Showing papers by "Hirohito Metoki published in 2006"
TL;DR: The association between stroke risk and the pattern of circadian BP variation was analyzed with a Cox proportional hazards model and there was no significant association between total strokerisk and the nocturnal decline in BP (percentage decline from diurnal level) or between total strokes and the morning pressor surge.
Abstract: There is continuing controversy over whether the pattern of circadian blood pressure (BP) variation that includes a nocturnal decline in BP and a morning pressor surge has prognostic significance for stroke risk. In this study, we followed the incidence of stroke in 1430 subjects aged > or =40 years in Ohasama, Japan, for an average of 10.4 years. The association between stroke risk and the pattern of circadian BP variation was analyzed with a Cox proportional hazards model after adjustment for possible confounding factors. There was no significant association between total stroke risk and the nocturnal decline in BP (percentage decline from diurnal level) or between total stroke risk and the morning pressor surge. The cerebral infarction risk was significantly higher in subjects with a or =10% nocturnal decline in BP (P=0.04). The morning pressor surge was not associated with a risk of cerebral infarction. On the other hand, an increased risk of cerebral hemorrhage was observed in subjects with a large morning pressor surge (> or =25 mm Hg; P=0.04). Intracerebral hemorrhage was also observed more frequently in extreme dippers (those with a > or =20% nocturnal decline in BP) than dippers (those with a 10% to 19% decline; P=0.02). A disturbed nocturnal decline in BP is associated with cerebral infarction, whereas a large morning pressor surge and a large nocturnal decline in BP, which are analogous to a large diurnal increase in BP, are both associated with cerebral hemorrhage.
414 citations
TL;DR: Morning BP and evening BP provide equally useful information for stroke risk, whereas morning HT, which indicates HT specifically observed in the morning, might be a good predictor of stroke, particularly among individuals using anti-HT medication.
Abstract: Predictive power of self-measured blood pressure at home (home BP) for cardiovascular disease risk has been reported to be higher than casual-screening BP. However, the differential prognostic significance of home BP in the morning (morning BP) and in the evening (evening BP), respectively, has not been elucidated. In the Ohasama study, 1766 subjects (≥40 years) were followed up for an average of 11 years. The predictive power for stroke incidence of evening BP was compared with that of morning BP as continuous variables. The Cox regression model demonstrated that evening BP and morning BP predicted future stroke risk equally. Subjects were also assigned to 1 of 4 categories based on home BP. In this analysis, stroke risk in morning hypertension ([HT] morning BP ≥135/85 mm Hg and evening BP <135/85 mm Hg; relative hazard (RH): 2.66; 95% CI:1.64 to 4.33) and that in sustained HT(morning BP and evening BP ≥135/85 mm Hg; RH: 2.38; 95% CI: 1.65 to 3.45) was significantly higher than that in normotension (morning BP and evening BP <135/85 mm Hg). The risk in morning HT was more remarkable in subjects taking antihypertensive medication (RH: 3.55; 95% CI: 1.70 to 7.38). Although the risk in evening HT (morning BP <135/85 mm Hg and evening BP ≥135/85 mm Hg) was higher than that in normotension, the differences were not significant. In conclusion, morning BP and evening BP provide equally useful information for stroke risk, whereas morning HT, which indicates HT specifically observed in the morning, might be a good predictor of stroke, particularly among individuals using anti-HT medication.
146 citations
TL;DR: Results suggest that the peripheral AI(r) measurement is clinically useful in predicting LVH, and enhanced wave reflection may be related to the development of LVH in hypertensive patients.
104 citations
TL;DR: High BP at different times of day were associated with different subtypes of cerebrovascular and cardiovascular mortality risk, significantly associated with elevated 2 h-SBP recorded during the night and early morning periods.
Abstract: Objective To clarify whether high blood pressure (BP) at a particular time of day is associated with cerebrovascular and cardiovascular mortality risk. Methods Cerebrovascular and cardiovascular mortality in 1360 individuals aged 40 years and older in Ohasama, Japan, was followed for an average of 10.6 years. We used 2-h moving averages of the BP (a total of 24 average BP measurements for two consecutive hours based on four BP readings taken every 30 min) to compare the predictive power of BP taken during a 24-h period given the same number of measurements. The associations between cerebrovascular and cardiovascular mortality risk and the 2-h moving averages of systolic blood pressure (2 h-SBP) recorded over 24 h were analysed using a Cox proportional hazards model after adjusting for possible confounding factors. Results The total cerebrovascular and cardiovascular mortality risk was significantly associated with elevated 2 h-SBP recorded during the night and early morning periods. Haemorrhagic stroke mortality was significantly associated with elevated daytime 2 h-SBP. Cerebral infarction mortality and heart disease mortality were significantly associated with elevated night-time 2 h-SBP. Conclusion High BP at different times of day were associated with different subtypes of cerebrovascular and cardiovascular mortality risk.
86 citations
TL;DR: It is demonstrated that resistant hypertension is mediated at least partly by the white-coat effect and home BP measurements and other relevant factors associated with resistant hypertension, such as relatively higher office SBP, type of drugs prescribed, and cardiovascular complications, should be taken into account for the diagnosis and treatment of resistant hypertension.
Abstract: ObjectivesTo diagnose resistant hypertension using self-measured blood pressure (BP) at home and office BP, and to evaluate the characteristics of resistant hypertensive patientsMethodsThe subjects were 528 hypertensive patients taking at least three or more different antihypertensive drugs Subjec
73 citations
TL;DR: The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs and adequate blood pressure control mediated by the change in the diagnostic method from clinic to homeBlood pressure measurement would improve the prognosis for hypertension.
Abstract: Objectives To investigate the economic consequences resulting from introduction of home blood pressure measurement in diagnosis of hypertension instead of casual clinic blood pressure measurement. Methods We constructed a decision tree model using data from the Ohasama study and a Japanese national database. The Ohasama study provided the prognostic value of home blood pressure as compared with clinic blood pressure measurement. Results It is predicted that the use of home blood pressure for hypertension diagnosis results in a saving of 9.30 billion US dollars (1013.6 billion yen) in hypertension-related medical costs in Japan. Most of this was attributable to medical costs saved by avoiding the start of treatment for untreated individuals who were diagnosed as hypertensive by clinic blood pressure but whose blood pressures were in the normal range when based on home blood pressure; that is, the so called white-coat hypertension. Furthermore, it could be expected that adequate blood pressure control mediated by the change in the diagnostic method from clinic to home blood pressure measurement would improve the prognosis for hypertension. We estimated that the prevention of hypertensive complications resulted in a reduction of annual medical costs by 28 million US dollars (3.0 billion yen). In addition, stroke prevention due to adequate blood pressure control based on home blood pressure measurement reduced annual long-term care costs by 39 million US dollars (4.2 billion yen). A per-person break-even cost for introducing home blood pressure monitoring was calculated as 409 US dollars (44,580 yen). Conclusions The introduction of home blood pressure measurement for the diagnosis and treatment of hypertension would be very effective to save costs.
52 citations
TL;DR: PP was the weakest predictor of stroke, and exclusion of age from covariates increased the predictive power of PP, suggesting that the stroke risk associated with PP reflected the risk of aging per se.
Abstract: We investigated the association between stroke and blood pressure (BP) indices (systolic BP [SBP], diastolic BP [DBP], mean BP [MBP], and pulse pressure [PP]) determined by ambulatory BP monitoring. The predictive power for stroke of these indices was compared in the general Japanese population. We obtained ambulatory BP data in 1271 subjects (40% men) aged > or = 40 (mean: 61) years. During a mean follow-up of 11 years, 113 strokes were observed. The multivariate adjusted relative hazard and likelihood ratio for a 1-SD increase for each BP index was determined by Cox proportional hazard regression. Comparison of the likelihood ratio between Cox models including 2 indices and those including 1 index indicated that PP was significantly less informative than other indices (P 0.09 when adding PP to the model including another index). However, after removing age from covariates, PP became more informative than DBP and MBP (P<0.0001 when adding PP to the MBP or DBP model, whereas SBP was more informative than PP even after removing age; P<0.05 when adding SBP to the PP model). In conclusion, PP was the weakest predictor of stroke. Exclusion of age from covariates increased the predictive power of PP, suggesting that the stroke risk associated with PP reflected the risk of aging per se.
51 citations
TL;DR: In Japan, HBP and office BP were not adequately controlled in most diabetic hypertensives, and the main reason for this would appear to be a lack of intensive treatment and a loss of recognition by physicians that their patients' BP was insufficiently controlled.
24 citations
TL;DR: Although a relatively high dosage is recommended in the diuretic product information and in the JSH guidelines, dosages of diuretics should be reconsidered in Japan.
Abstract: Current Usage of Diuretics among Hypertensive Patients in Japan: The Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study
23 citations
TL;DR: Physicians may need to be aware of ‘introverted’ patients who have high blood pressure in clinic settings, because they have the potential for ‘white-coat’ hypertension.
Abstract: Objective To explore the effect of personality on screening blood pressures measured in clinical settings and home blood pressure measurements. Methods From 1997 to 1999, 699 participants underwent screening and home blood pressure measurements and completed the Japanese version of the short-form Eysenck personality questionnaire. An increased screening blood pressure was defined as screening blood pressure > or = 140/90 mmHg and an increased home blood pressure was defined as home blood pressure > or = 135/85 mmHg. Results Participants with lower extroversion scores (i.e., introversion) showed a greater difference between screening and home systolic blood pressure. The association between introversion and differences was statistically significant, even after adjustment for other possible factors (younger age, female, wide screening pulse pressure, never smoked, and no antihypertensive medication). The adjusted means of SBP differences were 7.3 and 4.4 mmHg among the lowest and highest extroversion quartiles, respectively (P for trend = 0.02). Other personality scores (psychoticism or neuroticism) were not associated with screening and home blood pressure differences. The incorporation of an extroversion score in the basic model consisting of the above factors that affected the difference between screening and home blood pressure slightly improved the prediction of a high home blood pressure. The area under the receiver operating characteristic curve increased by 0.037 among participants with high screening blood pressure and 0.006 for those with normal screening blood pressure compared with the basic model. Conclusion Physicians may need to be aware of 'introverted' patients who have high blood pressure in clinic settings, because they have the potential for 'white-coat' hypertension.
20 citations
Journal Article•
TL;DR: In the study by Kario et al, the subjects were older, high-risk hypertensive subjects; the risk of intracerebral hemorrhage (ICH) was not adjusted by the average ambulatory blood pressure (BP) value, which is the most important confounding factor for ICH.
Abstract: We appreciate the comments by Tsivgoulis et al1 regarding our article.2 They pointed out the differences among our results,2 their own results,3 and the results by Kario et al.4 In the study by Kario et al,4 the subjects were older, high-risk hypertensive subjects; the risk of intracerebral hemorrhage (ICH) was not adjusted by the average ambulatory blood pressure (BP) value, which is the most important confounding factor for ICH. In their cross-sectional study, Tsivgoulis et al reported that an inverted dipper–type of circadian BP variation was associated with ICH.3 Although they did adjust for baseline characteristics and …