Miyoko Utsumi

Increased mean arterial pressure response to dynamic exercise in normotensive subjects with multiple metabolic risk factors.

Metabolic syndrome (MS) may influence vascular reactivity and might cause an excessive increase in blood pressure (BP) during dynamic exercise. We examined this hypothesis in 698 normotensive men (mean age: 43 years) free of cardiovascular disease, diabetes mellitus and renal disease. The response of BP to exercise was assessed by the mean arterial pressure (MAP) during bicycle ergometry. The MAP values were expressed as z-scores normalized to the relative increases in heart rate. High-normal BP, dyslipidemia and hyperglycemia were diagnosed according to the Japan-specific MS criteria. The z-score of MAP was significantly higher in subjects with high-normal BP (+0.57, P<0.001), dyslipidemia (+0.18, P<0.001) and hyperglycemia (+0.24, P<0.001) than in those without MS component (−0.38). In the high-normal BP subjects, the addition of dyslipidemia and/or hyperglycemia was associated with a progressive increase in the z-score of exercise MAP, whereas no such association was observed in the normal-BP subjects (P=0.033, two-way ANOVA). Multivariate regression analysis revealed that a greater number of MS components (β=0.102, P=0.010) was an independent determinant of increased MAP z-score after adjustment for potential confounders, including age (β=0.123, P<0.001), body mass index (β=0.145, P<0.001) and high-normal BP (β=0.410, P<0.001). These results suggest that accumulation of MS components may alter vascular structure and function and lead to the significant elevation of MAP during dynamic exercise even before clinical manifestation of arterial hypertension.

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.

Social development conditions and related factors for children in Japanese kindergarten in Shanghai, China

ObjectiveThe aim of this study is to clarify the social development conditions and related factors for children in Japanese kindergarten in Shanghai, China.MethodsThe target schools were three Japanese kindergartens in Shanghai, three in Wakayama, Japan, and three in Osaka, Japan. The target kindergarten children were all 5- or 6-year-olds. We used an anonymous questionnaire to the guardian of the child. The question items related to social development, lifestyle and daily activities of the child, and rearing awareness and conditions of the guardian. Social development was scored by Strength and Difficulties Questionnaires (SDQ).ResultsThe number of respondents was 246 (Shanghai group 72, Wakayama group 86, Osaka group 88). The median value of the score of total difficulties and prosocial behavior, SDQ subscale, and the proportion of children judged as low need showed no significant difference. Results of multiple logistic regression analysis showed that the frequency of eating fast-foods and the rearing condition “I become anxious or lose enthusiasm for childrearing when the child is recalcitrant” were the factors relevant to prosocial behavior in the Shanghai group. In the Wakayama group, the hours spent daily watching TV was designated as the relevant factor. In the Osaka group, hours spent daily playing outdoors was found to be the relevant factor.ConclusionsSocial development of children in Japanese kindergarten in Shanghai was the same as that of those living in Japan. The factors relevant to prosocial behavior in the Shanghai group were different from those in the two cities in Japan. This study may show the important points to keep in mind for childrearing abroad.

Age-specific nomogram of brachial-ankle pulse wave velocity in Japanese adolescents.

To obtain data on the brachial-ankle pulse wave velocity (baPWV) distribution during adolescence, a total of 3215 Japanese adolescents ranging from 12 to 18 years of age were studied. The brachial-ankle pulse wave velocity increased substantially with age and was significantly higher in males than in females. Multivariate regression analysis revealed that age, weight, and systolic and diastolic blood pressures were the major determinants of baPWV for both genders. Age-specific centile curves of baPWV were constructed for males and females by regression curve analysis. The proposed distribution curves of baPWV and its derived cutoff values may allow the atherosclerotic risk profile among adolescents of different ages to be more precisely estimated.

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.

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.

[PP.09.33] THE EFFECTS OF SMOKING ON CENTRAL BLOOD PRESSURE IN MIDDLE-AGED AND ELDERLY JAPANESE INDIVIDUALS

Objective: The aim of this study was to investigate the effect of smoking habits on central blood pressure in a population-based sample of middle-aged and elderly individuals. Design and method: A total of 406 normotensive and untreated hypertensive (stage-1) individuals (mean age; 59 ± 10 years) without a history of cardiovascular disease, renal disease and arteriosclerosis obliterans was recruited for this study. When the subject was in a comfortable seated position the peripheral brachial pressures were measured, and then the brachial waveform was captured by a standard brachial cuff (SphygmoCor XCEL) and the central aortic pressures were estimated using a generalized transfer function. Smoking status was determined by questionnaire. Current smokers and former smokers were asked how many cigarettes they smoked per day and the number of years spent smoking. Brinkman Index (BI) values were calculated as the number of cigarettes smoked per day multiplied by the number of years of smoking. Results: The subjects were divided into subgroups according to cumulative number of cigarettes smoked; never-smokers (N = 292), mild-to-moderate smokers (BI of < 800 per lifetime, N = 64), and heavy smokers (BI of > = 800 per lifetime, N = 50). Central systolic pressure was higher in both heavy smokers (123mmHg, P < .001) and mild-to-moderate smokers (117mmHg, P = .070) than those in never-smokers (112 ± 14mmHg) after adjustment for sex, age, and body mass index (p for trend<.001). This dose-response increase by smoking status was not clearly demonstrated in brachial systolic pressure. A stepwise multiple regression analysis revealed that the heavy smoking (&bgr; = .192, P < .001), age (&bgr; = .231, P < .001), body mass index (&bgr; = .278, P < .001), and LDL cholesterol (&bgr; = .099, P = .028) were selected as significant determinants of central systolic pressure independent of sex. Conclusions: These results suggest that smoking habits may have greater impact on central aortic pressure than peripheral brachial pressure and hence could be identified by abnormal increases in central systolic pressure and wave reflection even before clinical manifestation of hypertension.