Shin oyama City Hospital

Tochigi, Japan

Shin oyama City Hospital

Tochigi, Japan
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PubMed | Shin Oyama City Hospital and Toho University
Type: | Journal: Vascular health and risk management | Year: 2017

The objective of this study is to investigate the association of body mass index (BMI) with arterial stiffness assessed by cardioankle vascular index (CAVI).A retrospective cross-sectional study was conducted in 23,257 healthy Japanese subjects (12,729 men and 10,528 women, aged 47.1 12.5 years, BMI 22.9 3.4 kg/mMale subjects showed significantly higher BMI, CAVI, and triglycerides and lower high-density lipoprotein (HDL)-cholesterol compared with female subjects. Next, the subjects were divided into tertiles of BMI: lower, middle, and upper, in a gender-specific manner. After adjusting for confounders including age, systolic blood pressure, and HDL-cholesterol identified by multiple regression analysis, the mean CAVI decreased progressively as BMI tertile increased in both genders. Furthermore, a negative inverse relationship between BMI and adjusted CAVI was observed throughout the BMI distribution. Multivariate logistic regression model for contributors of high CAVI (90th percentile) identified obesity (odds ratios (95% confidence interval): 0.804 (0.720-0.899)], older age [15.6 (14.0-17.4)], male gender [2.26 (2.03-2.51)], hypertension [2.28 (2.06-2.54)], impaired fasting glucose [1.17 (1.01-1.37)], and low HDL-cholesterol [0.843 (0.669-1.06)] as independent factors.We demonstrated an inverse relationship between CAVI and BMI in healthy Japanese subjects, suggesting that systemic accumulation of adipose tissue per se may lead to a linear decrease of arterial stiffness in nonobese and obese subjects without metabolic disorders.


Kario K.,Jichi Medical University | Saito I.,Keio University | Kushiro T.,Life Planning Center Foundation | Teramukai S.,Kyoto Prefectural University of Medicine | And 4 more authors.
Hypertension | Year: 2014

This study aimed to investigate the relationship between on-treatment morning home blood pressure (HBP) and incidence of cardiovascular events using data from the Home Blood Pressure Measurement With Olmesartan Naive Patients to Establish Standard Target Blood Pressure (HONEST) study, a prospective observational study of 21 591 outpatients with essential hypertension (mean age, 64.9 years; women, 50.6%) enrolled between 2009 and 2010 at clinics and hospitals in Japan. They received olmesartan-based treatment throughout. The primary end point was major cardiovascular events. After a mean follow-up period of 2.02 years, cardiovascular events occurred in 280 patients (incidence, 6.46/1000 patient-years). The risk for the primary end point was significantly higher in patients with ontreatment morning HBP ≥145 to <155 mm Hg (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.12-2.99) and ≥155 mm Hg (HR, 5.03; 95% CI, 3.05-8.31) than <125 mm Hg and with on-treatment clinic blood pressure ≥150 to <160 mm Hg (HR, 1.69; 95% CI, 1.10-2.60) and ≥160 mm Hg (HR, 4.38; 95% CI, 2.84-6.75) than <130 mm Hg. Morning HBP associated with minimum risk was 124 mm Hg by spline regression analysis. Cardiovascular risk was increased in patients with morning HBP ≥145 mm Hg and clinic blood pressure <130 mm Hg (HR, 2.47; 95% CI, 1.20-5.08) compared with morning HBP <125 mm Hg and clinic blood pressure <130 mm Hg. In conclusion, it is essential to control morning HBP to <145 mm Hg, even in patients with controlled clinic blood pressure. Clinical Trial Registration-URL: http://www.umin.ac.jp/ctr/index.htm. UMIN Clinical Trials Registry, trial No. UMIN000002567. (Hypertension. 2014;64:989-996.) • Online Data Supplement. © 2014 American Heart Association, Inc.


Nagayama D.,Toho University | Nagayama D.,Shin Oyama City Hospital | Yamaguchi T.,Toho University | Saiki A.,Toho University | And 7 more authors.
Atherosclerosis | Year: 2015

Objective: To investigate the association of serum uric acid (SUA) with arterial stiffness assessed by cardio-ankle vascular index (CAVI). Methods: We analyzed the cross-sectional data from 27,360 healthy Japanese subjects (12,910 males and 14,450 females) aged between 20 and 74 years without a past history of heart disease, stroke, hypertension, diabetes, nephritis or gout. We investigated whether SUA was independently associated with CAVI in a gender-specific manner. Results: BMI, CAVI, systolic/diastolic BP, GOT, GPT, γ-GTP, triglyceride (TG), creatinine and SUA were higher and HDL-C was lower in males than in females. Next, they were stratified by SUA into 3 groups: lower tertile (T1), middle tertile (T2) and upper tertile (T3) and by gender. CAVI increased progressive with increasing SUA tertile, after adjusting for age, BMI and systolic BP (sBP) identified in multiple regression analysis for CAVI. Multivariate analysis showed that the odds ratios (95% CI) relative to T1 for high CAVI (≥90th percentile) were 1.233 (0.928-1.638) in T2 and 1.352 (1.031-1.773) in T3 for males, and 1.133 (0.984-1.303) in T2 and 1.361 (1.098-1.687) in T3 for females, after adjusting for confounders. Furthermore, increase in adjusted CAVI was observed in a lower SUA range in females compared to that observed in males. Conclusion: We demonstrated an independent correlation between SUA and CAVI, and observed gender difference in the SUA range for increase in CAVI. These results may suggest the need to set different target SUA levels for men and women in anti-hyperuricemic treatment for atherosclerosis prevention. © 2015 Elsevier Ireland Ltd.


Kario K.,Jichi Medical University | Saito I.,Keio University | Kushiro T.,Nihon University | Teramukai S.,Kanazawa University | And 4 more authors.
Journal of Human Hypertension | Year: 2013

Morning home blood pressure (BP) levels are more closely associated with cardiovascular risk than clinic BP levels. However, control of morning home BP has been worse than that of clinic BP in clinical practice. We examined the effects of olmesartan-based treatment using data (n=21 341) from the first 16 weeks of the Home BP measurement with Olmesartan Naive patients to Establish Standard Target blood pressure (HONEST) study, a prospective observational study for olmesartan-naive patients with essential hypertension. After 16-week olmesartan-based treatment, the clinic and morning home systolic BP (SBP) lowered from 151.6±16.4 and 153.6±19.0 mm Hg to 135.0±13.7 and 135.5±13.7 mm Hg, respectively (P<0.0001). The achievement percentage of target morning home SBP (<135 mm Hg) in all patients, those with diabetes mellitus (DM), and those with chronic kidney disease (CKD) increased from 13.5, 16.4 and 17.2% to 50.8, 47.9 and 48.8%, respectively, and the proportion of patients with well-controlled hypertension (clinic SBP<140 mm Hg and morning home SBP<135 mm Hg) increased from 7.9, 9.2 and 10.2% to 38.9, 34.5 and 36.3%, respectively. After 16-week olmesartan-based treatment, the proportion of patients with masked and white coat hypertension changed from 11.8 to 24.2% and 5.6 to 11.9%. In conclusion, both clinic and morning home BP in all, DM and CKD patients improved with 16-week olmesartan-based treatment in the 'real world', and the results showed a sustained 24-hour BP-lowering effect of olmesartan. Decrease in clinic and home BP resulted in an increased rate of masked and white coat hypertension, and further management is needed in those patients. © 2013 Macmillan Publishers Limited. All rights reserved.


Nakano M.,Shin Oyama City Hospital | Nakano M.,Jichi Medical University | Eguchi K.,Jichi Medical University | Sato T.,Jichi Medical University | And 3 more authors.
Journal of Clinical Hypertension | Year: 2016

The authors tested the hypothesis that low-salt diet education by nutritionists would lower blood pressure (BP) levels in treated hypertensive patients. The amount of urinary salt excretion and clinic, home, and ambulatory BP values at baseline and at 3 months were measured in 95 patients with hypertension. After randomization to a nutritional education group (E group, n=51) or a control group (C group, n=44), the C group received conventional salt-restriction education and the E group received intensive nutritional education aimed at salt restriction to 6 g/d by nutritionists. From baseline to the end of the study, 24-hour urinary sodium excretion was significantly lowered in the E group compared with the C group (6.8±2.9 g/24 h vs 8.6±3.4 g/24 h, P<.01). Morning home systolic BP tended to be lowered in the E group (P=.051), and ambulatory 24-hour systolic BP was significantly lowered in the E group (-4.5±1.3 mm Hg) compared with the C group (2.8±1.3 mm Hg, P<.001). Intensive nutritional education by nutritionists was shown to be effective in lowering BP in treated hypertensive patients. © 2016 Wiley Periodicals, Inc.


Ikeda Y.,Waseda University | Shimada K.,Shin Oyama City Hospital | Teramoto T.,Teikyo University | Uchiyama S.,International University of Health and Welfare | And 7 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

Importance: Prevention of atherosclerotic cardiovascular diseases is an important public health priority in Japan due to an aging population.Objective: To determine whether daily, low-dose aspirin reduces the incidence of cardiovascular events in older Japanese patients with multiple atherosclerotic risk factors.Design, Setting, and Participants: The Japanese Primary Prevention Project (JPPP)was a multicenter, open-label, randomized, parallel-group trial. Patients (N = 14 464) were aged 60 to 85 years, presenting with hypertension, dyslipidemia, or diabetes mellitus recruited by primary care physicians at 1007 clinics in Japan between March 2005 and June 2007, and were followed up for up to 6.5 years, with last follow-up in May 2012. A multidisciplinary expert panel (blinded to treatment assignments) adjudicated study outcomes.Interventions: Patients were randomized 1:1 to enteric-coated aspirin 100mg/d or no aspirin in addition to ongoing medications.Main Outcomes and Measures: Composite primary outcomewas death from cardiovascular causes (myocardial infarction, stroke, and other cardiovascular causes), nonfatal stroke (ischemic or hemorrhagic, including undefined cerebrovascular events), and nonfatalmyocardial infarction. Secondary outcomes included individual end points.Results The studywas terminated early by the data monitoring committee after a median follow-up of 5.02 years (interquartile range, 4.55-5.33) based on likely futility. In both the aspirin and no aspirin groups, 56 fatal events occurred. Patients with an occurrence of nonfatal stroke totaled 114 in the aspirin group and 108 in the no aspirin group; of nonfatalmyocardial infarction, 20in the aspirin group and 38 in the no aspirin group; of undefined cerebrovascular events, 3 in the aspirin group and 5 in the no aspirin group. The 5-year cumulative primary outcome event rate was not significantly different between the groups (2.77%[95%CI, 2.40%-3.20%]for aspirin vs 2.96%[95%CI, 2.58%-3.40%]for no aspirin; hazard ratio [HR], 0.94 [95%CI, 0.77-1.15]; P = .54). Aspirin significantly reduced incidence of nonfatalmyocardial infarction (0.30 [95%CI, 0.19- 0.47] for aspirin vs0.58 [95%CI, 0.42-0.81] for no aspirin;HR, 0.53 [95%CI, 0.31-0.91]; P = .02) and transient ischemic attack (0.26 [95%CI, 0.16-0.42] for aspirin vs0.49 [95%CI, 0.35-0.69] for no aspirin;HR, 0.57 [95%CI, 0.32-0.99]; P = .04), and significantly increased the risk of extracranial hemorrhage requiring transfusion or hospitalization (0.86 [95%CI, 0.67-1.11] for aspirin vs0.51 [95%CI, 0.37-0.72] for no aspirin;HR, 1.85 [95%CI, 1.22-2.81]; P = .004).Conclusions and Relevance: Once-daily, low-dose aspirin did not significantly reduce the risk of the composite outcome of cardiovascular death, nonfatal stroke, and nonfatalmyocardial infarction among Japanese patients 60 years or older with atherosclerotic risk factors.


PubMed | The Life Planning Center Foundation, Shin Oyama City Hospital, Daiichi Sankyo, Keio University and 2 more.
Type: Journal Article | Journal: Journal of the American College of Cardiology | Year: 2016

Few studies have evaluated out-of-office blood pressure (BP) measurements as predictors of coronary artery disease (CAD) events.The aim of this study was to determine morning home blood pressure (HBP) as a predictor of CAD events.Using data from the HONEST (Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure) study, we investigated the relationship between morning HBP and incidence of stroke and CAD events.In 21,591 treated hypertensive patients (mean age 64.9 years; mean follow-up 2.02 years), 127 stroke events(2.92 per 1,000 patient-years), and 121 CAD events (2.78 per 1,000 patient-years) occurred. The incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP)145 mmHg compared with<125 mmHg, and in patients with clinic systolic blood pressure (CSBP)150 mmHg compared with <130mmHg. Hazard ratios (HRs) were 6.01 (95% confidence interval [CI]: 2.85 to 12.68) between patients with morning HSBP155mmHg and those with morning HSBP<125 mmHg and 5.82 (95% CI: 3.17 to 10.67) between patients withCSBP160 mmHg and those with CSBP<130 mmHg; morning HSBP predicted stroke events similarly to CSBP. Incidence of CAD events was significantly higher in patients with morning HSBP145 mmHg compared with<125 mmHg and in patients with CSBP160 mmHg compared with<130 mmHg. The HR for morning HSBP155 mmHg was 6.24 (95% CI: 2.82 to 13.84) and for CSBP160 mmHg was 3.51 (95% CI: 1.71 to 7.20); therefore, compared with morning HSBP, CSBP may underestimate CAD risk. Goodness-of-fit analysis showed that morning HSBP predicted CAD events more strongly than CSBP.Morning HBP is a strong predictor of future CAD and stroke events, and may be superior to clinicBPinthis regard. There does not appear to be a J-curve in the relationship between morning HBP and strokeorCADevents.(Home blood pressure measurement with Olmesartan Naive patients to Establish Standard Target blood pressure Study [HONEST]; UMIN000002567).


PubMed | Shin Oyama City Hospital and Toho University
Type: | Journal: Molecular genetics and metabolism reports | Year: 2017

Type 2 diabetes mellitus (T2DM) is associated with an increased risk of bone fractures without reduction of bone mineral density. The cholesterol oxide 7-ketocholesterol (7KCHO) has been implicated in numerous diseases such as atherosclerosis, Alzheimers disease, Parkinsons disease, cancer, age-related macular degeneration and T2DM. In the present study, 7KCHO decreased the viability of MC3T3-E1 cells, increased reactive oxygen species (ROS) production and apoptotic rate, and upregulated the caspase-3/7 pathway. Furthermore, these effects of 7KCHO were abolished by pre-incubation of the cells with


PubMed | Shin Oyama City Hospital and Jichi Medical University
Type: Journal Article | Journal: Journal of clinical hypertension (Greenwich, Conn.) | Year: 2016

The authors tested the hypothesis that low-salt diet education by nutritionists would lower blood pressure (BP) levels in treated hypertensive patients. The amount of urinary salt excretion and clinic, home, and ambulatory BP values at baseline and at 3months were measured in 95 patients with hypertension. After randomization to a nutritional education group (E group, n=51) or a control group (C group, n=44), the C group received conventional salt-restriction education and the E group received intensive nutritional education aimed at salt restriction to 6g/d by nutritionists. From baseline to the end of the study, 24-hour urinary sodium excretion was significantly lowered in the E group compared with the C group (6.82.9g/24h vs 8.63.4g/24h, P<.01). Morning home systolic BP tended to be lowered in the E group (P=.051), and ambulatory 24-hour systolic BP was significantly lowered in the E group (-4.51.3mm Hg) compared with the C group (2.81.3mm Hg, P<.001). Intensive nutritional education by nutritionists was shown to be effective in lowering BP in treated hypertensive patients.


PubMed | Shin Oyama City Hospital
Type: Case Reports | Journal: Internal medicine (Tokyo, Japan) | Year: 2016

Scrub typhus is associated with various clinical symptoms. However, the pathogenesis of scrub typhus infection remains to be elucidated. A 73-year-old man was admitted to our hospital with consciousness disturbance and suspected meningoencephalitis. The patients laboratory data showed deterioration and were indicative of hemophagocytic lymphohistiocytosis (HLH). A whole body examination to detect the trigger disease revealed an eschar, which is a characteristic of scrub typhus, on his back. His symptoms showed dramatic improvement after the administration of minocycline (MINO). This case report highlights that the clinical course of a case of scrub typhus meningoencephalitis that was cured with MINO.

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