Mitsuru Shiba

Prevalence of Dementia in the Rural Village of Hanazono-mura, Japan

We studied the prevalence of dementing disorders in a rural municipality of Japan (Hanazono-mura), using a door-to-door two-phase design. In phase 1, the Hasegawa’s Dementia Scale-Revised was applied as a screening test to all subjects aged 65 years and older (n = 201). Among subjects screened positive, 17 were diagnosed with dementia in phase 2. The prevalence (cases/100 aged 65 years and older) was 8.5 for all types of dementia, 3.5 for Alzheimer’s disease, 3.0 for vascular dementia, and 2.0 for other dementia (including mixed dementia). The prevalence of dementia was slightly but consistently higher in men than women at all ages. The overall prevalence was higher in women for Alzheimer’s disease and in men for vascular dementia.

Effect of metabolic syndrome components and their clustering on carotid atherosclerosis in a sample of the general Japanese population

The objective of this study was to investigate the impact of metabolic syndrome (MS) on carotid atherosclerosis in a Japanese population. A total of 1727 subjects (805 males and 922 females) were included. Intima-media thickness (IMT) was measured using ultrasonography. To evaluate the independent determinants of IMT, a stepwise multiple regression analysis was employed that included age, current smoking habit, LDL-C, HbA1c and the MS components (SBP, DBP, TG, HDL-C, FBG, and WC) as independent variables. Multivariate regression analyses were performed to determine the independent associations of the MS components with IMT. In males, age (β=0.383, P<0.001), SBP (β=0.237, P<0.001), LDL-C (β=0.188, P<0.001), current smoking habit (β=0.124, P=0.007) and HbA1c (β=0.110, P=0.014) were significantly associated with IMT. In females, age (β=0.474, P<0.001), SBP (β=0.130, P=0.003) and FBG (β=0.110, P=0.038) were significantly associated with IMT. The present study demonstrated that an elevated number of MS components, with or without central obesity, is associated with higher IMT. Among the analyzed components, hypertension has the strongest association with higher IMT.

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.

Exaggerated exercise blood pressure response in middle-aged men as a predictor of future blood pressure: a 10-year follow-up.

ABSTRACT Objective: The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. This study was designed to assess whether an EESBPR is associated with the predictor of future blood pressure. Methods: From an initial population of 1,534 male-subjects with normal BP or no medication who underwent ergometric exercise, 733 subjects (mean age: 41 years old) at baseline to follow-up BP after an average of 10 years were selected. A 12-min exercise tolerance test with three phases of estimated load from predictive maximum oxygen intake was performed at baseline, and exercise BP was measured. Results: Exercise BP response was classified by three group: Low group (G) (exercise SBP < 180 mmHg), Middle G (exercise BP:180–199 mmHg), High G (exercise BP:200 mmHg ≦). BP after 10 years in Low G was 123 ± 12/79 ± 7 mmHg, in Middle G:127 ± 13/81 ± 8 mmHg, in High G :134 ± 15/84 ± 10 mmHg. Compared with in Low G, BP after 10 years in High G significantly increased (p < 0.05). Multiple regression analysis was carried out to clarify the relationship of exercise SBP at baseline to BP after 10 years. In multivariate-adjusted models, the relationship of SBP at follow-up was stronger to exercise SBP (β = 0.271, P < 0.001) than to resting SBP (β = 0.148, P < 0.001). Maximum oxygen intake (β = −0.193, P = 0.003) and resting SBP correlated with SBP after 10 years. Conclusions: In middle-aged men, exercise SBP would be a stronger predictor of future SBP, DBP rather than BP at rest. In optimal of classification of BP (SBP < 120 mmHg), exercise BP response was clearly associated with BP after 10 years.

Relationship between blood pressure response during step exercise test and atherosclerotic markers

Abstract The relationship between blood pressure (BP) response to exercise and atherosclerotic markers were evaluated in a population based sample of 426 normotensive subjects. The subjects with greater increase of SBP during exercise and delayed recovery of SBP after exercise showed higher hs-CRP and SBP2. Multiple regression analysis revealed that the greater BP response and delayed BP recovery were independently associated with SBP2 after adjusting for resting SBP, age, and gender. These results suggest that early atherosclerosis may contribute to greater BP responses to exercise, supporting the concept that exercise BP adds incremental information of cardiovascular risks to resting BP.

Re-examination of the value of localising aura sensations and lateralising interictal epileptiform discharges in view of structural lesions demonstrated by MRI

We examined the relationship between MRI lesions and electro-clinical findings with special attention to the localising value of aura sensations and the sides of interictal epileptiform discharges in 327 patients with symptomatic localisation-related epilepsy. As a result, while autonomic as well as psychic auras were correlated with temporal lesions, simple motor seizures were associated with extra-temporal ones. Within the group of patients with temporal lobe epilepsy, autonomic but not psychic auras concurred significantly more often with medial temporal structural lesions. Furthermore, there was a significant difference between concordance rates between sides of MRI lesions and EEG foci as a function of laterality: while the right-sided MRI lesions constantly showed ipsilateral EEG foci, EEG foci concurring with the left-sided MRI lesions proved to be often falsely lateralising. From these results, we assumed that lateral as well as medial temporal involvement is needed in the genesis of the psychic aura in contrast to the autonomic aura, which could be induced without lateral temporal involvement, and lesions in the left hemisphere are more apt to induce secondarily epileptogenic than those in the right hemisphere.

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.

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.

THE COMBINATION OF RENAL DYSFUNCTION AND MUSCLE MASS REDUCTION IS ASSOCIATED WITH ARTERIAL STIFFNESS IN ELDERLY INDIVIDUALS

Objective: Epidemiological studies have found that both renal dysfunction and muscle mass reduction (sarcopenia) are associated with the target organ damage and future risk of cardiovascular disease. This study aimed to examine whether the renal dysfunction, muscle mass reduction, and their combination related to arterial stiffness among elderly individuals. Design and method: From the participants in Wakayama study, a total of 552 normotensive and untreated hypertensive elderly individuals (mean age, 69.5 ± 3.6 years) without a history of stroke, coronary heart disease and renal disease was enrolled in this study. Brachial-ankle pulse wave velocity (baPWV) was measured by a simple automatic oscillometric technique and used as index of arterial stiffness. The skeletal muscle mass(SM) of the whole body was estimated by a bioelectrical impedance analysis. The renal dysfunction was evaluated by a glomerular filtration rate (eGFR) correlated by body surface area. Results: The eGFR and SM of subjects decreased with increase in age, and the values were significantly higher in men than women. The eGFR was positively correlated with SM in both genders. We divided the subjects into four groups according to eGFR and SM levels; namely, high-eGFR (> = 60 ml/min/1.73 m2) + high SM (> = age- and gender-specific median value) group (n = 228), high-eGFR + low-SM group (n = 189), low-eGFR + high-SM group (n = 58) and low-eGFR + low-SM group (n = 77). There was no significant difference in blood pressure between the four groups. The baPWV was the highest in the low-eGFR + low-SM group (1,751 cm/s), and followed by the high-eGFR + low-SM group (1,708 cm/s), the low-eGFR + high-SM group (1,687 cm/s) and the high-eGFR + high-SM group (1,610 cm/s). After adjustment for age and gender, the baPWV in the high-eGFR + low-SM group was significantly higher than that in the high-eGFR + high-SM group (p = 0.006); whereas no significant difference between the low-eGFR + high-SM group and the high-eGFR + high-SM group (p = 0.502). Conclusions: In elderly individuals, the combination of renal dysfunction and muscle mass reduction may contribute to the acceleration of arterial stiffening relative to the condition that they exist solely.

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.