Saga-shi, Japan
Saga-shi, Japan

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Kamura A.,Saga University | Inoue T.,Dokkyo Medical University | Kuroki S.,Saga Medical Association | Ishida S.,Saga Medical Association | And 6 more authors.
Hypertension Research | Year: 2011

The aim of the Saga Challenge Antihypertensive Study (S-CATS), a single-arm, prospective and multi-center trial, was to evaluate the effectiveness of combined antihypertensive treatment with losartan and hydrochlorothiazide (HCTZ). Enrolled in the study were a total of 161 patients with hypertension, who in spite of treatment with an angiotensin receptor blocker (ARB) alone or an ARB and calcium channel blocker (CCB), had not been able to reach blood pressure control goals set by the Japanese Society of Hypertension Guidelines (JSH 2004). The ARBs were replaced with a combination pill containing losartan (50 mg) and HCTZ (12.5 mg), and this treatment was continued for 3 months. This change in therapy resulted in significant decreases in systolic (158±14 to 137±15 mm Hg, P<0.001) and diastolic (85±11 to 76±10 mm Hg, P<0.001) blood pressure and heart rate (73±3 to 72±3) during the study. The patients quality of life (QOL) score, the EuroQol 5 dimensions (EQ-5D) and the visual analog scale (VAS) (n=96; 70.0 (68.8-80.0) to 80.0 (70.0-90.0), P<0.01) all improved significantly. Another QOL score, the hypertension symptom score (HSS), which we originally developed for the S-CATS trial, decreased significantly (n=93; 4.0 (1.0-9.0) to 2.0 (1.0-8.0), P<0.05). The Pittsburgh sleep quality index (PSQI), which is a psychometric assessment of subjective sleep quality, also decreased significantly (n=45; 4.0 (2.0-7.0) to 3.0 (2.0-5.0), P<0.05). There was a significant correlation between a change in HSS (baseline value 3-months value) and a decrease in systolic blood pressure (n=93; R0.241, P<0.05). These results suggest that an anti-hypertensive treatment combined with an ARB and a thiazide diuretic may improve patients QOL, including sleep quality. © 2011 The Japanese Society of Hypertension All rights reserved.

Sakamoto Y.,Saga University | Oyama J.-I.,Saga University | Ikeda H.,Saga Medical Association | Kuroki S.,Saga Medical Association | And 9 more authors.
Cardiovascular Diabetology | Year: 2013

Background: Recently, incretin hormones, including glucagon-like peptide-1 (GLP-1) analogue and dipeptidyl peptidase-4 (DPP-4) inhibitor, have been found to regulate glucose metabolism. The aim of this study was to elucidate the efficacy and safety of the clinical usage of DPP-4 inhibitors in Japan.Methods: This study was designed as a prospective, open-label, multi-center trial. Patients with diabetes mellitus type 2 (T2DM) with poor glycemic profiles (HbA1c ≥ 6.2%) in spite of receiving a medical diet, therapeutic exercise, and/or medications were eligible for this study. The participants received 50 to 100 mg of the DPP-4 inhibitor sitagliptin once daily for 12 months.Results: One hundred and eighty-eight subjects were enrolled. After 12 months of sitagliptin treatment, HbA1c levels decreased (7.65% ± 1.32% to 7.05% ± 1.10%, p < 0.001) as well as fasting plasma glucose (FPG) (145 ± 52 mg/dl to 129 ± 43 mg/dl, p = 0.005). The rate of glycemic control achieved (in accordance with the guidelines of the Japanese Diabetes Society) significantly increased. Blood pressure and serum levels of triglycerides and total cholesterol decreased significantly. Furthermore, the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Symptomatic Scores improved significantly. Adverse events such as hypoglycemia and loss of consciousness occurred in twenty three subjects (11%).Conclusions: These results suggest that the actions of DPP-4 inhibitors improve not only glycemic control, but also blood pressure, lipid profiles, and quality of life (QOL). Sitagliptin is a sound agent for use in the comprehensive treatment of patients with T2DM. © 2013 Sakamoto et al.; licensee BioMed Central Ltd.

Inoue T.,Dokkyo Medical University | Ikeda H.,Saga Medical Association | Nakamura T.,Shinmatsudo Central General Hospital | Abe S.,Dokkyo Medical University | And 7 more authors.
Internal Medicine | Year: 2011

Background: Dyslipidemia is a common complication of chronic kidney disease (CKD) and contributes to cardiovascular morbidity and mortality of CKD patients. Aim: The aim of the present study was to determine whether fluvastatin, which is mostly characterized by its pleiotropic anti-oxidant effects, has renoprotective effects in dyslipidemic patients with CKD. Methods: In 43 dyslipidemic patients with CKD taking fluvastatin 10 mg/day, 20 mg/day or 30 mg/day, renal functions as well as lipid profiles were assessed. Results: After 3 months of treatment with fluvastatin, LDL-cholesterol level significantly decreased. Serum creatinine level, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), urinary livertype fatty acid binding protein (L-FABP) level and urinary 8-hydroxydeoxyguanosine (8-OHdG) level did not change in overall patients. However, in patients with microalbuminuria (baseline UAE≥30 mg/g·creatinine; n=23), the UAE significantly decreased [2.43±0.67 to 1.98±0.80 log(mg/g·creatinine), p=0.01]. In patients with high L-FABP group (baseline L-FABP≥11 μg/g·creatinine; n=18), the urinary L-FABP level was significantly decreased (1.52±0.45 to 1.26±0.43 μg/g·creatinine, p<0.01). In the limited 23 patients with microalbuminuria, the L-FABP level was significantly decreased [1.20±0.62 to 1.03±0.49 log(μg/g·creatinine), p= 0.042], although the LDL-cholesterol level (139±28 to 129±23 mg/dL, p=0.08) only showed a tendency to decrease. The 8-OHdG level also was significantly decreased (13.6±9.6 to 9.8±3.8 ng/g·creatinine, p=0.043). In the overall patients, changes in the values for UAE and urinary L-FABP were not correlated with the changes in LDL-levels. Conclusion: Fluvastatin reduces both UAE and the urinary L-FABP level, and thus, has renoprotective effects, independent of its lipid lowering effects in dyslipidemic patients with CKD. © 2011 The Japanese Society of Internal Medicine.

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