Noriko Kikuchi

Home blood pressure measurement has a stronger predictive power for mortality than does screening blood pressure measurement: a population-based observation in Ohasama, Japan.

Objective To compare the predictive powers of self-measurement of blood pressure at home (home blood pressure measurement) and casual (screening) blood pressure measurement for mortality. Design A prospective cohort study. Subjects and methods We obtained home and screening blood pressure measurements for 1789 subjects aged ≥ 40 years who were followed up for a mean of 6.6 years. The prognostic significance of blood pressure for mortality was determined by the Cox proportional hazards regression model adjusted for age, sex, smoking status, past history of cardiovascular disease, and the use of antihypertensive medication. Results When the home blood pressure values and the screening blood pressure values were simultaneously incorporated into the Cox model as continuous variables, only the average of multiple (taken more than three times) home systolic blood pressure values was significantly and strongly related to the cardiovascular mortality risk. The average of the two initial home blood pressure values was also better related to the mortality risk than were the screening blood pressure values. Conclusions Home blood pressure measurement had a stronger predictive power for mortality than did screening blood pressure measurement for a general population. This appears to be the first study in which the prognostic significances of home and screening blood pressure measurements have been compared.

Relation Between Nocturnal Decline in Blood Pressure and Mortality ☆: The Ohasama Study

To investigate the relation between nocturnal decline in blood pressure and mortality, we obtained ambulatory blood pressures in 1542 residents aged 40 years or over of a rural Japanese community. Subjects were followed-up for a mean of 5.1 years and were then subdivided into four groups according to the percent decline in nocturnal blood pressure: 1) extreme dippers: percent decline in nocturnal blood pressure > or = 20% of the daytime blood pressure; 2) dippers: decline of > or = 10% but < 20%; 3) nondippers: decline of > or = 0% but < 10%; and 4) inverted dippers: no decline. The relationship between the decline in nocturnal blood pressure and mortality was examined by the Cox proportional hazards regression model adjusted for age, sex, smoking status, previous history of cardiovascular disease, and the use of antihypertensive medication. The mortality risk was highest in inverted dippers, followed by nondippers. There was no difference in mortality between extreme dippers and dippers. This relationship was observed for both treated and untreated subjects, was more pronounced for cardiovascular than for noncardiovascular mortality, and did not change after the data were adjusted for 24-h, daytime, and nighttime blood pressure levels.

Factors affecting the nocturnal decrease in blood pressure: a community-based study in Ohasama.

Objective To investigate factors affecting the nocturnal decrease in blood pressure. Design A cross-sectional study of 823 community-based untreated subjects aged > 20 years. Screening and ambulatory blood pressures were measured and the effects of age and the ambulatory blood pressure on the nocturnal decrease were examined. Results The magnitude of the decrease and the percentage decrease in the nocturnal blood pressure increased with increasing daytime ambulatory blood pressure and decreased with increasing night-time ambulatory blood pressure. Although the magnitude of the nocturnal decrease in blood pressure increased with increasing daytime blood pressure, the nocturnal blood pressure levels in hypertensives were still higher than those in normotensive subjects. The magnitude decreased with increasing age for men but not for women, whereas the percentage decrease decreased with increasing age both for men and for women. The SD of the 24 h blood pressure correlated strongly to the magnitude of the nocturnal decrease (systolic blood pressure r = 0.62, P < 0.0001; diastolic blood pressure r = 0.52, P < 0.0001), suggesting that the SD of the 24 h blood pressure is representative of the nocturnal decrease. A minimal nocturnal decrease was observed frequently in elderly normotensive men but infrequently in hypertensive individuals from the general population. A marked nocturnal decrease was observed frequently in hypertensive women aged > 70 years. Conclusion Although the magnitude of the nocturnal decrease in blood pressure increased with increasing daytime blood pressure, the nocturnal blood pressure levels increased with increasing daytime ambulatory blood pressure. Therefore, the blood pressure in hypertensive subjects should essentially be lowered throughout the 24 h period. A marked nocturnal decrease in blood pressure in some elderly hypertensive women was observed without treatment. The nocturnal blood pressure levels of such subjects should be considered during treatment.

Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with coronary artery disease.

Objective: The prognosis of hypertensive patients with reduced left ventricular ejection fraction (LVEF) is poorer than that with normal LVEF. The influence of LVEF on blood pressure (BP)-lowering therapy remains unclear. The aim of this study was to clarify the impact of LVEF on clinical outcomes of BP-lowering therapy in hypertensive patients with coronary artery disease (CAD). Methods: This study was a post hoc analysis from Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Heart Disease trial, a total of 2049 hypertensive patients with CAD were included. We analyzed 1849 patients with available LVEF data on enrollment. They were divided into three groups based on LVEF; reduced (<45%, n = 386), intermediate (45–55%, n = 524), and preserved (>55%, n = 999). The ‘achieved SBP’ was defined as the mean value of SBP in patients who did not experience major adverse cardiac events (MACE) and the mean value of SBP prior to MACE in those who experienced MACE. Results: During a median follow-up period of 4.2 years, MACE rates were 30.6, 27.6, and 24.0% in the reduced, intermediate, and preserved LVEF groups, respectively. A J-shaped association between achieved SBP and MACE was observed only in the preserved LVEF group [hazard ratio of MACE in patients with lower SBP (achieved SBP < 120 mmHg) was 1.81 (1.13–2.90) compared to reference SBP patients (120 < achieved BP < 130 mmHg)], but not in the reduced or intermediate LVEF groups. Conclusion: In hypertensive patients with CAD, the goal of BP-lowering therapy should consider LVEF status.

High Cardiac Output Immediately after Heart Transplantation is an Independent Risk Factor of Seizure early Posttransplant

Introduction Neurological complications are common complications after heart transplantation (HTx) and present with seizures, which are associated with significant morbidity. These neurologic complications occur predominantly in the early posttransplant period, especially in the first 3 months, owing to the accumulation of triggering factors, such as introduction of immunosuppressive drug. HTx for heart failure patients brings substantial hemodynamic changes early posttransplant. However, the relationship between hemodynamic changes and seizures remains to be investigated. Materials and Methods To investigate relationships between hemodynamic changes and seizures after HTx, we retrospectively reviewed consecutive 105 patients (mean age 39.2 ± 14.1 years, 82 males) who underwent HTx at our institution between May 1999 and October 2017. Data on patient characteristics and clinical outcomes were extracted from our transplant database and medical record review. Hemodynamic parameters were obtained before and 1 week after HTx. The diagnosis of seizure was based on direct observation by medical staff. Patient demographic characteristics, type of implanted left ventricular assist device, hemodynamic parameters, immunosuppressive regimen and clinical outcomes were compared between the seizure and non-seizure groups. Results and Discussion Over median follow-up of 1532 days [Interquartile range (IQR) 544-2703 days], 14 patients experienced seizures after HTx. In univariate analysis, there were significant differences between the two groups in history of cerebrovascular accidents before HTx (79% vs. 44% respectively: p = 0.02) and cardiac index after HTx (3.25 ± 0.62 vs. 2.69 ± 0.59: p = 0.02). The optimal cut-off of cardiac index was 2.8 L/min/m2 on ROC curve (AUC 0.74; Sensitivity 85.7%; Specificity 58.5%). Multivariate logistic regression analysis revealed that cardiac index is an independent risk factor of seizure after heart transplantation (Odds ratio: 1.18; 95% confidence interval: 1.02 to 1.39 per 0.1 L/min/m2; p = 0.02). There was no significant difference in survival between patients with seizures and without (at 5 years, 90% vs. 96.6% respectively: p = 0.40), but there was significant difference in hospital stay [106 (55-147) days vs. 54 (42-69) days: p = 0.02]. Table. No title available. Table. No title available. Table. No title available. Figure. No caption available. Conclusions These data suggested that high cardiac index immediately after HTx be an independent risk factor of seizure after HTx. Controlling immediate postoperative cardiac output might be important to reduce seizure and hospital stay after HTx.