1
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Ishiyama Y, Hoshide S, Kario K. Systemic hemodynamic atherothrombotic syndrome: from hypothesis to evidence. Hypertens Res 2024; 47:579-585. [PMID: 37833538 DOI: 10.1038/s41440-023-01459-9] [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: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/15/2023]
Abstract
Hypertension is a risk factor for cardiovascular disease (CVD). However, the association between blood pressure (BP) and CVD events has been based on mean BP alone. BP variability (BPV) is associated with increased organ damage and CVD events independently or beyond average home BP. To explain this association, we propose the systemic hemodynamic atherothrombotic syndrome (SHATS) hypothesis. The SHATS hypothesis indicates that hemodynamic stress increases vascular disease and vice versa, leading to a vicious cycle of the association between hemodynamic stress and a vascular disease; this association provides not only the risk but also the trigger for CVD events. The evidences of SHATS were gradually accumulating. We showed arterial stiffness synergistically amplified the association between hemodynamic stress and cardiac overload / CVD events in patients with at least one CVD risk factor.
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Affiliation(s)
- Yusuke Ishiyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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2
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Tomitani N, Hoshide S, Kario K. Diagnostic agreement of masked uncontrolled hypertension detected by ambulatory blood pressure and home blood pressure measured by an all-in-one BP monitoring device: The HI-JAMP study. Hypertens Res 2023; 46:157-164. [PMID: 36229535 DOI: 10.1038/s41440-022-01073-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 02/03/2023]
Abstract
Masked hypertension is defined by office blood pressure (BP) in the controlled-BP range while out-of-office BP measured by ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) is in the uncontrolled range. However, diagnosis of masked hypertension may differ if assessed by different out-of-office BP indices. This study aims to investigate the diagnostic agreement of masked uncontrolled hypertension (MUHT) detected by ABPM indices (ABPM-MUHT) and HBPM indices (HBPM-MUHT) using the same all-in-one device (TM2441; A&D Company). The present study enrolled a total of 2322 treated hypertensive patients (males 53.2%, average age 69.2 ± 11.5 years) from the Home-Activity ICT-based Japan Ambulatory Blood Pressure Monitoring Prospective (HI-JAMP) Study, who consecutively underwent office BP monitoring, 24-h ABPM (at 30-min intervals), and 5-day HBPM (twice each morning and evening) using the same device. When out-of-office BP control status was assessed only by 24-h average SBP or by the average of morning and evening SBP, the diagnostic agreement of MUHT detected by ABPM and HBPM was 29.7% among the 445 patients with any type of MUHT. When out-of-office BP indices in each time-window were simultaneously assessed, the diagnostic agreement increased to 40-45.7%. Our results indicated the importance of assessing BPs at various times of day, especially morning hours, for perfect hypertension management. Diagnosis of masked hypertension only by an averaged BP index, without considering specific time-windows, might underestimate cardiovascular risk.
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Affiliation(s)
- Naoko Tomitani
- Division of Cardiovascular Medicine, Department of Medicine, 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
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
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3
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Ishiyama Y, Hoshide S, Kanegae H, Kario K. Impact of home blood pressure variability on cardiovascular outcome in patients with arterial stiffness: Results of the J-HOP study. J Clin Hypertens (Greenwich) 2021; 23:1529-1537. [PMID: 34288371 PMCID: PMC8678810 DOI: 10.1111/jch.14327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/07/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
This study sought to investigate whether the relation between increased blood pressure (BP) variability and increased arterial stiffness confers a risk for cardiovascular disease (CVD) events. We analyzed 2648 patients from a practitioner‐based population (mean ± SD age 64.9 ± 11.4 years: 75.8% taking antihypertensive medication) with at least one cardiovascular risk factor who underwent home BP monitoring in the Japan Morning Surge‐Home Blood Pressure Study. The standard deviation (SDSBP), coefficient of variation (CVSBP), and average real variability (ARVSBP) were assessed as indexes of day‐by‐day home systolic BP (SBP) variability. The authors assessed arterial stiffness by brachial‐ankle pulse wave velocity (baPWV) and divided patients into lower (< 1800 cm/s, n = 1837) and higher (≥1800 cm/s, n = 811) baPWV groups. During a mean follow‐up of 4.4 years, 95 cardiovascular events occurred (8.1 per 1000 person‐years). In Cox proportional hazard models adjusted for traditional cardiovascular risk factors including average home SBP, the highest quartiles of SDSBP (hazard ratio [HR], 2.30; 95% confidence interval [CI], 1.23‐4.32), CVSBP (HR, 2.89; 95%CI, 1.59‐5.26) and ARVSBP (HR, 2.55; 95%CI, 1.37‐4.75) were predictive of CVD events compared to the other quartiles in the higher baPWV group. Moreover, 1SD increases in SDSBP (HR, 1.44; 95%CI, 1.13‐1.82), CVSBP (HR, 1.49; 95%CI, 1.16‐1.90) and ARVSBP (HR, 1.37; 95%CI, 1.09‐1.73) were also predictive of CVD events. These associations remained even after N‐terminal pro‐brain natriuretic peptide was added to the models. However, these associations were not observed in the lower baPWV group. We conclude that arterial stiffness contributes to the association between home BP variability and CVD incidence.
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Affiliation(s)
- Yusuke Ishiyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | | | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
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4
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Lozada-Martinez I, Aguas-Salazar O, Villaveces-Buelvas M, Martínez-Ocampo J. Systemic hemodynamic atherothrombotic syndrome: The real agent to consider for 24-h management of hypertension and cardiovascular events. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_94_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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5
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Suzuki D, Hoshide S, Kario K. The Importance of the Early Detection of Masked Hypertension. Am J Hypertens 2020; 33:990-992. [PMID: 32761063 DOI: 10.1093/ajh/hpaa122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daisuke Suzuki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.,Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satoshi Hoshide
- 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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6
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Suzuki D, Hoshide S, Kario K. Associations Between Day-by-Day Home Blood Pressure Variability and Renal Function and Albuminuria in Patients With and Without Diabetes. Am J Hypertens 2020; 33:860-868. [PMID: 32531041 DOI: 10.1093/ajh/hpaa091] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/25/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The phenotype of diabetic kidney disease represents a lower estimated glomerular filtration rate (eGFR) and albuminuria. We investigated the association between day-by-day home blood pressure (BP) variability and the eGFR in subjects with diabetes and compared this association with that in subjects without diabetes. We then attempted to determine whether the association is present in albuminuria. METHODS We analyzed 4,231 patients with risk factors of cardiovascular disease (24.4% with diabetes) from the J-HOP (Japan Morning Surge-Home Blood Pressure) study. Home BP was measured in the morning and evening for 14 days. We calculated the SD, coefficient of variation, average real variability (ARV), and variation independent of the mean of the subjects' morning and evening home systolic BP (SBP) as the indexes of day-by-day home BP variability. RESULTS A multiple linear regression analysis adjusted for covariates showed both average morning and evening SBP were associated with the log-transformed urine albumin-to-creatinine ratio (UACR) with and without diabetes (all P < 0.05), but not with the eGFR except for an association of average evening SBP in the no-diabetes group. None of the indexes of day-by-day morning and evening home SBP variability were associated with the log-transformed UACR except for the association between the ARV of home morning SBP in the diabetes group. All of the indexes of day-by-day morning and evening home SBP variability were associated with the eGFR only in the diabetes group (all P < 0.05). CONCLUSIONS The association between increased day-by-day home BP variability and impaired renal function was unique in diabetes.
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Affiliation(s)
- Daisuke Suzuki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
- Department of Medicine, Division of Endocrinology and Metabolism, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Satoshi Hoshide
- 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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7
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Ishiyama Y, Hoshide S, Kanegae H, Kario K. Increased Arterial Stiffness Amplifies the Association Between Home Blood Pressure Variability and Cardiac Overload. Hypertension 2020; 75:1600-1606. [DOI: 10.1161/hypertensionaha.119.14246] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Increased blood pressure (BP) variability, an index of hemodynamic stress, leads to cardiac overload and worse cardiovascular prognosis. The association between day-by-day home BP variability and NT-proBNP (N-terminal pro-B-type natriuretic peptide) as an index of cardiac overload may be amplified by increased arterial stiffness as assessed by brachial-ankle pulse wave velocity (baPWV). J-HOP (Japan Morning Surge-Home Blood Pressure) Study participants who were selected from a practitioner-based population with at least one cardiovascular risk factor underwent home BP monitoring, and their BP levels and SD, coefficient of variation, and average real variability as indexes of systolic BP variability were assessed. We analyzed 2115 individuals without prevalent heart failure and divided them into lower (<1800 cm/s, n=1464) and higher (≥1800 cm/s, n=651) baPWV groups. The higher baPWV group had significantly higher SD
SBP
, CV
SBP
, ARV
SBP
values, and NT-proBNP levels than the lower baPWV group (all
P
<0.001). In the higher baPWV group, a multiple linear regression analysis revealed that the SD
SBP
was associated with the NT-proBNP level after adjustment for traditional cardiovascular risk factors including the average home systolic BP (coefficient per 1 SD increase, 0.049 [95% CI, 0.018–0.081];
P
=0.002). Similar trends were found for CV
SBP
(
P
=0.003) and ARV
SBP
(
P
=0.004). However, these associations were not found in the lower baPWV group. There was an interaction between all indexes of systolic BP variability and the NT-proBNP level according to lower or higher baPWV group (all
P
<0.05). Arterial stiffness amplified the association between home BP variability and cardiac overload.
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Affiliation(s)
- Yusuke Ishiyama
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan (Y.I., S.H., K.K.)
| | - Satoshi Hoshide
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan (Y.I., S.H., K.K.)
| | - Hiroshi Kanegae
- Genki Plaza Medical Center for Health Care, Tokyo, Japan (H.K.)
| | - Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan (Y.I., S.H., K.K.)
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8
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Scuteri A, Morrell CH, Fegatelli DA, Fiorillo E, Delitala A, Orru' M, Marongiu M, Schlessinger D, Cucca F. Arterial stiffness and multiple organ damage: a longitudinal study in population. Aging Clin Exp Res 2020; 32:781-788. [PMID: 31302897 DOI: 10.1007/s40520-019-01260-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 06/24/2019] [Indexed: 12/18/2022]
Abstract
AIMS Previous cross-sectional observation identified arterial aging, indexed as pulse-wave velocity (PWV), as a key determinant of the simultaneous multiple organ damage (heart, carotid artery, and kidney). The aim of the present cohort study is to investigate trajectories of repeated measures of PWV and traditional CV risk factors in subjects who eventually presented clinical evidence of multiple organ damage in the SardiNIA study. METHODS AND RESULTS Organ damage was measured in the heart (left ventricular hypertrophy, LVH), the common carotid artery (intima-media thickness > 0.9 mm and/or plaque), and the kidney (eGFR < 60 ml/min/1.73 m2) of 2130 men and women of a broad age range participating the SardiNIA study. SHATS was defined as the simultaneous occurrence of all the three-organ damages. Trajectory in traditional CV risk factors and PWV was analyzed retrospectively (four observations over 9 years) according to the number of organ damage (from 0 to 3). Compared to subjects with no organ damage, after controlling for traditional CV risk factors, each 1 m/s increase in baseline PWV was accompanied by a 93% higher odds of developing SHATS; and each 1 cm/s (0.01 m/s) annual increase in PWV by a 31% greater odds of developing SHATS. CONCLUSIONS Arterial stiffness, a proxy of arterial aging that can be measured clinically as PWV, is an integrated predictive marker of multiple age-associated organ damage recognized as clinical diseases.
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Affiliation(s)
- Angelo Scuteri
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy.
| | - Cristopher H Morrell
- Laboratory of Cardiovascular Sciences, National Institute on Aging Intramural Research Program, NIH, Baltimore, USA
- Loyola University Maryland, Baltimore, USA
| | | | - Edoardo Fiorillo
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Lanusei, NU, Italy
| | - Alessandro Delitala
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Lanusei, NU, Italy
| | - Marco Orru'
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Lanusei, NU, Italy
| | - Michele Marongiu
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Lanusei, NU, Italy
| | - David Schlessinger
- Laboratory of Genetics, National Institute on Aging Intramural Research Program, NIH, Baltimore, USA
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica (IRGB), Consiglio Nazionale delle Ricerche (CNR), Cagliari, Italy
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9
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Control of 24-hour blood pressure with SGLT2 inhibitors to prevent cardiovascular disease. Prog Cardiovasc Dis 2020; 63:249-262. [PMID: 32275926 DOI: 10.1016/j.pcad.2020.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
The presence of hypertension (HTN) in patients with diabetes mellitus (DM) further worsens cardiovascular disease (CVD) prognosis. In addition, masked HTN and abnormal circadian blood pressure (BP) variability are common among patients with DM. Clinical trial data show that sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve CVD prognosis and prevent progression of renal dysfunction in high-risk patients with type 2 DM (T2DM). Consistent reductions in 24-hour, daytime and nocturnal BP have been documented during treatment with SGLT2i in patients with DM and HTN, and these reductions are of a magnitude that is likely to be clinically significant. SGLT2i agents also appear to have beneficial effects on morning, evening and nocturnal home BP. Greater reductions in BP during treatment with SGLT2i have been reported in patient subgroups with higher body mass index, and in those with higher baseline BP. Other documented beneficial effects of SGLT2i include reductions in arterial stiffness and the potential to decrease the apnea-hypopnea index in patients with DM and obstructive sleep apnea. Recent guidelines highlight the important role of SGLT2i as part of the pharmacological management of patients with DM and HTN, and recommend consideration of SGLT2i early in the clinical course to reduce all-cause and CVD mortality in patients with T2DM and CVD. Overall, available data support a role for SGLT2i as effective BP-lowering agents in patients with T2DM and poorly controlled HTN, irrespective of baseline glucose control status. Sustained improvements in 24-hour BP and the 24-hour BP profile are likely to contribute to the CVD benefits of SGLT2i treatment.
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10
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine (JMU), Tochigi, Japan.,JMU Center of Excellence, Community Medicine Cardiovascular Research and Development (JCARD), Tochigi, Japan
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Kario K, Chirinos JA, Townsend RR, Weber MA, Scuteri A, Avolio A, Hoshide S, Kabutoya T, Tomiyama H, Node K, Ohishi M, Ito S, Kishi T, Rakugi H, Li Y, Chen CH, Park JB, Wang JG. Systemic hemodynamic atherothrombotic syndrome (SHATS) – Coupling vascular disease and blood pressure variability: Proposed concept from pulse of Asia. Prog Cardiovasc Dis 2020; 63:22-32. [DOI: 10.1016/j.pcad.2019.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
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12
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Kario K. Systemic hemodynamic atherothrombotic syndrome (SHATS): Diagnosis and severity assessment score. J Clin Hypertens (Greenwich) 2019; 21:1011-1015. [DOI: 10.1111/jch.13542] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine Jichi Medical University School of Medicine Shimotsuke Japan
- Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network Tokyo Japan
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13
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Kario K. Hemodynamic arteriosclerotic syndrome - A vicious cycle of hemodynamic stress and vascular disease. J Clin Hypertens (Greenwich) 2018; 20:1073-1077. [DOI: 10.1111/jch.13313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Cardiovascular Research and Development (JCARD); Jichi Medical University School of Medicine, and Jichi Medical University Center of Excellence; Tochigi Japan
- Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network; Tochigi Japan
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14
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Imaizumi Y, Kario K, Eguchi K, Taketomi A. Daytime blood pressure surges following hypoxic episodes in a case of pneumoconiosis with lacunar stroke recurrences. Blood Press Monit 2017; 22:175-177. [PMID: 28263202 DOI: 10.1097/mbp.0000000000000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yuki Imaizumi
- aKotake Hospital bIizuka Municipal Hospital, Fukuoka cDepartment of Medicine, School of Medicine, Division of Cardiovascular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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15
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Imaizumi Y, Eguchi K, Murakami T, Saito T, Hoshide S, Kario K. Locomotive syndrome is associated with large blood pressure variability in elderly hypertensives: the Japan Ambulatory Blood Pressure Prospective (JAMP) substudy. J Clin Hypertens (Greenwich) 2016; 19:388-394. [PMID: 27862879 DOI: 10.1111/jch.12946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 01/24/2023]
Abstract
Chronic pain, represented by locomotive syndrome (LS), and psychosocial factors are possible factors of blood pressure (BP) variability (BPV). The authors tested the hypothesis that there are links among LS, depression, and BPV. In 85 Japanese elderly hypertensive patients with normal daily activities, the authors performed ambulatory BP monitoring, determined the LS scale (LSS), and administered the Self-Rating Questionnaire for Depression (SRQD). The LSS score but not the SRQD score was associated with the standard deviation (SD) and coefficient of variation (CV) of daytime systolic BP (SBP) and SD of nighttime SBP (all P<.05). Higher LSS score (in quartiles) was associated with a higher SD of daytime SBP (P=.041), even after adjusting for covariates. Regarding the components of the LSS score, movement-related difficulty and usual care difficulty were associated with the SD and CV of daytime SBP. In elderly hypertensive patients, the LSS score was associated with exaggerated systolic BPV. The LS state could be an important determinant of systolic BPV.
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Affiliation(s)
- Yuki Imaizumi
- Kotake Municipal Hospital, Kotake, Fukuoka, Japan.,Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | | | - Tomohiro Saito
- Department of Orthopedics, Fukuoka Mirai Hospital, Fukuoka, Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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16
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Kario K. Perfect 24-h management of hypertension: clinical relevance and perspectives. J Hum Hypertens 2016; 31:231-243. [PMID: 27604658 DOI: 10.1038/jhh.2016.65] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/27/2016] [Accepted: 08/05/2016] [Indexed: 12/31/2022]
Abstract
Out-of-office blood pressure (BP) measured by home BP monitoring, or ambulatory BP monitoring, was demonstrated to be superior to office BP for the prediction of cardiovascular events. The J-HOP study of a nationwide Japanese cohort demonstrated that morning home BP is the best stroke predictor. In the prospective HONEST study of >21 000 hypertensives, on-treatment morning home BP was shown to be a strong predictor both of future coronary artery disease and stroke events. In subjects whose office BP was maintained at ⩾150 mm Hg, there was no increase in cardiovascular events when their morning systolic BP was well-controlled at <125 mm Hg. Since Asians show greater morning BP surges, it is particularly important for Asians to achieve 'perfect 24-hr BP control,' that is, the 24-h BP level, nocturnal BP dipping and BP variability including morning surge. The morning BP surge and the extremes of disrupted circadian rhythm (riser and extreme dipper patterns) are independent risks for stroke in hypertensives. A morning BP-guided approach is thus the first step toward perfect 24-h BP control, followed by the control of nocturnal hypertension. In the resonance hypothesis, the synergistic resonance of BP variability phenotypes would produce an extraordinary large 'dynamic BP surge' that can trigger a cardiovascular event, especially in high-risk patients with systemic hemodynamic atherothrombotic syndrome, a vicious cycle of exaggerated BP variability and vascular disease. In the future, information and communications technology and artificial intelligence technology with the innovation of wearable continuous surge BP monitoring will contribute to 'anticipation medicine' with the goal of zero cardiovascular events.
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Affiliation(s)
- K Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi.,Jichi Medical University Center of Excellence, Cardiovascular Research and Development (JCARD), Shimotsuke, Tochigi.,Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tokyo
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17
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Kario K. Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events. Korean Circ J 2016; 46:456-67. [PMID: 27482253 PMCID: PMC4965423 DOI: 10.4070/kcj.2016.46.4.456] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/28/2016] [Accepted: 05/27/2016] [Indexed: 12/02/2022] Open
Abstract
Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.; Jichi Medical University Center of Excellence, Cardiovascular Research and Development (JCARD), Tochigi, Japan.; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tochigi, Japan
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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. Evidence and Perspectives on the 24-hour Management of Hypertension: Hemodynamic Biomarker-Initiated 'Anticipation Medicine' for Zero Cardiovascular Event. Prog Cardiovasc Dis 2016; 59:262-281. [PMID: 27080202 DOI: 10.1016/j.pcad.2016.04.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 12/29/2022]
Abstract
There are notable differences between Asians and Westerners regarding hypertension (HTN) and the relationship between HTN and cardiovascular disease (CVD). Asians show greater morning surges in blood pressure (BP) and a steeper slope illustrating the link between higher BP and the risk of CVD events. It is thus particularly important for Asian hypertensives to achieve 24-h BP control, including morning and night-time control. There are three components of 'perfect 24-h BP control:' the 24-h BP level, nocturnal BP dipping, and BP variability (BPV), such as the morning BP surge that can be assessed by ambulatory BP monitoring. The morning BP-guided approach using home BP monitoring (HBPM) is the first step toward perfect 24-h BP control, followed by the control of nocturnal HTN. We have been developing new HBPM devices that can measure nocturnal BP. BPV includes different time-phase variability from the shortest beat-by-beat, positional, diurnal, day-by-day, visit-to-visit, seasonal, and yearly changes. The synergistic resonance of each type of BPV would produce a great dynamic BP surge (resonance hypothesis), which triggers a CVD event, especially in the high-risk patients with systemic hemodynamic atherothrombotic syndrome (SHATS). In the future, the innovative management of HTN based on the simultaneous assessment of the resonance of all of the BPV phenotypes using a beat by beat wearable 'surge' BP monitoring device (WSP) and an information and communication technology (ICT)-based data analysis system will produce a paradigm shift from 'dots' BP management to 'seamless' ultimate individualized 'anticipation medication' for reaching a zero CVD event rate.
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Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Jichi Medical University Center of Excellence, Cardiovascular Research and Development (JCARD), Tochigi, Japan; Hypertension Cardiovascular Outcome Prevention and Evidence in Asia (HOPE Asia) Network, Tokyo, Japan.
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Kario K, Hamasaki H. Nocturnal Blood Pressure Surge Behind Morning Surge in Obstructive Sleep Apnea Syndrome: Another Phenotype of Systemic Hemodynamic Atherothrombotic Syndrome. J Clin Hypertens (Greenwich) 2015; 17:682-5. [DOI: 10.1111/jch.12576] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Kazuomi Kario
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
| | - Haruna Hamasaki
- Division of Cardiovascular Medicine; Department of Medicine; Jichi Medical University School of Medicine; Shimotsuke Tochigi Japan
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