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ABSTRACT: We have developed a new home blood pressure (BP) monitoring system by using cellular telephone and the Internet. All data of home BP and pulse rate were directly collected by I-converter date collecting system and sent online to a main server constructed in a central data center. The home doctor can monitor the exercise data of each patient by using this system. This home BP monitoring system was directly connected to the Internet by using application service provider technology (ASP). Anytime and anywhere, each patient can check the changes of these parameters by themselves by using cellular telephone and/or the Internet. The average of the data was calculated and demonstrated online. In real time, all data were monitored and sent to the home doctor's office. In the present study, we tried to use this monitoring system to compare the effect of some antihypertensive drugs on home BP. To compare the effects of telmisartan (TEL) and amlodipine (AM) on home BP, home BP was monitored for eight weeks using this telemedicine system. The target point of office BP was 140/90 mmHg or less. After two weeks control period, telmisartan (TEL group: 20-80 mg/day, n = 21) or amlodipine (AM group: 2.5-10 mg/day, n = 19) was orally administrated once a day in the morning. There was no significant difference of office BP between these two groups. Systolic home BP was significantly decreased from 144 +/- 4 to 134 +/- 3 mmHg (TEL group) and from 143 +/- 4 to 135 +/- 3 mmHg (AM group), respectively. There was no significant difference in the changes of home BP in the morning between groups (eight weeks home systolic BP reduction, TEL: 15 +/- 2 mmHg, AM: 13 +/- 2 mmHg). However the reduction of home BP in the evening in TEL group was significantly bigger than AM group (eight weeks home systolic BP reduction, TEL: 13 +/- 3 vs. AM: 6 +/- 3 mmHg). From these data, we concluded that there is a big difference on the effects of antihypertensive agents on diurnal variation and 24hr overall BP variability in home BP. TEL has a good effect on home BP for 24 hours compared to AM. This telemedicine system has a great advantage in monitoriong home BP correctly in hypertensive patients.
Clinical and Experimental Hypertension 02/2008; 30(1):57-67. · 1.07 Impact Factor
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ABSTRACT: We developed a new data collection system named i-converter that could transmit data to a website via cellular phone. Using the system, we compared the effects of two calcium channel blockers on the home blood pressure.
Amlodipine and nifedipine CR were administered to 41 patients with essential hypertension for more than 6 weeks each in a randomized open-label crossover study. The dose of each drug was increased until the home blood pressure reached the target level of under 135/85 mmHg.
The morning home systolic and diastolic blood pressures were significantly lower during nifedipine CR treatment: 133 +/- 10/81 +/- 8 mmHg with amlodipine versus 131 +/- 8/80 +/- 8 mmHg with nifedipine CR, P < 0.05. The morning pulse rate was significantly higher during nifedipine CR treatment (69 +/- 9 beats/min with amlodipine versus 70 +/- 9 beats/min with nifedipine CR, P < 0.05). The evening home blood pressure and pulse rate, however, showed no significant differences between the two drugs (128 +/- 11/74 +/- 7 mmHg and 74 +/- 10 beats/min with amlodipine versus 128 +/- 10/75 +/- 7 mmHg and 74 +/- 9 beats/min with nifedipine CR, all not significant).
Nifedipine CR had a stronger antihypertensive effect than amlodipine during the critical morning period, but the morning pulse rate was higher. Our new data transmission system was effective for collecting precise data on the blood pressure and pulse rate via the internet.
Journal of Hypertension 11/2007; 25(11):2352-8. · 4.02 Impact Factor
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ABSTRACT: We have developed a new telemedicine system that uses a cellular telephone and Internet Web site to monitor changes of blood pressure (BP) in patients on continuous ambulatory peritoneal dialysis (CAPD). An I-converter data collection system directly transmits all data on BP and heart rate (HR) measured by a fully automatic device (HEM-705IT: Omron Life Science, Tokyo, Japan) to a cellular telephone. The cellular telephone then sends the data directly to the main server at the NTT DoCoMo data center. All data, including BP and HR from each patient, are accumulated in the server. Application service provider technology (ASP) connects that system directly to the Internet. Any time and anywhere, each patient can use a cellular telephone or the Internet Web site to monitor, in graph form, changes in their data. The average data at each collection point are calculated and shown on the Web site. All data collected by cellular telephone are also calculated and sent directly, in real time, to the physician's office. Currently, we are using this telemedicine system for 44 hypertensive patients on CAPD at our center. In the present study, we used the telemedicine system to evaluate changes in 24-hour BP. We followed 20 CAPD patients, monitoring changes in BP for 3 months. At the end of study, we found that the average daytime home BP was 137 +/- 8 mmHg over 80 +/- 4 mmHg and that the average nighttime BP was 128 +/- 7 mmHg over 72 +/- 4 mmHg. The overall average home BP was 132 +/- 7 mmHg over 76 +/- 3 mmHg. The average outpatient clinic BP was 155 +/- 9 mmHg over 86 +/- 5 mmHg. The measured systolic and diastolic BP at the out-patient clinic were significantly higher than those measured at home. As measured at the outpatient clinic, BP indicated that 7 CAPD patients (35%) were hypertensive (> 160/95 mmHg). However, as measured at home, BP indicated that only 4 CAPD patients (20%) were truly hypertensive (> 135/85 mmHg). We were therefore able to determine that 43% of our hypertensive patients had "white coat" hypertension. Our new telemedicine system that monitors BP by cellular telephone provides great advantages in monitoring BP at home in patients on CAPD.
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 02/2004; 20:105-10.
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ABSTRACT: To clarify the renal protection conferred by angiotensin II converting enzyme inhibitor(ACEI), we compared an ACEI group and a conventional therapy (control) group with matched propensity scores. The propensity score is used to control imbalances in the conditional probability of a subject receiving a particular exposure given a set of defined confounders. To calculate the propensity score, the confounders are used in a logistic regression to predict the exposure of interest, without including the outcome. We used a database of the characteristics and clinical data for 1,309 renal insufficiency cases who visited our out-patient clinic between 1986 and 2001. The major contributing factors in the patient characteristics were primary disease, blood pressure, renal function(serum creatinine levels; sCr), urinary protein excretion (UP), and gender. The primary end-point was the doubling of the baseline sCr noted at the time of enrollment or endstage renal failure. The major characteristics of the two groups were not statistically different. An incidence of 90% was obtained at 95 months in the control group and at 183 months in the ACEI group. Using a Kaplan-Meier survival analysis, the survival rates of the two groups were found to be significantly different (p < 0.001 by log-rank test), with ACEI having a beneficial effect on the survival rate and renal function. Using a sub-analysis, neither the starting point of ACEI treatment, based on an sCr above or below 2 mg/dl, nor the amount of UP, more or less than 1 g/day, affected the superiority of ACEI in the prevention of renal failure progression. The ACEI treatment was superior to conventional therapy in patients with renal insufficiency, and this superiority was independent of blood pressure, renal function and the amount of UP, based on the analysis of an observational database of renal insufficiency cases with matched propensity scores.
Nippon Jinzo Gakkai shi 01/2004; 46(1):35-42.
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ABSTRACT: 腎髄質細胞は生体内において最も多様な浸透圧環境にさらされている.この多様な浸透圧環境に対応するため,調整物質として有機浸透圧物質が存在する.今回我々は尿濃縮力の低下している5/6腎摘ラットを用いて,腎機能低下時での有機浸透圧物質の役割につき検討した.コントロール, 5/6腎摘モデルにはWistar ratを用い3週間飼育後イヌリンクリアランスを施行した.その後腎髄質内の有機浸透圧物質をHPLCで測定した.尿浸透圧は1,302±204mOsm/kg H_2Oより918±88mOsm/kg H_2Oまで低下し,さらにfurosemideを負荷すると313±13mOsm/kg H_2Oまで低下した.有機浸透圧物質は5/6腎摘モデルではsorbitolが検出されず,尿濃縮機構の一端を担っていると考えられた.急速利尿をかけた状態ではその他の有機浸透圧物質の組成は保たれていた.以上より腎機能低下時でも尿の濃縮力は存在し,その調節に有機浸透圧物質が関与していることが示された. The aim of this study is to clarify the role of organic osmolytes in cellular osmoregulation in the renal medulla under conditions of limited urinary concentrative capability induced by renal mass reduction in 18 Wistar rats. The animals were examined three weeks after ablation of 5/6 of the kidney mass. Renal function was measured by inulin clearance and organic osmolytes by HPLC. Urine osmolality in the renal mass reduction model decreased from 917±214.3mOsm/kg H_2O in the control phase to 313.6±13.4mOsm/kg H_20 after furosemide infusion (p<0.05). Despite extremely low levels of sorbitol in the renal medulla of the ablated rats in the control phase, other major organic osmolytes e.g., myo-inositol, glycerophosphorylcholine, betaine, acted as the osmoregulator in the renal medulla under limited urinary concentrative capability. All these osmolytes except sorbitol remained in the renal medulla following treatment of acute diuresis after renal mass reduction. These data suggest that even a mild reduction of urinary concentrative capability induces changes in osmoregulator composition, and is probably necessary for the accumulation and release of organic osmolytes to control the cellular osmoregulation in a different manner.
