Changes in blood-pressure control among patients with hypertension from 2008 through 2011: surveys of actual clinical practice.

We performed cross-sectional surveys to investigate changes in clinical practices regarding blood-pressure control in patients with hypertension from 2008 through 2011. Questionnaires regarding the care of patients with hypertension were mailed to members of the Kanagawa Physicians Association in Kanagawa Prefecture, Japan. Data were obtained on 675 patients in 2008, 332 in 2009, and 1,076 in 2011. The mean systolic blood pressure (BP) was significantly lower in 2011 than in 2008 (132.2±11.9 mm Hg versus 134.6±10.6 mm Hg). The office-measured target BP, according to the 2009 guidelines of the Japanese Society of Hypertension for the management of patients with hypertension, was achieved in 53.9% of patients in 2008, 55.1% in 2009, and 57.1% in 2011. In nonelderly patients (younger than 65 years), the achievement rate was significantly greater in 2011 (41.2%) than in 2008 (23.6%). This analysis showed that the factor most significantly associated with a decrease in office-measured BP was treatment with a larger number and higher doses of antihypertensive agents. To investigate changes in clinical practices according to the guidelines, further follow-up surveys are necessary.

The current status of blood pressure control among patients with hypertension: a survey of actual clinical practice.

We performed a cross-sectional survey to investigate actual clinical practices regarding blood-pressure control in patients with hypertension. From October 16 to 31, 2008, postal questionnaires regarding the care of patients with hypertension were sent to members of the Kanagawa Physicians Association in Kanagawa, Japan. Data of 675 patients (mean age: 70.1 ± 10.6 years, 301 men and 374 women) were returned. The overall mean systolic blood pressure (BP) in these patients was 134.6 ± 10.6 mm Hg, and diastolic BP was 76.2 ± 8.3 mm Hg. According to the 2009 guidelines of the Japanese Society of Hypertension for the management of patients with hypertension, the target office BP was achieved by 53.9% of all subjects; 29.7% of patients with diabetes mellitus, chronic kidney disease, or a history of myocardial infarction; 72.0% of elderly patients; 23.6% of nonelderly patients (younger than 65 years); and 75.4% of patients with cerebrovascular disease. Cross-sectional analysis showed that factors significantly associated with an increased likelihood of achieving the target office BP were: 1) usage of a larger number of antihypertensive agents in nonelderly patienys and in patients with diabetes mellitus, chronic kidney disease, or a history of myocardial infarction and: 2) usage of a smaller number of antihypertensive agents in elderly patients and patients with cerebrovascular disease. Further follow-up surveys are necessary to provide a full assessment.

[Autoantibodies: new upstream targets of paroxysmal atrial fibrillation in patients with congestive heart failure].

OBJECTIVES: The clinical implications of autoantibodies (Abs) were investigated as upstream indicators of paroxysmal atrial fibrillation in patients with congestive heart failure. METHODS: Circulating Abs against myosin (M-Abs) detected by immunofluorescence, Abs against beta 1-adrenergic receptors (Beta 1-Abs) detected by enzyme-linked immunosorbent assay (ELISA), and Abs against NA-K-ATPase (NKA-Abs) detected by ELISA were screened in 95 congestive heart failure patients with < or = 45% left ventricular ejection fraction (coronary artery disease, n = 48; dilated cardiomyopathy, n = 47) and 48 age-matched control patients with hypertension. No patient received antiarrhythmic therapy. All patients were enrolled with angiotensin converting enzyme inhibitors in the chronic stable state. Relationship of the presence of paroxysmal atrial fibrillation to other clinical variables were assessed by 48-hour Holter monitoring. RESULTS: No control patient had Abs. However, M-Abs, Beta 1-Abs, and NKA-Abs were detected in 22%, 26% and 16% of patients with congestive heart failure (coronary artery disease; 8%, 10%, and 4%, dilated cardiomyopathy; 36%, 43%, and 28%, respectively). Paroxysmal atrial fibrillation was more frequent in patients with dilated cardiomyopathy than in those with coronary artery disease (47% vs 15%, p < 0.01). Multivariate analysis suggested that NKA-Abs was an independent risk factor for the occurrence of paroxysmal atrial fibrillation (p < 0.01), although there were no differences in other clinical factors: age, sex, New York Heart Association functional class, concomitant medication, left ventricular ejection fraction, left atrial diameter, severity of mitral regurgitation, serum potassium, plasma norepinephrine, and atrial natriuretic peptide concentration. CONCLUSIONS: Autoantibodies against sarcolemmal Na-K-ATPase were closely related to the occurrence of paroxysmal atrial fibrillation in patients with congestive heart failure, so an autoimmune process may be an upstream factor in atrial fibrillation.