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Biomedical subjects

I Kuwajima

Publications and source records attributed to I Kuwajima.

At least 55 records · Page 3Linked to original sources
PubMed1992

The cardiac functional reserve in elderly hypertensive patients with abnormal diurnal change in blood pressure.

OBJECTIVE: To evaluate the left ventricular function of hypertensive patients with abnormal diurnal change in blood pressure. DESIGN: We compared left ventricular structural and functional characteristics between hypertensive patients with a normal diurnal change in blood pressure (H2 group) and those with a nocturnal blood pressure increment (H1 group) using echocardiography. METHODS: The study group consisted of 36 hypertensives and 16 normotensives whose 24-h ambulatory blood pressure monitorings were measured non-invasively. The hypertensive group was subdivided into the H1 group, consisting of 11 patients (76 +/- 7 years), and the H2 group with 25 patients (73 +/- 7 years). The normotensive control group had a mean age of 73 +/- 6 years. Echocardiographic examinations were performed before and at the end of isometric exercise (handgrip for 3 min) and isoproterenol infusion (0.02 micrograms/kg per min for 5 min). RESULTS: The left ventricular mass index in the H1 group was significantly greater than in the H2 or control group. Left ventricular fractional shortening (LVFS) at rest in the H1 group was also significantly greater than in the other two groups. However, the peak late: early diastolic filling ratio, which indicated diastolic function, significantly deteriorated in the H1 group compared with the H2 and control groups. Furthermore, changes in LVFS after isometric exercise in the H1 group were more suppressed than in the H2 or control group. In addition, a significantly lower increment in LVFS after isoproterenol was observed in the H1 group compared with the H2 or control group. CONCLUSION: The H1 group had greater left ventricular mass and impaired left ventricular functional reserve than the H2 group.

Aged↗
PubMed1992

[Effect of antiplatelet and anticoagulant therapy on secondary prevention and long-term prognosis after acute myocardial infarction in aged patients].

The long-term efficacy and side effects of antiplatelet and anticoagulant therapy for secondary prevention after the first acute myocardial infarction (AMI) were retrospectively assessed in 133 patients over 60 years of age during a mean follow-up period of 36.6 months. Seventy five patients received antiplatelet and anticoagulant therapy (group 1) and 58 patients did not (group 2). In group 1 patients, 54, 12 and 9 patients received ticlopidine, aspirin and warfarin, respectively. Mean age, sex ratio, site of AMI, max CPK value and left ventricular ejection fraction in the convalescent phase did not differ between the two groups. There were no differences between the two groups in terms of the number and kind of combination drugs such as nitrate, beta-blocker and Ca antagonist. During the follow-up period 40 patients died; 18 patients (45%) suffered cardiac death and 22 patients (55%) experienced non-cardiac death. Nineteen patients had recurrent MI and 37 patients had cardiac events which were defined in total as cardiac death, recurrent MI and unstable angina pectoris. The total mortality rate and rate of recurrent MI based on the life time table method were significantly lower in group 1 than in group 2 by the generalized Wilcoxon test. The cumulative total mortality rate in the fifth year was 24.2% in group 1 and 49% in group 2. The cumulative rate for recurrent MI in the fifth year was 7.4% in group 1 and 27.5% in group 2 (p less than 0.05). However, the rate of cardiac events did not differ between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Acute hemodynamic effects of intravenous bolus injection of isosorbide dinitrate in aged patients with congestive heart failure].

In order to investigate whether intravenous bolus injection of isosorbide dinitrate (ISDN) is a safe and efficient therapy in aged patients with congestive heart failure, we studied acute hemodynamic effects in 11 patients. Peak effects on preload were observed after 5 to 10 minutes of bolus injection and unloading effects continued effectively for 60 minutes. At peak effect, pulmonary systolic pressure decreased from 50.2 +/- 2.6 to 36.2 +/- 2.6 mmHg (-28.5%, p less than 0.01) and pulmonary end diastolic pressure decreased from 25.0 +/- 2.2 to 18.5 +/- 2.1 mmHg (-26.0%, p less than 0.01). Mean pulmonary artery wedge pressure decreased from 23.4 +/- 2.2 to 16.0 +/- 2.1 mmHg (-31.6%, p less than 0.01). Mean right atrial pressure decreased from 10.5 +/- 1.8 to 7.4 +/- 2.0 mmHg (-29.5%, p less than 0.01). Blood pressure, heart rate, cardiac index, systemic and pulmonary vascular resistance showed no significant changes. Thus, intravenous bolus injection of ISDN showed a potent vasodilator effects on preload, and may be a safe and useful treatment for aged patients with acute congestive heart failure.

Aged↗
PubMed1992

[An autopsy case of endocardial cushion defect (ECD) in an 82-year-old female].

In an 82-year-old female case of endocardial cushion defect (ECD), a systolic regurgitant murmur was heard at the apex, and her ECG showed atrial fibrillation without right bundle branch block or left axis deviation. An echocardiogram demonstrated atrial septal defect (ASD) and a cleft of the anterior mitral leaflet with calcification. She died of refractory congestive heart failure. Autopsy revealed ECD (intermediate type) with mitral and tricuspid cleft, and ASD (ostium primum type, 2.0 x 1.0 cm in diameter). In addition, mitral ring calcification and calcification of the cleft mitral valve was disclosed, causing mitral stenosis in addition to mitral regurgitation due to the cleft mitral valve. This was the second oldest Japanese autopsy case of ECD. We concluded that echocardiographic examinations, including color flow imaging, in aged patients with heart murmur are necessary to confirm the diagnosis of congenital heart disease in the aged.

Aged↗
PubMed1992

[Congestive heart failure in elderly readmitted patients].

The clinical features of congestive heart failure in the elderly were investigated in 104 patients (57 males, 47 females, mean age of 79.2). Patients were divided into two subgroups, the readmission group, 33 patients who were readmitted within 6 months after discharge, and the non-readmission group. Chief complaints were dyspnea, edema, chest pain, loss of appetite, chest compression, and palpitation. Heart failure was caused by infection, myocardial ischemia, arrhythmia, inappropriate drug usage including poor drug compliance, the use of beta-blockers, excessive intake of sodium, and anemia. Careful use of drug was essential especially in the readmission group. Major underlying heart disease were ischemic heart disease (39.4%), valvular disease (26.9%), hypertensive heart disease (9.6%), with cardiomyopathy, congenital heart disease seen in the minority. There was no statistically significant difference in underlying heart diseases between the two groups. Supraventricular arrhythmias such as atrial fibrillations, paroxysmal atrial fibrillations, paroxysmal supraventricular tachycardias, and premature atrial contractions were noted in 85.3% of the cases. Drugs for treatment were diuretics, digitalis, isosorbide dinitrate, calcium antagonists. ACE inhibitors and alpha-blockers were also used, showing that vasodilators were more extensively used than before. The major complications were hypertension (39.4%), renal dysfunction (27.9%), cerebrovascular disease (26.9%), diabetes mellitus (16.5%), arteriosclerosis obliterans (7.7%). Renal dysfunction, arteriosclerosis obliterans was seen significantly more frequently in the readmission group. The prognosis at one year after admission was significantly worse in the readmission group. In summary, the major underlying diseases were ischemic heart disease, valvular disease, and hypertensive heart disease. Ischemic heart disease was seen more frequently than in previous investigations at our hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Postprandial hypotension in the elderly with and without hypertension].

To clarify the mechanism of postprandial hypotension in the elderly, blood pressure and humoral factors were measured before and after meal, water, and glucose ingestion in 20 healthy elderly. The elderly patients were divided into 10 normotensive and 10 hypertensive cases. A reduction in systolic BP after meals in the hypertensive group was significantly larger than that in the normotensive group (-12.0 +/- 4.1 vs. 4.0 +/- 3.2 mmHg, p < 0.05). Systolic BP in hypertensive group significantly decreased at 30, 45 and 60 minutes after meals compared to the value before meals. However, no significant reduction in systolic BP was observed in the normotensive group. A change in systolic BP after meal significantly correlated with that after glucose, but not with that after water ingestion, suggesting that glucose intake mainly contributes to the postprandial hypotension in the elderly. An increase in plasma renin activity and plasma catecholamine were observed after meals in the normotensive group, but not in the hypertensive group. An increase in systolic BP significantly correlated with an increase in PRA. It was suggested that an impairment of the sympathetic nervous system in the elderly with hypertension was involved in the mechanism of postprandial hypotension.

Aged↗
PubMed1992

[A study on 24-hour ambulatory blood pressure in normotensive elderly, living in a local home for the aged].

Ambulatory blood pressure (BP) was non-invasively monitored in 124 normotensive elderly, living in an old people's home at the annual health examination. Cases were divided into 41 cases < 75 years (group A, mean age 70.6) and 83 cases > or = 75 years (group B, 82.7) for analysis of the office BP and 24-hour BP. Whole-day systolic BP in group B was significantly higher than those in the group A (p < 0.02) although no significant differences were observed in diastolic BP and pulse rate. Separated analysis of whole-day BP into daytime and nighttime revealed that the nighttime systolic BP in the group B was significantly higher than those in group A (132.2 +/- 17.4% vs. 123.8 +/- 18.6 mmHg, p < 0.02) whereas no significant difference was observed in day-time systolic BP between two groups (136.6 +/- 14.9 vs. 132.1 +/- 14.4 mmHg, n.s.). The day-night difference in systolic BP tended to be less in group B than in group A (4.5 +/- 11.6 vs. 8.2 +/- 12.2 mmHg, p < 0.10). The prevalence of non-dippers, who had a higher nighttime systolic BP than daytime systolic BP were 24.4% of the group A and 30.1% of the group B. It was concluded that systolic BP during the nighttime increased with the ageing process after age 60, although that during daytime did not change.

Aged↗
PubMed1992

[Changes in blood pressure and pulse rate during visit to a doctor's office].

Changes in blood pressure (BP) and pulse rate were measured during visits to a doctor's office by means of an non-invasive ambulatory BP monitoring device in 47 elderly hypertensive patients (mean age 73.0 years). Systolic BP increased from 140.5/85.4 mmHg to 157.9/85.7 mmHg immediately after entering the doctor's office and tended to return to the previous level at 5 minutes after entering although diastolic BP did not change during the visit. Pulse rate also increased slightly, but significantly on entering the office. The difference in BP between 25 minute before and just after entering an office was +17.4 mmHg in systolic. -0.1 mmHg in diastolic. If an increment in systolic BP more than 10 mmHg was defined as positive for white coat effect, they were observed in 59.6%. The frequency of white coat hypertension was 46.7% in the age of sixties, 65.2% in seventies and 66.7% in eighties but there was no significant difference among 3 groups. There was a tendency for white coat hypertensions to be more frequent in men compared than in women (p = 0.07).

Aged↗
PubMed1991

Effect of nifedipine tablets on ambulatory blood pressure in patients aged less than 60 and greater than 65 years with systemic hypertension.

To evaluate the effect of age on the pattern of circadian blood pressure after nifedipine tablets, ambulatory blood pressure after administration of low and high doses of nifedipine, taken twice daily, was measured over a 24-hour period in 10 elderly and 8 young hypertensive patients. After a 2-week control period without antihypertensive drug, 10 mg of nifedipine was administered twice daily for 2 weeks (low-dose period), followed by 2 weeks of 20 mg (high-dose period). At the end of each period, ambulatory BP monitoring was conducted every 30 minutes for 24 hours, using an ABPM 630 (Nippon-Colin, Komaki, Japan). In both groups, averages of systolic and diastolic BP for the entire day decreased significantly from the control to the low-dose periods. However, after the high-dose period, only the elderly group had further significant reduction of systolic BP, whereas no further reduction was seen in the young group. Separate analysis of whole-day data into daytime and nighttime values revealed that a further decrease in systolic BP after the high-dose period in the elderly group was a reflection of nighttime decline. It was suggested that circadian BP patterns after administration of nifedipine tablets in the elderly differed from those in young hypertensive patients, especially after administration of the high-dose.

Aged↗
PubMed1991

Structure of (+/-)-(2S,1'S)-2-[hydroxy(phenyl)methyl]-2-methylcyclohexanone, C14H1802.

Mr = 281.30, monoclinic, P2(1)/n, a = 10.966 (4), b = 7.170 (3), c = 15.976 (4) A, beta = 93.14 (2) degrees, V = 1254.3 (9) A3, Z = 4, Dx = 1.16 g cm-3, lambda (Mo K alpha) = 0.71069 A, mu = 0.706 cm-1, F(000) = 472, T = 295 K, final R = 0.057 for 1212 unique observed reflections. The compound was prepared by reaction of the trichlorotitanium-delta 1(2)-enolate of 2-methylcyclohexanone with benzaldehyde.

Cyclohexanones↗
PubMed1991

Cardiac performance in elderly hypertensive patients with left ventricular hypertrophy: responses to isometric exercise and beta-agonists.

To assess the cardiac functional reserve of elderly hypertensive patients with left ventricular hypertrophy (LVH) we studied cardiac function after isometric exercise and beta-adrenergic stimulation. Forty-five elderly hypertensive and 16 normotensive patients (NC group) were recruited for the study. The hypertensive patients were divided into two groups: those with LVH (n = 17) mass index (LV mass index greater than 130 g/m2; H1 group) and those without LVH (n = 28) (H2 group). Echocardiographic studies were performed before and after isometric exercise (handgrip) and isoproterenol (ISP) administration. We measured the LV mass index, fractional shortening (FS), isovolumic relaxation time (IRT), and the ratio of late and early diastolic transmitral flow velocity (A/E). The FS at rest in the H1 group was significantly higher than those in the H2 and NC groups. In the H1 group, the IRT was elongated and A/E was greater than in the NC group, which indicated the impaired diastolic function in the H1 group. After the HG stress, the FS in the H1 group significantly decreased whereas it did not change in the H2 or NC groups. The FS increased in all three groups after the infusion of ISP, although the increment of FS was smaller in the H1 group. In conclusion, (a) diastolic function was impaired whereas systolic function was supranormal at rest in the hypertrophied heart of the elderly hypertensive patients and (b) when exercise or pharmacological stress was loaded, the systolic function deteriorated, suggesting the impairment of cardiac reserve in those patients.

Aged↗
PubMed1991

Effects of aging on the cardiopulmonary receptor reflex in hypertensive patients.

In order to evaluate the effects of aging on cardiopulmonary receptor function in hypertensive patients, hemodynamic responses after unloading were studied in middle aged and older hypertensive patients. Twenty-one hypertensive patients were divided into 2 groups according to age. The younger group consisted of 9 patients less than 65 years old (mean age: 57.2 years) and the older group contained 12 patients more than 65 years old (77.2 years). Following 10 min rest, deactivation of cardiopulmonary receptors was obtained by reducing central venous pressure through the application of graded negative pressures of -10, -20, and -40 mmHg to the lower body. Blood pressure, pulse rate, and forearm blood flow were measured at baseline and at each level of negative pressure. Furthermore, plasma norepinephrine and plasma renin activity levels were measured at baseline and at -40 mmHg. Forearm blood flow was measured by venous occlusive plethysmography using a Silastic strain gauge applied around the forearm. Forearm peripheral vascular resistance was calculated by dividing the mean arterial pressure by the forearm blood flow. Baseline mean blood pressure, pulse rate, and peripheral vascular resistance were similar in both age groups. Following lower body negative pressure (LBNP), mean blood pressure and pulse rate did not change, suggesting the selective deactivation of cardiopulmonary receptors. The increase in peripheral vascular resistance at LBNP of -40 mmHg in the older group (20.0 +/- 6.2) was significantly lower than that in the younger group (15.5 +/- 8.9, p less than 0.05). Furthermore, the increase in peripheral vascular resistance after LBNP was inversely related to age (Y = -0.32X + 38.8, r = -0.43, p less than 0.05). Increases in plasma norepinephrine and plasma renin activity in the older group were not different from those in the younger group. It is concluded that the sensitivity of cardiopulmonary baroreceptor function in hypertensive patients deteriorates with increasing age.

Aged↗
PubMed1991

Cost-effectiveness analysis of screening for colorectal cancer in Japan.

To clarify the best cost-effective screening strategy for colorectal cancer in Japan, the cost-effectiveness ratio was compared among six currently performed procedures. The analysis was made using a simulation model to estimate long-term cost and effectiveness of the screening programs. In the screening by the immunological fecal occult blood test (FOBT), a comparison between the one- and two-day fecal collection methods indicated that the latter was more cost-effective than the former. A comparison was also made on the four workup methods: barium enema (BE) alone, a combination of BE and sigmoidoscopy (BE + SIG), total colonoscopy (TCF) alone, and a combination of BE and TCF (BE + TCF). The cost-effectiveness ratio was the lowest in the method using TCF alone, followed by those based on BE alone and BE + TCF, and the highest in the BE + SIG method. The superiority of TCF alone strategy was stable over a range of estimates such as the sensitivity of diagnostic tests, the probability of complications due to TCF, etc. It is concluded that a combination of the two-day FOBT and TCF yields the best cost-effectiveness.

Barium Sulfate↗
PubMed1991

Cost-effectiveness analysis of screening for gastric cancer in Japan.

Cost-effectiveness analysis of gastric cancer screening in Japan was performed, and the cost-effectiveness ratio was compared with that of colorectal cancer screening. The analytical model was the same as that adopted in our previous study on colorectal cancer screening (Tsuji et al. 1991). The results indicated that the cost per case-fatality prevented by colorectal cancer screening was 5.5 and 2.7 times more expensive for males and females, respectively, than that by gastric cancer screening. The age of the population influenced the cost-effectiveness of screening programs. The cost-effectiveness ratio in gastric cancer screening became negative among males older than the age of 65 years, suggesting that the total cost for prevention and control of deaths by gastric cancer in these age populations is saved by the screening program.

Adult↗
PubMed1990

Pseudohypertension in the elderly.

Pseudohypertension is a condition in which indirect blood pressure measured by the cuff method overestimates the true intra-arterial blood pressure. Despite the clinical importance of pseudohypertension, reports regarding its prevalence are scarce. We compared direct measurements of brachial arterial blood pressure with those measured indirectly by the cuff method in 59 healthy volunteers aged greater than 65 years, with or without hypertension, in order to investigate the prevalence of pseudohypertension in the elderly. The average systolic blood pressure of 161.5 mmHg obtained by the indirect method was significantly lower than the 169.2 mmHg obtained by the direct method was not significantly different from the 76.9 mmHg obtained by the direct method. Only one volunteer was observed in whom the indirect cuff method overestimated the diastolic blood pressure by greater than 10 mmHg, which was defined as pseudohypertension. Thus, the prevalence of pseudohypertension was only 1.7%. The difference in systolic blood pressure between the two methods was 8.7 mmHg in Osler-positive cases and was not significantly different from the 6.9 mmHg observed in Osler-negative cases. Pulse wave velocity was significantly correlated with the systolic blood pressure (y = 11.4x + 66.1, r = 0.65, P less than 0.05). No correlation was observed between the pulse wave velocity and direct/indirect pressure differences for either systolic or diastolic measurements. These results show that the prevalence of pseudohypertension is very low in a non-selected elderly population and that Osler's maneuver was not related to the pressure difference between the direct and indirect methods.

Aged↗
PubMed1989

[Age and efficacy of new long acting calcium blocker, nisoldipine, is essential hypertension].

The relationship between the age and the clinical efficacy of a new long acting calcium entry blocker, nisoldipine, was investigated in essential hypertension using two double blind group studies, in which nifedipine or atenolol was used as a control drug. Following 4 weeks of the observation period, nisoldipine was administered 2.5 mg once a day and an increase in dose was available up to 5 to 10 mg per day for 12 weeks of the treatment period. One hundred fourty nine cases who received nisoldipine were divided into the following two groups; 97 cases of the middle aged patients under 59 years old (mean age of 49.5 years) and 62 cases of the elderly patients more than 60 years old (mean age of 64.8 years). Average dose of nisoldipine at 12 weeks of treatment period was 4.8 mg in middle age and 5.8 mg in elderly group. The positive antihypertensive effect was observed in 82.2% in the middle aged patients and in 83.6% in the elderly patients; there was no significant difference between the two groups. In each group, significant fall in blood pressure was observed after the treatment, although no significant difference in the fall of systolic and diastolic blood pressure in the treatment period was observed between the two age groups. The side effect was observed in 16 cases (16.5%) of the middle aged patients and in 7 cases (11.3%) of the elderly patients, but no significant difference in the incidence was observed. The significant deterioration of the clinical laboratory findings was not observed in both groups. The rate of usefulness (useful or above) was 74.7% in the middle aged patients and 81.5% in the elderly patients, and there was no significant difference between the two groups. These results indicate that a new long acting calcium entry blocker, nisoldipine, is effective and safe antihypertensive drug for the elderly as well as for the middle aged patients.

Adult↗
PubMed1989

[Pharmacokinetics and pharmacodynamics of antihypertensive drugs in the elderly].

In order to study pharmacokinetics and pharmacodynamics of antihypertensive drugs in the elderly, plasma concentration and blood pressure response to 4 antihypertensive drugs with different modes of action (captopril, nifedipine retard tablet, bunazosin, arotinolol) were measured in young and elderly hypertensive patients without liver or renal dysfunction after oral administration of each drug. Systolic and diastolic blood pressure fell after 25 mg of captopril in both groups and the rate of decrease in each group was similar. Plasma concentration of captopril at 1 and 2 hours after administration in the elderly group tended to be higher than in the young group. Suppression of angiotensin-converting enzyme activity persisted longer in the elderly group than in the young group. The area under the curve (AUC) of captopril in the elderly group (335.4 +/- 98.6 hr.2ng/ml) was significantly greater than in the young group (186.7 +/- 79.9) (p less than 0.005), while no significant differences in Cmax, Tmax and T1/2 were observed. The percent decrease in systolic blood pressure in the elderly group (25.2 +/- 10.2%) after 1 hour of nifedipine tablet (20 mg) was significantly higher than in the young group (16.6 +/- 1.5%) (p less than 0.05). Cmax and AUC of nifedipine in the elderly tended to be higher than in the young group (303.5 v.s. 210.0 ng/ml and 1258.9 v.s. 725.1 hr.ng/ml, p less than 0.1, respectively). The percent decrease of diastolic blood pressure after 2 mg of bunazosin was also significantly higher in the elderly group than in the young group (p less than 0.05).2+ antihypertensive response after captopril and arotinolol in two groups.

Adult↗