Mayumi Oka

Orthostatic Blood Pressure Changes and Subclinical Markers of Atherosclerosis

BACKGROUND Using a simple standing-up test in normotensive subjects, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP changes and subclinical markers of atherosclerosis. METHODS A total of 515 normotensive subjects aged 35-75 years (58.4±10.0 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP), serum lipids, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and urinary albumin-to-creatinine ratio. Brachial to ankle pulse wave velocity (baPWV) and carotid mean intima-media thickness (IMT) were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. RESULTS SBP and DBP decreased when standing, with a reduction of SBP when changing position of -8.0±10.2mm Hg. Orthostatic hypotension (OH) produced a significantly higher SBP than without OH. The baPWV was significantly higher in OH than in without OH. Stepwise regression analysis adjusted for age, sex, BMI, baseline SBP, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, HbA1c, hs-CRP, IMT, late systolic peak of the pressure wave form (SBP2), and baPWV confirmed that baPWV, SBP2, and triglycerides were independently related to orthostatic BP changes. Multiple regression analyses showed that a decrease in SBP as well as baseline SBP, age, BMI, and fasting glucose were independent determinants of PWV. CONCLUSIONS We have shown that increased arterial stiffness was associated with OH during a standing-up test. Arterial stiffness may contribute to greater BP responses to postural changes from standing.

Analysis of impact of geographic characteristics on suicide rate and visualization of result with Geographic Information System.

The aim of our study was to understand the geographic characteristics of Japanese communities and the impact of these characteristics on suicide rates.

Association of serum uric acid with subsequent arterial stiffness and renal function in normotensive subjects

Serum uric acid (SUA) is correlated with an increased risk of not only gout but also cardiovascular diseases. The present study aimed to longitudinally evaluate the effects of SUA level on renal function and arterial stiffness in a population-based sample of normotensive subjects. The subjects completed a health checkup in 2002 at baseline and in 2011 or 2012 at the end of the follow-up period. A total of 407 normotensive subjects (171 men and 236 women) aged 26–66 years were enrolled in this study. We measured blood pressure (BP), brachial-ankle pulse wave velocity (baPWV), central BP, intima–media thickness, SUA level and estimated glomerular filtration rate (eGFR). We divided the subjects into four subgroups according to the SUA quartile at baseline and compared renal function and arterial stiffness after the follow-up. The cutoff values were 3.6, 4.4, 5.6 and 9.6 mg dl−1. The SUA levels associated with baPWV (Q1, 1324; Q2, 1457; Q3, 1442; Q4, 1489 cm s−1), systolic BP (SBP) (Q1, 110.9; Q2, 110.1; Q3, 112.8; Q4. 116.1 mm Hg) and eGFR (P for trend <0.001). There was a significant difference in the incidence of arterial stiffness in women. Multivariate regression analyses showed that after adjusting for potential confounders, including age, sex, body mass index, SBP and lipids, SUA was a significant determinant of baPWV (β=0.117; P<0.05) and eGFR (β=−0.335, P<0.001). The results of this study suggest that elevated SUA levels may be associated with a higher risk of increased arterial stiffness and reduced renal function in normotensive subjects.

Relationships between Lifestyle, Living Environments, and Incidence of Hypertension in Japan (in Men): Based on Participant's Data from the Nationwide Medical Check-Up.

This study aims to investigate factors that contribute to the differences in incidence of hypertension between different regions in Japan, by accounting for not only individual lifestyles, but also their living environments. The target participants of this survey were individuals who received medical treatment for hypertension, as well as hypertension patients who have not received any treatment. The objective variable for analysis was the incidence of hypertension as data aggregated per prefecture. We used data (in men) including obesity, salt intake, vegetable intake, habitual alcohol consumption, habitual smoking, and number of steps walked per day. The variables within living environment included number of rail stations, standard/light vehicle usage, and slope of habitable land. In addition, we analyzed data for the variables related to medical environment including, participation rate in medical check-ups and number of hospitals. We performed multiple stepwise regression analyses to elucidate the correlation of these variables by using hypertension incidence as the objective variable. Hypertension incidence showed a significant negative correlation with walking and medical check-ups, and a significant positive correlation with light-vehicle usage and slope. Between the number of steps and variables related to the living environment, number of rail stations showed a significant positive correlation, while, standard- and light-vehicle usage showed significant negative correlation. Moreover, with stepwise multiple regression analysis, walking showed the strongest effect. The differences in daily walking based on living environment were associated with the disparities in the hypertension incidence in Japan.

Mps 10-04 The Combination Of Obesity And Sarcopena Is Associated With Cognitive Decline In Elderly Hypertensive Individuals

Objective: The combination of obesity and sarcopenia, defined as sarcopenic obesity, may contribute to cognitive decline more than the two conditions exist solely. This study aimed to investigate the risk of cognitive impairment associated with the sarcopenia, obesity, and its combination among elderly hypertensive individuals. Design and Method: A total of 348 elderly hypertensive subjects (175 men and 173 women, 69.5 ± 2.9 years of age), was enrolled in this study. We evaluated the cognitive functioning of individuals based on the 12-signs version of the Observations List for early signs of Dementia (OLD). Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM). A value of ASM was normalized for height and conversed to an ASM index. Results: Subject with an ASM index of less than the gender-specific lowest quartiles was classified as sarcopenic. Obesity was defined as waist circumference greater than 85 cm for men and 90 cm for women. Based on the cutoffs, four categorical groups were created as solely sarcopenic (sarcopenic non-obese), solely obese (non-sarcopenic obese), sarcopenic obese, and normal. The OLD score was highest (namely, cognitive functioning was lowest) among the sarcopenic obese group (5.3 ± 0.7 points), followed by non-sarcopenic obese group (3.3 ± 0.2 points), the sarcopenic non-obese group (3.4 ± 0.3 points), and normal group (2.8 ± 0.2 points) after adjusting for confounding factors (p for trend <.001). When a cognitive decline was defined as the OLD score of 5 points or above, 25.9% of the subjects met the criteria. Multiple logistic regression analysis revealed that the sarcopenic obese condition was significantly associated with the increased risk for cognitive decline (odds ratio, 4.0; 95% CI, 1.3–12.0; P<.05), independent of age, gender, education level, and use of anti-hypertensive agents. Conclusions: In elderly hypertensive individuals, the combination of obesity and sarcopenia may contribute to the acceleration of cognitive decline relative to the condition that they exist solely.

PS 12-22 ASSOCIATION OF Lp-PLA2 (PLA2G7) V279F GENOTYPES WITH ATHEROSCLEROTIC MARKERS IN THE GENERAL JAPANESE POPULATION

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been reported as a sensitive biomarker for cardiovascular disease. However, the association of La-PLA2 and atherosclerotic markers are now always warranted. The V279F loss-of-function variant of PLA2G7 gene encoding Lp-PLA2 is commonly seen in East Asians. To clarify the association of Lp-PLA2 and atherosclerotic markers, the PLA2G7 V279F genotypes in the general Japanese populations were investigated. Design and Method: Serum triglyceride, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C), systolic and diastolic blood pressure (SBP and DBP), and atherosclerosis indices such as brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and carotid intima-media thickness (CIMT) were assessed in 792 participants (385 men, 64.1 ± 9.0 years; 407 women, 62.6 ± 9.5 years). Rs 76863441 polymorphism (exon 9, G994T) was screened using a TaqMan allelic discrimination assay. Multivariate regression analyses and analyses of covariance adjusted for age, BMI, medication, alcohol consumption, smoking and walking status were carried. Results: Significant association of V279F genotype with triglyceride (&bgr;=0.15, P = 0.005) and with ABI (&bgr; = 0.12, P = 0.036) were seen in men. It also showed trend of being associated with HDL-C in men (&bgr; =− 0.09, P = 0.080) and with baPWV in women (&bgr; = 0.08, P = 0.080). Men with rare T allele showed significantly higher triglyceride (P = 0.004) compared to those in men with GG wild type, and women with T allele showed significantly higher baPWV (P = 0.011) compared with those in women with GG wild type. Conclusions: Lp-PLA2 V279F polymorphisms were significantly associated with atherosclerotic markers in the general Japanese population with gender differences.

3D.08: ARTERIAL STIFFNESS AND AUTONOMIC NERVOUS FUNCTION ON ORTHOSTATIC BLOOD PRESSURE-ELEVATION IN HYPERTENSIVE PATIENTS.

Objective: Using a simple standing-up test in hypertensive patients, we evaluated orthostatic upright postural blood pressure (BP) changes and autonomic nervous function, as well as the relationship between orthostatic BP-elevation and subclinical markers of atherosclerosis. Design and method: A total of 351 hypertensive patients aged 35–75 years (60.4 ± 8.7 years) were enrolled. We measured body mass index (BMI), systolic BP (SBP) and diastolic BP (DBP) and subclinical markers of atherosclerosis. Brachial ankle pulse wave velocity (baPWV), late systolic peak of the pressure wave form (SBP2) and carotid mean IMT were measured. Participants underwent a simple standing-up test involving sitting then standing for 2 minutes each, followed again by sitting. To evaluate autonomic fluctuations, we calculated the coefficient of variation of the R-R interval, the ratio of low to high frequency heart rate variability (LF/HF), and the coefficient of component variance of high frequency. Results: Orthostatic hypotension (OH: &dgr;SBP < −20 mmHg) and hypertension(OHT: &dgr;SBP > 10mmHg) was assessed with blood pressure measurements in sitting and standing position. OH was present in 30, normal response in 283, and OHT was 38 patients. OH was excluded in this study. Significant correlations were found between baPWV and resting SBP(r2 = 0.462, P < 0.001) and sympathetic &agr; function(r2 = 0.177, p < 0.01). In OHT group, &dgr;SBP(15.0 vs-3.25mmHg;p < 0.0001), &dgr;DBP(3.3 vs -0.27mmHg;p < 0.001), baseline SBP(145.4 vs 138.7mmHg;p-0.02), SBP2(134.6 vs 125.9mmHg; p = 0.001), baPWV(1757 vs 1637 mm/s; p = 0.014), LF/HF at standing(6.17 vs 3.86; p = 0.015), CVRR at standing (2.95 vs 2.56; p = 0.031)were significantly higher than in OHT(-) group. Multiple regression analyses showed that an increase in SBP as well as baseline SBP, age, BMI, were independent determinants of PWV. Conclusions: We have shown that increased arterial stiffness and autonomic nervous function in the hemodynamic response was associated with OHT during a standing-up test. Arterial stiffness may contribute to greater BP elevation to postural changes from standing.

5D.02: WHY DOES WAKAYAMA PREFECTURE HAVE THE HIGHEST RATES OF HYPERTENSION IN JAPAN? CONSIDERATION ON EXERCISE INCORPORATED INTO EVERYDAY LIFE.

Objective: In Japan, there are 47 prefectures with differences in topography, industrial structure, population distribution and hypertension rate as well. The authors’ home prefecture of Wakayama has the highest incidence of hypertension in the nation at 25.0%. This shows 7.6 point spread compared with the prefecture with the lowest rate at 17.4%. The aim of our study is to search for the reasons of high rate of hypertension in Wakayama, and to consider effective prevention of hypertension in Wakayama as well as in Japan. Design and method: Correlation analysis was performed using hypertension rate for each prefecture versus the variables of: 1. salt intake, 2. vegetable intake, 3. alcohol habits, 4. smoking habits, and 5. walking paces per day (walking), using 5% significance level. To find the social causes that impact walking, correlation analysis was performed with the variables of: 1. number of train stations, 2. vehicle ownership rate, 3. light-vehicle ownership rate, and 4. slope of habitable areas (index of steepness), versus walking, as well as hypertension rate. Lastly, with hypertension rate as the dependent variable, all aforementioned variables, adding the rate of health examination and the number of hospitals, multiple regression analysis was performed. Results: There was a significant negative correlation between hypertension rate and walking (r = -0.440, p = 0.004). Walking was positively correlated with number of train stations (0.381, 0.008) and negatively with vehicle ownership rate (-0.424, 0.003) as well as light-vehicle ownership rate (-0.616, 0.000). Hypertension rate was most strongly affected by walking and slope. There were no significant correlations for the salt, vegetable, alcohol, smoking, rate of health examination, or number of hospitals. R2 coefficient was 0.442. Conclusions: It is suggested that high incidence of hypertension in Wakayama may be due to less walking habits. In the prefectures with larger mountainous areas where transportation rely on vehicle rather than train, people walked less. Use of light-vehicle particularly reduced walking. It is suggested that the daily habits shaped by the characteristics of living environments such as topography and transportation infrastructure could affect the habitants’ health.