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Takama N, Kato T, Shiina T, Fujii T, Amanai S, Ishibashi Y, Ishii H. Real-world data in the management of hypertension for patients with sleep disordered breathing after initiating continuous positive airway pressure treatment. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
There are many reports that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) is effective for hypertension for improvement of sympathetic nervous activity reason. Previously, we reported that SDB is just as, if not more, important as common classical risk factors (hypertension, dyslipidemia, diabetes mellitus) for patients with cardiovascular diseases (Figure 1).
Purpose
Our aim in this study is to estimate the real-world data in the management of hypertension for patients with SDB after initiating CPAP treatment.
Methods
All patients were conducted full night polysomnography. One-hundred ninety-five patients showed obstructive SDB {apnea hypopnea index (AHI) >20/hour}, and CPAP treatment were initiated. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the blood pressure and presence of blood pressure-lowering agents to assess effectiveness of CPAP treatment after six-month follow up.
Results
The study group consisted of 195 SDB patients (166 males, 29 females). The mean age was 59±7 years. Figure 2 showed the blood pressure and presence of blood pressure-lowering agents after initiating CPAP treatment. Group A which showed systolic blood pressure (SBP) <130 mmHg without intake of blood pressure-lowering agents was 20.9%. Group B which showed SBP <130 mmHg with intake of blood pressure-lowering agents was 9.6%. Group C showed SBP≥130 mmHg without intake of blood pressure-lowering agents was 30.5%. Group D showed SBP≥130 mmHg with intake of blood pressure-lowering agents was 39.0%.
Conclusion
We could estimate that there were high prevalence of hypertension for patients with SDB after initiating CPAP treatment. It is true that CPAP treatment have a beneficial effect on hypertension, but 70% patients (Group C and D) still remain inadequately treated. We need the strict blood pressure follow up for patient with SDB before and after initiating CPAP treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Takama
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - T Kato
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - T Shiina
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - T Fujii
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - S Amanai
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - Y Ishibashi
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
| | - H Ishii
- Gunma University School of Medicine, Department of Cardiovascular Medicine , Maebashi , Japan
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Yanagi T, Takama N, Kato E, Baba F, Shimohira M, Kitase M, Shibamoto Y. Clinical Outcomes of Intraoperative Radiation Therapy, Postoperative Radiation Therapy, and Definitive Radiation Therapy for Non-Metastatic Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nagasaka T, Funada R, Umeyama A, Sato M, Takama N, Kurabayashi M. P870Long-term outcome of hemodialysis patients after deferral revascularization based on functional flow reverse. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nakajima T, Ono Y, Kaneko Y, Saito A, Imai M, Iizuka T, Irie T, Funada R, Takama N, Kasama S, Nakamura K, Niwamae N, Tange S, Kurabayashi M. P799The clinical and genetic predispositions to ventricular tachyarrhythmias associated with vasospastic angina. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Umeyama A, Takama N, Nagasaka T, Kurabayashi M. P6177Brain natriuretic peptide is good predictor for assessing super responders of adaptive servo ventilation therapy in patients with heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Iwata H, Ogino H, Akita K, Takama N, Murai T, Uchiyama K, Nakamae K, Iwana M, Baba F, Shibamoto Y, Mizoe J. Tumor Regression Curve During and After Concurrent Chemotherapy and Proton Therapy for Unresectable Stage III Non-Small Cell Lung Cancer: Comparison With Chemo-X-Radiation Therapy. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hayashi A, Sugie C, Yoshihiko M, Takaoka T, Nagasawa M, Takama N, Iwabuchi M, Takenaka R, Yanagi T, Shibamoto Y. Study on the Optimal Field Width in Helical Tomotherapy With the New Dynamic Jaws Technology for Small Metastatic Brain Tumors. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kawaguchi R, Hoshizaki H, Oshima S, Ito S, Hiratsuji T, Tsurugaya H, Ito I, Sekiguchi M, Takama N, Seta Y, Adachi H, Toyama T, Naito S, Kaneko T, Taniguchi K. [Strategy for post coronary artery bypass grafting in patients with bypass graft stenosis: comparison of percutaneous transluminal coronary angioplasty for the native coronary artery, internal mammary artery and saphenous vein graft]. J Cardiol 2001; 38:239-44. [PMID: 11729723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVES The strategy for post coronary artery bypass grafting (CABG) was investigated in patients with graft stenosis. METHODS The study included 123 post-CABG patients with graft stenosis. The patients were divided into three groups according to target vessels; saphenous vein graft (SVG; n = 72), internal mammary artery (IMA; n = 21) and native coronary artery (n = 30). Furthermore, SVG lesions were divided into proximal anastomosis (n = 23), body (n = 40) and distal anastomosis (n = 9). The procedural success rate and late patency rate were compared between the three groups. Furthermore, the relationships between pre percutaneous transluminal coronary angioplasty (PTCA) percentage diameter stenosis, procedural success rate and late patency rate were evaluated. RESULTS Procedural success rate was similar in the three groups, but late patency rate was higher in the IMA group. Procedural success rate and late patency rate were significantly lower in proximal anastomoses compared to other sites of SVG stenoses, IMA group and native coronary artery group (p < 0.05). Totally occluded native coronary artery lesions had a high procedural success rate compared with occluded IMA and SVG lesions, but the late patency rate was not higher. Procedural success rate showed no significant difference for 75-99% stenotic lesions, but the late patency rate was significantly higher in the IMA group (p < 0.05). Patients in the stenting group had a greater late patency rate compared with the balloon angioplasty group. There was no significant difference in late patency rate between the IMA group and SVG group. CONCLUSIONS Late patency rate of the IMA is higher than that of the native coronary artery. SVG with proximal anastomosis and severe stenosis shows a significantly lower late patency rate than the native coronary artery. Therefore, PTCA should be considered for the native coronary artery in the absence of chronic total occlusion.
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Affiliation(s)
- R Kawaguchi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Kameizumimachi 3-12, Maebasi, Gunma 371-0004
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Kawaguchi R, Toyama T, Sekiguchi M, Takama N, Adachi H, Naito S, Hoshizaki H, Oshima S, Taniguchi K. [Outcome of patients with significant coronary stenosis but without ischemic evidence on exercise myocardial perfusion scintigraphy]. J Cardiol 2001; 37:151-6. [PMID: 11281055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVES The rates of cardiac events and coronary revascularization were evaluated in patients with significant coronary stenosis of more than 75% by the American Heart Association (AHA) classification but no ischemic evidence by exercise myocardial perfusion scintigraphy. METHODS Subjects were 171 patients (113 males, 58 females, mean age 66 +/- 9 years) undergoing coronary angiography and without scintigraphic evidence of myocardial ischemia. They were divided into two groups according to the severity of coronary artery stenosis based on AHA classification. Group A was composed of 139 patients with more than 75% stenosis (101 patients with 75% stenosis and 38 patients with more than 90% stenosis), and Group B was composed of 32 patients with 50% stenosis. Cardiac events including angina pectoris (n = 63), myocardial infarction (n = 1), heart failure (n = 2) and cardiac death (n = 0), coronary revascularization and predictive factors were evaluated during follow-up of 34 +/- 21 months. Furthermore, the interval between coronary revascularization and exercise myocardial perfusion scintigraphy was estimated. RESULTS The rates of cardiac events (45%) and coronary revascularization (29%) in Group A were significantly higher than the rate of cardiac events (9%, p < 0.05) and coronary revascularization (6%, p < 0.05) in Group B. Only percentage stenosis and the number of diseased vessels affected the rates of cardiac event and coronary revascularization. CONCLUSIONS Patients with significant coronary stenosis, but without ischemic evidence by exercise myocardial perfusion scintigraphy, have a relatively high rate of cardiac event and coronary revascularization, especially in patients with severe stenosis or multivessel disease. However, coronary revascularization should not be performed in all patients with significant coronary stenosis.
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Affiliation(s)
- R Kawaguchi
- Cardiology Division, Gunma Prefectural Cardiovascular Center, Kameizumimachi 3-12, Maebashi, Gunma 371-0004
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Toyama T, Suguta M, Hoshizaki H, Koitabashi N, Takama N, Nakatsugawa M, Oshima S, Taniguchi K. [Usefulness of early tetrofosmin myocardial SPECT during subacute period to estimate salvaged myocardium in patients with acute myocardial infarction--comparing with tetrofosmin myocardial SPECT during chronic period and evaluating regional wall motion using QGS method]. Kaku Igaku 2000; 37:613-20. [PMID: 11193446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
To evaluate salvaged myocardium of acute myocardial infarction (AMI), we performed rest 99mTc-tetrofosmin (TF) SPECT with rest Tl and Tc-pyrophosphate (PYP) dual SPECT within 10 days after admission in 19 patients with initial AMI, who all were reperfused successfully and without restenosis. TF SPECT was obtained at 15 minutes (E) after tracer injection, 4 hours later (D), and 5 months later (FU). We calculated the regional uptake score (RUS) of infarcted area estimated by Tc-PYP uptake and defined RUS(FU) of TF(FU) as salvaged myocardium, and then regarded RUS/RUS(FU) x 100 (%) as subacute predicted value of salvaged myocardium. Furthermore, we regarded the improvement of wall motion estimated by QGS method as the guidepost of myocardial viability. The subacute predicted value of TF(E) was 85 +/- 25%, which was significantly higher than 61 +/- 28% of Tl and 36 +/- 24% of TF(D) (p < 0.01). Sensitivity and specificity of myocardial viability based on the improvement of wall motion SPECT image were 78% and 73% for Tl, 90% and 87% for TF(E) and 52% and 87% for TF(D). TF myocardial early imaging in subacute period was useful to detect salvaged myocardium.
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Affiliation(s)
- T Toyama
- Gunma Prefectural Cardiovascular Center
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Takama N, Nakamura T, Nagai R. [Hypertensive hypertrophic cardiomyopathy]. Nihon Rinsho 2000; 58 Suppl 1:749-53. [PMID: 11026372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- N Takama
- Second Department of Internal Medicine, Gunma University School of Medicine
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Otaka Y, Takama N, Umehara C, Matsuo H, Shibata N. [Discussion: ideal medical education in the future--humanity, medicine, and education]. Zasshi Tokyo Ika Daigaku 1969; 27:741-63. [PMID: 5408480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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