Lifestyle modification in metabolic syndrome and associated changes in plasma amino acid profiles.

BACKGROUND: Although lifestyle modification is the key treatment of metabolic syndrome (MetS), clinical data on the dynamical relationship between metabolic state and MetS has been limited. This study investigated the mutual correlations between demographic and biochemical variables, and the metabolic state based on the plasma amino acid (AA) concentrations, during a lifestyle modification for MetS. METHODS AND RESULTS: Japanese subjects, consisting of 54 patients with MetS [MetS(+)] and 35 persons without MetS [MetS(-)] were included in the study. Before a lifestyle modification program, the levels of glutamate metabolism-related AA (Glu-mAA), aromatic AA metabolism-related AA (Aromatic-mAA) and alanine metabolism-related AA (Ala-mAA) were significantly higher, while those of glycine-serine-threonine metabolism-related AA (Gly-Ser-Thr-mAA) were significantly lower compared to those in MetS(-). After a lifestyle modification, significant reductions (P<0.05) in the BMI (-1.4 kg/m(2)), mean blood pressure (-7.9 mmHg), hemoglobin A(1c) (-0.4%), and triglycerides (-30.6 mg/dl) were observed, and significant differences in the plasma AA levels between MetS(+) and MetS(-) were resolved. In addition, the diagnostic items of MetS were positively correlated with the levels of Glu-mAA, Ala-mAA, branched chain AA (BCAA)-mAA, Aromatic-mAA, and negatively correlated with the levels of Gly-Ser-Thr-mAA. CONCLUSIONS: As MetS subsided, the abnormality of mean plasma AA levels of the MetS(+) group returned to similar values as those in the MetS(-) group, suggesting a novel viewpoint regarding the metabolic mechanism of lifestyle modification.

Estimation of base blood pressure by using a new device in the outpatient clinic.

Direct measurement of intra-arterial blood pressure (BP) for 24-h provides approximately 100,000 values that vary enormously, but each (BPi) can be expressed by the equation BPi = BP0 + DeltaBPi (BP0, base BP; DeltaBPi, BP increment, i=1, 2, ..., 100 x 10(3)). About 20% of outpatients with hypertension exhibit white-coat hypertension (WCH). In such patients, DeltaBPc (i = c; c, time at the clinic) is surmised to be large. A method for explaining the physiological factors in DeltaBPc and the estimation of base BP in the outpatient clinic is important. This study addresses this issue. A total of 293 subjects were divided into four groups: 1) WCH group, 45 individuals (office BP > or = 140/90 mmHg and 24-h indirect BP < 125/80 mmHg); 2) normotensive (NT) group, 84 controls matched for age and sex; 3) WHO-I group, 95 hypertensive patients with WHO stage I (office BP > or = 140/90 mmHg and 24-h BP > or = 125/80 mmHg); and 4) WHO-II group, 69 hypertensive patients with WHO stage II. Their BPc and heart rate (HR; HRc, clinic HR) values were measured by a BP-ECG monitoring device in the outpatient clinic. Power-spectral analysis was used to obtain the ratio between the low-frequency component (LF) and high-frequency component (HF) of ECG-RR variability (LF/HF = LH). Twenty-four-hour indirect BP (and BP0) and base HR (HR0) were measured by a portable device (TM2425) at 30-min intervals. Then, DeltaBPc (= BPc - BP0) was estimated by performing linear multivariate analysis applying the model equation DeltaBPc = (BPc -alphaLH)(1-betaHR0/HRc) + epsilon to the above variables (alpha and beta, constant values; epsilon, error). This model equation made it possible to estimate BP0 (and DeltaBPc) with a high coefficient of correlation (r > or = 0.85, mean of error less than 0.82 +/- 5.9 mmHg). The predictive accuracy for discrimination between WCH and sustained hypertension (WHO-I and WHO-II groups) by this equation was 88%. The new DeltaBP-estimation device (BP-ECG monitor) enabled us to infer BP0 and is therefore useful in estimating WCH in the outpatient clinic.

Sodium intake and cardiac sympatho-vagal balance in young men with high blood pressure.

We have previously reported that a high sodium intake increases sleep-time blood pressure (BP) in young men. However, there are cases in which this relation does not apply. To account for them, we investigated the relation between sodium intake and cardiac sympatho-vagal balance (SVB) in young men with high BP. Sodium intake was estimated from the amount of urinary sodium excretion over 1 week. Twenty-four-hour (24-h) urinary sodium excretion (Salt24), 24-h ambulatory BP and ECG were obtained on the last day of the observation period. As an index of sodium intake, the expression In(Salt24/Cr24) (Cr24, 24-h urinary creatinine excretion) was used. From power-spectral analysis of ECG-RR intervals during sleep, we obtained the LF/HF ratio between the low-frequency component (LF) and the high frequency component (HF) and used it as an index of SVB. The subjects were male medical students divided into a normal BP group (N-group; n=103) and a high BP group (H-group; n=26, 24-h BP>125/75 mmHg). Mean In(Salt24/Cr24) and LF/HF in the H-group were significantly higher than those in the N-group (LF/HF: 1.86+/-0.44 [SD] vs. 1.37+/-0.30, p<0.001). The calculated discriminant function (D) for the H-group and N-group was D=1.6x + 5y - 11, where x is In(Salt24/Cr24) and y is LF/HF. This formula (D) resulted in high discriminant predictive accuracy (82%) between the groups. If D=0 (the value of the cut-off line determining separation of the groups), the relation y=-0.32x + 2.2 (negative relation between y and x) was obtained. These results suggest that excessive sodium intake in combination with accentuated SVB (LF/HF) increases BP in young men.

Accuracy and applicability of the Terumo ES-H55 double-cuff sphygmomanometer for hospital use.

BACKGROUND: We have developed a new blood pressure (BP)-measuring device with a double-cuff, and evaluated its accuracy and applicability for practical use. DESIGN: The double-cuff method features a small cuff placed in the centre of the compression cuff to detect the oscillation of arterial pulsation, by which algorithms for the determination of systolic BP (SBP) and diastolic BP (DBP) were rendered more objective than with the conventional oscillometric method. Algorithms for automatic BP determination were developed from the oscillation data taken with the small cuff from 217 men and 256 women, and then installed in the Terumo ES-H55 device (length: 17 cm, weight: 120 g). This ES-H55 device was tested on 87 subjects (65 hypertensives and 22 normotensives) to compare its accuracy with that of the auscultatory method according to the AAMI SP-10 protocol. RESULTS: Using Bland and Altman scatter plots, the difference in SBP between the ES-H55 device and the auscultatory method was within +/- 5 mmHg in 88% of subjects, and within +/- 10 mmHg in 97% (mean difference +/- SD: 0.2 +/- 3.9 mmHg). The difference in DBP was within +/- 5 mmHg in 80%, and within +/- 10 mmHg in 97% (difference: -0.1 +/- 4.6 mmHg). These results satisfied AAMI guidelines, and this device was easy to use. CONCLUSIONS: The ES-H55 device is compact and light, with clear algorithms for the determination of BP, and satisfies AAMI criteria, so that it is considered a useful BP-measuring device that could be used instead of a mercury sphygmomanometer by nurses and doctors in hospital wards.

Relation between sodium intake and blood pressure during sleep in young men.

In the past, cross-sectional studies of small groups have not always shown a significant relation between habitual sodium intake and blood pressure (BP). This study examined the relation between 24-h urinary sodium excretion (Salt24, g/day) and BP during sleep in young subjects. The subjects were 132 medical students (93 males, 39 females) aged 21 to 26 years, with no renal disorder. Urine was collected for 24 h, and sodium (Na), chloride (Cl), and creatinine (Cr) excretion were measured. The 24-h urinary Cr excretion (Cr24) was compared with the Cr24 estimated from lean body mass as a guide to ensure accurate collection of 24-h urine. The natural logarithm [ln (Salt24/Cr24)] was taken as an index of sodium intake. On the same day, a portable multi-biomedical recorder (TM2425) was used to measure 24-h systolic BP (SBP)/diastolic BP (DBP). Daytime BP was calculated as the average of waking-time BP, and sleep BP was taken as statistical base BP (minimum BP) during nighttime sleep. No correlation was observed between ln (Salt24/Cr24) and daytime BP. The correlation coefficient with sleep SBP, on the other hand, was 0.34 (p<0.05) in the male group and 0.54 (p<0.01) in the male high-BP group (24-h BP>127/75 mmHg, n=28). No relation of this kind was observed in the female group. In conclusion, despite the small number of subjects, the present cross-sectional study revealed a significant positive correlation between sodium intake and sleep SBP in young men with high BP.