Hakuo Takahashi’s research while affiliated with Kansai Medical University and other places

The aim of this study was to validate the performance of Omron HEM-7252G-HP and Omron HEM-7251G for monitoring upper arm blood pressure (BP) in accordance with the European Society of Hypertension International Protocol revision 2010 (ESH-IP revision 2010). Three trained medical doctors validated the performance of these devices by comparing data obtained from these devices with those obtained using a standard mercury sphygmomanometer. We included 33 participants (19 men and 14 women for the experiment using HEM-7252G-HP; 16 men and 17 women for the experiment using HEM-7251G). The mean age of the participants was 50±12 and 53±10 years in the respective studies. The percentages of test device-observer mercury sphygmomanometer BP differences within 5, 10, and 15 mmHg were 76, 92, and 97% for systolic BP (SBP) and 83, 97, and 99% for diastolic BP (DBP), respectively, in the Omron HEM-7252G-HP and 77, 92, and 99% for SBP and 85, 94, and 98% for DBP, respectively, in the Omron HEM-7251G in the part 1 analysis; both SBP and DBP passed the part 1 and part 2 criteria.The mean differences between the device and mercury readings for SBP and DBP were as follows: HEM-7252G-HP, -1.5±5.1 and -1.2±3.9 mmHg, respectively; HEM-7351G, -0.6±4.7 and -0.2±4.4 mmHg, respectively. The Omron HEM-7252G-HP and HEM-7251G passed all the requirements of the ESH-IP 2010 revision.

Background Allowing patients to measure their blood pressure (BP) at home will be the standard for evaluating the disease state as the process of clinical diagnosis, and it is recognized as having great clinical utility. To measure BP as accurately as possible, innovative techniques have been incorporated into home BP measurement devices. Objective The present study aimed to evaluate the performance of the Omron BP765 (HEM-7311-ZSA) and the Omron BP760N (HEM-7320-Z), which are equipped with functions to detect irregular pulses and arm movement that lead to inaccurate BP readings. Methods A team of three trained medical doctors validated the performance of these devices by comparing the data alternatively obtained from both devices with those from a standard mercury sphygmomanometer. Results The magnitude of the difference in BP readings between the tested device and the standard mercury sphygmomanometer in the Omron BP765 and BP760N was within the range of ±3 mmHg (mean) allowed by the American National Standards Institute, Inc/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2009 guidelines. Conclusion The Omron BP765 and BP760N were found useful for the self-measurement of BP at home, and their performance fulfilled the requirement of the ANSI/AAMI/ISO 81060-2:2009 guidelines.

The aim of the present study was to validate the Omron HEM-7130, HEM-7320F, and HEM-7500F for monitoring upper arm blood pressure (BP) according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP revision 2010). Three trained medical doctors validated the performance of these devices by comparing the data obtained from the devices with those of a standard mercury sphygmomanometer. We included 33 participants (20 men and 13 women for the HEM-7130 experiment; 18 men and 15 women for the HEM-7320F experiment; and 21 men and 12 women for the HEM-7500F experiment). The mean age of the participants was 49±15, 50±11, and 50±11 years in the respective studies. The mean differences between the device and the mercury readings for systolic and diastolic BP were as follows: HEM-7130, -1.8±5.3 and -0.1±4.0 mmHg, respectively; HEM-7320F, -0.9±4.7 and -1.9±4.4 mmHg, respectively; and HEM-7500F, -1.0±4.6 and -1.1±4.0 mmHg, respectively. These findings indicated that the device was reading lower than the mercury. However, the number of absolute differences between the devices and observers fulfilled the requirement of the ESH-IP revision 2010. The Omron HEM-7130, HEM-7320F, and HEM-7500F passed all the requirements of the ESH-IP 2010 revision. Therefore, we recommend these devices for the home measurement of BP in adults.

Background/aims: The assessment of myocardial fatty acid metabolism impairment by single-photon emission computed tomography (SPECT) using (123)I-β-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the risk of cardiac death in hemodialysis patients. We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention (PCI) in this population. Methods: We evaluated 128 hemodialysis patients who had obtained coronary revascularization by PCI (90 men and 38 women, 66 ± 9 years). Participants for the analysis were randomly assigned to either the nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed every year after coronary revascularization by PCI. Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores (SS). Results: The incidence of cardiac death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in the control group (21/65, 32.3%) during a mean follow-up of 2.7 ± 1.4 years. BMIPP SS reduction rates improved in the nicorandil group compared with the control group from 3 years of administration. In Kaplan-Meier analyses, free survival rate of cardiac death was higher in patients with a ≥20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS reduction rate (p = 0.0001). In multiple logistic analysis, oral administration of nicorandil was associated with ≥20% reduction rates of BMIPP SS (odds ratio 2.823, p = 0.011). Conclusion: Long-term oral administration of nicorandil may improve impaired myocardial fatty acid metabolism after coronary revascularization by PCI in hemodialysis patients.

Although some studies conducted outside of Japan have addressed the effectiveness of intravenous immunoglobulins (IVIG) in treating infections, the dosing regimens and amounts used in Japan are very different from those reported. Here, we investigate the effectiveness of single-dose administration of IVIG in sepsis patients in Japan. We analyzed 79 patients admitted to the intensive care unit (ICU) of a tertiary care institution due to severe sepsis or septic shock. Patients were randomly divided into a group that was administered standard divided doses of IVIG (5 g/day for 3 days, designated the S group) or a group that was administered a standard single dose of IVIG (15 g/day for 1 day, H group); freeze-dried sulfonated human IVIG was used. The longitudinal assessment of procalcitonin (PCT) levels, C-reactive protein (CRP) levels, white blood cell count, blood lactate levels, IL-6 levels, Sequential Organ Failure Assessment (SOFA) score, and Systemic Inflammatory Response Syndrome (SIRS) was conducted. We also assessed mechanical ventilation duration (days), ICU stay (days), 28-day survival rate, and 90-day survival rate. The study showed no significant differences in PCT levels, CRP levels, 28-day survival rate, and 90-day survival rate between the two groups. However, patients in the H group showed improvements in the various SIRS diagnostic criteria, IL-6 levels, and blood lactate levels in the early stages after IVIG administration. In light of the non-recommendation of IVIG therapy in the Surviving Sepsis Campaign Guidelines 2012, our findings of significant early post-administration improvements are noteworthy. IVIG's anti-inflammatory effects may account for the early reduction in IL-6 levels after treatment, and the accompanying improvements in microcirculation may improve blood lactate levels and reduce SOFA scores. However, the low dosages of IVIG in Japan may limit the anti-cytokine effects of this treatment. Further studies are needed to determine appropriate treatment regimens of single-dose IVIG. In this study, we investigated the effectiveness of single-dose IVIG treatment in patients with severe sepsis or septic shock. Although there were no significant effects on patient prognoses, patients who were administered single-dose IVIG showed significantly improved IL-6 levels, blood lactate levels, and disease severity scores.

Allowing patients to measure their blood pressure at home is recognized as being of clinical value. However, it is not known how often these measurements are taken correctly. Blood pressure monitors for home use fall into two types based on the position of the cuff, ie, at the upper arm or the wrist. The latter is particularly convenient, as measurements can be taken fully clothed. This study aimed to evaluate the performance of the wrist-type blood pressure monitors Omron RS8 (HEM-6310F-E), Omron RS6 (HEM-6221-E), and Omron RS3 (HEM-6130-E). A team of three trained doctors validated the performance of these devices by comparing the measurements obtained from these devices with those taken using a standard mercury sphygmomanometer. All the devices met the validation requirements of the European Society of Hypertension International Protocol revision 2010. The difference in blood pressure readings between the tested device and the standard mercury sphygmomanometer was within 3 mmHg, which is acceptable according to the European Society of Hypertension guidelines. All the home devices tested were found to be suitable for measuring blood pressure at home because their performance fulfilled the requirement of the guidelines.

The mortality among patients with heart diseases increases steadily in an aging society like Japan. Among those, the patients with chronic heart failure (CHF) are thought to be increasing rapidly although the official report is missing. It is well-known that BNP or NT-proBNP is useful for a clinical diagnosis of CHF, but a role of the cardiac troponin (cTn) attracts attention as a novel biomarker of their prognosis. However, because the level of cTn in patients with CHF is far lower than that in cases of acute coronary syndrome (ACS), development of the high-sensitive method with precision is desired. In the present study, a new sensitive assay system with an analyzer, ARCHITECT STAT (cTnI hs-ARCH) was basically studied and found more sensitive than other conventional 2 sensitive methods. The performance of cTnI hs-ARCH was evaluated in patients with CHF by comparing it to findings with other 2 methods. When CHF patients are allocated into categories of NYHA classification according to their subjective symptoms, cTnI hs-ARCH was superior to other methods in discriminating subgroups. In addition, multivariable analysis disclosed that cTnI hs-ARCH is influenced by the level of renal function at the minimum among the 3 methods. Therefore, cTnI hs-ARCH may be a useful method for evaluation of prognosis in patients with CHF who often have impaired renal function.

Basic research using animal models points to a causal role of the central nervous system in essential hypertension; however, since clinical research is technically difficult to perform, this connection has not been confirmed in humans. Recently, renal nerve ablation in humans proved to continuously decrease blood pressure in resistant hypertension. Furthermore, when electrical stimulation was continuously applied to the carotid baroreceptor nerve of human adults, their blood pressure lowered. These findings promoted the concept that the central nervous system may actually be involved in the pathogenesis of essential hypertension, which is closely associated with excess sodium intake. We have demonstrated that endogenous digitalis plays a key role in hypertension associated with excess sodium intake via sympathetic activation in rats. Increased sodium concentration inside the brain activates epithelial sodium channels and the renin-angiotensin-aldosterone system in the brain. Aldosterone releases ouabain from neurons in the paraventricular nucleus in the hypothalamus. Angiotensin II and aldosterone of peripheral origin reach the brain to augment sympathetic outflow. Collectively essential hypertension associated with excess sodium intake and obesity, renovascular hypertension, and primary aldosteronism and pseudoaldosteronism all seem to have a common cause originating from the central nervous system.

It has been reported that the clinical characteristics of infective endocarditis are changing during the course of the decades. However, most of the available data are obtained in the early 2000s or earlier. We therefore evaluated the more recent clinical spectrum of infective endocarditis. Fifty-four consecutive patients diagnosed as infective endocarditis based on the Duke criteria at our hospital from January 2006 to December 2010 were evaluated. Of 54 cases, 31 (57%) were male and 23 (43%) were female, with mean age of 57 +/- 17 years. Twenty-three (43%) patients were older than 65 years. The number of patients with diabetes mellitus or undergoing chronic hemodialysis, or cancer were 9 (17%), 5 (9%), and 5 (9%), respectively. In 25 patients (46%), endocarditis occurred without any underlying cardiac disease. The frequencies of streptococcal endocarditis and staphylococcal endocarditis were almost identical [18 (33%) vs. 17 (32%)]. Methicillin resistant staphylococcus aureus was found in 6 patients (11%). A survey of patients with infective endocarditis from 2006 to 2010 revealed a trend towards increased staphylococcal endocarditis in compromised patients without prior cardiac disorders.