two groups: Those who had taken at least 7000 steps per day were placed in an IHG-only group (n = 11), and those who took fewer steps were placed in an IHG + walking group (n = 4). Both groups then performed IHG for 12 weeks. No significant blood pressure reduction occurred from before to after intervention in either group. In the IHG-only group, brain natriuretic peptide (BNP) was significantly higher and left atrial (LA) volume (24.6 ± 9.1 to 36.4 ± 17.9 mL, P =.007) was significantly larger after intervention than before. Long-term IHG may induce both LA enlargement and increased BNP in hypertensive patients.
-
American Journal of Hypertension 33(9) 860-868 2020年9月10日BACKGROUND The phenotype of diabetic kidney disease represents a lower estimated glomerular filtration rate (eGFR) and albuminuria. We investigated the association between day-by-day home blood pressure (BP) variability and the eGFR in subjects with diabetes and compared this association with that in subjects without diabetes. We then attempted to determine whether the association is present in albuminuria. METHODS We analyzed 4,231 patients with risk factors of cardiovascular disease (24.4% with diabetes) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study. Home BP was measured in the morning and evening for 14 days. We calculated the SD, coefficient of variation, average real variability (ARV), and variation independent of the mean of the subjects' morning and evening home systolic BP (SBP) as the indexes of day-by-day home BP variability. RESULTS A multiple linear regression analysis adjusted for covariates showed both average morning and evening SBP were associated with the log-transformed urine albumin-to-creatinine ratio (UACR) with and without diabetes (all P < 0.05), but not with the eGFR except for an association of average evening SBP in the no-diabetes group. None of the indexes of day-by-day morning and evening home SBP variability were associated with the log-transformed UACR except for the association between the ARV of home morning SBP in the diabetes group. All of the indexes of day-by-day morning and evening home SBP variability were associated with the eGFR only in the diabetes group (all P < 0.05). CONCLUSIONS The association between increased day-by-day home BP variability and impaired renal function was unique in diabetes.
-
Cardiovascular Revascularization Medicine 21(9) 1108-1112 2020年9月1日Purpose: To analyze the difference in morphological patterns between in-stent restenosis (ISR) lesions of overlapping segments and ISR lesions of non-overlapping segments with second- and third-generation drug-eluting stents (DESs) using optical frequency domain imaging (OFDI). Methods: We analyzed 23 consecutive ISR lesions after second- or third-generation DES implantation using OFDI. Results: A total of 18 men and 5 women (median age, 68.0 years interquartile range, 51.0–74.0 years) were included in the analysis. Fourteen and nine patients underwent second- and third-generation DES implantation, respectively. The median ISR detection timepoint was 10.0 months after implantation (interquartile range, 9.0–34.0 months). In 9 out of 23 lesions, ISR was found in the stent overlap area (overlapping segment group) the remaining 14 cases were categorized as the non-overlapping segment group. In OFDI analysis, homogeneous, layered, and heterogeneous patterns were found in 22%, 55%, and 22%, respectively, of lesions in the overlapping segment group and 14%, 50%, and 35%, respectively, of lesions in the non-overlapping segment group. There was no difference in the distribution of restenotic tissue structure patterns between the groups (p = .756). Conclusions: Morphological assessments of ISR tissue using OFDI showed no difference between the overlapping and non-overlapping segment groups with second and third-generation DESs in this hypothesis generating study.
-
American journal of hypertension 33(7) 620-628 2020年7月18日BACKGROUND: Although seasonal variation of home blood pressure (BP) has been reported to be higher in winter, seasonal difference in home BP (HBP) and its association with target organ damage (TOD) remains unclear. METHODS: This is a cross-sectional study using the dataset from the Japan Morning Surge-Home Blood Pressure (J-HOP) study to assess seasonal differences in HBP, prevalence of masked hypertension, and association of HBP with TOD. The J-HOP study is a nationwide, multicenter prospective study whose participants with cardiovascular risks underwent morning and evening HBP measurements for a 14-day period in 71 institutions throughout Japan. Urine albumin-creatinine ratio (UACR) and serum-B-type natriuretic peptide (BNP) were obtained at enrollment. RESULTS: Among 4,267 participants (mean age, 64.9 ± 10.9 years; 46.9% male; 91.4% hypertensives), 1,060, 979, 1,224, and 1,004 participants were enrolled in spring, summer, autumn, and winter, respectively. Morning and evening home systolic/diastolic BP levels, and prevalence of masked hypertension (office BP <140/90 mm Hg and HBP ≥135/85 mm Hg) were significantly lower in summer than other seasons after adjustment for covariates. When we assessed the interaction between BP parameters and each season for an association with TOD, we found the association between morning home diastolic BP and each of UACR and BNP was stronger in winter than other seasons (both P for interaction <0.05). CONCLUSIONS: In this study, we revealed that the prevalence of masked hypertension was higher in other seasons than in summer and found a notable association between morning home diastolic BP and TOD in winter.
-
Hypertension 76(1) 259-266 2020年7月1日There is no information regarding the potential association between cardiovascular disease (CVD) event risks and masked nocturnal hypertension defined by home blood pressure (BP) monitoring. We sought to examine this association in a general practice population. For this purpose, we used data from the J-HOP (Japan Morning Surge-Home Blood Pressure) Nocturnal BP Study, which recruited 2745 high-cardiovascular-risk participants (mean [SD] age, 63.6 [10.4] years 48.7% men 82.7% on antihypertensive medications). Nocturnal home BPs (HBPs) were measured at 2:00, 3:00, and 4:00 AM using a validated, automated HBP device for 14 consecutive days. The average (SD) of nocturnal HBP measures was 17.1 (13.5). The percentages of participants with controlled BP (nocturnal HBP < 120/70 mm Hg and average morning and evening BP < 135/85 mm Hg), daytime hypertension (nocturnal HBP < 120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg), masked nocturnal hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP < 135/85 mm Hg), and sustained hypertension (nocturnal HBP ≥120/70 mm Hg and average morning and evening BP ≥135/85 mm Hg) were 31.7%, 7.9%, 26.7%, and 33.7%, respectively. During a median 7.6-year follow-up (19 519 person-years), 162 CVD events occurred. The cumulative incidence of CVD events was higher in those with masked nocturnal hypertension and sustained hypertension than in the controlled BP group. Results from Cox models suggested that masked nocturnal hypertension (adjusted hazard ratio, 1.57 [95% CI, 1.00-2.46]) and sustained hypertension (adjusted hazard ratio, 1.97 [95% CI, 1.26-3.06]) were associated with increased risk of CVD events. Participants with masked nocturnal hypertension defined by HBP monitoring are at high risk of future CVD events.
-
Journal of clinical hypertension (Greenwich, Conn.) 22(7) 1208-1215 2020年7月The value of the cardio-ankle vascular index (CAVI) increases with age. All large-scale studies of the CAVI have investigated patients <80 years old. Thus, the clinical characteristics of high CAVI in patients aged 80 or more remain unclear. Therefore, we investigated (1) the CAVI in very elderly patients and (2) the determinants of a high CAVI in high-risk patients, including very elderly patients. The Cardiovascular Prognostic Coupling Study in Japan (Coupling Registry) is a prospective observational study of Japanese outpatients with any cardiovascular risk factors. We enrolled 5109 patients from 30 institutions (average age 68.7 ± 11.4 years, 52.4% males). We investigated the determinants of the CAVI by separating the patients into three groups: 970 middle-aged (<60 years), 3252 elderly (60-79 years), and 887 very elderly (≥80 years) patients. The CAVI values of the males were significantly higher those of the females in all age groups (<60 years: 7.81 ± 1.11 vs. 7.38 ± 0.99, P < .001; 60-79 years: 9.20 ± 1.29 vs. 8.66 ± 1.07, P < .001; ≥80 years: 10.26 ± 1.39 vs. 9.51 ± 1.12, P < .001). In all age groups, the CAVI of the patients with diabetes/glucose tolerance disorder was higher than that of the patients without diabetes/glucose tolerance disorder (<60 years: 7.82 ± 1.22 vs 7.58 ± 1.03, P = .002; 60-79 years: 9.23 ± 1.20 vs 8.78 ± 1.19, P < .001; ≥80 years: 10.04 ± 1.24 vs 9.75 ± 1.32, P = .002). The determinants of the CAVI in these very elderly patients were age, male sex, low BMI, and mean blood pressure. Diabetes/glucose tolerance disorder and glucose were independently associated with the CAVI in the patients aged <60 years and 60-79 years, but not in those aged ≥80 years after adjusting for other covariates.
-
JACC: Cardiovascular Interventions 13(12) 1492-1494 2020年6月22日
-
Echocardiography 37(6) 928-929 2020年6月1日A 70-year-old asymptomatic male who had undergone a right nephrectomy for renal pelvic cancer was referred to us with a thrombus in the ascending aorta detected by contrast-enhanced computed tomography after chemotherapy with gemcitabine/cisplatin. Transesophageal echocardiography revealed a 4-cm mobile mural thrombus in the ascending aorta. An emergency thoracotomy for planned aortic root replacement was performed, but the intraoperative epi-aortic ultrasound indicated that the thrombus had disappeared, and it showed prominent spontaneous-echo contrast (SEC) in the ascending aorta. We speculate that vascular endothelium damage due to the cisplatin-based chemotherapy induced the thrombus and SEC in the ascending aorta.
-
Hypertension 75(6) 1600-1606 2020年6月1日Increased blood pressure (BP) variability, an index of hemodynamic stress, leads to cardiac overload and worse cardiovascular prognosis. The association between day-by-day home BP variability and NT-proBNP (N-terminal pro-B-type natriuretic peptide) as an index of cardiac overload may be amplified by increased arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV). J-HOP (Japan Morning Surge-Home Blood Pressure) Study participants who were selected from a practitioner-based population with at least one cardiovascular risk factor underwent home BP monitoring, and their BP levels and SD, coefficient of variation, and average real variability as indexes of systolic BP variability were assessed. We analyzed 2115 individuals without prevalent heart failure and divided them into lower (< 1800 cm/s, n=1464) and higher (≥1800 cm/s, n=651) baPWV groups. The higher baPWV group had significantly higher SDSBP, CVSBP, ARVSBPvalues, and NT-proBNP levels than the lower baPWV group (all P< 0.001). In the higher baPWV group, a multiple linear regression analysis revealed that the SDSBPwas associated with the NT-proBNP level after adjustment for traditional cardiovascular risk factors including the average home systolic BP (coefficient per 1 SD increase, 0.049 [95% CI, 0.018-0.081] P=0.002). Similar trends were found for CVSBP(P=0.003) and ARVSBP(P=0.004). However, these associations were not found in the lower baPWV group. There was an interaction between all indexes of systolic BP variability and the NT-proBNP level according to lower or higher baPWV group (all P< 0.05). Arterial stiffness amplified the association between home BP variability and cardiac overload.
-
American Journal of Hypertension 33(6) 520-527 2020年5月21日BACKGROUND: We examined our hypothesis that participants with higher mean nighttime blood pressure (BP) levels and/or those with a riser BP pattern, both measured by ambulatory blood pressure (BP) monitoring (ABPM), would show higher risk for cardiovascular disease (CVD) events compared to those with normal nighttime BP levels or a normal dipper BP pattern of circadian BP rhythm, even in very elderly participants in a general practice population. METHODS: This prospective observational study enrolled 485 very elderly outpatients of ≥80 years (mean age: 83.2 ± 3.3 years 44.7% male 89.3% using antihypertensive medications). The prevalences of extreme dipper, dipper, nondipper, and riser status were 15.5%, 38.6%, 32.2%, and 13.8%, respectively. RESULTS: During a mean follow-up of 3.9 years (1,734 person-years), 41 CVD events occurred. The participants with a riser pattern (higher nighttime systolic BP [SBP] than daytime SBP) showed a significantly higher risk for CVD events with adjustment for covariates: hazard ratio (HR), 2.61 95% confidence interval (CI), 1.03-6.62. Even after adjusting for covariates and mean nighttime SBP level, the CVD risks in participants with a riser pattern remained significant: HR, 3.11 95% CI, 1.10-8.88. On the other hand, all BP variables showed no significant risks for CVD events. In addition, when we divided study participants into quartiles by their ambulatory BP levels, none of the ambulatory BP variables showed a J-or U-shaped relationship with CVD event risk. CONCLUSIONS: In very elderly general practice outpatients, a riser BP pattern was significantly associated with CVD events independently of mean nighttime BP.
-
The Lancet 395(10234) 1444-1451 2020年5月2日Background: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. Methods: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. Findings: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was −3·9 mm Hg (Bayesian 95% credible interval −6·2 to −1·6) and for office systolic blood pressure the difference was −6·5 mm Hg (−9·6 to −3·5). No major device-related or procedural-related safety events occurred up to 3 months. Interpretation: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. Funding: Medtronic.
-
American Journal of Hypertension 33(5) 430-438 2020年4月29日BACKGROUND: We hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level. METHODS: We examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR - sleep HR)/awake HR < 0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high). RESULTS: The mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P < 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13 95% confidence interval, 1.35-3.36 P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure. CONCLUSIONS: The combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events.
-
診断と治療 108(4) 435-443 2020年4月＜Headline＞1 「高血圧治療ガイドライン2019」(JSH2019)では、JSH2014より治療目標が診察室血圧130/80mmHg、家庭血圧が125/75mmHgへと引き下げられた。2 JSH2019では高血圧の診断の基準値についてはJSH2014から変更はなく、診察室140/90mmHg、家庭血圧135/85mmHgである。3 これまでのガイドラインと同様にJSH2019においても、高血圧の診断および治療に際して診察室外血圧測定を用いることが推奨されている。(著者抄録)
-
Journal of Clinical Hypertension 22(3) 363-368 2020年3月1日The new Chinese hypertension guideline comprehensively covers almost all major aspects in the management of hypertension. In this new guideline, hypertension remains defined as a systolic/diastolic blood pressure of at least 140/90 mm Hg. For risk assessment, a qualitative approach is used similarly as in previous Chinese guidelines according to the blood pressure level and the presence or absence of other risk factors, target organ damage, cardiovascular complications, and comorbid diseases. The therapeutic target is 140/90 mm Hg in general, and if tolerated, especially in high-risk patients, can be more stringent, that is, 130/80 mm Hg. However, a less stringent target, that is, 150/90 mm Hg, is used in the younger (65-79 years, if tolerated, 140/90 mm Hg) and older elderly (≥80 years). Five classes of antihypertensive drugs, including β-blockers, can be used either in initial monotherapy or combination. The guideline also provided information on the management of hypertension in several special groups of patients and in the presence of secondary causes of hypertension. To implement the guideline recommendations, several nationwide hypertension control initiatives are being undertaken with new technology. The new technological platforms hopefully will help improve the management of hypertension and generate scientific evidence for future hypertension guidelines, including a possible Asian hypertension guideline in the near future.
-
Journal of Clinical Hypertension 22(3) 451-456 2020年3月1日A direct comparison of the effects of febuxostat and allopurinol on flow-mediated dilatation (FMD) will help to clarify which agent provides a better reduction of cardiovascular risk in hypertensive patients. Hypertensive patients with hyperuricemia were randomized into a febuxostat (10-40 mg, n = 33) or allopurinol (100-200 mg, n = 31) group and followed up for 6 months. Both the febuxostat (7.9 ± 1.3 mg/dL vs 5.6 ± 1.0 mg/dL, P < .001) and allopurinol (8.2 ± 1.3 mg/dL vs 6.1 ± 1.0 mg/dL, P < .001) groups exhibited significant reductions in uric acid after treatment. There was no significant difference in the change in FMD between the two treatment groups (0.6 ± 2.6% vs 0.2 ± 2.3%, P =.504). However, stratified analysis showed that febuxostat achieved a significantly greater change in FMD compared to allopurinol in the elderly group (1.3 ± 2.9% vs −0.7%±1.8%, P =.047). There was no difference in the improvement of FMD between febuxostat and allopurinol, but febuxostat may provide an improvement of FMD in elderly people.
MISC
224-
日本循環器学会学術集会抄録集 88回 PJ122-2 2024年3月
-
Hypertension Research 2024年Hypertension, a disease whose prevalence increases with age, induces pathological conditions of ischemic vascular disorders such as cerebral infarction and myocardial infarction due to accelerated arteriosclerosis and circulatory insufficiency of small arteries and sometimes causes hemorrhagic conditions such as cerebral hemorrhage and ruptured aortic aneurysm. On the other hand, as it is said that aging starts with the blood vessels, impaired blood flow associated with vascular aging is the basis for the development of many pathological conditions, and ischemic changes in target organs associated with vascular disorders result in tissue dysfunction and degeneration, inducing organ hypofunction and dysfunction. Therefore, we hypothesized that hypertension is associated with all age-related vascular diseases, and attempted to review the relationship between hypertension and diseases for which a relationship has not been previously well reported. Following our review, we hope that a collaborative effort to unravel age-related diseases from the perspective of hypertension will be undertaken together with experts in various specialties regarding the relationship of hypertension to all pathological conditions. (Figure presented.).
-
Journal of Clinical Hypertension 23(9) 1681-1683 2021年9月1日
-
Journal of Clinical Hypertension 23(8) 1526-1528 2021年8月1日
所属学協会
11Works(作品等)
2共同研究・競争的資金等の研究課題
28-
日本学術振興会 科学研究費助成事業 2022年4月 - 2027年3月
-
日本学術振興会 科学研究費助成事業 2020年4月 - 2025年3月
-
日本学術振興会 科学研究費助成事業 2020年7月 - 2023年3月
-
日本学術振興会 科学研究費助成事業 2019年4月 - 2023年3月
-
日本学術振興会 科学研究費助成事業 2018年4月 - 2023年3月