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1.
Hipertens. riesgo vasc ; 39(2): 79-91, abr.-jun. 2022. graf, tab, ilus
Article in English | IBECS | ID: ibc-203957

ABSTRACT

Information and communication technology (ICT) have advanced remarkably in recent years. In the field of medicine, the problem of hypertension management seems especially well-suited to the application of novel methods. In patients with hypertension, it is important to assess blood pressure (BP) levels throughout the day and night, along with circadian BP variation, using out-of-office BP monitoring. ICT is an attractive tool to facilitate such monitoring and promises to change the current management of hypertension. The combination of self-telemonitoring of BP with lifestyle modification appears to be effective for strict BP control. ICT could be a solution to the challenging problem of nonadherence to antihypertensive medications and could reduce so-called clinical inertia in the treatment of hypertension. ICT approaches would be especially useful in geographically isolated areas or during natural disasters or complex health emergencies such as the ongoing coronavirus pandemic. However, it will be necessary to develop innovative ICT devices for easy and accurate BP measurement in a range of individuals, including the elderly, and to confirm their effectiveness in large scale clinical trials. ICT-based management of hypertension is expected to be pivotal for reducing the public-health burden of cardiovascular diseases and to be widely adopted in daily clinical practice in the future.


Las tecnologías de la información y la comunicación (TIC) han avanzado notablemente en los últimos años. En el campo de la medicina, el problema de la gestión de la hipertensión parece especialmente adecuado para la aplicación de métodos novedosos. En los pacientes con hipertensión, es importante evaluar los niveles de presión arterial (PA) a lo largo del día y de la noche, junto con la variación circadiana de la PA, mediante la monitorización de la PA fuera de la consulta. Las TIC son una herramienta atractiva para facilitar dicha monitorización y prometen cambiar el tratamiento actual de la hipertensión. La combinación de la autovigilancia de la PA con la modificación del estilo de vida parece ser eficaz para el control estricto de la PA. Las TIC podrían ser una solución al difícil problema de la falta de adherencia a la medicación antihipertensiva y podrían reducir la llamada inercia clínica en el tratamiento de la hipertensión. Los enfoques de las TIC serían especialmente útiles en zonas geográficamente aisladas o durante catástrofes naturales o emergencias sanitarias complejas como la actual pandemia de coronavirus. Sin embargo, será necesario desarrollar dispositivos TIC innovadores para medir la PA de forma fácil y precisa en una serie de individuos, incluidos los ancianos, y confirmar su eficacia en ensayos clínicos a gran escala. Se espera que la gestión de la hipertensión basada en las TIC sea fundamental para reducir la carga sanitaria de las enfermedades cardiovasculares y que se adopte ampliamente en la práctica clínica diaria en el futuro.


Subject(s)
Humans , Aged , Cardiovascular Diseases , Blood Pressure Monitoring, Ambulatory , Antihypertensive Agents/therapeutic use , Blood Pressure Determination , Arterial Pressure , Hypertension/drug therapy , Healthy Lifestyle , Biomedical Technology
2.
Hipertens Riesgo Vasc ; 39(2): 79-91, 2022.
Article in English | MEDLINE | ID: mdl-35210178

ABSTRACT

Information and communication technology (ICT) have advanced remarkably in recent years. In the field of medicine, the problem of hypertension management seems especially well-suited to the application of novel methods. In patients with hypertension, it is important to assess blood pressure (BP) levels throughout the day and night, along with circadian BP variation, using out-of-office BP monitoring. ICT is an attractive tool to facilitate such monitoring and promises to change the current management of hypertension. The combination of self-telemonitoring of BP with lifestyle modification appears to be effective for strict BP control. ICT could be a solution to the challenging problem of nonadherence to antihypertensive medications and could reduce so-called clinical inertia in the treatment of hypertension. ICT approaches would be especially useful in geographically isolated areas or during natural disasters or complex health emergencies such as the ongoing coronavirus pandemic. However, it will be necessary to develop innovative ICT devices for easy and accurate BP measurement in a range of individuals, including the elderly, and to confirm their effectiveness in large scale clinical trials. ICT-based management of hypertension is expected to be pivotal for reducing the public-health burden of cardiovascular diseases and to be widely adopted in daily clinical practice in the future.


Subject(s)
Cardiovascular Diseases , Hypertension , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure , Blood Pressure Determination , Humans , Hypertension/drug therapy
5.
J Hum Hypertens ; 31(4): 231-243, 2017 04.
Article in English | MEDLINE | ID: mdl-27604658

ABSTRACT

Out-of-office blood pressure (BP) measured by home BP monitoring, or ambulatory BP monitoring, was demonstrated to be superior to office BP for the prediction of cardiovascular events. The J-HOP study of a nationwide Japanese cohort demonstrated that morning home BP is the best stroke predictor. In the prospective HONEST study of >21 000 hypertensives, on-treatment morning home BP was shown to be a strong predictor both of future coronary artery disease and stroke events. In subjects whose office BP was maintained at ⩾150 mm Hg, there was no increase in cardiovascular events when their morning systolic BP was well-controlled at <125 mm Hg. Since Asians show greater morning BP surges, it is particularly important for Asians to achieve 'perfect 24-hr BP control,' that is, the 24-h BP level, nocturnal BP dipping and BP variability including morning surge. The morning BP surge and the extremes of disrupted circadian rhythm (riser and extreme dipper patterns) are independent risks for stroke in hypertensives. A morning BP-guided approach is thus the first step toward perfect 24-h BP control, followed by the control of nocturnal hypertension. In the resonance hypothesis, the synergistic resonance of BP variability phenotypes would produce an extraordinary large 'dynamic BP surge' that can trigger a cardiovascular event, especially in high-risk patients with systemic hemodynamic atherothrombotic syndrome, a vicious cycle of exaggerated BP variability and vascular disease. In the future, information and communications technology and artificial intelligence technology with the innovation of wearable continuous surge BP monitoring will contribute to 'anticipation medicine' with the goal of zero cardiovascular events.


Subject(s)
Blood Pressure Monitoring, Ambulatory , Hypertension , Disease Management , Humans
6.
J Hum Hypertens ; 30(1): 62-7, 2016 Jan.
Article in English | MEDLINE | ID: mdl-25787779

ABSTRACT

The significance of ambulatory blood pressure (ABP) monitoring during pregnancy has not been established. We performed a prospective study to elucidate whether ABP measures are associated with small-for-gestational-age birth weight (SGA). We studied 146 pregnant women who were seen for maternal medical checkups or suspected hypertension. ABP monitoring was performed for further assessment of hypertension. The outcome measure was SGA. The subjects were classified by their medical history and ABP as having preeclampsia or gestational hypertension (n=68 cases), chronic hypertension (n=48) or white-coat hypertension (n=30). There were 50 (34.2%) cases of SGA by the fetal growth reference standard. In multivariable logistic regression analyses adjusting for age, body mass index, the presence of prior pregnancy, current smoking habit and the use of antihypertensive medications, 24-h SBP (per 10 mm Hg (odds ratio (OR): 1.74; 95% confidence interval (CI): 1.28-2.38; P<0.001)) was more closely associated with SGA than clinic BP (OR: 1.40; 95% CI: 0.92-2.13; P=0.11). The results were essentially the same if 24-h BP was replaced by awake or sleep SBP. Ambulatory diastolic BP showed the same tendency. However, abnormal circadian rhythm was not associated with the outcome. In conclusion, ambulatory BP monitoring measures performed during pregnancy were more closely associated with SGA than clinic BP.


Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , Hypertension, Pregnancy-Induced/diagnosis , Infant, Small for Gestational Age , Pre-Eclampsia/diagnosis , White Coat Hypertension/diagnosis , Adult , Birth Weight , Female , Humans , Infant, Newborn , Predictive Value of Tests , Pregnancy , Prospective Studies , Risk Factors
8.
Life Sci ; 118(2): 410-3, 2014 Nov 24.
Article in English | MEDLINE | ID: mdl-24690389

ABSTRACT

AIMS: Chronic thromboembolic pulmonary hypertension (CTEPH) is a devastating disease, and treating patients with CTEPH who are not eligible for pulmonary endarterectomy is particularly challenging. Short-term bosentan or phosphodiesterase type-5-inhibitor treatment can greatly improve symptoms and hemodynamics in these patients; however, the long-term benefits of advanced pulmonary vasodilators are not known. We retrospectively investigated the long-term effects of advanced pharmacological therapy in Japanese patients with inoperable CTEPH. MAIN METHODS: Seven consecutive patients with inoperable CTEPH (five women; mean age, 62.6±6.9 years) treated with bosentan were included. World Health Organization functional class (WHO-FC), hemodynamics, exercise capacity, and plasma B-type natriuretic peptide (BNP) concentration were evaluated at baseline and for more than 2 years. Time to clinical worsening was also examined during long-term follow-up. KEY FINDINGS: WHO-FC improved significantly, from 3.1±0.4 to 2.1±0.4 (p=0.005). Significant improvement was also seen in pulmonary vascular resistance, which decreased from 786.9±300.0 to 352.2±210.7 dynes s cm(-5) (p<0.05). Plasma BNP concentration decreased significantly from 1160.0±971.4 to 305.1±285.9 pg/mL (p<0.05). No patient required hospitalization during the follow-up period (mean, 896±564 days). SIGNIFICANCE: Long-term advanced therapy with bosentan significantly improves symptoms, pulmonary vascular resistance, plasma BNP concentration, and time to clinical worsening in Japanese patients with inoperable CTEPH. We consider bosentan to be an essential treatment for these patients.


Subject(s)
Hypertension, Pulmonary/complications , Hypertension, Pulmonary/drug therapy , Pulmonary Embolism/complications , Pulmonary Embolism/drug therapy , Sulfonamides/therapeutic use , Asian People , Bosentan , Chronic Disease , Female , Hemodynamics/drug effects , Humans , Hypertension, Pulmonary/physiopathology , Hypertension, Pulmonary/surgery , Japan , Male , Middle Aged , Pulmonary Embolism/physiopathology , Pulmonary Embolism/surgery , Sulfonamides/pharmacology , Time Factors
9.
J Hum Hypertens ; 28(12): 731-5, 2014 Dec.
Article in English | MEDLINE | ID: mdl-24553635

ABSTRACT

We tested the hypothesis that multiple clinic blood pressure (BP) readings over an extended baseline period would be as predictive as ambulatory BP (ABP) for cardiovascular disease (CVD). Clinic and ABP monitoring were performed in 457 hypertensive patients at baseline. Clinic BP was measured monthly and the means of the first 3, 5 and 10 clinic BP readings were taken as the multiple clinic BP readings. The subjects were followed up, and stroke, HARD CVD, and ALL CVD events were determined as outcomes. In multivariate Cox regression analyses, ambulatory systolic BP (SBP) best predicted three outcomes independently of baseline and multiple clinic SBP readings. The mean of 10 clinic SBP readings predicted stroke (hazards ratio (HR)=1.39, 95% confidence interval (CI)=1.02-1.90, P=0.04) and ALL CVD (HR=1.41, 95% CI=1.13-1.74, P=0.002) independently of baseline clinic SBP. Clinic SBPs by three and five readings were not associated with any CVD events, except that clinic SBP by three readings was associated with ALL CVD (P=0.015). Besides ABP values, the mean of the first 10 clinic SBP values was a significant predictor of stroke and ALL CVD events. It is important to take more than several clinic BP readings early after the baseline period for the risk stratification of future CVD events.


Subject(s)
Blood Pressure Determination/methods , Blood Pressure Monitoring, Ambulatory , Cardiovascular Diseases/diagnosis , Aged , Female , Forecasting , Humans , Hypertension/diagnosis , Male , Regression Analysis , Stroke/diagnosis
10.
J Hum Hypertens ; 28(1): 51-5, 2014 Jan.
Article in English | MEDLINE | ID: mdl-23636007

ABSTRACT

The effects of percutaneous transluminal angioplasty (PTA) on hemodynamic parameters are not established. We tested the hypothesis that PTA would achieve reductions in hemodynamic and target organ damage (TOD) measures in patients with peripheral artery disease (PAD). We enrolled 56 consecutive PAD patients who were scheduled to undergo elective PTA procedures. Brachial blood pressure (BP), central BP, left ventricular mass index (LVMI) and urinary microalbumin excretion ratio (UACR) were assessed at baseline and follow-up. The ankle-brachial index in the diseased leg significantly improved after the PTA (P<0.001). Compared with the pretreatment levels, brachial and central BPs, the carotid augmentation index (AI) and central augmentation pressure (AP) were significantly reduced after the PTA, as were LVMI and UACR. The change in AI in the PTA group was significantly associated with the extent of change in LVMI (P=0.002) and marginally associated with the change in UACR (P=0.07), independently of other covariates. In conclusion, in patients with PAD, significant reductions in carotid AI were observed by PTA treatment; these changes may be attributable to improvements in measures of cardiac and renal target organ damage.


Subject(s)
Angioplasty , Cardiovascular Diseases/prevention & control , Kidney Diseases/prevention & control , Aged , Albuminuria/diagnosis , Ankle Brachial Index , Cardiovascular Diseases/diagnostic imaging , Comorbidity , Female , Humans , Male , Peripheral Arterial Disease/therapy , Prospective Studies , Risk Factors , Treatment Outcome , Ultrasonography
11.
Eur J Neurol ; 21(3): 419-26, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24261412

ABSTRACT

BACKGROUND AND PURPOSE: The characteristics of reverse magnetic resonance angiography and diffusion-weighted imaging (MRA-DWI) mismatch (RMM), defined as a large DWI lesion in the absence of major artery occlusion (MAO), remain unknown, especially in patients treated with intravenous recombinant tissue plasminogen activator (rt-PA). METHODS: Patients with stroke in the middle cerebral artery territory were included. Early ischaemic changes (EIC) were assessed with the Alberta Stroke Program Early CT Score on DWI (DWI-ASPECTS). All patients were divided into four groups based on the presence of MAO and a DWI-ASPECTS cut-off value of <7. RMM was defined as DWI-ASPECTS <7 without MAO. Clinical characteristics, symptomatic intracerebral hemorrhage (sICH) and favorable functional outcome (modified Rankin Scale score 0-2) at 90 days were compared amongst the four groups. RESULTS: Of the 486 patients enrolled (167 women, median age 74 years, median initial National Institutes of Health Stroke Scale score 13), reverse MRA-DWI mismatch was observed in 24 (5%). Of the clinical characteristics, cardioembolism was the only factor that was independently associated with RMM [odds ratio (OR) 5.49, 95% confidence interval (CI) 1.25-24.1]. Multivariable analyses revealed that patients with RMM more commonly had sICH than those with DWI-ASPECTS ≥ 7 irrespective of the presence (OR 5.44, 95% CI 1.13-26.1) or absence (13.1, 2.07-83.3) of MAO, and they had a more favorable functional outcome than those with DWI-ASPECTS < 7 plus MAO (7.45, 2.39-23.2). CONCLUSION: RMM was observed in 5% of patients treated with rt-PA and associated with cardioembolism. Patients with RMM may benefit from thrombolysis compared with those with EIC with MAO, although increment in the rate of sICH is a concern.


Subject(s)
Diffusion Magnetic Resonance Imaging , Fibrinolytic Agents/administration & dosage , Magnetic Resonance Angiography , Stroke/diagnosis , Stroke/drug therapy , Tissue Plasminogen Activator/administration & dosage , Administration, Intravenous , Aged , Aged, 80 and over , Female , Humans , Logistic Models , Male , Middle Aged , Predictive Value of Tests , Registries , Retrospective Studies , Severity of Illness Index , Thrombolytic Therapy , Treatment Outcome
12.
J Hum Hypertens ; 28(3): 176-9, 2014 Mar.
Article in English | MEDLINE | ID: mdl-23924872

ABSTRACT

The definitive diagnosis of hypertension based on home blood pressure (BP) monitoring (HBPM) results may be practical, particularly in the primary care setting; however, some hypertensive patients are overlooked by HBPM alone. It is unclear which HBP cutoff value should set for patients who require ambulatory BP monitoring (ABPM). In the present study, home systolic BP (SBP) data (6 BP measurements taken for 3 days in the morning and evening) and 24-h ambulatory SBP data from 462 hypertensive subjects were obtained from a real-world clinical study. Using HBPM as an initial step for the definitive diagnosis of hypertension, 381 of 462 total subjects had a home SBP value of 135 mm Hg. Of these 381 subjects, 90.3% had ambulatory SBP values of 130 mm Hg. Among the other 81 subjects with home SBP values of <135 mm Hg, 60.5% had ambulatory SBP values of 130 mm Hg ('true uncontrolled hypertension'). These percentages differed significantly (P<0.0001). The cutoff home SBP value of 135 mm Hg could discriminate between subjects who did not require ABPM (home SBP value of 135 mm Hg) and those who did (home SBP value of <135 mm Hg) for the diagnosis of true uncontrolled hypertension.


Subject(s)
Blood Pressure Monitoring, Ambulatory/methods , Hypertension/diagnosis , Aged , Antihypertensive Agents/therapeutic use , Circadian Rhythm , Comorbidity , Female , Humans , Hypertension/drug therapy , Japan , Male
13.
J Hum Hypertens ; 27(12): 721-8, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23863805

ABSTRACT

Morning home blood pressure (BP) levels are more closely associated with cardiovascular risk than clinic BP levels. However, control of morning home BP has been worse than that of clinic BP in clinical practice. We examined the effects of olmesartan-based treatment using data (n=21 341) from the first 16 weeks of the Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, a prospective observational study for olmesartan-naive patients with essential hypertension. After 16-week olmesartan-based treatment, the clinic and morning home systolic BP (SBP) lowered from 151.6±16.4 and 153.6±19.0 mm Hg to 135.0±13.7 and 135.5±13.7 mm Hg, respectively (P<0.0001). The achievement percentage of target morning home SBP (<135 mm Hg) in all patients, those with diabetes mellitus (DM), and those with chronic kidney disease (CKD) increased from 13.5, 16.4 and 17.2% to 50.8, 47.9 and 48.8%, respectively, and the proportion of patients with well-controlled hypertension (clinic SBP<140 mm Hg and morning home SBP<135 mm Hg) increased from 7.9, 9.2 and 10.2% to 38.9, 34.5 and 36.3%, respectively. After 16-week olmesartan-based treatment, the proportion of patients with masked and white coat hypertension changed from 11.8 to 24.2% and 5.6 to 11.9%. In conclusion, both clinic and morning home BP in all, DM and CKD patients improved with 16-week olmesartan-based treatment in the 'real world', and the results showed a sustained 24-hour BP-lowering effect of olmesartan. Decrease in clinic and home BP resulted in an increased rate of masked and white coat hypertension, and further management is needed in those patients.


Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Blood Pressure/drug effects , Hypertension/drug therapy , Imidazoles/therapeutic use , Tetrazoles/therapeutic use , Aged , Diabetes Complications/complications , Diabetes Complications/drug therapy , Female , Heart Rate/drug effects , Humans , Hypertension/complications , Male , Middle Aged , Prospective Studies , Renal Insufficiency, Chronic/complications , Time Factors
14.
Neurology ; 75(6): 555-61, 2010 Aug 10.
Article in English | MEDLINE | ID: mdl-20697108

ABSTRACT

OBJECTIVE: To evaluate whether the pretreatment Alberta Stroke Programme Early CT Score (ASPECTS) assessed using diffusion-weighted imaging (DWI) predicts stroke outcomes at 3 months following IV recombinant tissue-type plasminogen activator (rt-PA) therapy. METHODS: Stroke patients treated with rt-PA (0.6 mg/kg alteplase) in 10 stroke centers in Japan were retrospectively studied. ASPECTS was assessed on DWI just prior to rt-PA injection. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 3 months. Secondary outcomes included death at 3 months and symptomatic intracerebral hemorrhage (sICH) within 36 hours. RESULTS: For the 477 patients (316 men, 71 +/- 11 years old) enrolled, the median NIH Stroke Scale score was 13 (interquartile range 7-18.5), the median ASPECTS on DWI was 8 (7-10), and sICH was identified in 15 patients (3.1%). At 3 months, 245 (51.4%) had an mRS score of 0-2, and 29 (6.1%) had died. Patients with an mRS score of 0-2 had higher median ASPECTS (9; interquartile range 8-10) than other patients (8; 6-9, p < 0.001). Using receiver operating characteristic curves, the optimal cutoff ASPECTS to predict an mRS score of 0-2 was > or =7. On multivariate regression analysis, ASPECTS > or =7 was related to an mRS score of 0-2 (odds ratio 1.85; 95% confidence interval 1.07-3.24), ASPECTS < or =4 was related to death (3.61; 1.23-9.91), and ASPECTS < or =5 was related to sICH (4.74; 1.54-13.64). CONCLUSION: ASPECTS on DWI was independently predictive of functional and vital outcomes at 3 months, as well as sICH within 36 hours, following rt-PA therapy for stroke patients.


Subject(s)
Fibrinolytic Agents/administration & dosage , Registries , Severity of Illness Index , Stroke/diagnosis , Stroke/drug therapy , Tissue Plasminogen Activator/administration & dosage , Aged , Aged, 80 and over , Female , Fibrinolytic Agents/therapeutic use , Humans , Japan/epidemiology , Male , Middle Aged , Predictive Value of Tests , Recombinant Proteins/administration & dosage , Recombinant Proteins/therapeutic use , Retrospective Studies , Stroke/epidemiology , Tissue Plasminogen Activator/therapeutic use , Treatment Outcome
15.
J Hum Hypertens ; 24(12): 779-85, 2010 Dec.
Article in English | MEDLINE | ID: mdl-20520631

ABSTRACT

Self-monitoring of blood pressure by patients at home (home blood pressure monitoring (HBPM)) is being increasingly used in many countries and is well accepted by hypertensive patients. Current hypertension guidelines have endorsed the use of HBPM in clinical practice as a useful adjunct to conventional office measurements. Recently, a detailed consensus document on HBPM was published by the European Society of Hypertension Working Group on Blood Pressure Monitoring. However, in daily practice, briefer documents summarizing the essential recommendations are needed. It is also accepted that the successful implementation of clinical guidelines in routine patient care is dependent on their acceptance by involvement of practising physicians. The present document, which provides concise and updated guidelines on the use of HBPM for practising physicians, was therefore prepared by including the comments and feedback of general practitioners.


Subject(s)
Blood Pressure Monitoring, Ambulatory/standards , Blood Pressure , General Practice/standards , Hypertension/diagnosis , Societies, Medical/standards , Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitors/standards , Europe , Humans , Hypertension/physiopathology , Office Visits , Patient Compliance , Predictive Value of Tests , Time Factors
17.
Nihon Koshu Eisei Zasshi ; 48(10): 827-36, 2001 Oct.
Article in Japanese | MEDLINE | ID: mdl-11725526

ABSTRACT

BACKGROUND: In Japan, a national survey indicated that only 7% of hypertensive patients had a blood pressure less than 140/90 mmHg. There have been no reports of studies investigating all of the prevalence of hypertension, the percentage of subjects who are aware of hypertension, the percentage being treated, and the percentage that are well-controlled (awareness, treatment and control, respectively) among hypertensives in the Japanese general population. OBJECTIVE: To investigate the prevalence of hypertension, and awareness, treatment and control of hypertension among hypertensives in a Japanese rural population. DESIGN: A cross-sectional analysis of base-line data of the Jichi Medical School Cohort Study. SETTING: Twelve rural communities is 8 prefectures in Japan. PARTICIPANTS: Community-dwelling people who participated in the health examination program in 1992-1995. MAIN OUTCOME MEASURES: Blood pressure (BP) measured once in the sitting position after a 5-minute rest using oscillometric automatic BP monitors (BP203RV-II; Nippon Colin, Japan), and history of hypertension assessed using a self-administered questionnaire. RESULTS: We analyzed data from 11,302 subjects (4,415 men and 6,887 women). The mean (standard deviation) age was 55(12) years for men and 55(11) years for women. Mean systolic BP and diastolic BP levels were, respectively, 131(21) mmHg and 79(12) mmHg for men and 128(21) mmHg and 76(12) mmHg for women. Prevalence of hypertension (systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or on antihypertensive medication) was 37% for men and 33% for women. Percentages for awareness (on medication or present past history), treatment and control (both systolic BP < 140 mmHg and diastolic BP < 90 mmHg) were, respectively, 39%, 27% and 10% for men and 46%, 38% and 13% for women. CONCLUSIONS: About one third of the study popUlation were hypertensive, and awareness, treatment and control of hypertension among the hypertensives were 43%, 34% and 12%, respectively. Less than half of the hypertensives were well-controlled even when measurement bias was considered. In the rural Japanese population, improvements are required with regard to awareness, treatment and control of hypertension.


Subject(s)
Awareness , Hypertension/epidemiology , Hypertension/psychology , Rural Population , Adolescent , Adult , Aged , Cohort Studies , Cross-Sectional Studies , Female , Humans , Hypertension/therapy , Japan/epidemiology , Male , Middle Aged , Prevalence
18.
J Am Coll Cardiol ; 37(3): 871-7, 2001 Mar 01.
Article in English | MEDLINE | ID: mdl-11693764

ABSTRACT

OBJECTIVES: We sought to study the association of the silent cerebral infarct (SCI), a predisposing condition of stroke, with hyperinsulinemia and hemostatic abnormalities in older hypertensive subjects. BACKGROUND: Hypertension is a powerful risk factor for stroke. However, the role of other risk factors for stroke in hypertensive subjects remains incompletely understood. METHODS: We performed brain magnetic resonance imaging and measured cardiovascular risk factors, by administering the 75-g oral glucose tolerance test and measuring plasma insulin and hemostatic variables, in 123 asymptomatic hypertensive subjects (mean age 69 years). RESULTS: At least one SCI was detected in 80 subjects (65%), and multiple SCIs were found in 48 subjects (39%). The presence of SCIs was associated with older age, higher levels of 24-h systolic blood pressure, 2-h insulin, thrombin-generation markers (prothrombin fragment 1+2 and thrombin-antithrombin complexes), plasminogen activator inhibitor-1 (PAI-1), D-dimer and von Willebrand factor (vWF), but not with plasmin-alpha2-plasmin complex (PIC) levels. The 2-h insulin area under the curve (AUC) was positively correlated with PAI-1 and vWF levels (p < 0.01), and the PAI-1 level was negatively correlated with the PIC level (p < 0.02). Multiple logistic regression analysis revealed that age and the 2-h insulin AUC were significantly associated with SCIs, particularly those located in the subcortical white matter, and hemostatic abnormalities were significantly associated with the presence of multiple SCIs, particularly those located in the basal ganglia. CONCLUSIONS: In older asymptomatic hypertensive subjects, hyperinsulinemia appears to be associated with lacunar-type SCIs, particularly those located in the subcortical white matter, and hemostatic abnormalities show an association with the presence of multiple SCIs, particularly those located in the basal ganglia.


Subject(s)
Cerebral Infarction/blood , Cerebral Infarction/epidemiology , Hyperinsulinism/blood , Hyperinsulinism/epidemiology , Hypertension/blood , Hypertension/epidemiology , Plasminogen Activator Inhibitor 1/blood , Aged , Aged, 80 and over , Basal Ganglia/pathology , Brain/pathology , Cerebral Infarction/pathology , Female , Glucose Tolerance Test , Hemostasis , Humans , Logistic Models , Magnetic Resonance Imaging , Male , Middle Aged , Risk Factors , Tissue Plasminogen Activator/blood , von Willebrand Factor/analysis
19.
Hypertension ; 38(5): 997-1002, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11711488

ABSTRACT

This study reports on the associations among depression, anxiety, awake physical activity, sleep quality (assessed by nocturnal physical activity), and diurnal blood pressure (BP) variation in a nonpsychiatric sample (The Work Site Blood Pressure Study). We conducted ambulatory BP (ABP) monitoring and actigraphy in 231 working men and women. Depression and anxiety were measured by the Brief Symptom Inventory. There were gender-specific associations between depression or anxiety and ABP parameters. In men, depression was associated positively with the sleep/awake systolic BP (SBP) ratio (r=0.24, P=0.006). After controlling for age, body mass index, and awake and sleep activity, depression remained significantly associated with the sleep/awake SBP ratio (r=0.25, P=0.005) and was also significantly related to sleep SBP (r=0.21, P=0.02). Anxiety, which was related to depression (r=0.73, P<0.0001), had a similar but slightly weaker pattern of associations with ABP and activity. These associations were not found in women, but there were associations of anxiety with awake SBP (r=0.24, P=0.01) and pulse rate (r=0.27, P=0.006). In conclusion, depression is associated with disrupted diurnal BP variation independent of ambulatory physical activity in working men, whereas anxiety is associated with awake SBP and pulse rate in women.


Subject(s)
Anxiety/physiopathology , Blood Pressure , Cardiovascular Diseases/etiology , Circadian Rhythm , Depression/physiopathology , Sleep , Adult , Aged , Anxiety/complications , Anxiety/diagnosis , Blood Pressure Monitoring, Ambulatory , Depression/complications , Depression/diagnosis , Female , Humans , Male , Middle Aged , Occupational Diseases/etiology , Physical Exertion , Sex Factors
20.
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