Ohasama Hospital

Hanamaki, Japan

Ohasama Hospital

Hanamaki, Japan
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Otani H.,Tohoku University | Kikuya M.,Tohoku University | Hara A.,Tohoku University | Terata S.,Tohoku University | And 8 more authors.
Cerebrovascular Diseases | Year: 2010

Background: No previous study has investigated the association of kidney dysfunction with silent lacunar infarcts and white-matter hyperintensity (WMH) independent of ambulatory blood pressure (BP). Methods: A cross-sectional study involving 1,008 participants (mean age 66 years) from a general population of Ohasama, Japan, was conducted. Calculated creatinine clearance (CCr) was estimated using the Cockcroft-Gault equation. In continuous and categorical analyses, the association between CCr and the prevalence of silent lacunar infarcts and WMH was investigated. Silent lacunar infarcts and WMH were detected on MRI. Multiple logistic regression analysis adjusted for 24-hour ambulatory BP, sex, age, body mass index, smoking and drinking status, antihypertensive medication, and histories of hypercholesterolemia, diabetes mellitus and heart disease was performed. Results: On univariate analysis, decreased CCr (continuous variable) and CCr <60 ml/min/1.73 m2 (categorical variable) were significantly associated with lacunar infarcts and WMH. After adjustment, each 1-standard-deviation decrease in CCr (odds ratio = 1.22; p = 0.036) and CCr <60 ml/min/1.73 m2 (odds ratio = 1.68; p = 0.007) was significantly associated with a high prevalence of lacunar infarcts. Even when 24-hour ambulatory BP was within the normal range (<130/80 mm Hg), CCr <60 ml/min/1.73 m2 was associated with a high prevalence of lacunar infarcts (odds ratio = 1.62; p = 0.047). CCr <60 ml/min/1.73 m 2 and 24-hour ambulatory BP had additive effects on lacunar infarcts. After the same adjustment, the association between CCr and WMH was not significant. Conclusions: CCr is closely associated with lacunar infarcts, suggesting that kidney dysfunction in the elderly is an independent risk factor or predictor for silent lacunar infarcts. Copyright © 2010 S. Karger AG, Basel.

Hashimoto T.,Tohoku University | Kikuya M.,Tohoku University | Ohkubo T.,Tohoku University | Ohkubo T.,Shiga University of Medical Science | And 16 more authors.
American Journal of Hypertension | Year: 2012

Background Hypertension and smoking independently contribute to the risk of stroke. Our objective was to investigate home blood pressure (HBP) levels, day-by-day BP variability, and smoking in the prediction of stroke in Japanese men. Methods In this study, 902 men (mean age, 58.6 years) without a past history of stroke were evaluated. HBP was measured once every morning for 4 weeks. Day-by-day BP variability was defined as within-subject standard deviations (SD) of HBP. Smoking history was obtained from a standardized questionnaire. Hazard ratios (HRs) for stroke were examined by Cox regression model, with adjustment for possible confounders. Results During 13.1 years (median) of follow-up, 89 cerebral infarctions, 28 intracranial hemorrhages, and six other strokes occurred. Systolic HBP levels (HR = 1.59 per 14.6 mm Hg increase, P>0.0001) and variability (HR = 1.26 per 3.1 mm Hg increase, P = 0.03) of 1 between-subject SD were significantly associated with cerebral infarction. The relationship between HBP and cerebral infarction differed with smoking status (interaction P = 0.021 and 0.017 for systolic level and variability, respectively). In analyses stratified according to smoking, systolic level (HR = 1.78, P 0.0001) and variability (HR = 1.38, P = 0.006) were significantly associated with cerebral infarction in ever smokers (N = 511), but not in never smokers (N = 391; P≤0.6 for both). No significant association was found between smoking and the risk of intracranial hemorrhage. Conclusions In ever smokers, both HBP levels and variability are significantly associated with the risk of cerebral infarction. Our findings further validate the benefit of smoking cessation in preventing cardiovascular disease (CVD), especially cerebral infarction. © 2012 American Journal of Hypertension, Ltd.

Matsumoto A.,Tohoku University | Satoh M.,Tohoku University | Kikuya M.,Tohoku University | Ohkubo T.,Teikyo University | And 18 more authors.
Hypertension | Year: 2014

Although an association between high blood pressure and cognitive decline has been reported, no studies have investigated the association between home blood pressure and cognitive decline. Home blood pressure measurements can also provide day-to-day blood pressure variability calculated as the within-participant SD. The objectives of this prospective study were to clarify whether home blood pressure has a stronger predictive power for cognitive decline than conventional blood pressure and to compare the predictive power of the averaged home blood pressure with day-to-day home blood pressure variability for cognitive decline. Of 485 participants (mean age, 63 years) who did not have cognitive decline (defined as Mini-Mental State Examination score, <24) initially, 46 developed cognitive decline after a median follow-up of 7.8 years. Each 1-SD increase in the home systolic blood pressure value showed a significant association with cognitive decline (odds ratio, 1.48; P=0.03). However, conventional systolic blood pressure was not significantly associated with cognitive decline (odds ratio, 1.24; P=0.2). The day-to-day variability in systolic blood pressure was significantly associated with cognitive decline after including home systolic blood pressure in the same model (odds ratio, 1.51; P=0.02), whereas the odds ratio of home systolic blood pressure remained positive, but it was not significant. Home blood pressure measurements can be useful for predicting future cognitive decline because they can provide information not only on blood pressure values but also on day-to-day blood pressure variability. © 2014 American Heart Association, Inc.

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.

Kikuya M.,Tohoku University | Ohkubo T.,Tohoku University | Ohkubo T.,Shiga University of Medical Science | Satoh M.,Tohoku University | And 13 more authors.
American Journal of Hypertension | Year: 2012

Background Arterial stiffness is a stroke risk factor. The home arterial stiffness index (HASI) can be calculated from self-measured blood pressure using the same formula as the calculation of ambulatory arterial stiffness index (AASI).MethodsIn 2,377 inhabitants (baseline age, 35-96 years) without a history of stroke, home blood pressure was measured once every morning for 26 days (median). HASI was defined as 1 minus the regression slope of diastolic over systolic on home blood pressure in individual subjects. The standardized hazard ratio (HR) of HASI was computed for cerebral infarction, while adjusting for sex, age, body mass index, pulse pressure, mean arterial pressure, heart rate, day-by-day variability of systolic blood pressure, smoking and drinking habits, serum total cholesterol, diabetes mellitus, and antihypertensive treatment. Results A total of 191 (8.0%) cerebral infarctions and 75 (3.2%) hemorrhagic strokes occurred over a median of 13.8 years. Mean ± s.d. of HASI was 0.60 ± 0.23 units. An increase in HASI of 1 s.d. was associated with an increased HR for cerebral infarction in all subjects (1.19, P = 0.034), men (1.37, P = 0.002), and normotensive subjects (1.46, P = 0.006), but not in women or hypertensive patients (P 0.56). For hemorrhagic stroke, HASI was not prognostic. Conclusion sHASI predicted cerebral infarction independent of pulse pressure and other risk factors in men and normotensive subjects. One important role of home blood pressure measurement is early recognition of onset of hypertension in normotensive subjects who are at risk of developing hypertension. HASI provides additional benefits for such subjects.

Kanno A.,Sendai Shakai Hoken Hospital | Kanno A.,Tohoku University | Kikuya M.,Tohoku University | Asayama K.,Tohoku University | And 15 more authors.
Journal of Hypertension | Year: 2013

OBJECTIVE:: Ambulatory blood pressure (BP) is reportedly associated with target organ damage. However, whether ambulatory BP carries prognostic significance for the development of chronic kidney disease (CKD) has not been confirmed. METHOD:: We measured ambulatory BP in 843 participants without CKD at baseline from a general Japanese population and examined the incidence of CKD defined as positive proteinuria or an estimated glomerular filtration rate (eGFR) less than 60âŠml/min per 1.73 m at health checks. The association between baseline ambulatory BP and CKD incidence was examined using the Cox proportional hazard regression model adjusted for sex, age, BMI, habitual smoking, habitual alcohol consumption, diabetes mellitus, hypercholesterolemia, a history of cardiovascular disease, antihypertensive medication, eGFR at baseline, the number of follow-up examinations, and the year of the baseline examination. RESULTS:: The mean age of the participants averaged 62.9⊱â̌8.1 years, 71.3% were women and 23.7% were under antihypertensive medication. During a median follow-up of 8.3 years, 220 participants developed CKD events. The adjusted hazard ratios for CKD in a 1-standard deviation increase in daytime and night-time SBP were 1.13 [95% confidence interval (CI) 0.97-1.30] and 1.21 (95% CI 1.04-1.39), respectively. When night-time and daytime BP was mutually adjusted into the same model, only night-time BP persisted as an independent predictor of CKD. CONCLUSION:: Night-time BP is a better predictor of CKD development than daytime BP in the general population. Ambulatory BP measurement is considered useful for evaluating the risk of progression to CKD. © 2013 Wolters Kluwer Health.

PubMed | Collège de France, Tohoku Fukushi University, Tohoku University, Teikyo University and 3 more.
Type: Journal Article | Journal: American journal of hypertension | Year: 2015

In cross-sectional studies, the aldosterone-to-renin ratio (ARR) has been reported to be associated with hypertension under conditions of higher sodium intake. The objective of this prospective study was to investigate the association between ARR and the development of hypertension in community residents stratified by dietary sodium intake.From the general population of Ohasama, we obtained plasma renin activity (PRA) and plasma aldosterone concentrations (PACs) for 608 participants (mean age = 57.6 years; 71.4% women) without hypertension at baseline. Using the Cox model, we computed the adjusted hazard ratio (HR) of natural log-transformed ARR (lnARR) for the development of hypertension, defined as blood pressure 140/90mm Hg or start of treatment with antihypertensive drugs during follow-up.During a mean follow-up of 6.8 years, 298 participants developed hypertension. The median PRA, PAC, and ARR were 1.2ng/ml/hour, 6.6ng/dl, and 5.5ng/dl per ng/ml/hour, respectively. Each 1 SD increase in lnARR was associated with an increased risk for the development of hypertension in participants overall (HR = 1.18; P = 0.007). In participants with higher sodium intake (median 4,102mg/day), a significant association of lnARR with hypertension remained (HR = 1.25; P = 0.009), whereas no significant association was observed in participants with lower sodium intake (P = 0.18). Participants who developed hypertension had significantly lower PRA than those who did not (P = 0.003), despite no differences in PAC (P = 0.91).These results raise the hypothesis that relative aldosterone excess may have a deleterious effect on the development of hypertension by contributing to salt/volume-related hypertension.

Kato T.,Tohoku University | Kikuya M.,Tohoku University | Ohkubo T.,Tohoku University | Satoh M.,Tohoku University | And 11 more authors.
American Journal of Hypertension | Year: 2010

Background We previously reported that high day-by-day blood pressure (BP) variability derived from self-measured BP at home (home BP) predicted cardiovascular mortality over and beyond other risk factors. The objective of this study is to clarify the determinants of the day-by-day home-BP variability. Methods We conducted a cross-sectional community survey in 1,215 inhabitants (female gender 59%, mean age 62 years) of Ohasama, Japan. The subjects measured their BP and heart rate once every morning and once every evening for 4 weeks. The day-by-day BP variability and heart rate variability were defined as within individual standard deviation of all home BP and heart rate, respectively. We also considered coefficient of variation (CV). These parameters in the morning and those in the evening were calculated separately. Results The level and standard deviation of home systolic/diastolic BP (SBP/DBP) in the morning were 123.4±15.1/75.7±9.0mmHg and 8.6±3.1/5.8±2.0mmHg. Multivariate linear regression analysis demonstrated that older age, female gender, elevated home BP, low home heart rate, and elevated home heart rate variability were significant determinants of elevated home-BP variability. In addition to these factors, alcohol intake and sedentary lifestyle were also determinants of elevated home-BP variability in the evening. Conclusions Day-by-day home-BP variability was associated with home BP, alcohol intake or sedentary lifestyle. Whether modifying these factors would reduce BP variability and whether such reduction would lead to better outcomes needs further study. © 2010 American Journal of Hypertension, Ltd.

Yasui D.,Tohoku University | Asayama K.,Tohoku University | Ohkubo T.,Tohoku University | Kikuya M.,Tohoku University | And 10 more authors.
American Journal of Hypertension | Year: 2010

Several observational studies have shown that treated hypertensives are characterized as having worse prognosis than nonhypertensives. However, there is little evidence based on home blood pressure (home BP) measurement. We compare the risk of stroke between untreated individuals and those taking antihypertensive medication based on home BP and casual-screening BP (casual BP) in the general population.MethodsThe study included 1,690 untreated and 700 treated subjects aged 35 years. We measured home BP and casual BP at the beginning of the study. The risk of first stroke was examined by using the Cox proportional hazards model.ResultsDuring 11.9 years of follow-up, we observed 242 first-time stroke cases. Treated subjects had significantly higher risk for stroke than untreated subjects based on home BP (relative hazard (RH) = 1.48) as well as on casual BP (RH = 1.78), adjusted for systolic BP values and characteristics. When subjects were classified into six categories based on BP (optimal, normal, high normal, and grade 1-3 hypertension), RHs in treated hypertensives linearly increased (trend P 0.01) based on home BP. However, there was no consistent association for casual BP (trend P: not significant) in treated subjects. Stroke risk was linearly increased regardless of the BP information source in untreated subjects (home BP: trend P 0.01, casual BP: trend P 0.01).ConclusionThe results suggest a strong association between elevated home BP and increased risk of stroke. Home BP is a better tool to assess stroke risk, especially in treated hypertensives. © 2010 American Journal of Hypertension, Ltd.

Seki M.,Tohoku University | Inoue R.,Tohoku University | Ohkubo T.,Tohoku University | Kikuya M.,Tohoku University | And 11 more authors.
Journal of Hypertension | Year: 2010

Objective: Only a few of numerous epidemiological studies have demonstrated a positive association between environmental tobacco smoke (ETS) exposure and blood pressure (BP), despite experimental studies showing such a positive association. The association between home blood pressure (HBP) and ETS exposure was investigated in the general population. Methods: Five hundred and seventy-nine nonsmoking Japanese women were enrolled. The participants were classified into four categories according to their responses to a self-administered questionnaire: unexposed women (non-ETS), women exposed at home [ETS(home)], at the workplace/other places [ETS(work/other)] and at home and at the workplace/other places [ETS(both)]. Variables were compared using analysis of covariance adjusted for age, marital status, body mass index, diabetes mellitus, stroke, heart disease, hyperlipidemia, alcohol intake, salt intake and activity levels. Results: In participants without antihypertensive medication, systolic morning HBP in ETS(both) was 4 mmHg higher than that in non-ETS (116.8 ± 1.01 vs. 113.1 ± 1.08 mmHg, P = 0.02) and systolic morning HBP in ETS(home) and systolic evening HBP in ETS(both) were 3 mmHg higher than those in non-ETS (116.2 ± 1.07 vs. 113.1 ± 1.08 mmHg, P = 0.04; and 115.3 ± 1.02 vs. 111.9 ± 1.09 mmHg, P = 0.03, respectively). In participants with antihypertensive medication, ETS exposure status was not significantly associated with increased HBP levels. Conclusions: A positive association between HBP levels and ETS exposure was confirmed. HBP measurement is recommended in population-based studies investigating the effects of ETS exposure. ETS exposure may increase BP, thereby synergistically contributing to unfavorable cardiovascular outcomes along with other deleterious effects of ETS. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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