Kagawa General Rehabilitation Center

Kagawa, Japan

Kagawa General Rehabilitation Center

Kagawa, Japan
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Masugata H.,Kagawa University | Senda S.,Kagawa University | Hoshikawa J.,Kagawa General Rehabilitation Center | Okuyama H.,Kagawa University | And 4 more authors.
Clinical and Experimental Hypertension | Year: 2010

Scheie's classification regarding hypertensive and atherosclerotic lesions in retinal arteries is generally used to assess the severity of hypertensive retinopathy and the risks of cardiovascular events in hypertensive patients. However, the differences between these two types of retinal artery lesions have not been fully examined. Both arterial stiffness and aortic root diameter are increased in hypertensive patients. The aim of this study was to elucidate differences in the two types of lesions by comparing their relationships to arterial stiffness and aortic root diameter in hypertensive patients following stroke. Fifty-two hypertensive patients following stroke were divided into five stages according to Scheie's classification of hypertensive (H stage 04) and atherosclerotic (S stage 04) lesions by ophthalmologists. Arterial stiffness was measured as brachial-ankle pulse wave velocity (baPWV) using an automatic waveform analyzer. Aortic root diameter was measured using M-mode echocardiography. The H and S stages in retinal arteries correlated with each other (ρ 0.443, p < 0.001). However, the S stage correlated with baPWV (ρ 0.385, p 0.005) and the aortic root diameter (ρ 0.285, p 0.043), while the H stage did not correlate with these parameters. Multiple stepwise regression analysis demonstrated that the aortic root diameter was independently associated with S stage (β 0.373, p 0.006), even though baPWV was independently associated with neither S stage nor H stage. In conclusion, hypertensive lesions (H stage) in retinal arteries are associated with atherosclerotic lesions (S stage) in retinal arteries. However, S stage may reflect arterial stiffening and aortic root dilatation better than H stage in hypertensive patients following stroke. This difference between H and S stages of Scheie's classification should be kept in mind when considering the association between retinal microcirculation and large vessel arteriosclerosis. © 2010 Informa UK Ltd.


Masugata H.,Kagawa University | Senda S.,Kagawa University | Hoshikawa J.,Kagawa General Rehabilitation Center | Murao K.,Kagawa University | And 9 more authors.
Tohoku Journal of Experimental Medicine | Year: 2010

Brachial-ankle pulse wave velocity (baPWV) is widely used as a marker of arterial stiffness, but there are no data regarding the usefulness of measuring baPWV in hypertensive patients after stroke. The purpose of this study was to examine the clinical significance of baPWV by assessing its correlation with echocardiographic parameters in hypertensive patients after stroke. The study enrolled 61 hypertensives after stroke (24 patients with cerebral infarction and 37 with cerebral hemorrhage) and 61 age-matched hypertensives without stroke. Left ventricular (LV) hypertrophy was evaluated by measuring LV mass index (LVMI) and relative wall thickness (RWT), and LV diastolic function was evaluated by measuring peak early mitral annular velocities (E') using echocardiography. Concentric LV hypertrophy showing increased RWT (0.50 ± 0.12) was observed in hypertensives after stroke, but not in hypertensives without stroke. In hypertensives after stroke, elevated baPWV correlated with age (r = 0.60, p < 0.001), systolic blood pressure (r = 0.56, p < 0.001), increased LVMI (r = 0.47, p < 0.001), and decreased E' (r = -0.40, p = 0.002). Multiple regression analysis showed that age (β coefficient = 0.43, p < 0.001), systolic blood pressure (β coefficient = 0.40, p < 0.001), and LVMI (β coefficient = 0.25, p = 0.008) were independent determinants of elevated baPWV. In conclusion, elevated baPWV is more closely associated with LV hypertrophy than with LV diastolic dysfunction. Elevated baPWV is independently associated with the severity of LV hypertrophy adjusted with systolic blood pressure and age in hypertensive patients after stroke. © 2010 Tohoku University Medical Press.


Masugata H.,Kagawa University | Senda S.,Kagawa University | Goda F.,Kagawa University | Yamagami A.,Kagawa University | And 9 more authors.
Clinical and Experimental Hypertension | Year: 2010

Although left ventricular (LV) hypertrophy and diastolic function assessed by echocardiography and chronic kidney disease (CKD) have been established as predictors of cardiovascular events in hypertensive patients, the relationships between the echocardiographic parameters and renal function have not been fully examined. We examined which echocardiographic parameter correlates best with estimated glomerular filtration rate (eGFR) in patients with cardiovascular risk factors. Enrolled in the study were 309 patients (mean age 67 ± 13 y) with cardiovascular risk factors. Echocardiography was performed to measure left ventricular mass index (LVMI) as an index of LV hypertrophy. Transmitral early to atrial velocity (E/A) ratio and peak early diastolic mitral annular velocity (E′) were measured as indexes of LV diastolic function. E/E′ was calculated as a parameter of LV preload. eGFR was measured using the equation proposed by the Japanese Society of Nephrology. The correlations of LVMI (r = -0.333, p < 0.001) and hypertension (r = -0.326, p < 0.001) to eGFR were closer than those of E′ (r = 0.276, p < 0.001) and E/A (r = 0.224, p < 0.001) to eGFR. Stepwise regression analysis showed that hypertension (β coefficient -0.211, p < 0.001) and LVMI (β coefficient -0.206, p < 0.001) were independently associated with eGFR. The E/E′ increased with a decrease in eGFR, and E/E′ in CKD stage 5 (16.0 ± 6.8) was significantly higher than that in patients in whom eGFR ≥ 90 mL/min/1.73 m2 (10.5 ± 4.5) (p < 0.001). Left ventricular diastolic function may be influenced by the increase in LV preload due to progression of CKD stage. Therefore, LV hypertrophy may be superior to LV diastolic dysfunction in predicting low eGFR in patients with CKD using echocardiography. Copyright © 2010 Informa UK Ltd.

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