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Biomedical subjects

I Kuwajima

Publications and source records attributed to I Kuwajima.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Antihypertensive therapy of patients with cerebrovascular disease].

In the acute phase of the stroke, it must be prudent to reduce blood pressure (BP) because the rapid reduction might cause the exacerbation of the perfusion pressure to the brain. The target BP level should be higher than the level of primary prevention as the blood pressure regulatory function is disturbed in acute phase. In chronic phase, BP should be reduced so slowly through the several months so as not to cause the ischemia of the brain by rapid reduction of BP. However, the optimal target BP level should be the same degree as the primary prevention level as far as the speed of reduction is taken into consideration. The several large scale trials, are now in progress to determine the optimal BP level for the secondary prevention in the patients with prion stroke.

Antihypertensive Agents↗
PubMed1996

Current status of antihypertensive therapy for elderly patients in Japan.

To assess how elderly Japanese hypertensive patients are treated by specialists, we conducted a cross-sectional survey. A total of 1,163 outpatients aged 50 years or older were studied. Hypertension was diagnosed in 939 of these patients, and 827 were receiving drug therapy. The average blood pressure during therapy was 143 +/- 16/81 +/- 10 mmHg. In patients aged 70 years or older, systolic blood pressure during antihypertensive therapy was significantly higher (p < 0.01) and diastolic blood pressure was significantly lower (p < 0.01) than the corresponding values in those aged 50 to 59 years or 60 to 69 years. The calculated mean blood pressures were similar in the different age groups. The rate of monotherapy in the patients aged 70 years or older was 58.8%, which was significantly higher (p < 0.01) than the rates of monotherapy in the other age groups. Calcium channel blockers were prescribed in about 80% of patients, irrespective of age or comorbidity. Of the patients receiving calcium channel blockers, 43.5% were treated with monotherapy. This rate significantly (p < 0.01) increased with advancing age. Diastolic blood pressures were significantly lower (p < 0.05) in patients with stroke and in those with ischemic heart disease, diabetes mellitus, or dyslipidemia, as compared with patients with no comorbidity. Among patients aged 70 years or older, the difference in systolic blood pressure between those with ischemic heart disease and those with no comorbidity was not significant. Blood pressure in elderly hypertensive patients was reduced to a level similar to that in younger patients. The target blood pressure was influenced by the presence of comorbidity. Furthermore, specialists showed a high preference for the use of calcium channel blockers in the management of hypertension.

Activities of Daily Living↗
PubMed1996

[The effect of ACE inhibitors, beta blockers and calcium antagonists on the responses to pressor stress tests in the elderly hypertensive patients].

The purpose of the study was to elucidate the effects of antihypertensive drugs on the hemodynamics in elderly hypertensive patients. Forty-two elderly hypertensives (mean 72 +/- 5 years) were given either ACE inhibitors (A group: perindopril in 10 and captopril in 4 cases), beta blockers (B group: arotinolol in 15 cases) or calcium antagonists (C group: nifedipine in 3 and nitrendipine in 10 cases) for 8-12 weeks. The responses to handgrip and mental arithmetic stress and cardiac functional changes were determined by echocardiography before and after the medications. The decrease in blood pressure at rest and on the stress tests was similar among the three groups, though the hemodynamic responses to the stress tests showed some differences. In the A group, no hemodynamic changes were seen either at rest or on the stress tests after the medication. In the B group, the heart rate and the cardiac output were decreased at rest, and the increase of them on the stress tests were diminished after the medication. On the contrary, the heart rate and the cardiac output were increased, and showed exaggerated responses on the stress tests in the C group. In conclusion, in antihypertensive treatment of elderly hypertensive patients it is important to consider the effects of the antihypertensive drugs on the hemodynamics, although the comparable decrease in blood pressure is expected.

Adrenergic beta-Antagonists↗
PubMed1996

[Circadian variation in blood pressure in elderly hypertensive patients].

We studied circadian variation in blood pressure in elderly patients with hypertension, using three criteria for "non-dipper". Ambulatory blood pressure monitoring was done in 107 elderly outpatients whose average 24-hour systolic blood pressure was greater than 140 mmHg. Daytime was distinguished from nighttime by the level of physical activity as measured with an activity sensor and a questionnaire. The three criteria for "non-dipper" were as follows: 1. A nocturnal decline in systolic blood pressure that was less than 10% of the daytime average blood pressure. 2. A nocturnal decline in systolic blood pressure that was less than 10 mmHg. 3. A nighttime average systolic blood pressure that was greater than the daytime average systolic blood pressure. The nocturnal decrease in blood pressure was smaller in older patients than in younger patients. In patients over 80 years old, it was 6.0 mmHg (p < 0.05, as compared with patients aged 60-69 and with patients aged 70-79). The percentages of patients classified as "non-dippers" according to the criteria listed above were 53.3%, 37.4%, and 15.9%, respectively. Older patients were more likely than younger patients to be classified as "non-dippers". When defined according to criterion # 1, "non-dippers" made up 83.3% of those over 80 years old. These results was consistent with a continuous age-related decline in neuroendocrine regulation involving both peripheral and central nervous system.

Aged↗
PubMed1996

[The relationship between office and ambulatory blood pressure in elderly patients in a non-academic setting].

We investigated the relationship between clinic blood pressure (BP) and ambulatory blood pressure (ABP) in 297 elderly patients who underwent 24 hour ABP monitoring as a non-academic clinical references. Among 107 cases who were normotensive in office BP measurements, 33 cases (30.8%) proved to be hypertensive with more than 140 mmHg in ambulatory systolic BP. Those patients should be referred to as home hypertension or white coat normotension. On the other hand, among 187 patients who were hypertensive in the clinic, 78 cases (41.7%) turned out to be white coat hypertension with an ambulatory daytime systolic BP of less than 140 mmHg. Ambulatory systolic BP in white coat hypertension was comparable with that in the non-hypertensive group although their BP in the clinic was significantly higher than the latter (p < 0.02). Ambulatory systolic BP in the home hypertension group was significantly higher than that in the normotension but was comparable with that in true hypertension. The number of the antihypertensive drugs prescribed in the white coat hypertensive group tended to be greater than that in other groups although that in the home hypertensive group was similar to the other groups. The incidence of cerebro vascular disease in each group was similar.

Aged↗
PubMed1995

Cardiac implications of the morning surge in blood pressure in elderly hypertensive patients: relation to arising time.

Although morning surge in blood pressure has been shown to be associated with the occurrence of myocardial ischemic events and stroke, few studies have been done regarding its pathogenesis, probably because of a lack of method for the quantitative assessment of awakening time. We conducted an echocardiographic study and ambulatory blood pressure monitoring in 23 elderly hypertensive patients to evaluate the relationship between the hypertensive cardiac change and morning surge in blood pressure. Of note was that the time of arising from bed was assessed quantitatively by an activetracer equipped with an internal acceleration sensor to monitor the physical activity. The change in systolic blood pressure after arising from bed was correlated significantly with the left ventricular mass index (r = 0.51, P < .02) and the A/E ratio, which represents the diastolic function (r = 0.70, P < .01). In contrast, the change in systolic blood pressure before rising from bed was not correlated with any echocardiographic parameters. We conclude that the magnitude of morning surge in blood pressure after arising from bed was related with the severity of hypertensive target organ damage.

Aged↗
PubMed1994

[Circadian profiles of blood pressure with respect to age].

UNLABELLED: The effects of ageing on nocturnal blood pressure (BP) and the circadian rhythm of BP were studied. Ambulatory BP and heart rate (HR) were monitored at 30-minute intervals for 24 hours, in 326 normotensive volunteers aged 15-83. The following groups were monitored: young: < 40 yrs, n = 177; middle: 40 yrs < or = - < 60 years, n = 100; old: 60 yrs < or =, n = 49 Firstly, the ratio of nocturnal fall (RONF) of BP (or HR) was calculated as follows: [(average day time BP (or HR)-average night time BR (or HR)]/averaged whole day BP (or HR) x 100. Then we calculated 2 measurements: 1. The dipper (RONF of BP (or HR) > or = 10% 2. The non-dipper. (RONF of BP (or HR) < 10%. A cosine fitting technique using the least-squares method was employed to find the circadian rhythm of BP and HR. The results of the study showed that the incidence of the non-dipper on systolic BP (SBP) was higher for old subjects than for young subjects. In addition, the nocturnal BP and HR were higher for old subjects than for young subjects. The circadian amplitude of HR was lower in old subjects. The circadian midline estimating statistic of rhythm (MESOR) or SBP increased with age. The circadian acrophase of BP and HR increased with age. CONCLUSION: non-dippers of BP and HR were observed in any age groups. The frequency of BP and HR non-dipper was greater for old subjects than young subjects. This result may suggest the clinical significance of nocturnal BP and HR for the evaluation of hypertensive subjects.

Adolescent↗
PubMed1994

[Effect of warm bathing on short-term and 24-hour blood pressure in bedridden elderly patients].

The effects of the bathing on short-term and ciracadian blood pressure (BP) in bedridden elderly patients were investigated in 10 bedridden patients (4 male: 6 female) living in a community home. The mean age of the subjects was 78.7 years old and causes of bedridden status were cerebrovascular disease in 9 and spinal damage in one. To study the short-term hemodynamic effect of bathing, BP and pulse rate were measured every 2 minutes from 10 minutes before bathing to 14 minutes after. Blood samples were collected before and after bathing for measurements of plasma catecholamine and plasma renin activity. To study the effect of warm bathing on circadian, BP, ambulatory BP was non-invasively monitored every 15 minutes for 24 hours on days with and without bathing. In the short-term phase, BP temporally elevated when washing the body outside the bathtub accompanied with a decline soaking in warm water (38 degrees C). Plasma catecholamine did not change after warm bathing. In the study of circadian change of BP, systolic BP on days of warm bathing remained at a lower level for 12 hours after bathing compared to days without bathing. In conclusion, hypotensive effects after bathing were prolonged in the bedridden elderly patients.

Aged↗
PubMed1994

[Characteristics of blood pressure regulating endocrinological factors in elderly essential hypertensives].

Plasma renin activity (PRA) was lower in elderly normotensive subjects and essential hypertensives (EHT), and a significant negative correlation was found between PRA and age in both groups. In EHT, the proportion of the low renin group to total EHT increased with aging. There was a significantly positive correlation between plasma norepinephrine (PNE) and age in NT, but not in EHT. The mean value of PNE in young subjects was significantly higher in EHT than in NT, but not in the middle-aged and elderly groups, suggesting the important role of PNE in young EHT. Power spectral analysis revealed a significant reduction of both sympathetic and parasympathetic activity with aging in NT and EHT, indicating much caution may be required if sympathetic nerve activity is evaluated only by PNE levels in elderly EHT. The expanded plasma volume was another characteristic in elderly EHT, and suppressed activity of renal kallikrein-kinin, prostaglandin and dopamine may be involved with its mechanisms. Regarding insulin sensitivity in elderly EHT, it was shown that 1) the reduction of insulin sensitivity plays some role in age related acceleration of hypertension and glucose intolerance, 2) selective insulin resistance with respect to glucose metabolism already exists at lower ages in EHT, and 3) both Na retention and pressor system activation via insulin action might be a cause of blood pressure elevation in EHT.

Adult↗
PubMed1993

Effects of alpha,beta-blocker, arotinolol chloride, on 24-h blood pressure--difference between elderly and younger hypertensive patients.

To assess the effect of age on the circadian blood pressure (BP) after an alpha,beta-adrenergic blocker, the ambulatory BP was measured before and after arotinolol chloride administration in nine younger (mean age 49.1 years) and 14 older (72.1 years) patients with essential hypertension. After a 4-week control period, arotinolol chloride was administered twice daily (08:00 and 20:00 hours) for 8 weeks and the ambulatory BP was measured non-invasively at the end of the control and treatment period. Arotinolol significantly reduced the daytime systolic BP from 152.3 to 140.9 mmHg (P < 0.05) and night-time systolic BP from 137.3 to 122.3 mmHg (P < 0.01) in the younger hypertensive patients. In contrast, in the older group, the night-time systolic BP did not show a significant change, although the daytime systolic BP was significantly reduced from 155.0 to 142.2 mmHg (P < 0.02). Diastolic BP in both groups was significantly reduced by arotinolol during the day and night. Night-time reduction of BP was significantly less in the older group (-8.6 vs -15.1 mmHg for the systolic pressure P < 0.01; -5.8 vs -9.8 mmHg for the diastolic pressure P < 0.01).

Adrenergic beta-Antagonists↗
PubMed1993

Is white coat hypertension innocent? Structure and function of the heart in the elderly.

To evaluate the morphological and functional characteristics of the heart in elderly patients with white coat hypertension, we performed an echocardiographic study in 67 elderly individuals older than 60 years: 17 patients with white coat hypertension, 34 patients with true hypertension, and 16 normotensive control subjects. White coat hypertension was defined as a mean 24-hour ambulatory systolic blood pressure of less than 140 mm Hg associated with office hypertension. Cardiac responses to an isometric handgrip exercise test were used to evaluate left ventricular functional reserve. Left atrial dimension and left ventricular mass index were significantly greater in the white coat hypertension group than in the normotension group (P < .05) but were similar to values in the true hypertension group. Left ventricular diastolic function, expressed by peak late-early filling ratio of diastolic mitral flow, showed increasing impairment in the order of the normotension, white coat hypertension, and true hypertension groups (analysis of variance, P < .05); the ratio in the white coat hypertension group tended to be higher than that in the normotension group (unpaired t test, P = .054). The relation between fractional shortening and end-systolic stress did not shift downward after handgrip exercise in the white coat hypertension group, indicating that functional reserve in the left ventricle was maintained. Thus, patients with white coat hypertension had a moderately increased left atrial dimension and left ventricular mass in association with a tendency for disturbed diastolic function, although systolic functional reserve remained the same. These findings suggest that white coat hypertension in the elderly may not be innocent.

Aged↗
PubMed1993

The relationship between ambulatory blood pressure and physical activity in young and older shiftworkers. A quantitative assessment of physical activity using a microcomputer with acceleration sensor.

We studied the relationship between physical activity and ambulatory blood pressure (BP) in young and older shiftworkers by simultaneous recordings of activity, blood pressure and pulse rate (PR). Activity was assessed using Activetracer, a self-contained microcomputer with an acceleration sensor, attached to a waist belt. Ambulatory BP was monitored every 30 minutes for 48 hours with a TM2421. Three types of hemodynamic responses were noted in relation to the physical activity. The balance type, in which both BP and PR increase with physical activity, was observed in 5 of 10 young cases (50%) but only in 1 of 7 older cases (14.3%). The BP response type, in which the BP increases with no change in the PR, was observed in 6 of the 7 older (86%) but only in 3 cases in the young group (30%). The PR response type, in which only the PR increase correlated with activity, was observed in 2 cases in the young group (20%) and none in the older group. The difference in systolic BP between periods of activity and rest in the older shiftworker was significantly larger than that in the young group (15.9 +/- 6.4 vs. 5.9 +/- 6.6 mmHg, p < .01), although no significant difference was observed in diastolic BP. In contrast, the increase in pulse rate after movement was significantly higher in the young group (4.4 +/- 4.0 vs. 9.0 +/- 4.8 bpm, p < .05). Thus, the fluctuation of the systolic BP was more dependent on physical activity in the older group, whereas PR variations correlated with the physical activity in the young group.

Acceleration↗
PubMed1993

[Clinical evaluation of finger blood pressure measurement devices for home-use].

We evaluated the accuracy of two types of finger blood pressure (BP) measurement devices for home-use (EW276 H, NATIONAL Ltd. and HEM 804F, OMRON Ltd.) by comparing BP values with upper-arm BP measured with a standard mercury column sphygmomanometer in 28 elderly subjects (13 Hypertensives and 15 normotensives). The correlation coefficient of systolic BP value and that obtained by each method was R2 = 0.5 for EW 276H and R2 = 0.6 for HEM 804F. The higher the systolic BP, the greater was the difference between the upper-arm and finger BP values. The magnitude of the difference between finger and upper-arm values for systolic BP did not correlate with pulse wave velocity. An underestimation of the finger BP device in systolic BP was 23.8 mmHg in hypertensives and 7.6 mmHg in normotensives for the EW 276H, and 15.3 and 3.5 mmHg, respectively for the HEM 804F. This study demonstrated a large difference between the finger BP value measured with the home-use devices and upper-arm BP value measured with a standard mercury sphygmonanometer in elderly hypertensive patients. The difference may be due not only to atherosclerotic change, but also to methodological factors related to finger BP measurement.

Aged↗
PubMed1993

[Age and gender difference in circadian rhythm in blood pressure].

In order to evaluate the effect of gender and aging on the diurnal rhythm of blood pressure (BP), we performed ambulatory BP monitoring in 267 normotensive volunteers (mean age +/- SD 52.1 +/- 24.6 years, range 16-93 years, 114 men, 153 women). Ambulatory 24-hour BP was recorded every 30 minutes with an oscillometric method by ABPM630 (Nippon-Kolin, Japan). Circadian rhythm was determined by fitting the 24-hour cosine function curve. Subjects were divided into three age groups, consisting of the Y group (age < 30), M group (age > or = 30 but < 60), and E group (age > or = 60). Highest normal values of the 24-hour mean BP (90 percentile of the values) were 126/75 mmHg in the Y group, 126/76 mmHg in the M group, and 154/85 mmHg in the E group in men. They were 117/67 mmHg, 125/77 mmHg 151/79 mmHg respectively in women. The MESOR of SBP increased with age in women, though it was significantly higher only in the E group among men. The amplitude of SBP decreased with age significantly only in men. The acrophase of SBP shifted to an earlier time of day with aging in both men and women. The trends in the circadian rhythm of DBP with age were similar to those of SBP. In conclusion, the circadian rhythm of blood pressure varies with gender and aging. The 24-hour blood pressure values should be considered with evaluating sex-age matched reference values.

Adult↗
PubMed1993

[The relation between blood pressure variation and daily physical activity in early morning surge in blood pressure].

Morning rise in blood pressure (morning surge; MS) has been shown to be associated with the occurrence of myocardial ischemic events and stroke. This study aimed to elucidate the incidence and the mechanism of MS in hypertensive patients (HT). We monitored ambulatory blood pressure (BP) and physical activity in 68 untreated HTs using TM2421 (A & D Co. Ltd.) and ACTIVETRACER (GMS Ltd.) for detection of MS. MS was defined as a rise in BP > 50 mmHg (90% tile of 35 normotensives) during early morning (4:00 to 9:00 A.M.) compared with the lowest basal BP at night. MS was seen in 41 patients (52.6%) and was classified into two groups; MS1: BP rose steeply after waking up (27 patients) and MS2: BP started to rise gradually during sleep (14 patients). The mean age of MS1 was significantly higher than that of MS2 (72 vs. 62 years, p < 0.01). BP reached its basal value earlier in MS2 than in MS1 at night though the basal BP values were comparable between the two groups. Mean 24-hour BP and physical activity were similar between the two groups, though significantly higher incidence of cases with a correlation between SBP and activity was seen in MS1. In conclusion, there are two types of MS, the mechanisms of which may differ. MS occurring immediately after waking up was more common in older HTs, and possibly was related to augmented arousal response in BP, while MS beginning gradually during sleep was more common in younger HTs and was characterized by reaching basal BP earlier at night.

Activities of Daily Living↗
PubMed1992

Diminished nocturnal decline in blood pressure in elderly hypertensive patients with left ventricular hypertrophy.

To assess the circadian blood pressure (BP) changes in elderly hypertensive patients with left ventricular hypertrophy (LVH), the ambulatory BP was measured noninvasively every 30 minutes for 24 hours in those patients with LVH (n = 15) and without LVH (n = 23), and in normotensive elderly subjects (n = 11). Although the daytime systolic BP (SBP) was comparable in the two hypertensive groups, the nighttime SBP in patients with LVH tended to be higher than in patients without LVH (149.0 +/- 15.1 versus 138.4 +/- 20.1 mm Hg, p less than 0.10). The LV mass index correlated significantly with the nighttime SBP (r = 0.43, p less than 0.01), but not with the daytime SBP (r = 0.24, ns), with clinic SBP (r = 0.14, p = ns) or the SBP after handgrip exercise (r = 0.31, p = ns). The difference in the systolic BP between daytime and nighttime (D-N SBP) in patients with LVH (2.8 +/- 9.4 mm Hg) was significantly less than that in patients without LVH (12.8 +/- 16.0 mm Hg) (p less than 0.02). In addition, the D-N SBP correlated inversely with the left ventricular mass index (r = -0.33, p less than 0.05). It was concluded that hypertension in the elderly with LVH was associated with a diminished nocturnal decline in blood pressure.

Aged↗