Keiko Nishida

University of Occupational and Environmental Health, Kitakyūshū, Fukuoka-ken, Japan

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Publications (9)10.1 Total impact

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    ABSTRACT: Objective The aim of the present study was to assess changes in blood pressure and metabolism after switching treatment from maximum-dose angiotensin II receptor blocker (ARB) therapy to a mixture of conventional-dose ARBs and low-dose diuretics. Methods This study was conducted among 43 Japanese patients with type 2 diabetes complicated with hypertension in whom continuous treatment with high doses of ARBs did not reduce their blood pressure to the target level (a systolic blood pressure of 130 mmHg or lower and a diastolic blood pressure of 80 mmHg or lower). The antihypertensive and metabolic effects of switching from high-dose ARBs to a combination of losartan (50 mg/day) plus hydrochlorothiazide (12.5 mg/day) were examined. The primary endpoint was a decrease in blood pressure at 24 weeks. Results The combination treatment significantly decreased both systolic (baseline: 147±11; 24 weeks: 133±13 mmHg) and diastolic (baseline: 79±8; 24 weeks: 72±10 mmHg) blood pressure. This treatment was also associated with a significant increase in the HbA1c level (baseline: 7.0±0.8%; 24 weeks: 7.2±0.9%) and a significant decrease in the urinary albumin-creatinine ratio (baseline: 280±590; 24 weeks: 110±253 mg/g creatinine). However, the combination treatment had no effect on lipid metabolism or the serum uric acid or potassium levels. Conclusion In patients with diabetes, sodium reabsorption in the renal tubules is enhanced, which leads to the development of salt-sensitive hypertension. Therefore, the concurrent use of a diuretic that promotes sodium excretion can increase the antihypertensive effects of other drugs. This study demonstrated that switching from high-dose ARB treatment to losartan/hydrochlorothiazide combination therapy results in significant control of blood pressure.
    Internal medicine (Tokyo, Japan). 01/2014; 53(12):1283-9.
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    ABSTRACT: We performed a crossover study in hypertensive patients with type 2 diabetes to compare olmesartan (40 mg/day) with telmisartan (80 mg/day) in terms of their antihypertensive and metabolic effects. The subjects were 36 patients (20 men and 16 women) with type 2 diabetes who did not achieve a blood pressure <130/80 mmHg following treatment with olmesartan at 40 mg/day or telmisartan at 80 mg/day for 8 weeks or more. The primary endpoint was the blood pressure reduction rate, while the secondary endpoints were BMI, parameters of glucose metabolism, HMW-adiponectin, hs-CRP and lipids metabolism. All parameters were measured in Weeks 0, 12, and 24. Treatments were switched in Week 0, and Week 12 and the following results were obtained. There were 1) no significant differences in baseline characteristics; 2) no significant difference of the blood pressure reduction rate; 3) significant reductions of HbA1c (NGSP), FPG and HOMA-IR in olmesartan group; 4) a significant increase of HDL-C in olmesartan group; 5) a decrease of hs-CRP and a increase of HMW-adiponectin in olmesartan group; and 6) a positive correlation between the percent changes of HOMA-IR and hs-CRP in olmesartan group. In conclusion, there was no difference of the blood pressure reduction achieved at the highest dose in olmesartan group and telmisartan group. But improvement of glycemic control and insulin resistance was only observed in olmesartan group. Because there was a correlation between the percent changes of HOMA-IR and hs-CRP, these effects of olmesartan might be mediated by an anti-inflammatory action.
    Endocrine Journal 01/2013; · 2.23 Impact Factor
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    ABSTRACT: It is insufficient to distinguish benign tumors from malignant pheochromocytoma using histological analyses of resected tissue alone. We experienced an 18-year-old woman who complained of severe headaches in whom hypertension was revealed. She was suspected of having a malignant tumor based on her clinical characteristics, despite showing no evidence of metastatic lesions. The patient was diagnosed with an aggressive form of hereditary pheochromocytoma-paraganglioma syndrome (HPPS) based on immunohistochemical analyses and genetic testing. The present case indicates that conducting genetic testing, including SDHB mutation analyses, is required to determine the prognosis in patients highly suspected of having HPPS.
    Internal Medicine 01/2013; 52(2):281-4. · 0.97 Impact Factor
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    ABSTRACT: A 49-year-old man was referred to our clinic for suspected hypoglycemic symptoms of palpitation, cold sweat, faintness and sinking feeling at movement since 43 years old. The 75 g oral glucose tolerance test showed a decrease in plasma glucose to 56 mg/dl at five hours, but this was not associated with clear hypoglycemic symptoms, and normal plasma glucose level recovered naturally after the test. At 48-hour fasting test, plasma glucose dropped to under 50 mg/dl, but the patient didn't feel hypoglycemia symptom and plasma glucose recovered naturally, but the patient developed cold sweat and hyperventilation after returning to his own room after the test. At that stage, the heart rate increased to 140 beats/min of sinus tachycardia, as confirmed by Holter monitoring. Postural orthostatic tachycardia syndrome (POTS) was suspected because tachycardia occurred only in daytime after an event such as consumption of diet and urination. A head-up tilt test was ordered since sinus tachycardia developed especially on standing. The results showed an increase in heart rate without reduction in blood pressure, confirming the diagnosis of POTS. A repeat head-up tilt test under the use of a beta-blocker showed no increase in heart rate. Though it is generally difficult to distinguish POTS from other forms of tachyarrhythmia, such as inappropriate sinus tachycardia and sinus node reentry tachycardia, and from neutrally mediated reflex syncope (NMS), POTS should be differentiated from hypoglycemia since each condition should be treated differently.
    Journal of UOEH 12/2012; 34(4):353-61.
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    ABSTRACT: The clinical dose of telmisartan necessary for activation of peroxisome proliferator-activated receptor gamma (PPAR-gamma) has not been established. The authors investigated the effect of high-dose telmisartan on serum levels of the high-molecular-weight (HMW) adiponectin in patients with diabetes and hypertension. In this open-label, prospective, randomized study, patients with type 2 diabetes and hypertension with poor control of blood pressure by 40 mg/day telmisartan were randomly assigned into the telmisartan 80 mg/day (Tel80) group (dose increase from 40 to 80 mg/day) or the telmisartan 40 mg + amlodipine 5 mg (Tel40 + Aml5) group. Serum levels of HMW adiponectin and parameters of glucose and lipid metabolism were measured at baseline and end of 3-months of treatment. Although the antihypertensive effects of the two doses of telmisartan were similar, a significant increase in HMW adiponectin levels was noted only in the Tel80 group. The increase was evident particularly in a group of patients whose HMW adiponectin levels were less than 4.0 μg/dL. A significant improvement in homeostasis model assessment of insulin resistance (HOMA-IR), a measure of insulin resistance, was also observed in the Tel80 group only. In diabetic patients with hypertension, high-dose telmisartan increased HMW adiponectin levels and improved insulin resistance through activation of PPAR-gamma.
    Advances in Therapy 07/2012; 29(7):635-44. · 2.44 Impact Factor
  • Yoshiya Tanaka, Keiko Nishida, Yosuke Okada
    Endocrine Journal 06/2008; · 2.23 Impact Factor
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    ABSTRACT: Tumor necrosis factor-alpha (TNF-alpha) plays an important role in forming atherosclerosis based on chronic inflammatory condition in vivo and animal models. In human system, it is not clear the involvement of TNF-alpha to atherosclerosis. To clarify the relevance of TNF-alpha to atherosclerotic factors in human, We performed a prospective cohort study to investigate the inhibition of TNF-alpha with anti-TNF-alpha antibody infliximab may contribute to increase serum adiponectin levels, adipocyte-derived hormone with antiatherogenic properties, in patients with RA. 97 patients with active RA had been treated every 8 weeks for 1 year(13 men and 84 women, 54.2 +/- 12.6 years, disease duration; 8.5 +/- 1.5 years). They received a fixed dose of infliximab of 3 mg/kg every 8 weeks for 52 weeks. We evaluated changes of inflammatory markers, high molecular weight form of adiponectin levels and blood lipid levels. We also studied the association between increment rate of serum adiponectin and improvement of disease activity and inflammatory markers. Infliximab were strikingly dropped inflammatory markers (p<0.01), increased total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) (p<0.05). Besides, serum adiponectin significantly increased, independent of RA activity and clinical backgrounds, suggesting that TNF-alpha and adiponectin exhibit opposite effects in human body. TNF-alpha blockade may interfere in the atherosclerosis directly or indirectly, by increasing serum adiponectin levels, therefore TNF-alpha blockade may improve cardiovascular morbidity and mortality in chronic inflammatory disease such as RA.
    Endocrine Journal 03/2008; 55(1):213-6. · 2.23 Impact Factor
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    ABSTRACT: High-frequency severe atherosclerosis/calcinosis is observed in diabetes mellitus and chronic dialysis, which leads to cardiovascular events. However, the effective treatment for suppressing the progression of vascular calcification has not been established. Here we review the mechanism of vascular calcification and present our findings that a first generation of bisphosphonate is useful in prevention of vascular calcification in diabetes and chronic renal failure.
    Clinical calcium 09/2006; 16(8):1316-20.
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    ABSTRACT: Prader-Willi Syndrome (PWS) is a complex neurogenetic disorder with considerable clinical variability, and is considered to be mainly the result of a hypothalamic defect. PWS is characterized by hyperphagia, obesity, mental retardation and hypogonadism from a young age. Hyperphagia is one of the most serious problems, which is organic in origin, inducing morbid obesity and leading to respiratory failure. Most studies attempting to control obesity in children with PWS by dietary management reported limited success due to difficulty in controlling foraging and food stealing. Here we report 16- and 20-year-old female patients with PWS who showed marked weight loss and improvement of respiratory failure by behavior modification and improvement of the environment.
    Journal of UOEH 04/2006; 28(1):65-73.