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Liu J, Li Y, Zhang X, Bu P, Du X, Fang L, Feng Y, Guo Y, Han F, Jiang Y, Li Y, Lin J, Liu M, Liu W, Long M, Mu J, Sun N, Wu H, Xie J, Xie J, Xie L, Yu J, Yuan H, Zha Y, Zhang Y, Zhu S, Wang J. Management of nocturnal hypertension: An expert consensus document from Chinese Hypertension League. J Clin Hypertens (Greenwich) 2024; 26:71-83. [PMID: 38126623 PMCID: PMC10795100 DOI: 10.1111/jch.14757] [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: 07/20/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
Nocturnal hypertension is highly prevalent among Chinese and Asian populations, which is mainly attributed to high salt intake and high salt sensitivity. Nocturnal hypertension increases the risk of cardiovascular and all-cause mortality, independent of daytime blood pressure (BP). However, it can usually be detected by 24-h ambulatory BP monitoring, rather than routine office or home BP measurement, thus is often underdiagnosed in clinical practice. Currently, no specific guidance is available for the management of nocturnal hypertension in China or worldwide. Experts from the Chinese Hypertension League summarized the epidemiologic and pathophysiologic characteristics and clinical phenotype of nocturnal hypertension and provided consensus recommendations on optimal management of nocturnal hypertension, with the goal of maximally reducing the cardiovascular disease risks. In this consensus document, 24-h ABPM is recommended for screening and diagnosis of nocturnal hypertension, especially in the elderly, patients with diabetes, chronic kidney diseases, obstructive sleep apnea and other conditions prone to high nocturnal BP. Lifestyle modifications including salt intake restriction, exercise, weight loss, sleep improvement, and mental stress relief are recommended. Long-acting antihypertensive medications are preferred for nocturnal and 24-h BP control. Some newly developed agents, renal denervation, and other device-based therapy on nocturnal BP reduction are evaluated.
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Affiliation(s)
- Jing Liu
- Peking University People's HospitalBeijingChina
| | - Yan Li
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Xinjun Zhang
- West China Hospital of Sichuan UniversityChengduSichuanChina
| | - Peili Bu
- Qilu Hospital of Shandong UniversityJinanShandongChina
| | - Xueping Du
- Yuetan Community Health Service CenterFuxing HospitalCapital Medical UniversityBeijingChina
| | - Lizheng Fang
- Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiangChina
| | - Yingqing Feng
- Guangdong Provincial People's HospitalGuangzhouGuangdongChina
| | - Yifang Guo
- Hebei General HospitalShijiazhuangHebeiChina
| | - Fei Han
- The First Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejiangChina
| | - Yinong Jiang
- The First Affiliated Hospital of Dalian Medical UniversityDalianChina
| | - Yuming Li
- T International Cardiovascular HospitalTianjinChina
| | - Jinxiu Lin
- The First Affiliated Hospital of Fujian Medical UniversityFuzhouFujianChina
| | - Min Liu
- Henan Province People's HospitalZhengzhouHenanChina
| | - Wei Liu
- Beijing HospitalBeijingChina
| | - Mingzhi Long
- The Second Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Jianjun Mu
- The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | | | - Hao Wu
- School of General Practice and Continuing Education, Capital Medical UniversityBeijingChina
| | - Jianhong Xie
- Zhejiang Provincial People's HospitalHangzhouZhejiangChina
| | - Jingyuan Xie
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Liangdi Xie
- The First Affiliated Hospital of Fujian Medical UniversityFuzhouFujianChina
| | - Jing Yu
- Lanzhou University Second HospitalLanzhouGansuChina
| | - Hong Yuan
- The Third Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Yan Zha
- Guizhou Provincial People's HospitalGuiyangGuizhouChina
| | - Yuqing Zhang
- Fuwai HospitalChinese Academy of Medical Sciences & Peking Union Medical CollegeBeijingChina
| | - Shanzhu Zhu
- Zhongshan HospitalFudan UniversityShanghaiChina
| | - Jiguang Wang
- Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
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2
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Parcha V, Kalra R, Li P, Oparil S, Arora G, Arora P. Nocturnal blood pressure dipping in treated hypertensives: insights from the SPRINT trial. Eur J Prev Cardiol 2020; 29:e25-e28. [PMID: 33624057 DOI: 10.1093/eurjpc/zwaa125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL 35294-0019, USA
| | - Rajat Kalra
- Cardiovascular Division, Department of Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Peng Li
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Suzanne Oparil
- Vascular Biology and Hypertension Program, Department of Medicine, University of Alabama, 1900 University Boulevard, Birmingham, AL 35233, USA
| | - Garima Arora
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL 35294-0019, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL 35294-0019, USA.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, 700 19th Street South, Birmingham, AL 35233, USA
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Liu NW, Huang X, Liu S, Liu WJ, Wang H, Wang WD, Lu Y. Elevated BNP caused by recombinant human interleukin-11 treatment in patients with chemotherapy-induced thrombocytopenia. Support Care Cancer 2019; 27:4293-4298. [PMID: 30877597 PMCID: PMC6803615 DOI: 10.1007/s00520-019-04734-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/05/2019] [Indexed: 10/27/2022]
Abstract
Thrombocytopenia is a condition characterized by abnormally low levels of thrombocytes and often induced by chemotherapy. Recombinant human interleukin-11 (rhIL-11) is a cytokine that can stimulate thrombopoiesis and is commonly used to treat thrombocytopenia. We observed the side effects of rhIL-11 in 24 leukemia patients with chemotherapy-induced thrombocytopenia. To determine the cardiovascular effects of rhIL-11, we detected changes in the patients' serum brain natriuretic peptide (BNP), blood pressure fluctuations, weight change, and whether edema or heart failure occurred in leukemia patients after chemotherapy. The results showed that BNP was significantly elevated after using rhIL-11 (P < 0. 05) but regressed after 2-4 days. Furthermore, nine patients had edema and experienced weight gain, and four experienced acute left heart failure. In addition, the average blood pressure was 119/75 mmHg (range 139/86 mmHg to 99/64 mmHg) before rhIL-11 administration and 127/79 mmHg (range 146/89 mmHg to 108/69 mmHg) after rhIL-11 use. In conclusion, although rhIL-11 is useful for treating chemotherapy-induced thrombocytopenia, it is important to monitor the patients' clinical status and re-examine BNP levels frequently during the use of rhIL-11. Furthermore, senile patients should be given special attention. However, the appropriate timing to begin and discontinue rhIL-11 treatment needs further investigation.
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Affiliation(s)
- Na-Wei Liu
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Xin Huang
- Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.,Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuang Liu
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Wen-Jian Liu
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Hua Wang
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Wei-da Wang
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Center State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Yue Lu
- Department of Hematologic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. .,Center State Key Laboratory of Oncology in South China, Guangzhou, China. .,Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
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Tamura S, Iwata S, Ito A, Ishikawa S, Mizutani K, Izumiya Y, Yamada T, Murakami T, Shibata T, Yoshiyama M. Greater Nocturnal Blood Pressure Is Associated With Natriuretic Peptide Level in Aortic Stenosis With Preserved Ejection Fraction. Circ J 2019; 83:447-451. [PMID: 30464111 DOI: 10.1253/circj.cj-18-0818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although careful monitoring of asymptomatic severe aortic stenosis (AS) is recommended to prevent missing the optimal timing of surgical or transcatheter aortic valve replacement, prophylactic treatment that could extend the asymptomatic period remains unknown. In a hypertensive population, high blood pressure (BP) measured at the doctor's office is known to be associated with B-type natriuretic peptide (BNP) level, a surrogate marker for symptomatic deterioration in AS. Little is known regarding the association between nocturnal BP variables and BNP in severe AS with preserved ejection fraction (EF). Methods and Results: The subjects consisted of 78 severe AS patients (mean age, 79±6 years) with preserved EF. Nocturnal BP was measured hourly using a home BP monitoring device. On multiple regression analysis, nocturnal mean systolic BP (SBP) remained independently associated with BNP after adjustment for age, sex, body mass index, estimated glomerular filtration rate, antihypertensive medication class, early diastolic mitral annular velocity, and left ventricular mass index (P=0.03), whereas diastolic BP (DBP) and variables of BP variability were not. CONCLUSIONS Higher nocturnal SBP rather than DBP or indices of BP variability was independently associated with BNP in AS patients with preserved EF. Intervention for nocturnal SBP may therefore extend the asymptomatic period and improve prognosis.
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Affiliation(s)
- Soichiro Tamura
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Sera Ishikawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
| | - Tokuhiro Yamada
- Department of Anesthesiology, Osaka City University Graduate School of Medicine
| | - Takashi Murakami
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
- Jichi Medical University Center of Excellence, Cardiovascular Research and Development (JCARD), Tochigi, Japan (K.K.)
- and Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tokyo, Japan (K.K.)
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Kario K, Tomitani N, Kanegae H, Ishii H, Uchiyama K, Yamagiwa K, Shiraiwa T, Katsuya T, Yoshida T, Kanda K, Hasegawa S, Hoshide S. Comparative Effects of an Angiotensin II Receptor Blocker (ARB)/Diuretic vs. ARB/Calcium-Channel Blocker Combination on Uncontrolled Nocturnal Hypertension Evaluated by Information and Communication Technology-Based Nocturnal Home Blood Pressure Monitoring - The NOCTURNE Study. Circ J 2017; 81:948-957. [PMID: 28321001 DOI: 10.1253/circj.cj-17-0109] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Nocturnal blood pressure (BP) is an independent risk factor of cardiovascular events. The NOCTURNE study, a multicenter, randomized controlled trial (RCT) using our recently developed information and communication technology (ICT) nocturnal home BP monitoring (HBPM) device, was performed to compare the nocturnal HBP-lowering effects of differential ARB-based combination therapies in 411 Japanese patients with nocturnal hypertension (HT).Methods and Results:Patients with nocturnal BP ≥120/70 mmHg at baseline even under ARB therapy (100 mg irbesartan daily) were enrolled. The ARB/CCB combination therapy (irbesartan 100 mg+amlodipine 5 mg) achieved a significantly greater reduction in nocturnal home systolic BP (primary endpoint) than the ARB/diuretic combination (daily irbesartan 100 mg+trichlormethiazide 1 mg) (-14.4 vs. -10.5 mmHg, P<0.0001), independently of urinary sodium excretion and/or nocturnal BP dipping status. However, the change in nocturnal home systolic BP was comparable among the post-hoc subgroups with higher salt sensitivity (diabetes, chronic kidney disease, and elderly patients). CONCLUSIONS This is the first RCT demonstrating the feasibility of clinical assessment of nocturnal BP by ICT-nocturnal HBPM. The ARB/CCB combination was shown to be superior to ARB/diuretic in patients with uncontrolled nocturnal HT independently of sodium intake, despite the similar impact of the 2 combinations in patients with higher salt sensitivity.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Hiroshi Kanegae
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine.,Genki Plaza Medical Center for Health Care
| | | | | | | | | | | | | | | | | | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
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7
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Kario K, Tomitani N, Matsumoto Y, Hamasaki H, Okawara Y, Kondo M, Nozue R, Yamagata H, Okura A, Hoshide S. Research and Development of Information and Communication Technology-based Home Blood Pressure Monitoring from Morning to Nocturnal Hypertension. Ann Glob Health 2016; 82:254-73. [DOI: 10.1016/j.aogh.2016.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kario K, Hoshide S, Uchiyama K, Yoshida T, Okazaki O, Noshiro T, Aoki H, Mizuno H, Matsumoto Y. Dose Timing of an Angiotensin II Receptor Blocker/Calcium Channel Blocker Combination in Hypertensive Patients With Paroxysmal Atrial Fibrillation. J Clin Hypertens (Greenwich) 2016; 18:1036-1044. [DOI: 10.1111/jch.12814] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/20/2016] [Accepted: 01/27/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine and Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine; Department of Medicine and Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | | | - Tetsuro Yoshida
- Onga Nakama Medical Association Onga Hospital; Fukuoka Japan
| | - Osamu Okazaki
- National Center for Global Health and Medicine; Tokyo Japan
| | | | | | - Hiroyuki Mizuno
- Division of Cardiovascular Medicine; Department of Medicine and Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | - Yuri Matsumoto
- Division of Cardiovascular Medicine; Department of Medicine and Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
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Shimizu M, Hoshide S, Ishikawa J, Yano Y, Eguchi K, Kario K. Correlation of Central Blood Pressure to Hypertensive Target Organ Damages During Antihypertensive Treatment: The J-TOP Study. Am J Hypertens 2015; 28:980-6. [PMID: 25548141 DOI: 10.1093/ajh/hpu250] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/16/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Some previous studies have shown that central blood pressure (BP) is more closely related to cardiovascular risks than brachial BP. This study compared the correlations between asymptomatic organ damages and each of central BP, brachial clinic BP, and home BP during antihypertensive treatment. METHODS In the Japan Morning Surge-Target Organ Protection (J-TOP) study, which compared bedtime or awakening dosing of candesartan (+diuretics as needed) among subjects with home systolic BP (SBP) higher than 135 mm Hg, we evaluated 180 hypertensive patients who successfully underwent pulse wave analysis by HEM-9000AI and measured their urinary albumin/creatinine ratio (UACR) and left ventricular mass index (LVMI) (n = 144) at baseline and after 6 months of treatment. RESULTS During antihypertensive treatment, significant reductions were found in central SBP, UACR, and LVMI (all P < 0.001). Multiple regression analyses showed that the decrease in central SBP was associated with those of log-transformed UACR (β = 0.24, P < 0.01) and LVMI (β = 0.23, P = 0.04), independently of the decrease in both clinic and home SBP. The goodness-of-fit of the association between the reduction in SBP and the UACR (P < 0.01) or LVMI (P = 0.04) was improved by adding central SBP to the SBP measurement. CONCLUSION These findings suggest that the change in central BP could be an important therapeutic target during antihypertensive treatment, in addition to peripheral clinic and home BP.
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Affiliation(s)
- Motohiro Shimizu
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Joji Ishikawa
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Yuichiro Yano
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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Kario K, Hoshide S, Haimoto H, Yamagiwa K, Uchiba K, Nagasaka S, Yano Y, Eguchi K, Matsui Y, Shimizu M, Ishikawa J, Ishikawa S. Sleep Blood Pressure Self-Measured at Home as a Novel Determinant of Organ Damage: Japan Morning Surge Home Blood Pressure (J-HOP) Study. J Clin Hypertens (Greenwich) 2015; 17:340-8. [DOI: 10.1111/jch.12500] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
- Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
- Department of Sleep and Circadian Cardiology; Jichi Medical University School of Medicine; Tochigi Japan
| | | | | | | | - Shoichiro Nagasaka
- Division of Endocrinology and Metabolism; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Yuichiro Yano
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Yoshio Matsui
- Iwakuni City Medical Center Ishikai Hospital; Yamaguchi Japan
| | - Motohiro Shimizu
- Department of General Internal Medicine; Kyusyu University Hospital; Fukuoka Japan
| | - Joji Ishikawa
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Tochigi Japan
| | - Shizukiyo Ishikawa
- Division of Community and Family Medicine; Jichi Medical University School of Medicine; Tochigi Japan
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Rationale, study design, and implementation of the ACS1 study: effect of azilsartan on circadian and sleep blood pressure as compared with amlodipine. Blood Press Monit 2014; 19:123-8. [PMID: 24637789 PMCID: PMC4011602 DOI: 10.1097/mbp.0000000000000032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective The ACS1 (Azilsartan Circadian and Sleep Pressure – the first study) is a multicenter, randomized, open-label, two parallel-group study carried out to investigate the efficacy of an 8-week oral treatment with azilsartan 20 mg in comparison with amlodipine 5 mg. Materials and methods The patients with stage I or II primary hypertension will be randomly assigned to either an azilsartan group (n=350) or an amlodipine group (n=350). The primary endpoint is a change in nocturnal systolic blood pressure (BP) as measured by ambulatory BP monitoring at the end of follow-up relative to the baseline level during the run-in period. In addition, we will carry out the same analysis after dividing four different nocturnal BP dipping statuses (extreme-dippers, dippers, nondipper, and risers). Conclusion The findings of this study will help in establishing an appropriate antihypertensive treatment for hypertensive patients with a disrupted circadian BP rhythm.
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Assessment of the reductions in night-time blood pressure and dipping induced by antihypertensive medication using a home blood pressure monitor. J Hypertens 2014; 32:82-9. [PMID: 24326992 DOI: 10.1097/hjh.0b013e328365c8a8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Night-time blood pressure (BP) is strongly associated with hypertensive target organ damage; however, no previous studies have compared home BP monitor measurements of the reduction in night-time BP induced by antihypertensive medications with those obtained with ambulatory BP monitors. METHODS As part of the Japan Morning Surge-Target Organ Protection study, in which candesartan (thiazide diuretics were added, if needed) was administered to hypertensive patients in the morning or at bedtime, 50 hypertensive patients had their night-time home and ambulatory BP successfully measured at the baseline and 6 months. In addition, three night-time home BP readings were taken during sleeping hours (at 2, 3, and 4 o'clock) for 6 months. RESULTS The mean reduction in night-time BP did not differ significantly between home and ambulatory BP monitoring (10.4 ± 17.9/6.0 ± 12.0 vs. 13.3 ± 14.6/7.6 ± 8.9 mmHg, P = 0.219/0.344), but the differences varied among individual patients. The reduction in night-time BP according to home BP monitoring was significantly correlated with the value obtained with ambulatory BP monitoring (r = 0.51/0.38, P < 0.001/=0.006). The reduction in night-time SBP according to home BP monitoring was significantly correlated with the reductions in left ventricular mass index (r = 0.385, P = 0.013, N = 41) and Sokolow-Lyon voltage (r = 0.335, P = 0.035, N = 40). CONCLUSION Home BP monitoring produces estimates of mean night-time BP reductions comparable to those from ambulatory monitoring, while the differences varied among individual patients. The reduction in night-time home BP according to home BP monitoring is significantly correlated with the reduction in left ventricular hypertrophy.
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Kario K, Sun N, Chiang FT, Supasyndh O, Baek SH, Inubushi-Molessa A, Zhang Y, Gotou H, Lefkowitz M, Zhang J. Efficacy and safety of LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor, in Asian patients with hypertension: a randomized, double-blind, placebo-controlled study. Hypertension 2014; 63:698-705. [PMID: 24446062 DOI: 10.1161/hypertensionaha.113.02002] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LCZ696 (Japanese adopted name: sucabitril valsartan sodium hydrate), a first-in-class angiotensin receptor neprilysin inhibitor, concomitantly inhibits neprilysin and blocks angiotensin type 1 receptor. This randomized, double-blind, placebo-controlled study, the first in Asia for this drug, evaluated the dose-related efficacy and safety of LCZ696 in patients with hypertension using 24-hour ambulatory blood pressure (BP) monitoring. Asian patients aged ≥18 years (n=389) with hypertension were randomized to receive LCZ696 100 mg (n=100), 200 mg (n=101), 400 mg (n=96), or placebo (n=92) for 8 weeks. The primary end point was mean difference across the 3 single-dose pairwise comparisons of LCZ696 versus placebo in clinic diastolic BP after 8-week treatment. Key secondary efficacy variables included changes in clinic systolic BP and pulse pressure and changes in 24-hour, daytime, and nighttime ambulatory BPs and pulse pressure. Safety assessments included recording all adverse events and serious adverse events. A total of 362 patients completed the study. Reductions in clinic systolic BP, diastolic BP (P<0.0001), and pulse pressure (P<0.001) were significantly greater with all doses of LCZ696 than with placebo. There were also significant reductions in 24-hour, daytime, and nighttime ambulatory systolic BP, diastolic BP, and pulse pressure for all doses of LCZ696 compared with placebo (P<0.0001). LCZ696 was well tolerated, and no cases of angioedema were reported. In conclusion, LCZ696 is effective for the treatment of hypertension in Asian population and, in general, is safe and well tolerated. Clinical Trial Information- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01193101.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
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14
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B-type natriuretic peptide-guided hypertension management? J Hypertens 2012; 30:890-2. [DOI: 10.1097/hjh.0b013e328352f562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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