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ABSTRACT: An association between visit-to-visit variability (VVV) of blood pressure (BP) and renal damage was recently reported in a cross-sectional study. We aimed to clarify the longitudinal effect of VVV of BP on deterioration of renal function in patients with non-diabetic chronic kidney disease (CKD). We retrospectively studied 56 patients with non-diabetic CKD (stage 3 or 4) who visited our nephrology clinic between September 1994 and May 2011. VVV of BP was defined as the standard deviation and coefficient of variation (CV) of office BP measured at 12 consecutive visits. Main outcomes were the annual decline in the estimated glomerular filtration rate (eGFR) and the composite renal end point defined as a doubling of serum creatinine or the need for dialysis. The median observation period was 83 months. Standard deviation and CV of office systolic BP (SBP) were significantly associated with the slope of the eGFR after adjustments for confounders. The adjusted risk for composite renal end points more than doubled for each increment of 1-standard deviation of the standard deviation of office SBP (hazard ratio (HR) 2.20, P=0.001), and for each increment of 1-standard deviation of the CV of office SBP (HR 2.12, P=0.002). The present study demonstrated that the visit-to-visit variability of BP is an independent determinant of deterioration of renal function in patients with non-diabetic CKD.Hypertension Research advance online publication, 27 September 2012; doi:10.1038/hr.2012.145.
Hypertension Research 09/2012; · 2.58 Impact Factor
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ABSTRACT: We aimed to investigate the association of the change in the ambulatory arterial stiffness index (AASI) with that in carotid-femoral pulse wave velocity (cfPWV) during treatment with antihypertensive medication.
We enrolled 207 hypertensive patients treated with olmesartan monotherapy for 12 weeks. Patients were randomly assigned to treatment with hydrochlorothiazide (HCTZ; n = 104) or azelnidipine (n = 103) for 24 weeks. The cfPWV and 24-h ambulatory blood pressure monitoring (ABPM) results were assessed at baseline and 24 weeks later. The AASI was defined as 1 minus the regression slope of diastolic blood pressure (DBP) on systolic BP (SBP), and was calculated by standard and symmetric regression.
The changes in the AASI and symmetrical AASI were similar between the two groups, while cfPWV in the azelnidipine group decreased more than in the HCTZ group (P < 0.001). The change in AASI was not significantly correlated with change in cfPWV (r = 0.08, P = 0.26), whereas the change in symmetrical AASI was significantly but weakly correlated with change in cfPWV (r = 0.22, P < 0.001). The multivariable linear regression analysis revealed that the association of the change in symmetrical AASI with change in cfPWV remained significant even after adjustments for covariates derived from ABPM (regression coefficient (95% confidence interval): 1.33 (0.35-2.30), P = 0.01).
The present study demonstrated that neither AASI nor symmetrical AASI may be an unequivocal marker of arterial stiffness during antihypertensive treatment.
American Journal of Hypertension 05/2012; 25(8):862-8. · 3.18 Impact Factor
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ABSTRACT: Day-by-day home blood pressure (BP) variability (BPV) was reported to be associated with increased cardiovascular risk. We aimed to test the hypothesis that the angiotensin II receptor blocker/calcium-channel blocker combination decreases day-by-day BPV more than the angiotensin II receptor blocker/diuretic combination does and investigated the mechanism underlying the former reduction. We enrolled 207 hypertensive subjects treated with olmesartan monotherapy for 12 weeks. The subjects were randomly assigned to treatment with hydrochlorothiazide (n = 104) or azelnidipine (n = 103) for 24 weeks. Home BP was taken in triplicate with a memory-equipped device in the morning and evening, respectively, for 5 consecutive days before each visit. Visits occurred at 4-week intervals. Home BPV was defined as within-individual SD of the 5-day home BP. Arterial stiffness was assessed by aortic pulse wave velocity at baseline and 24 weeks later. The reductions in home systolic BP were similar between the 2 groups, whereas the SD of home systolic BP decreased more in the azelnidipine group than in the hydrochlorothiazide group during the follow-up period (follow-up mean: 6.3 versus 7.1 mm Hg; P = 0.007). In the azelnidipine group, the change in aortic pulse wave velocity was independently associated with the change in SD of home systolic BP (regression coefficient ± SE = 0.79 ± 0.37; P = 0.036). This study demonstrated that the angiotensin II receptor blocker/calcium-channel blocker combination improved home BPV in addition to home BP reduction and that the reduction in home BPV was partly attributable to the arterial stiffness reduction by this combination.
Hypertension 04/2012; 59(6):1132-8. · 6.21 Impact Factor
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Hypertension 02/2012; 59(4):e33; author reply e34. · 6.21 Impact Factor
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ABSTRACT: To clarify the implications of the home arterial stiffness index (HASI), we compared HASI with other arterial stiffness measures and investigated the association between HASI and hypertensive target organ damage (TOD).
We assessed brachial-ankle pulse wave velocity (baPWV) and the carotid augmentation index (cAIx) as measures of arterial stiffness and wave reflection, and the left ventricular mass index (LVMI), carotid intima-media thickness (IMT) using ultrasonography, and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home blood pressure (BP) was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. HASI was defined as 1 minus the respective regression slope of diastolic on systolic BP.
HASI was significantly correlated with age (r = 0.32, P < 0.001), home pulse pressure (r = 0.36, P < 0.001), morning-evening difference in home systolic BP (r = -0.29, P < 0.001), baPWV (r = 0.18, P < 0.001), cAIx (r = 0.16, P = 0.002), carotid IMT (r = 0.26, P < 0.001), and UACR (r = 0.24, P < 0.001), but not with LVMI (r = 0.05, P = 0.38). After adjustment for age and sex, the significant correlation between HASI and baPWV/cAIx was lost. In multivariate regression analyses, HASI and baPWV were significantly associated with carotid IMT (standardized β = 0.21, P<0.001; β = 0.14, P = 0.014) and UACR (β = 0.13, P = 0.018; β = 0.21, P < 0.001), independently of age, sex, and home mean arterial pressure. On the other hand, cAIx was independently associated only with LVMI (β = 0.24, P < 0.001).
These findings indicate that HASI adds nothing to the existing measures of arterial stiffness, but might be a BP component that can aid in the detection of carotid atherosclerosis and renal damage, similar to PWV.
Atherosclerosis 12/2011; 219(2):637-42. · 3.79 Impact Factor
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ABSTRACT: To determine the role of home blood pressure (BP) monitoring for a reproducible assessment of orthostatic hypertension (OHT) and the effectiveness of hypertension control by doxazosin. In this study, 605 medicated hypertensive outpatients were enrolled. Home BP in the sitting and standing positions was monitored in all patients in the morning and evening for 6 months. According to an open-label multicenter trial design, the patients were randomly allocated to either an intervention group that took doxazosin (1-4 mg) at bedtime or to a control group that did not receive any add-on medication. The patients were divided into deciles of orthostatic BP change as evaluated by home BP monitoring at baseline. Those in the top decile, in the lowest decile and in deciles two through eight were then assigned to the OHT group, the orthostatic hypotension group and the orthostatic normotension group, respectively.Orthostatic BP in the OHYPO group did not change, whereas that of the OHT group was markedly reduced by doxazosin (P<0.01). In the control group, classification into orthostatic BP categories using home BP monitoring was more reproducible (κ coefficient: 0.42-0.50) than when using clinical BP (κ coefficient: 0.13-0.24). In all groups, a reduction in the urinary albumin/creatinine ratio was significantly associated with a reduction in orthostatic BP doxazosin (P<0.001).The identification of OHT based on home BP monitoring was highly reproducible. The administration of doxazosin might control OHT and consequently prevent target organ damage.
Hypertension Research 09/2011; 35(1):100-6. · 2.58 Impact Factor
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ABSTRACT: The maximum office systolic blood pressure (SBP) has been shown to be a strong predictor of cardiovascular events, independently of the mean SBP level. However, the clinical implications of maximum home SBP have never been reported. We investigated the association between the maximum home SBP and target organ damage (TOD). We assessed the left ventricular mass index (LVMI) and carotid intima-media thickness (IMT) using ultrasonography and the urinary albumin/creatinine ratio (UACR) as measures of TOD in 356 never-treated hypertensive subjects. Home BP was taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. The maximum home SBP was defined as the maximum mean triplicate BP reading in the 14-day period for each individual and was significantly correlated with LVMI (r=0.51, P<0.001), carotid IMT (r=0.40, P<0.001), and UACR (r=0.29, P<0.001). The correlation coefficients with LVMI and carotid IMT were significantly larger for the maximum home SBP than the mean home SBP. In multivariate regression analyses, the maximum home SBP was independently associated with LVMI and carotid IMT, regardless of the mean home BP level. In the prediction of left ventricular hypertrophy and carotid atherosclerosis, the goodness-of-fit of the model was significantly improved when the maximum home SBP was added to the sum of the mean office and home BPs (P=0.002 and P<0.001, respectively). These findings indicate that assessment of the maximum home SBP, in addition to the mean home SBP, might increase the predictive value of hypertensive TOD in the heart and artery.
Hypertension 06/2011; 57(6):1087-93. · 6.21 Impact Factor
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ABSTRACT: We aimed to test the hypothesis that the angiotensin II receptor blocker (ARB)/diuretic combination decreases the urinary albumin/creatinine ratio (UACR) to a greater extent than treatment with the ARB/calcium-channel blocker (CCB) combination through a mechanism related to a greater reduction of sleep blood pressure (BP).
We conducted a prospective, randomized, open-label, blinded end-point trial in hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by an additional use of hydrochlorothiazide (HCTZ) (n = 104) or azelnidipine (n = 103) for 24 weeks after randomization. The measurements of central and ambulatory BP, and laboratory tests were performed at baseline and the end of the study.
The adjusted percent reduction in UACR in the olmesartan/HCTZ group was significantly greater than that in the olmesartan/azelnidipine group (-43.2 vs. -24.0%, P = 0.0014), although the olmesartan/azelnidipine group showed greater decreases in central systolic BP (SBP; P = 0.04), oxidative stress (urinary 8-isoprostane; P = 0.02), inflammation (high-sensitivity C-reactive protein; P = 0.04), and insulin resistance (the homeostasis model assessment insulin resistance index (HOMA(IR)); P < 0.001) than the olmesartan/HCTZ group. In multivariate regression analyses, the significant determinants of change in UACR in the olmesartan/HCTZ group were changes in sleep SBP (P < 0.001), central SBP (P = 0.01), estimated glomerular filtration rate (eGFR) (P = 0.02), and HOMA(IR) (P = 0.03), and those in the olmesartan/azelnidipine group were changes in central SBP (P = 0.001) and urinary 8-isoprostane (P = 0.02).
These data showed that the ARB/diuretic combination decreased UACR significantly more than the ARB/CCB combination, and this decrease in UACR was associated with a greater magnitude reduction in sleep SBP.
American Journal of Hypertension 12/2010; 24(4):466-73. · 3.18 Impact Factor
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ABSTRACT: Excess aldosterone has a detrimental effect on large artery stiffness. We aimed to investigate the association of the change in plasma aldosterone concentration (PAC) by antihypertensive medication with the change in aortic pulse wave velocity (aPWV).
We conducted a prospective, randomized, open-label, blinded end-point study in 207 hypertensive patients. Patients received olmesartan monotherapy for 12 weeks, followed by add-on use of hydrochlorothiazide (HCTZ; n=104) or azelnidipine (n=103) for 24 weeks after randomization. The aPWV, which was determined by measuring the carotid to femoral PWV, and laboratory data were assessed at baseline and 24 weeks later.
PAC in the HCTZ group increased more than that in the azelnidipine group, while aPWV and mean arterial pressure in the azelnidipine group decreased more than those in the HCTZ group. In univariable analyses, the change in PAC was significantly and positively correlated with the change in aPWV in the total population (r=0.26, P<0.001) and the HCTZ group (r=0.28, P=0.004), but not in the azelnidipine group (r=0.17, P=0.09). In multivariable analyses, a positive association of the change in PAC with the change in aPWV was observed in the total population (standardized regression coefficient β=0.18, P<0.001) and the HCTZ group (β=0.23, P=0.004), independently of the changes in covariates, but not in the azelnidipine group (β=0.13, P=0.06).
The change in PAC was significantly and positively associated with the change in aPWV in patients treated with HCTZ. These findings may partly explain why thiazide diuretics have little effect on large artery stiffness.
Atherosclerosis 12/2010; 215(1):184-8. · 3.79 Impact Factor
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ABSTRACT: This study was performed to test whether morning hypertension defined by the morning-evening difference in home blood pressure (BP) (MEdif) and the average of morning and evening BP (MEave) is a determinant of concentric left ventricular hypertrophy (LVH). The authors enrolled patients with untreated hypertension and performed echocardiography and home BP monitoring for 14 consecutive days. All patients were classified into 4 groups by the MEave and MEdif and morning hypertension was defined by MEave ≥135 mm Hg and MEdif ≥15 mm Hg. Left ventricular (LV) geometry was classified as normal, concentric remodeling, eccentric LVH, or concentric LVH. The morning hypertensive patients had a higher LV mass index and relative wall thickness than the other groups. According to multivariable logistic regression analysis, morning hypertensive patients had a significantly increased risk of the concentric LVH (odds ratio, 6.5; 95% confidence interval, 2.5-17.2; P<.001) compared with home normotensive patients with MEdif <15 mm Hg, after adjusting for confounders. Moreover, even among the home normotensives (white-coat hypertensives), patients with MEdif ≥15 mm Hg had a higher percentage of concentric remodeling than those with MEdif <15 mm Hg (32.5% vs 14.7%, P=.017). Morning hypertension defined by the MEdif and MEave is a strong determinant of concentric LVH, suggesting that this definition could be used to determine the cardiovascular risk of morning hypertension.
Journal of Clinical Hypertension 10/2010; 12(10):776-83. · 1.83 Impact Factor
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ABSTRACT: There has been no report investigating the impact of the arterial stiffness reduction induced by antihypertensive medications on the improvement of target organ damage in hypertension. The aim of this study was to assess the association of the change in pulse wave velocity (PWV) with that in urinary albumin excretion as a measure of renal damage.
We studied 404 treated hypertensive patients (mean age, 70.5 +/- 9.5 years), who were allocated to either an active treatment group (doxazosin and atenolol when needed) or a control group. Blood pressure, urinary albumin-to-creatinine ratio (UACR), and brachial-ankle PWV (baPWV) were measured at baseline and after 6 months of treatment.
In the total population, home/office SBP, UACR, and baPWV decreased significantly from the baseline. In multivariate regression analyses, DeltabaPWV was significantly associated with DeltaUACR, independent of Deltahome SBP (beta = 0.21, P < 0.001). When the patients were divided into a group with DeltabaPWV of at least 0 cm/s (positive DeltaPWV) and a group with DeltabaPWV of less than 0 cm/s (negative DeltaPWV), the reduction of UACR was greater in the latter group, even after adjustment for the covariates including the change in home SBP. These results were essentially the same when office SBP was entered in place of home SBP, and similar both in the active treatment group and the control group.
These findings suggest that the arterial stiffness reduction induced by antihypertensive medications is associated with the improvement of renal damage, independent of home/office SBP reduction.
Journal of hypertension 08/2010; 28(8):1752-60. · 4.02 Impact Factor
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ABSTRACT: The significance of home blood pressure (BP) measurement in type 2 diabetes (T2DM) has not been well investigated. We aimed to test the hypotheses that home BP is more closely associated with target-organ damage than clinic BP, and that the presence of prediabetes/T2DM enhances the impact of home BP measurement.
We studied 551 hypertensives (99 diabetics and 452 nondiabetics) whose self-measured systolic BP (SBP) was >135 mm Hg while on medication. The subjects were followed for 6 months after allocation to either a control group or an active treatment group. The changes in clinic BP and home BP were analyzed in relation to the changes in the spot urine albumin-creatinine ratio (UAR).
The extent of clinic and home BP reduction was similar between the diabetic and nondiabetic groups. The change in UAR in nondiabetics was significantly associated with the extent of SBP reduction in the clinic (r = 0.19), morning (r = 0.33), and evening (r = 0.22, all P < 0.01). In contrast, in the diabetic group, the change in UAR was significantly associated with the changes in morning SBP (r = 0.23, P = 0.02) and evening SBP (r = 0.39, P < 0.001), but not with clinic BP. The correlation with evening SBP in the diabetic group tended to be stronger than the nondiabetic group.
In hypertensives with prediabetes/T2DM, changes in home BP were better than changes in clinic BP to predict changes in UAR. In particular, this suggests the hypothesis that aggressive control of evening home BP might be equally or more important to morning BP in hypertensives with prediabetes/T2DM.
American Journal of Hypertension 02/2010; 23(5):522-7. · 3.18 Impact Factor
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ABSTRACT: The aim of this study was to compare the effects between calcium channel blockers and diuretics when used in combination with angiotensin II receptor blocker on aortic systolic blood pressure (BP) and brachial ambulatory systolic BP. We conducted a prospective, randomized, open-label, blinded end point study in 207 hypertensive patients (mean age: 68.4 years). Patients received olmesartan monotherapy for 12 weeks, followed by additional use of azelnidipine (n=103) or hydrochlorothiazide (n=104) for 24 weeks after randomization. The central BP by radial artery tonometry, aortic pulse wave velocity, and ambulatory BP were assessed at baseline and 24 weeks later. After adjustment for baseline covariates, the extent of the reduction in central systolic BP in the olmesartan/azelnidipine group was significantly greater than that in the olmesartan/hydrochlorothiazide group (the between-group difference was 5.2 mm Hg; 95% CI: 0.3 to 10.2 mm Hg; P=0.039), whereas the difference in the reduction in brachial systolic BP between the groups was not significant (2.6 mm Hg; 95% CI: -2.2 to 7.5 mm Hg; P=0.29). The aortic pulse wave velocity showed a significantly greater reduction for the olmesartan/azelnidipine combination than for the olmesartan/hydrochlorothiazide combination (0.8 m/s; 95% CI: 0.5 to 1.1 m/s; P<0.001) after adjustment for covariates. The extent of the reduction in brachial ambulatory systolic BP was similar between the groups. These data showed that the combination of olmesartan (20.0 mg) and azelnidipine (16.0 mg) had a more beneficial effect on central systolic BP and arterial stiffness than the combination of olmesartan (20.0 mg) and hydrochlorothiazide (12.5 mg), despite the lack of a significant difference in brachial systolic BP reduction between the 2 treatments.
Hypertension 09/2009; 54(4):716-23. · 6.21 Impact Factor
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ABSTRACT: It has been demonstrated that insulin resistance is associated with morning hypertension. We investigated the hypothesis that the lowering of morning blood pressure (BP) can improve insulin resistance in patients with morning hypertension.
In the present study, 611 treated hypertensive patients with morning hypertension were randomized into either a doxazosin group, for whom a once-daily bedtime dose of doxazosin was added to the current medication regimen, or a control group, who continued their current medication. The homeostasis model assessment of the insulin resistance index (HOMA-IR) was performed at baseline and the 6th month of treatment. The associations between change in HOMA-IR and changes in systolic BP (SBP) measures were assessed by multiple regression analyses with adjustment for covariates.
HOMA-IR was significantly decreased in the doxazosin group (2.1 +/- 3.0 to 1.8 +/- 2.6, P = 0.04) but not in the control group. The change in HOMA-IR was significantly associated with the change in morning SBP (r = 0.10, P = 0.02) but not with evening SBP. In multiple regression analysis, the change in HOMA-IR was independently and significantly associated with the change in morning SBP (beta = 0.15, P = 0.016) but not with the change in evening SBP.
In patients with morning hypertension, specific treatment for morning hypertension with an adrenergic blockade has a beneficial effect on insulin resistance.
Journal of hypertension 07/2009; 27(6):1252-7. · 4.02 Impact Factor
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ABSTRACT: The present study investigated whether the morning-evening difference in self-measured blood pressure (BP) (MEdif) can be an independent determinant of cardiac damage in untreated hypertensive patients.
In a cross-sectional study, the left ventricular (LV) mass, relative wall thickness, and diastolic function using echocardiography were assessed in 356 untreated hypertensive patients. Home BP measurements were taken in triplicate in the morning and evening, respectively, for 14 consecutive days with a memory-equipped device. Thereafter, the association between the MEdif in systolic BP (SBP) and the echocardiographic parameters was assessed.
The MEdif in SBP was significantly correlated with LV mass index (r = 0.28, P < 0.001), relative wall thickness (r = 0.21, P < 0.001), ratio of E-wave to A-wave (r = -0.24, P < 0.001), and the deceleration time of the E-wave velocity (r = 0.23, P < 0.001). In a multivariable regression analysis, the MEdif in SBP was a significant determinant of these parameters, independent of age, sex, duration of hypertension, current smoking, habitual drinking, diabetes mellitus, the average of morning and evening SBP, and the heart rate at echo. When the MEdif in SBP was divided into quartiles, the highest quartile had increased likelihood of LV concentric hypertrophy (odds ratio = 2.63, 95% confidence interval = 1.20-5.87, P = 0.008) in comparison with the lowest quartile after adjusting for confounding factors.
The MEdif is a significant determinant of LV hypertrophy, LV geometry, and diastolic function, and therefore, evaluation of the MEdif combined with the average of morning and evening SBP might be useful in the early stage assessment of hypertensive patients.
Journal of hypertension 04/2009; 27(4):712-20. · 4.02 Impact Factor
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Journal of Hypertension 03/2009; 27(2):434-5. · 4.02 Impact Factor
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ABSTRACT: Lowering of the central pulse pressure (PP) has been shown to contribute to an improvement of the cardiac damage beyond that of lowering the brachial PP. We assessed the hypothesis that the change in the central PP is more useful than that in the brachial PP in the assessment of the change in cardiac load.
We studied 434 treated hypertensive patients whose home systolic blood pressure was 135 mmHg or higher. They were followed for 6 months after allocation to either a control group or an added treatment group (doxazosin 1-4 mg and atenolol when needed). We measured the brachial and central (carotid) blood pressure simultaneously using a validated device, and the B-type natriuretic peptide at baseline and at the sixth month of treatment.
In the added treatment group, the brachial systolic blood pressure was successfully reduced, but the central PP increased significantly, whereas the other blood pressure parameters did not change from the baseline. In the added treatment group, the change in the B-type natriuretic peptide was significantly correlated with the change in the brachial PP (r = 0.18), central systolic blood pressure (r = 0.18), central PP (r = 0.26), and PP amplification (r = -0.22) even after adjusting for the confounding factors. The correlation with the central PP was stronger than with the brachial PP (P = 0.018) or central systolic blood pressure (P = 0.002), and these relationships were essentially the same even after adjustment for the use of atenolol or the change in heart rate.
This study showed that the central PP measurement may be more important to assess cardiac load than the brachial PP during antiadrenergic treatment.
Journal of Hypertension 11/2008; 26(10):1928-34. · 4.02 Impact Factor
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Satoshi Hoshide, Yoshio Matsui,
Seiichi Shibasaki,
Kazuo Eguchi,
Joji Ishikawa,
Shizukiyo Ishikawa,
Tomoyuki Kabutoya,
Joseph E Schwartz,
Thomas G Pickering,
Kazuyuki Shimada,
Kazuomi Kario
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ABSTRACT: Orthostatic blood pressure (BP) dysregulation is a risk factor for both falls and cardiovascular events. Self-measured BP, carried out at home, is both highly reproducible and useful for evaluating antihypertensive treatment. However, there have been a few reports on the clinical implications of orthostatic BP changes in home BP monitoring (HBPM). In the baseline examination for the Japan Morning Surge-1 Study, a multicenter randomized control trial, we evaluated 605 hypertensive outpatients who had a morning systolic BP above 135 mmHg. The plasma brain natriuretic peptide (BNP) level and urinary albumin excretion were measured. When the patients were divided into 10 groups, according to orthostatic BP change evaluated by HBPM, after adjusting for age, gender, body mass index and sitting home BP level, those in the top decile (n=60, orthostatic BP increase>7.8 mmHg) had a higher urinary albumin/creatinine ratio (UAR) than the lowest decile group (geometric mean [SEM range]: 209.1 [134.7-318.7] vs. 34.1 [20.1-56.2] mg/g creatinine [Cr], p=0.003) and the pooled second to ninth decile groups (n=485, 209.1 [134.7-318.7] vs. 39.7 [33.2-47.3] mg/g Cr, p<0.02). Additionally, patients in the top decile had a higher BNP level than the second to ninth decile groups (75.7 [55.0-103.1] vs. 23.6 [20.8-26.6] pg/mL, p=0.003). Evaluation of orthostatic hypertension at home might be a high-risk factor for cardiovascular events in hypertensive subjects with increased levels of BNP and a higher UAR, independent of the home sitting BP level.
Hypertension Research 09/2008; 31(8):1509-16. · 2.58 Impact Factor
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ABSTRACT: Doxazosin is reported to increase the incidence of congestive heart failure. The benefits of doxazosin, for controlling morning blood pressure as well as its effect on the left ventricular structure and function, are herein examined.
In this study, 223 morning hypertensive patients were randomized into either the doxazosin group, with a once-daily bedtime dose of doxazosin, or the control group, who continued their current medication. Atenolol was added to the doxazosin group when needed. The effect of doxazosin was evaluated by measurement of echocardiographic parameters and B-type natriuretic peptide.
The left ventricular wall thickness decreased, but the left ventricular diastolic diameter in the doxazosin group increased from the baseline. The changes in the left ventricular mass index were similar between the groups, whereas the relative wall thickness in the doxazosin group decreased more than that in the control group. The left ventricular diastolic function could deteriorate in the doxazosin group. In the doxazosin group, an increase in the left ventricular diameter was only seen in the patient who did not take diuretics throughout the study. The office and home blood pressure in the doxazosin group decreased more than that in the control group, whereas the B-type natriuretic peptide increased in the doxazosin group. Three cases of congestive heart failure were observed in the doxazosin group, but none in the control group.
Although a bedtime dose of doxazosin can significantly lower the blood pressure, it can also increase left ventricular diameter, thus increasing the risk of congestive heart failure. However, the prior use of diuretics can prevent the unfavorable effects of doxazosin on the left ventricular structure.
Journal of Hypertension 08/2008; 26(7):1463-71. · 4.02 Impact Factor
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Kazuomi Kario, Yoshio Matsui,
Seiichi Shibasaki,
Kazuo Eguchi,
Joji Ishikawa,
Satoshi Hoshide,
Shizukiyo Ishikawa,
Tomoyuki Kabutoya,
Joseph E Schwartz,
Thomas G Pickering,
Kazuyuki Shimada
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ABSTRACT: The impact on microalbuminuria of strict treatment aimed at lowering of self-measured morning blood pressure using an adrenergic blockade is unclear.
We conducted an open-label multicenter trial, the Japan Morning Surge-1 Study, that enrolled 611 hypertensive patients, whose self-measured morning systolic blood pressure levels were more than 135 mmHg while taking antihypertensive drugs. These were randomly allocated to an experimental group, whose members received bedtime administration of 1-4 mg doxazosin (doxazosin group) or a control group whose members continued without any add-on medication (control group). The urinary albumin/creatinine ratio was investigated at the baseline and 6 months after the randomization.
Both the morning and evening blood pressures and urinary albumin/creatinine ratio (-3.4 vs. 0.0 mg/gCr for urinary albumin/creatinine ratio; P < 0.001) were more markedly reduced in the doxazosin group than in the control group. This difference in the urinary albumin/creatinine ratio between the two groups was more marked in the patients with microalbuminuria (n = 238, -27.9 vs. -8.1 mg/gCr, P < 0.001). The reduction of urinary albumin/creatinine ratio was significantly associated with the use of doxazosin, and the change in all self-measured blood pressures (morning, evening, the average morning-evening), and these associations were independent of each other (P < 0.001).
Adding a bedtime dose of an alpha-adrenergic blocker titrated by self-measured morning blood pressure in treated hypertensive patients with uncontrolled morning hypertension significantly reduced blood pressure and urinary albumin excretion rate, particularly in those with microalbuminuria.
Journal of Hypertension 07/2008; 26(6):1257-65. · 4.02 Impact Factor
