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Satoh M.,Tohoku University | Kikuya M.,Tohoku University | Ohkubo T.,Tohoku University | Ohkubo T.,Shiga University of Medical Science | And 17 more authors.
American Journal of Hypertension | Year: 2012

Background Aldosterone is thought to have deleterious effects on the cardiovascular system. The aldosterone-to-renin ratio (ARR) is more reproducible than aldosterone levels alone and could be an index for inappropriate aldosterone secretion or activity. We previously reported the apparent relation between ARR and hypertension in subjects with high sodium intake. This prospective study investigated the risk of ARR for a first stroke in a general population stratified by sodium intake.MethodsWe obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PAC) for 883 participants aged 35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.0 1±1.3 years; 65.6% women).ResultsOver a mean of 10.9 follow-up years, 45 strokes occurred. The median PRA, PAC, and ARR were 1.2 ng/ml/h, 6.4 ng/dl, and 5.3 ng/dl per ng/ml/h, respectively. Using Cox regression, we computed hazard ratios adjusted for sex, age, body mass index (BMI), and systolic blood pressure. No association between logARR and stroke was observed in subjects overall. However, in subjects with high sodium intake (median of 4,058 mg/day (salt equivalent, 10.5 g/day)), each 1 s.d. increase in logARR was associated with an increased hazard ratio for stroke (hazard ratio: 1.49, P = 0.04). No significant association was observed in subjects with low sodium intake (P = 0.7). When we repeated all the analyses using logPRA or logPAC, no significant associations were found.ConclusionThese results suggest that high ARR, that is, relative aldosterone excess, is a predictor for stroke under conditions of high sodium intake. © 2012 American Journal of Hypertension, Ltd.

Terata S.,Tohoku University | Kikuya M.,Tohoku University | Satoh M.,Tohoku University | Ohkubo T.,Tohoku University | And 16 more authors.
Journal of Hypertension | Year: 2012

Background: The aldosterone-to-renin ratio (ARR) is used to screen for primary aldosteronism and could be an index for salt sensitivity. The association between ARR and the development of chronic kidney disease (CKD) is completely unknown. Method: A longitudinal observational study involving 689 participants from a general Japanese population (mean age 58.2 years; 68.5% women) who did not have CKD and were not receiving antihypertensive medication at baseline was conducted. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine levels, and CKD was defined as eGFR less than 60ml/min per 1.73m2 and/or dipstick-positive proteinuria. The associations of baseline plasma renin activity (PRA), plasma aldosterone concentration, and ARR with the development of CKD were examined using Cox proportional hazard regression analysis adjusted for sex, age, BMI, smoking, drinking, history of hypercholesterolemia, diabetes mellitus, and cardiovascular disease, SBP, and baseline eGFR. Results: During a mean 9.1-year follow-up, 118 participants developed CKD. A 1 standard deviation increment in the natural log-transformed (ln) ARR was positively associated with the incidence of CKD (hazard ratio 1.29, P=0.012). LnPRA showed an inverse association (hazard ratio 0.76, P=0.007). Meanwhile, plasma aldosterone concentration was not associated with CKD. Individuals who developed CKD had significantly lower baseline PRA (0.97 vs. 1.14ng/ml per h; P=0.03) and higher baseline ARR levels [66.6 vs. 56.8 (pg/ml)/(ng/ml per h); P=0.02] than those who did not. Conclusions: Lower PRA and higher ARR were associated with the development of CKD in a general population, suggesting that they are independent predictors of CKD. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Satoh M.,Tohoku University | Kikuya M.,Tohoku University | Hara A.,Research Center for Cancer Prevention | Ohkubo T.,Tohoku University | And 13 more authors.
Hypertension Research | Year: 2011

Aldosterone-to-renin ratio (ARR) is used to screen primary hyperaldosteronism. We investigated the association between ARR and the prevalence of hypertension using home blood pressure (HBP) measurements in community residents stratified for long-term habitual dietary sodium intake. We obtained HBP and conventional blood pressure (CBP) data for 514 participants aged >35 years not receiving antihypertensive treatment in the general population of Ohasama (mean age: 59.7±10.8 years; 71.2% women). A standardized method was used to calculate habitual sodium intake from a food-frequency questionnaire. The prevalence of HBP hypertension (>135/85 mm Hg) and CBP hypertension (>140/90 mm Hg) were 12.6 and 20.2%, respectively. The median plasma renin activity (PRA), plasma aldosterone concentration (PAC) and ARR were 1.1 ng ml-1 h-1, 6.4 ng per 100 ml and 5.5 ng per 100 ml per ng ml-1 h-1, respectively. After adjustment for possible confounding factors, each 1 s.d. increase in logARR was associated with the prevalence of HBP hypertension (odds ratio 1.37; P=0.04), but not with the prevalence of CBP hypertension (P=0.2). The association of ARR with HBP hypertension was strengthened for subjects with high sodium intake (greater than or equal to the median of 4822 mg day-1), whereas it became nonsignificant for those with low sodium intake (interaction P=0.03). Among subjects with high sodium intake, HBP hypertensives had significantly lower PRA than normotensives, despite no differences in PAC. In conclusion, relative aldosterone excess or low-renin hypertension may have an important role in HBP hypertension in the general population with high sodium intake. © 2011 The Japanese Society of Hypertension All rights reserved.

Yasui D.,Embassy of Japan in Zambia | Asayama K.,Catholic University of Leuven | Asayama K.,Tohoku University | Takada N.,Tohoku University | And 13 more authors.
Blood Pressure Monitoring | Year: 2012

OBJECTIVE: The target home blood pressure (BP) levels for antihypertensive treatment have not been fully investigated. We estimated home BP values that corresponded to the referential values of casual screening of BP using reduced major axis (RMA) regression for data from untreated and treated individuals in a general population. METHODS: The study included 2651 participants (778 treated) aged 20 years or above. The relationships between casual BP and home BP were examined using RMA regression to consider measurement errors. We calculated estimated home BP values that corresponded to casual BP using the regression equations. RESULTS: Although casual BPs and home BPs were significantly correlated (all: P<0.0001), the coefficients of determination in multiple regression were higher in untreated individuals than those in treated ones. When RMA regression was applied between casual BP (x) and morning home BP (y), the equations were expressed as y=0.78x+26.55 (systolic BP) and y=0.84x+14.34 (diastolic BP) in treated individuals and y=0.79x+19.29 (systolic BP) and y=0.85x+9.94 (diastolic BP) in untreated ones. The estimated home BPs corresponded to 140/90 mmHg of casual BP: 135.8/89.8 mmHg (morning), 132.2/86.6 mmHg (evening), and 133.9/87.8 mmHg (average) in treated individuals and 129.2/86.7 mmHg (morning), 127.8/84.8 mmHg (evening), and 128.2/85.2 mmHg (average) in untreated individuals. CONCLUSION: We estimated the referential values of home BP in treated hypertensives using a regression model; however, further intervention studies on home BP are needed to clarify the target treatment goals of home BP. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Ueno M.,Tokyo Medical and Dental University | Ohara S.,Tokyo Medical and Dental University | Inoue M.,Research Center for Cancer Prevention | Tsugane S.,Research Center for Cancer Prevention | Kawaguchi Y.,Tokyo Medical and Dental University
Community Dentistry and Oral Epidemiology | Year: 2012

Objectives The aim of this study was to examine whether there is an educational gradient in dentition status among Japanese adults who are under the universal public health insurance system. Methods Subjects were 1201 community residents aged 55-75 years as of May 2005 who completed a self-administered questionnaire and had a standard clinical oral examination. Analysis focused on the association of three education levels (junior high school, senior high school, and any college or higher education) with dentition status. Results The proportion of subjects with 20 or more teeth (P < 0.001), number of teeth present (P = 0.037), number of filled teeth (P = 0.016), and two types of functional tooth units (FTUs): FTUs with natural teeth (n-FTUs) (P < 0.001) and FTUs with natural teeth and artificial teeth on implant-supported and fixed prostheses (nif-FTUs) (P < 0.001) were significantly associated with education level after adjusting for confounders. The significant trend of these values in dental indexes indicated a poorer dentition status with a lower education level. Conclusions The results suggest that the level of education has an independent impact on dentition status in a group of Japanese adults, even after taking into account oral health-related factors. Therefore, providing appropriate oral health information from an early age within a compulsory school education program appears necessary to enhance health literacy and lessen the inequalities in dental health by educational level. © 2012 John Wiley & Sons A/S.

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