Hypertension research : official journal of the Japanese Society of Hypertension
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Multicenter Study
Cognitive dysfunction and physical disability are associated with mortality in extremely elderly patients.
A few reports have demonstrated that cognitive or physical dysfunction is associated with increased mortality in very elderly patients, those over 80 years of age. Using simple clinical tests, we evaluated the impact of cognitive or physical dysfunction on future total and cardiovascular deaths. We conducted a multicenter prospective study of 523 extremely elderly outpatients, aged > or = 80 years (mean +/- SD age: 84 +/- 5.3 years). ⋯ In a Cox regression analysis model controlling for age, sex, body mass index (BMI), diastolic blood pressure (BP), cholesterol level, and history of cardiovascular diseases, cognitive dysfunction was found to be an independent risk factor for total death (p < 0.001), and cognitive dysfunction (p < 0.001) and physical dysfunction (p = 0.05) were independent risk factors for cardiovascular death. The determinants of cognitive dysfunction were associated with a lower diastolic BP (p = 0.04) adjusted for age, BMI, and a history of cardiovascular disease. Cognitive function, which was associated with lower BP levels, and physical function were the independent predictors of total and cardiovascular mortality among all cardiovascular risk factors in the very elderly, those at least 80 years of age.
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Randomized Controlled Trial Multicenter Study
Effect of renin-angiotensin-aldosterone system triple blockade on non-diabetic renal disease: addition of an aldosterone blocker, spironolactone, to combination treatment with an angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker.
Although dual blockade of the renin-angiotensin-aldosterone system (RAAS) with the combination of an angiotensin-converting enzyme inhibitor (ACE-I) and angiotensin II receptor blocker (ARB) is generally well-established as a treatment for nephropathy, this treatment is not fully effective in some patients. Based on the recent evidence implicating aldosterone in renal disease progression, this study was conducted to examine the efficacy of blockade with three different mechanisms by adding an aldosterone blocker in patients who do not respond adequately to the dual blockade. A 1-year randomized, open-label, multicenter, prospective controlled study was conducted, in which 32 non-diabetic nephropathy patients with proteinuria exceeding 0.5 g/day were enrolled after more than 12 weeks of ACE-I (5 mg enalapril) and ARB (50 mg losartan) combination treatment. ⋯ The decreases in urinary protein and urinary type IV collagen were not accompanied by a decrease in blood pressure. Mean serum creatinine, potassium and blood pressure did not change significantly by either treatment. In conclusion, triple blockade of the RAAS was effective for the treatment of proteinuria in patients with non-diabetic nephropathy whose increased urinary protein had not responded sufficiently to a dual blockade.
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Multicenter Study
The Japan Morning Surge-1 (JMS-1) study: protocol description.
Morning blood pressure is reported to be more closely related to hypertensive organ damages such as left ventricular mass index, microalbuminuria and silent cerebral infarcts, than blood pressure at other times of the day. Morning blood pressure may play an important role in the pathogenesis of hypertensive target organ damage. Increased sympathetic nerve activity is reported to be one of the mechanisms of morning hypertension; however, there are no available data that show whether strict home blood pressure control, especially in the morning period, can reduce target organ damage. ⋯ Patients in the control group continue the treatment they are receiving at the enrollment for 6 months. Blood pressure levels, adverse effects, and hypertensive target organ damage before and after the study are evaluated. In the JMS-1 study, we will evaluate whether strict morning blood pressure control by sympathetic nervous system blockade using an alpha-blocker, doxazosin, and with the addition of a beta-blocker if needed, can reduce hypertensive target organ damage.