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1.
Int J Chron Obstruct Pulmon Dis ; 16: 1813-1822, 2021.
Article in English | MEDLINE | ID: mdl-34168442

ABSTRACT

Background: Asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO) are complex and heterogeneous diseases that share clinical characteristics (phenotypes) and molecular mechanisms (endotypes). Whilst physicians make clinical decisions on diagnostic groups, for some such as ACO there is no commonly accepted criteria. An alternative approach is to evaluate phenotypes and endotypes that are considered to respond well to a specific type of treatment ("treatable traits") rather than diagnostic labels. Purpose: The prospective, longitudinal, and observational TRAIT study will evaluate disease characteristics, including both phenotypes and endotypes, in relation to the presentation of obstructive respiratory disease characteristics in patients diagnosed with asthma, COPD, or ACO in Japan, with the aim of further understanding the clinical benefit of a treatable traits-based approach. Patients and Methods: A total of 1500 participants will be enrolled into three cohorts according to their treating physician's diagnosis of asthma, COPD, or ACO at screening. Part 1 of the study will involve cross-sectional phenotyping and endotyping at study enrollment. Part 2 of the study will evaluate the progression of clinical characteristics, biomarker profiles, and treatment over a 3-year follow-up period. The follow-up will involve three annual study visits and three telephone calls scheduled at 6-month intervals. A substudy involving 50 participants from the asthma cohort (in which the ratio will be approximately 1:1 including 25 participants with a smoking history of ≥10 pack-years and 25 participants with no smoking history), 100 participants from the ACO cohort, and 100 participants from the COPD cohort will evaluate disease phenotypes using inspiratory and expiratory computed tomography scans. Conclusion: TRAIT will describe clinical characteristics of patients with obstructive respiratory diseases to better understand potential differences and similarities between clinical diagnoses, which will support the improvement of personalized treatment strategies.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Cohort Studies , Cross-Sectional Studies , Humans , Japan/epidemiology , Phenotype , Prospective Studies , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy
2.
Hypertens Res ; 41(8): 622-628, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29808033

ABSTRACT

We compared the predictive power for a major adverse cardiovascular event (MACE) of four home blood pressure (BP) indices (systolic BP, diastolic BP, mean BP, and pulse pressure (PP)) obtained at baseline before treatment and during the on-treatment follow-up period in 3147 patients with essential hypertension (women: 50.1%, mean age: 59.5 years). Associations between MACE and each index were determined using Cox proportional hazard models and the likelihood ratio (LR) test. During a median follow-up of 5.4 years, 46 patients experienced MACE, which was a composite of cardiovascular death, non-fatal stroke, and non-fatal myocardial infarction. The LR test showed that systolic, diastolic, and mean BP during follow-up was more closely associated with cardiovascular risk than the corresponding indices at baseline (LR χ2 for baseline versus follow-up: systolic BP, (6.0, P = 0.014) versus (11.3, P = 0.0008); diastolic BP, (0.4, P = 0.53) versus (12.4, P = 0.0004); mean BP, (3.2, P = 0.074) versus (15.0, P = 0.0001)), whereas neither PP at baseline nor that during follow-up was significantly associated with MACE risk. Among home BP indices during follow-up, mean BP further improved prediction models in which systolic or diastolic BP was already included (P ≤ 0.042), but neither systolic nor diastolic BP improved models with mean BP (P = 0.80). In addition to home systolic and diastolic BP, mean BP during follow-up period provides essential information in predicting future cardiovascular diseases, whereas its utilization should be further assessed by an intervention trial targeting mean BP levels.


Subject(s)
Blood Pressure/physiology , Hypertension/physiopathology , Models, Cardiovascular , Myocardial Infarction/physiopathology , Stroke/physiopathology , Aged , Blood Pressure Monitoring, Ambulatory , Female , Follow-Up Studies , Humans , Hypertension/complications , Male , Middle Aged , Myocardial Infarction/etiology , Predictive Value of Tests , Risk Factors , Stroke/etiology
3.
J Am Heart Assoc ; 7(10)2018 05 04.
Article in English | MEDLINE | ID: mdl-29728372

ABSTRACT

BACKGROUND: The clinical significance of long-term seasonal variations in self-measured home blood pressure (BP) has not been elucidated for the cardiovascular disease prevention. METHODS AND RESULTS: Eligible 2787 patients were classified into 4 groups according to the magnitude of their seasonal variation in home BP, defined as an average of all increases in home BP from summer (July-August) to winter (January-February) combined with all decreases from winter to summer throughout the follow-up period, namely inverse- (systolic/diastolic, <0/<0 mm Hg), small- (0-4.8/0-2.4 mm Hg), middle- (4.8-9.1/2.4-4.5 mm Hg), or large- (≥9.1/≥4.5 mm Hg) variation groups. The overall cardiovascular risks illustrated U-shaped relationships across the groups, and hazard ratios for all cardiovascular outcomes compared with the small-variation group were 3.07 (P=0.004) and 2.02 (P=0.041) in the inverse-variation group and large-variation group, respectively, based on systolic BP, and results were confirmatory for major adverse cardiovascular events. Furthermore, when the summer-winter home BP difference was evaluated among patients who experienced titration and tapering of antihypertensive drugs depending on the season, the difference was significantly smaller in the early (September-November) than in the late (December-February) titration group (3.9/1.2 mm Hg versus 7.3/3.1 mm Hg, P<0.001) as well as in the early (March-May) than in the late (June-August) tapering group (4.4/2.1 mm Hg versus 7.1/3.4 mm Hg, P<0.001). CONCLUSIONS: The small-to-middle seasonal variation in home BP (0-9.1/0-4.5 mm Hg), which may be partially attributed to earlier adjustment of antihypertensive medication, were associated with better cardiovascular outcomes.


Subject(s)
Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure , Hypertension/diagnosis , Seasons , Aged , Antihypertensive Agents/administration & dosage , Blood Pressure/drug effects , Female , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Japan , Male , Middle Aged , Predictive Value of Tests , Prognosis , Randomized Controlled Trials as Topic , Reproducibility of Results , Time Factors
4.
Clin Exp Hypertens ; 40(5): 468-475, 2018.
Article in English | MEDLINE | ID: mdl-29172732

ABSTRACT

The aim of this study was to assess the effects of irbesartan alone and combined with amlodipine, efonidipine, or trichlormethiazide on blood pressure (BP) and urinary albumin (UA) excretion in hypertensive patients with microalbuminuria (30≤UA/creatinine (Cr) ratio [UACR] <300 mg/g Cr) and upper-normal microalbuminuria (10≤UACR<30 mg/g Cr). This randomized controlled trial enrolled 175 newly diagnosed and untreated hypertensive patients (home systolic blood pressure [SBP]≥135 mmHg; 10≤UACR<300 mg/g Cr of casual spot urine at the first visit to clinic). All patients were treated with irbesartan (week 0). Patients who failed to achieve home SBP ≤125 mmHg on 8-week irbesartan monotherapy (nonresponders, n = 115) were randomized into three additional drug treatment groups: trichlormethiazide (n = 42), efonidipine (n = 39), or amlodipine (n = 34). Irbesartan monotherapy decreased home SBP and first morning urine samples (morning UACR) for 8 weeks (p < 0.0001). At 8 weeks after randomization, all three additional drugs decreased home SBP (p < 0.0002) and trichlormethiazide significantly decreased morning UACR (p = 0.03). Amlodipine decreased morning UACR in patients with microalbuminuria based on casual spot urine samples (p = 0.048). However, multivariate analysis showed that only higher home SBP and UACR at week 8, but not any additional treatments, were significantly associated with UACR reduction between week 8 and week 16. In conclusion, crucial points of the effects of combination therapy on UACR were basal UACR and SBP levels. The effect of trichlormethiazide or amlodipine treatment in combination with irbesartan treatment on microalbuminuria needs to be reexamined based on a larger sample size after considering basal UACR and SBP levels.


Subject(s)
Albuminuria/drug therapy , Amlodipine/therapeutic use , Antihypertensive Agents/pharmacology , Biphenyl Compounds/therapeutic use , Dihydropyridines/therapeutic use , Essential Hypertension/drug therapy , Nitrophenols/therapeutic use , Tetrazoles/therapeutic use , Trichlormethiazide/therapeutic use , Aged , Albuminuria/complications , Albuminuria/urine , Amlodipine/pharmacology , Antihypertensive Agents/therapeutic use , Biphenyl Compounds/pharmacology , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , Dihydropyridines/pharmacology , Drug Therapy, Combination , Essential Hypertension/complications , Female , Humans , Irbesartan , Male , Middle Aged , Nitrophenols/pharmacology , Organophosphorus Compounds/pharmacology , Organophosphorus Compounds/therapeutic use , Tetrazoles/pharmacology , Trichlormethiazide/pharmacology , Urinalysis
5.
Hypertens Res ; 40(8): 789-790, 2017 08.
Article in English | MEDLINE | ID: mdl-28446806
6.
Hypertens Res ; 40(5): 504-510, 2017 May.
Article in English | MEDLINE | ID: mdl-28077858

ABSTRACT

Few studies have focused on the effect of organ damage on achievement of long-term home blood pressure (BP) control. Based on the nationwide home BP-based trial data, we aimed to investigate the factors associated with home BP control, in particular, left ventricular hypertrophy (LVH) using the electrocardiogram in patients who started antihypertensive drug treatment. According to the trial protocol, we defined BP as controlled when systolic home BP reached specified targets (125-134 mm Hg in usual control (UC), n=1261; <125 mm Hg in tight control (TC), n=1288). At baseline, before drug treatment started, the mean Sokolow-Lyon voltage was 2.57±0.87 mV, and the mean Cornell product was 1573±705 mm·ms. The numbers of patients who achieved the target BP level in the UC and TC groups were 892 (70.7%) and 576 (44.7%), respectively. In both the UC and TC groups, systolic home BP at baseline was significantly lower in patients who achieved target levels than in those who did not achieve target levels (P<0.0001). Sokolow-Lyon voltage was significantly lower in patients who achieved target levels than in those who did not (P⩽0.0055). The Cornell product levels in each group were similar (P⩾0.12), although significantly different between patients who did or did not achieve the target level when the UC and TC groups were combined for analysis (P=0.031). Sokolow-Lyon voltage was significantly associated with achievement of home BP control in the multivariable-adjusted model (odds ratio, 1.13; 95% confidence intervals, 1.02-1.26; P=0.015), but Cornell product was not (P=0.13). These results indicate the difficulty of sufficient antihypertensive treatment when untreated patients had target organ damage, that is, LVH diagnosed by Sokolow-Lyon voltage.


Subject(s)
Antihypertensive Agents/therapeutic use , Electrocardiography , Hypertension/drug therapy , Hypertrophy, Left Ventricular/diagnosis , Aged , Algorithms , Blood Pressure , Female , Humans , Hypertension/physiopathology , Hypertrophy, Left Ventricular/physiopathology , Male , Middle Aged , Predictive Value of Tests , Treatment Outcome
7.
Hypertens Res ; 40(3): 284-290, 2017 Mar.
Article in English | MEDLINE | ID: mdl-27682651

ABSTRACT

Seasonal variation of blood pressure (BP) has been reported in small populations or by BP levels captured at only a few points in a year, for example, summer and winter. We aimed to investigate the multiyear seasonal variation in self-measured home BP among hypertensive patients receiving antihypertensive medications. We selected 1649 eligible patients receiving antihypertensive drug treatment, and weekly averaged home BPs were analyzed throughout the follow-up period. Systolic and diastolic home BPs were fitted with the cosine function: 'Variation+Other Effects+Intercept', in which the 'Variation' was expressed by a cosine curve with three parameters representing: (1) maximum-minimum difference of home BP in one cycle of the cosine curve; (2) time required for one cycle of the cosine curve for home BP variation; and (3) time at which home BP reached the maximum point. Maximum-minimum differences in home BP were 6.7/2.9 mm Hg, and the highest home BPs were observed in mid-to-late January. In the multivariable-adjusted model, a large maximum-minimum difference in home BP was associated with lower body mass index and older age, and larger differences were observed in men compared with women. Summer-winter difference in home BP was essentially similar every year, though it was marginally reduced by 0.14/0.04 mm Hg per year, under long-term antihypertensive treatment. Records of daily home BP measurements enable us to capture long-term factors such as seasonal variation. Home BP should therefore be carefully monitored, particularly in patients with increased BP in winter, to mitigate cardiovascular risk.


Subject(s)
Antihypertensive Agents/therapeutic use , Blood Pressure/physiology , Hypertension/physiopathology , Seasons , Aged , Antihypertensive Agents/pharmacology , Blood Pressure/drug effects , Blood Pressure Determination , Female , Humans , Hypertension/drug therapy , Male , Middle Aged , Sex Factors
8.
J Am Heart Assoc ; 5(3): e002995, 2016 Mar 23.
Article in English | MEDLINE | ID: mdl-27009620

ABSTRACT

BACKGROUND: Recent literature suggests that blood pressure variability (BPV) predicts outcome beyond blood pressure level (BPL) and that antihypertensive drug classes differentially influence BPV. We compared calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockade for effects on changes in self-measured home BPL and BPV and for their prognostic significance in newly treated hypertensive patients. METHODS AND RESULTS: We enrolled 2484 patients randomly allocated to first-line treatment with a calcium channel blocker (n=833), an angiotensin-converting enzyme inhibitor (n=821), or angiotensin receptor blockade (n=830). Home blood pressures in the morning and evening were measured for 5 days off treatment before randomization and for 5 days after 2 to 4 weeks of randomized drug treatment. We assessed BPL and BPV changes as estimated by variability independent of the mean and compared cardiovascular outcomes. Home BPL response in each group was significant (P≤0.0001) but small in the angiotensin-converting enzyme inhibitor group (systolic/diastolic: 4.6/2.8 mm Hg) compared with the groups treated with a calcium channel blocker (systolic/diastolic: 8.3/3.9 mm Hg) and angiotensin receptor blockade (systolic/diastolic: 8.2/4.5 mm Hg). In multivariable adjusted analyses, changes in home variability independent of the mean did not differ among the 3 drug classes (P≥0.054). Evening variability independent of the mean before treatment significantly predicted hard cardiovascular events independent of the corresponding home BPL (P≤0.022), whereas BPV did not predict any cardiovascular outcome based on the morning measurement (P≥0.056). Home BPV captured after monotherapy had no predictive power for cardiovascular outcome (P≥0.22). CONCLUSIONS: Self-measured home evening BPV estimated by variability independent of the mean had prognostic significance, whereas antihypertensive drug classes had no significant impact on BPV changes. Home BPL should remain the primary focus for risk stratification and treatment. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: C000000137.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Blood Pressure Determination/methods , Blood Pressure/drug effects , Calcium Channel Blockers/therapeutic use , Circadian Rhythm , Hypertension/diagnosis , Hypertension/drug therapy , Adult , Aged , Chi-Square Distribution , Female , Humans , Hypertension/physiopathology , Japan , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Proportional Hazards Models , Prospective Studies , Reproducibility of Results , Risk Factors , Severity of Illness Index , Time Factors , Treatment Outcome
9.
Clin Exp Hypertens ; 33(7): 427-36, 2011.
Article in English | MEDLINE | ID: mdl-21777149

ABSTRACT

Low-dose (25 mg) or very low-dose (12.5 mg) spironolactone were added among 86 uncontrolled hypertensive patients who were undergoing monotherapy with calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), or angiotensin AT1-receptor blockers (ARBs). Morning home systolic/diastolic blood pressure (BP) reduction was similar among the CCB (n = 30, -8.2/-2.6 mmHg), ACEI (n = 22, -13.0/-4.7 mmHg), and ARB (n = 34, -11.5/-5.1 mmHg) groups. An increase in serum potassium correlated positively with the decline in morning systolic BP. Even very low-dose (12.5 mg) spironolactone is clinically effective, although serum potassium should be carefully monitored.


Subject(s)
Antihypertensive Agents/administration & dosage , Blood Pressure/drug effects , Diuretics/administration & dosage , Hypertension/drug therapy , Hypertension/physiopathology , Spironolactone/administration & dosage , Aged , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Blood Pressure Monitoring, Ambulatory , Calcium Channel Blockers/administration & dosage , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Humans , Hypertension/blood , Male , Middle Aged , Potassium/blood
10.
Clin Exp Hypertens ; 33(3): 147-52, 2011.
Article in English | MEDLINE | ID: mdl-21271815

ABSTRACT

We measured the brachial-ankle pulse wave velocity (baPWV) in 491 normotensives and determined the "PWV index" (measured baPWV-theoretical baPWV) in 491 normotensives and 83 controlled hypertensives. Linear regression analysis revealed that the theoretical baPWV (cm/sec) was 0.21 × age(2) (years(2))-13.73 × age (years) + 0.05 × mean arterial pressure(2) (mmHg(2)) + 3.95 × heart rate (bpm) + 36.49 × gender (1 male; 0 female) + 733 (R(2) = 0.53). The calculated PWV index was significantly higher in 13 smokers than 70 nonsmokers among controlled hypertensives. The calculated PWV index might provide more precise information about inherent arterial stiffness.


Subject(s)
Ankle Brachial Index/methods , Brachial Artery/physiopathology , Elasticity/physiology , Hypertension/physiopathology , Nomograms , Pulsatile Flow/physiology , Adult , Aged , Blood Flow Velocity/physiology , Blood Pressure/physiology , Case-Control Studies , Female , Humans , Japan , Linear Models , Male , Middle Aged , Smoking/physiopathology
11.
Am J Hypertens ; 21(4): 413-8, 2008 Apr.
Article in English | MEDLINE | ID: mdl-18369360

ABSTRACT

BACKGROUND: Microalbuminuria is recognized as a marker of generalized vascular dysfunction. However, the associations between microalbuminuria and pulse wave velocity (PWV), carotid intima-media thickness (IMT), and ambulatory blood pressure (ABP), respectively, have not been investigated. METHODS: Brachial-ankle PWV (baPWV), IMT, and ABP were determined in 328 individuals (mean age, 65.7 +/- 6.4 years) from the general population of Ohasama, a rural Japanese community. The participants were assigned to groups with microalbuminuria and with normoalbuminuria, and their characteristics were compared. We also examined the association between microalbuminuria and baPWV, IMT, and ABP, respectively, using multivariate analyses. RESULTS: Seventy-nine participants (24%) with microalbuminuria had significantly higher baPWV (P < 0.001) and 24-h systolic BP (SBP) (P = 0.006) than those with normoalbuminuria, although 24-h pulse pressure and mean IMT did not significantly differ between the groups. Multiple logistic regression analyses showed that baPWV, but not 24-h ABP, was independently associated with microalbuminuria (P = 0.002) when adjusted for various confounding factors. After further adjustment for 24-h SBP, the association between baPWV and microalbuminuria remained significant (P = 0.012). The trend was significant even when daytime or nighttime SBP was used instead of 24-hour SBP in this model. CONCLUSIONS: Microalbuminuria appears to be associated with baPWV more closely than with IMT and ABP, and its association with baPWV is independent of ABP and other cardiovascular risk factors.


Subject(s)
Albuminuria/physiopathology , Blood Flow Velocity/physiology , Brachial Artery/physiology , Rural Population , Tibial Arteries/physiopathology , Vascular Diseases/complications , Aged , Aged, 80 and over , Albuminuria/epidemiology , Albuminuria/etiology , Biomarkers/blood , Biomarkers/urine , Blood Pressure/physiology , Blood Pressure Monitoring, Ambulatory/methods , Disease Progression , Female , Follow-Up Studies , Humans , Incidence , Japan/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Severity of Illness Index , Vascular Diseases/metabolism , Vascular Diseases/physiopathology
12.
Am J Hypertens ; 19(12): 1199-205, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17161763

ABSTRACT

BACKGROUND: Whether arterial stiffness per se contributes to left ventricular hypertrophy (LVH) independently of blood pressure (BP) remains unknown. We examined the relationship between pulse wave velocity (PWV) and LVH in a large population. METHODS: The PWV was measured between the brachial and ankle regions (baPWV) of 798 individuals. We diagnosed LVH using electrocardiographic criteria: Cornell voltage-duration product >2440 mm x msec or Sokolow-Lyon voltage >38 mm. The participants were initially separated into those with and without LVH [LVH(+) and LVH(-) groups, respectively]. To determine theoretical baPWV, we first constructed a nomogram for the LVH(-) group, calculated the PWV index (measured baPWV - theoretical baPWV) for each individual and then compared the two groups. We also examined the factors associated with LVH(+) using multivariate analyses. RESULTS: Linear regression analysis revealed that the theoretical baPWV (m/sec) = 0.20 x age (years) + 0.13 x Mean arterial pressure (MAP) (mm Hg) + 0.05 x Heart rate (beats/min) - 11.74 (R(2) = 0.56). The PWV index was greater in the LVH(+) than in the LVH(-) group (P = .025). The baPWV was independently related to LVH(+) along with MAP, medication for hypertension, and for diabetes; a 1 SD (4.3 m/sec) increase in baPWV was associated with a 26% increase in the risk of LVH(+) (P = .022). When LVH(+) risk factors were defined as hypertension, diabetes, and high baPWV (> or =14.6 m/sec), the prevalence of LVH(+) linearly increased with the number of concomitant LVH(+) risk factors (P < .001). CONCLUSIONS: Arterial stiffness is independently related to electrocardiographically determined LVH in the general population.


Subject(s)
Ankle/blood supply , Brachial Artery/physiopathology , Electrocardiography , Hypertrophy, Left Ventricular/etiology , Hypertrophy, Left Ventricular/physiopathology , Adult , Age Distribution , Age Factors , Aged , Aged, 80 and over , Blood Flow Velocity , Blood Pressure , Cross-Sectional Studies , Diabetes Complications/physiopathology , Elasticity , Female , Heart Rate , Humans , Hypertension/complications , Hypertension/physiopathology , Hypertrophy, Left Ventricular/epidemiology , Japan/epidemiology , Linear Models , Logistic Models , Male , Middle Aged , Models, Cardiovascular , Odds Ratio , Prevalence , Pulsatile Flow , ROC Curve , Risk Factors
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