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Toh N.,Okayama University | Ishii K.,Kansai Electric Power Co. | Kihara H.,Kihara Cardiovascular Clinic | Iwakura K.,Sakurabashi Watanabe HospitalOsaka | And 35 more authors.
Circulation Journal | Year: 2016

Background: Hypertension increases the risk of left ventricular (LV) diastolic dysfunction, and anti-hypertensive therapy may improve LV relaxation. The aim of this study was to investigate whether combining an angiotensinreceptor blocker (ARB) with either hydrochlorothiazide (HCTZ) or a calcium-channel blocker (CCB) improves LV relaxation in patients with hypertension and diastolic dysfunction. Methods and Results: Hypertensive patients who had not achieved their target blood pressure with at least 4 weeks of ARB therapy were randomly assigned to receive either a fixed-dose combination of losartan and HCTZ (losartan/HCTZ; n=110) or a combination of amlodipine and a typical ARB dosage (CCB/ARB; n=121) and followed for 24 weeks. The primary endpoint was change in early diastolic mitral annular velocity (e’, cm/s). Systolic blood pressure decreased in both groups after switch to the combination therapies. E’ velocity increased both in the losartan/ HCTZ (0.52 cm/s) and in the CCB/ARB (0.59 cm/s) groups. The mean (95% CI) treatment difference was −0.02 (−0.37 to 0.34) cm/s, indicating that improvement in LV relaxation was similar between the groups. The ratio of early mitral inflow velocity to e’ velocity and left atrial volume index were significantly decreased in the losartan/HCTZ group. Conclusions: The combination of losartan and HCTZ is as effective as amlodipine plus ARB in improving LV relaxation in hypertensive patients. © 2016, Japanese Circulation Society. All rights reserved.


Hen Y.,Sakakibara Heart Institute Clinic | Iguchi N.,Sakakibara Heart Institute Hospital | Takada K.,Sakakibara Heart Institute Hospital | Utanohara Y.,Sakakibara Heart Institute Hospital | And 9 more authors.
Respiration and Circulation | Year: 2011

We examined the relationship between late gadolinium enhancement (LGE) findings on cardiac MRI and the reverse remodeling effect of Carvedilol. Fifty-six patients with left ventricular ejection fraction (EF) of less than 50% and no significant stenotic lesion on coronary angiography were studied. Cardiac MRI was conducted before Carvedilol administration, and ultrasonography was conducted both before and 3 months after administration. Heart rate decreased significantly (p<0.0001) from 80.9±19.6/min before administration to 69.1±11.0/min after administration. The patients were stratified into LGE-negative, low-LGE, and high-LGE groups from pre-treatment MRI findings. The change (post-treatment - pre-treatment values) in the end-diastole volume index (ΔEDVI), change in end-systole volume index (ΔESVI), and change in EF (ΔEF) were compared among these three groups. ΔEDVI (ml/m 2) was -31.0±32.7 in the LGE-negative group, -24.0±21.7 in the low-LGE group and -3.3±24.2 in the high-LGE group. ΔESVI (ml/m 2) was -31.0±27.5 in the LGE-negative group, -30.7±18.8 in the low-LGE group. and -7.0±20.1 in the high-LGE group. ΔEF(%) was 13.5±11.6 in the LGE-negative group, 18.3±9.6 in the low-LGE group, and 5.7±8.1 in the high-LGE group. Significant differences were observed between groups for all three parameters. The reverse remodeling effect as a result of Carvedilol administration differed depending on the percentage of LGE findings in the left ventricle.


Isono M.,Waseda University | Ueda M.,Sakakibara Heart Institute Clinic | Fukuda H.,Fukuda Clinic | Sumiyoshi T.,Sakakibara Heart Institute Clinic
Japanese Journal of Clinical Pharmacology and Therapeutics | Year: 2014

Objectives: Blood pressure control is important for reducing the risk of diseases related to arteriosclerosis. However, medication non-adherence by patients is a constant challenge for health care practitioners. To understand the complexity of medication non-adherence, qualitative evaluation of patient perspectives on prescribed medications is being undertaken worldwide, but such studies are scarce in Japan. This study attempted to investigate qualitatively the perspectives of patients with high blood pressure on antihypertensive drugs. Methods: Medical consultations were observed and qualitative interviews with patients were conducted in the following two clinical settings: medical consultations for cardiovascular diseases (n=82; 47 males, 35 females; age, 68±11 years) and consultations for Kampo medicine (n=31; 18 males, 13 females; age, 72±8 years). The narratives were categorized, and the reasons for medication non-adherence were determined using a cultural anthropological method. Results: The narratives were categorized into the following 5 types: (1) willingness to take drugs because of concern about hypertension, (2) taking drugs as prescribed, but without interest in blood pressure changes, (3) no hesitation in taking antihypertensive drugs despite adverse side effects experienced after taking these drugs, (4) taking antihypertensive drugs and objectively describing how blood pressure changed on a daily basis, and (5) taking antihypertensive drugs while having concern about future side effects, or not wanting to take antihypertensive drugs. Furthermore, the concern over medications and medication non-adherence shown in (5) were attributed to a combination of the following 4 reasons: (1) prior experience in medical care, (2) physical sensations, (3) political and economic reasons, (4) a negative opinion toward modem medicine, and (5) the description of side effects listed on package inserts. Conclusion: Most patients take antihypertensive drugs because they consider the drugs to be essential for their health. However, some patients are concerned about or reject the medications. If such concern or rejection is not based on medical reason, understanding the patients' views from their sociocultural, political, and economic perspectives is important to improve adherence. ©2014 the Japanese Society of Clinical Pharmacology and Therapeutics (JSCPT).


Numata Y.,Sakakibara Heart Institute Clinic | Hen Y.,Sakakibara Heart Institute Clinic | Usui H.,Sakakibara Heart Institute Clinic | Ueda M.,Sakakibara Heart Institute Clinic | And 2 more authors.
Respiration and Circulation | Year: 2010

This study aimed at investigating the relationship between plasma unsaturated fatty acid levels [dihomogamma-linolenic acid(DGLA), arachidonic acid(AA), eicosapentaenoic acid(EPA), docosahexaenoic acid (DHA)] and biochemical data (hemoglobin A1c, LDL-cholesterol, HDL-cholesterol, high sensitivity C-reactive protein), and to examine the relationship between meal content using the Fish Check Sheet and plasma unsaturated fatty acid levels in cardiovascular outpatients. Blood was collected and analyzed for lipid and biochemical parameters in a total of 165 patients (120 men and 45 women, mean age 66±11 years). In patients with low EPA levels(n=17), nutrition counseling was conducted and the patients were instructed to record fish consumption on the Fish Check Sheet that we designed. After counseling, the meal content as recorded on the Fish Check Sheet was scored. No correlation was observed between biochemical data and the EPA/AA ratio before counseling. Plasma EPA level and EPA/AA ratio were significantly increased after counseling (64.6±35.0 μg/ml vs. 102.5±46.4 μg/ml, 0.40±0.22 vs. 0.66±0.28; both p<0.001). Furthermore, a significant positive correlation was found between the Fish Check Sheet score and EPA level (R=0.49, p=0.05). These results suggest that the Fish Check Sheet is useful for providing guidance on lipid management.


Nagamachi C.,Sakakibara Heart Institute Clinic | Ono M.,Sakakibara Heart Institute Clinic | Hen Y.,Sakakibara Heart Institute Clinic | Miyamoto K.,Sakakibara Heart Institute Clinic | And 8 more authors.
Respiration and Circulation | Year: 2010

We examined the effects of essential oils on the autonomic nervous system in healthy adults, using three different inhaling methods. The heart rate, blood pressure, power spectral analysis of heart rate variability(HF, LF/HF) and salivary amylase activity were measured before and after inhaling for 5 min lying supine on a bed (method 1), before and after inhaling for 5 min while watching a video in a sitting position (method 2), or with or without inhaling a continuous indoor diffusion during a mental arithmetic stress test (method 3). In method 1, no significant differences in the measurements were detected. In method 2, heart rate was lowered (-2.6±3.9/min ; p = 0.03), while HF(125±47% ; p = 0.05) and salivary amylase activity were elevated (136±35%, p = 0.03). In method 3, LF/HF (no inhalation 279±239% vs. inhalation 122±66% ; p = 0.05)and salivary amylase activity(no inhalation 113±30% vs. inhalation 90±23% ; p = 0.02) were both significantly reduced during mental arithmetic stress. Short inhalation of essential oils suppresses parasympathetic nervous activation while continuous inhalation during mental arithmetic stress suppresses sympathetic nervous activation. Power spectral analysis of heart rate variability is useful for assessing the effects of essential oils.

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