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Halimi JM, Sarafidis P, Azizi M, Bilo G, Burkard T, Bursztyn M, Camafort M, Chapman N, Cottone S, de Backer T, Deinum J, Delmotte P, Dorobantu M, Doumas M, Dusing R, Duly-Bouhanick B, Fauvel JP, Fesler P, Gaciong Z, Gkaliagkousi E, Gordin D, Grassi G, Grassos C, Guerrot D, Huart J, Izzo R, Jaén Águila F, Járai Z, Kahan T, Kantola I, Kociánová E, Limbourg F, Lopez-Sublet M, Mallamaci F, Manolis A, Marketou M, Mayer G, Mazza A, MacIntyre I, Mourad JJ, Muiesan ML, Nasr E, Nilsson P, Oliveras A, Ormezzano O, Paixão-Dias V, Papadakis I, Papadopoulos D, Perl S, Polónia J, Pontremoli R, Pucci G, Robles NR, Rubin S, Ruilope LM, Rump LC, Saeed S, Sanidas E, Sarzani R, Schmieder R, Silhol F, Sokolovic S, Solbu M, Soucek M, Stergiou G, Sudano I, Tabbalat R, Tengiz I, Triantafyllidi H, Tsioufis K, Václavík J, van der Giet M, der Niepen PV, Veglio F, Venzin R, Viigimaa M, Weber T, Widimsky J, Wuerzner G, Zelveian P, Zebekakis P, Lueders S, Persu A, Kreutz R, Vogt L. Management of patients with hypertension and chronic kidney disease referred to Hypertension Excellence Centres among 27 countries. On behalf of the European Society of Hypertension Working Group on Hypertension and the Kidney. Blood Press 2024; 33:2368800. [PMID: 38910347 DOI: 10.1080/08037051.2024.2368800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70-95%]) than MRA (20% [10-30%]), SGLT2i (30% [20-50%]) or (GLP1-RA (10% [5-15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15-40%) vs 18% [10%-25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5-5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.
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Affiliation(s)
- Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation rénale, Hôpital Bretonneau, Tours, France
| | | | - Michel Azizi
- Université Paris Cité Department of Cardiology, Paris, France
- APHP, Service d'Hypertension Artérielle, Hôpital Européen Georges Pompidou, Paris, France
| | - Grzegorz Bilo
- Grzegorz Bilo, Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Thilo Burkard
- Medical Outpatient Department and Hypertension Clinic, University Hospital Basel, Basel, Switzerland
| | - Michael Bursztyn
- Hypertension Clinic, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem
- Faculty of Medicine, School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Miguel Camafort
- Hypertension Unit, Department of Internal Medicine, Hospital Clinic, University of Barcelona, Spain
| | - Neil Chapman
- Peart-Rose Clinic, Hammersmith Hospital, Imperial College Healthcare Trust, London, UK
| | - Santina Cottone
- PROMISE Department, Nephrology and Dialisys Unit with Hypertension ESH Excellence Centre, University Hospital P.Giaccone, Palermo, Italy
- University of Palermo Department of Nephrology, Palermo, Italy
| | - Tine de Backer
- Department of Cardiovascular Diseases, Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Jaap Deinum
- Department of Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philippe Delmotte
- Hypertension Unit (European Society of Hypertension Excellence Centre), Department of Cardiology, HELORA University Hospitals, Mons, Belgium
| | - Maria Dorobantu
- Emergency Clinical Hospital of Bucharest Department of Emergency Medicineap: Department of Cardiology, Bucharest, Romania
| | - Michalis Doumas
- 2nd Prop Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Rainer Dusing
- Hypertoniezentrum Bonn, Schwerpunktpraxis Kardiologie, Angiologie, Prävention, Rehabilitation, Bonn, Germany
| | | | - Jean-Pierre Fauvel
- Department of Nephrology and Hypertension, Hôpital Ed Herriot, Lyon, France
| | - Pierre Fesler
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, Montpellier, France
| | - Zbigniew Gaciong
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - Daniel Gordin
- Department of Nephrology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Guido Grassi
- Clinica Medica, University Milano Bicocca, Milan, Italy
| | | | - Dominique Guerrot
- Service de Néphrologie, CIC-CRB 1404, INSERM EnVi U1096, CHU Rouen, France
| | - Justine Huart
- Division of Nephrology, University of Liège Hospital (ULg CHU), University of Liège, and Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - Raffaele Izzo
- Department of Advanced Medical Sciences, Federico II University of Naples, Italy
| | - Fernando Jaén Águila
- Vascular Risk Unit, Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Zoltán Járai
- South-Buda Center Hospital, St. Imre University Teaching Hospital, Budapest, Hungary
| | - Thomas Kahan
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Cardiology, Danderyd University Hospital Corp, Stockholm, Sweden
| | - Ilkka Kantola
- Division of Medicine, Turku University Hospital, Turku University, Turku, Finland
| | - Eva Kociánová
- First Department of Internal Medicine - Cardiology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - FlorianP Limbourg
- Dept. of Nephrology and Hypertension, Hypertension Center, Hannover Medical School, Hannover, Germany
| | - Marilucy Lopez-Sublet
- AP-HP, Unité d'hypertension artérielle, service de médecine interne, Hôpital Avicenne, Bobigny, France
- INSERM UMR 942 MASCOT, Paris 13-Université Paris Nord, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Bobigny, France
| | - Francesca Mallamaci
- Grande Ospedale Metropolitano, UOC di Nefrologia abilitata al trapianto renale, CNR Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Reggio Calabria, Italy
| | | | - Maria Marketou
- Hypertension Outpatient Clinic, Cardiology Department, Heraklion University General Hospital, Heraklion, Greece
| | - Gert Mayer
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck Anichstrasse, Innsbruck, Austria
| | - Alberto Mazza
- Internal Medicine Unit, Department of Medicine, ESH Excellence Center Unit, Italy
| | - IainM MacIntyre
- Cardiovascular Risk Clinic, Western General Hospital, Edinburgh, UK
| | - Jean-Jacques Mourad
- Service de Médecine Interne, Hôpital Franco-Britannique, Levallois-Perret, France
| | - Maria Lorenza Muiesan
- Centro Studi Diagnosi e Cura dell'Ipertensione Arteriosa e del Rischio Cardiovascolare (IARC), University of Brescia and ASST Spedali Civili, Italy
| | - Edgar Nasr
- St George University Medical Center Achrafieh-Beirut, Lebanon
| | - Peter Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
| | - Anna Oliveras
- Hypertension and Vascular Risk Unit, Department of Nephrology, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Pompeu Fabra, Barcelona, Spain
| | - Olivier Ormezzano
- UF Hypertension et Athérothrombose, Centre Européen d'Excellence en Hypertension Artérielle, Service de Cardiologie, CHU Michallon, Grenoble, France
| | - Vitor Paixão-Dias
- Internal Medicine Department, Hospital Centre of Vila Nova de Gaia/Espinho, Portugal
| | - Ioannis Papadakis
- Hypertension Unit, Dept. of Internal Medicine, University Hospital of Heraklion, Heraklion, Greece
| | | | - Sabine Perl
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Jorge Polónia
- Department of Medicine CINTESIS RISE, Faculty of Medicine of Porto, Portugal
| | - Roberto Pontremoli
- Università degli Studi e IRCCS Ospedale Policlinico San Martino di Genova, Italy
| | - Giacomo Pucci
- Department of Medicine and Surgery, University of Perugia, Unit of Internal Medicine - Santa Maria Terni Hospital, Terni, Italy
| | | | - Sébastien Rubin
- Service de Néphrologie-transplantation-dialyse-aphérèses, CHU Bordeaux, France
| | | | - Lars Christian Rump
- Department of Internal Medicine/Nephrology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Elias Sanidas
- Department of Cardiology, LAIKO General Hospital, Athens, Greece
| | - Riccardo Sarzani
- Università Politecnica delle Marche and IRCCS-INRCA Department of Clinical and Molecular Sciences, Ancona, Italy
| | - Roland Schmieder
- Department of Nephrology, Hypertension University Hospital Erlangen, Friedrich Alexander University Erlangen/Nürnberg, Germany
| | - François Silhol
- Service de Médecine Vasculaire et Hypertension Artérielle, Centre de compétence régional des maladies artérielles rares, Centre d'excellence Européen en Hypertension Artérielle 264, rue Saint Pierre, CHU Timone, Marseille, France
| | | | - Marit Solbu
- University Hospital of North Norway Department of Nephrology cb: Department of Internal Medicine and Cardiology, Tromsø, Norway
| | - Miroslav Soucek
- 2nd Department of Internal Medicine, St. Anne's University Hospital, Brno, Czech Republic
- Fakulty of Medicine, Masaryk University Brno, Czech Republic
| | - George Stergiou
- School of Medicine, Third Department of Medicine, Sotiria Hospital, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, Athens, Greece
| | - Isabella Sudano
- University Hospital Zurich University Heart Center, Cardiology and University of Zurich, Zurich, Switzerland
| | - Ramzi Tabbalat
- Department of Cardiology, Abdali Hospital, Amman, Jordan
| | - Istemihan Tengiz
- Division of Cardiology, Izmir Medicana International Hospital, Yenisehir, Turkey
| | - Helen Triantafyllidi
- 2nd Department of Cardiology, Medical School, University of Athens, ATTIKON Hospital, Athens, Greece
| | - Konstontinos Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocratio Hospital, Greece
| | - Jan Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, Czech Republic
- Faculty of Medicine, University of Ostrava, Czech Republic
| | - Markus van der Giet
- Medinische Klinik für Nephrologie und internistische Intensivtherapie, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Van der Niepen
- Departement of Nephrology & Hypertension, Universitair Ziekenhuis Brussel Department of Nephrology and Hypertension, VUB, Belgium
| | - Franco Veglio
- Department of Medical Sciences, University of Turin, Italy
| | - RetoM Venzin
- Department of Nephrology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Margus Viigimaa
- Centre of Cardiology, North Estonia Medical Centre, Tallinn University of Technology, Tallinn, Estonia
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Jiri Widimsky
- IIIrd Internal Department, Centre for Hypertension, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Gregoire Wuerzner
- Service de néphrologie et d'hypertension, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Parounak Zelveian
- Center of Preventive Cardiology, Armenia Parounak Zelveian, Hospital N2 CJSC, Yerevan, Armenia
| | - Pantelis Zebekakis
- Hypertension Unit of the First Department of Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | | | - Alexandre Persu
- Department of Cardiovascular Diseases, Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Reinhold Kreutz
- Institute of Clinical Pharmacology and Toxicology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Liffert Vogt
- Department of Internal Medicine, Section of Nephrology, Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, the Netherlands
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Xu XY, Wang JX, Chen JL, Dai M, Wang YM, Chen Q, Li YH, Zhu GQ, Chen AD. GLP-1 in the Hypothalamic Paraventricular Nucleus Promotes Sympathetic Activation and Hypertension. J Neurosci 2024; 44:e2032232024. [PMID: 38565292 PMCID: PMC11112640 DOI: 10.1523/jneurosci.2032-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024] Open
Abstract
Glucagon-like peptide-1 (GLP-1) and its analogs are widely used for diabetes treatment. The paraventricular nucleus (PVN) is crucial for regulating cardiovascular activity. This study aims to determine the roles of GLP-1 and its receptors (GLP-1R) in the PVN in regulating sympathetic outflow and blood pressure. Experiments were carried out in male normotensive rats and spontaneously hypertensive rats (SHR). Renal sympathetic nerve activity (RSNA) and mean arterial pressure (MAP) were recorded. GLP-1 and GLP-1R expressions were present in the PVN. PVN microinjection of GLP-1R agonist recombinant human GLP-1 (rhGLP-1) or EX-4 increased RSNA and MAP, which were prevented by GLP-1R antagonist exendin 9-39 (EX9-39) or GLP-1R antagonist 1, superoxide scavenger tempol, antioxidant N-acetylcysteine, NADPH oxidase (NOX) inhibitor apocynin, adenylyl cyclase (AC) inhibitor SQ22536 or protein kinase A (PKA) inhibitor H89. PVN microinjection of rhGLP-1 increased superoxide production, NADPH oxidase activity, cAMP level, AC, and PKA activity, which were prevented by SQ22536 or H89. GLP-1 and GLP-1R were upregulated in the PVN of SHR. PVN microinjection of GLP-1 agonist increased RSNA and MAP in both WKY and SHR, but GLP-1 antagonists caused greater effects in reducing RSNA and MAP in SHR than in WKY. The increased superoxide production and NADPH oxidase activity in the PVN of SHR were augmented by GLP-1R agonists but attenuated by GLP-1R antagonists. These results indicate that activation of GLP-1R in the PVN increased sympathetic outflow and blood pressure via cAMP-PKA-mediated NADPH oxidase activation and subsequent superoxide production. GLP-1 and GLP-1R upregulation in the PVN partially contributes to sympathetic overactivity and hypertension.
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Affiliation(s)
- Xiao-Yu Xu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Jing-Xiao Wang
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Jun-Liu Chen
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Min Dai
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Yi-Ming Wang
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Qi Chen
- Department of Pathophysiology, Nanjing Medical University, Nanjing 211166, China
| | - Yue-Hua Li
- Department of Pathophysiology, Nanjing Medical University, Nanjing 211166, China
| | - Guo-Qing Zhu
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
| | - Ai-Dong Chen
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, and Department of Physiology, Nanjing Medical University, Nanjing 211166, China
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Tsukamoto S, Kobayashi K, Toyoda M, Hatori N, Kanaoka T, Wakui H, Sakai H, Furuki T, Chin K, Ito S, Suzuki D, Umezono T, Aoyama T, Nakajima S, Hishiki T, Hatori Y, Hayashi M, Shimura H, Minagawa F, Mokubo A, Takihata M, Sato K, Miyakawa M, Terauchi Y, Tamura K, Kanamori A. Pretreatment body mass index affects achievement of target blood pressure with sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes mellitus and chronic kidney disease. Hypertens Res 2024; 47:628-638. [PMID: 37848562 DOI: 10.1038/s41440-023-01464-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Sodium-glucose cotransporter 2 inhibitor (SGLT2-I) shows excellent antihypertensive effects in addition to its hypoglycemic effects. However, whether body mass index (BMI) affects the antihypertensive effect of SGLT2-I remains unknown. We investigated the impact of baseline BMI on the achievement of target blood pressure (BP) with SGLT2-I treatment in Japanese patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). We retrospectively evaluated 447 Japanese patients with T2DM and CKD treated with SGLT2-I for at least 1 year. The primary outcome was achieving the target BP (<130/80 mmHg) after SGLT2-I treatment. Patients were divided into two groups according to a baseline BMI of 29.1 determined by receiver operating characteristic analysis and analyzed in a cohort model with propensity score matching. In each group, 130 patients were compared by propensity score matching. The target BP achievement rate was significantly higher in the BMI < 29.1 group than in the BMI ≥ 29.1 group (34% and 21%, respectively, p = 0.03). The odds ratio for achieving the target BP in the BMI ≥ 29.1 group was 0.50 (95% confidence interval, 0.28-0.90, p = 0.02). The BMI < 29.1 group had significantly lower systolic and diastolic BPs after SGLT2-I treatment than the BMI ≥ 29.1 group. Only the BMI < 29.1 group was showed a significant decrease in the logarithmic albumin-to-creatinine ratio from baseline after SGLT2-I treatment. In patients with T2DM and CKD, baseline BMI was associated with the antihypertensive effects of SGLT2-I. Patients in the lower baseline BMI group were more likely to achieve the target BP after SGLT2-I treatment. Pretreatment BMI affects the antihypertensice effect of SGLT2 inhibirors in patients with T2DM and CKD.
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Affiliation(s)
- Shunichiro Tsukamoto
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuo Kobayashi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of internal medicine, Tokai University School of Medicine, lsehara, Japan
| | - Nobuo Hatori
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroyuki Sakai
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Takayuki Furuki
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Keiichi Chin
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Shun Ito
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Daisuke Suzuki
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Tomoya Umezono
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Togo Aoyama
- Division of Nephrology, Department of internal medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shinichi Nakajima
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Toshimasa Hishiki
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Yutaka Hatori
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Masahiro Hayashi
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Hidetoshi Shimura
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Fuyuki Minagawa
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Atsuko Mokubo
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Masahiro Takihata
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Kazuyoshi Sato
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Masaaki Miyakawa
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Akira Kanamori
- Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan
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