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Article: [Guidelines for antihypertensive treatment of elderly hypertensive patients without complications based on EBM].

Okaishi, Kohya / Morimoto, Shigeto / Matsumoto, Masayuki

Nihon rinsho. Japanese journal of clinical medicine

2005 Volume 63, Issue 6, Page(s) 1016–1027

Abstract: Hypertension is one of the most significant risk factors for cerebrovascular and heart diseases, which rank as the second and third most frequent causes of death in Japan, respectively. The prevalence of hypertension rises as the population grows older, ... ...

Abstract	Hypertension is one of the most significant risk factors for cerebrovascular and heart diseases, which rank as the second and third most frequent causes of death in Japan, respectively. The prevalence of hypertension rises as the population grows older, affecting approximately 60% of the Japanese aged 65 yr or older, and there are currently more patients receiving treatment for hypertension than for any other disease in Japan. As the size of the elderly populations in our country continuously increases rapidly, hypertension has become one of the most important diseases to be treated. Based on the results of numerous clinical intervention trials, treatment of hypertension in the elderly, including treatment of systolic hypertension, has generally been of great benefit. However, the efficacy of treatment of so-called very old hypertensive patients aged 85 yr or older is still controversial. Recently, Guidelines for the Management of Hypertension of Japanese Society of Hypertension (JSH 2004) has been reported, which are based on evidence-based medicine(EBM), adopting the results of mega-trials in Japan and in Western countries, but also considering the lifestyle of Japanese. This paper explaines the part of "Antihypertensive Treatment of Elderly Hypertensive Patients without Complications" in the Guidelines.
MeSH term(s)	Aged ; Aged, 80 and over ; Antihypertensive Agents/administration & dosage ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Circadian Rhythm ; Contraindications ; Diagnosis, Differential ; Drug Interactions ; Drug Therapy, Combination ; Evidence-Based Medicine ; Humans ; Hypertension/diagnosis ; Hypertension/etiology ; Hypertension/physiopathology ; Hypertension/therapy ; Japan ; Life Style ; Practice Guidelines as Topic ; Quality of Life ; Societies, Medical
Chemical Substances	Antihypertensive Agents
Language	Japanese
Publishing date	2005-06
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	390903-7
ISSN	0047-1852
ISSN	0047-1852
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Article: [Prevention of hip fracture in the elderly].

Morimoto, Shigeto / Okaishi, Kohya / Nakahashi, Tsuyoshi / Matsumoto, Masayuki

Clinical calcium

2003 Volume 13, Issue 2, Page(s) 158–163

Abstract: Hip fracture directly resulted in bedridden state in the elderly. Both development of osteoporosis and contusion of greater trochanter by accidental fall are important causes for the fracture. Large-scale interventions with randomized controlled methods ... ...

Abstract	Hip fracture directly resulted in bedridden state in the elderly. Both development of osteoporosis and contusion of greater trochanter by accidental fall are important causes for the fracture. Large-scale interventions with randomized controlled methods revealed that alendronate, risedronate, some estrogens and hip protector were effective for prevention of hip fractures in the elderly although newly administration of estrogens are not recommended due to their increasing effects for cardiovascular complications. This report gives an outline fo prevention of hip fracture in the elderly.
Language	Japanese
Publishing date	2003-02
Publishing country	Japan
Document type	English Abstract ; Journal Article
ZDB-ID	2386417-5
ISSN	0917-5857
ISSN	0917-5857
DOI	CliCa0302158163
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Article: Tilting-induced decrease in systolic blood pressure in bedridden hypertensive elderly inpatients: effects of azelnidipine.

Morimoto, Shigeto / Takahashi, Takashi / Okaishi, Kohya / Nakahashi, Takeshi / Nomura, Kohji / Kanda, Tsugiyasu / Okuro, Masashi / Murai, Hiroshi / Nishino, Tomoichi / Matsumoto, Masayuki

Hypertension research : official journal of the Japanese Society of Hypertension

2006 Volume 29, Issue 12, Page(s) 943–949

Abstract: The object of this study was to examine blood pressure (BP) variability due to postural change in elderly hypertensive patients. The subjects studied were 154 elderly inpatients in a hospital for the elderly (48 male and 106 female; median age: 82 years), ...

Abstract	The object of this study was to examine blood pressure (BP) variability due to postural change in elderly hypertensive patients. The subjects studied were 154 elderly inpatients in a hospital for the elderly (48 male and 106 female; median age: 82 years), consisting of age- and sex-matched bedridden (n=39) and non-bedridden (n=39) normotensive controls and bedridden (n=38) and non-bedridden (n=38) hypertensive patients. BP and pulse rate (PR) were measured in the supine position, then again after a 2-min, 45 deg head-up tilt with the legs horizontal. The decrease in systolic BP (SBP) on tilting in the bedridden hypertensive group (median: -10 mmHg; range: -32 to 9 mmHg) was significantly (p<0.008) greater than those in the other three groups. Monotherapy with azeinidipine, a long-acting calcium channel blocker, for 3 months not only significantly reduced the basal BP and PR of hypertensive patients in the two groups, but also significantly (p<0.05) attenuated the tilt-induced decrease in the SBP to -3 mmHg (-19 to 25 mmHg) and enhanced the change in PR from -1 bpm (-10 to 7 bpm) to 1 bpm (-4 to 23 bpm) in the bedridden hypertensive group. Our findings indicate that tilt-induced decrease in SBP is a rather common phenomenon in bedridden elderly hypertensive patients, and that treatment with azelnidipine attenuates tilt-induced decrease in SBP, probably through an improvement of baroreceptor sensitivity.
MeSH term(s)	Aged ; Aged, 80 and over ; Azetidinecarboxylic Acid/analogs & derivatives ; Azetidinecarboxylic Acid/therapeutic use ; Blood Pressure ; Calcium Channel Blockers/therapeutic use ; Dihydropyridines/therapeutic use ; Female ; Humans ; Hypertension/drug therapy ; Inpatients ; Male ; Posture ; Systole
Chemical Substances	Calcium Channel Blockers ; Dihydropyridines ; Azetidinecarboxylic Acid (2517-04-6) ; azelnidipine (PV23P19YUG)
Language	English
Publishing date	2006-12
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1175297-x
ISSN	0916-9636
ISSN	0916-9636
DOI	10.1291/hypres.29.943
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Zs.A 3898: Show issues

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Article: Angiotensin I-converting enzyme inhibitor improves reactive hyperemia in elderly hypertensives with arteriosclerosis obliterans.

Okuro, Masashi / Morimoto, Shigeto / Takahashi, Takashi / Okaishi, Kohya / Nakahashi, Takeshi / Murai, Hiroshi / Iwai, Kunimitsu / Kanda, Tsugiyasu / Matsumoto, Masayuki

Hypertension research : official journal of the Japanese Society of Hypertension

2006 Volume 29, Issue 9, Page(s) 655–663

Abstract: Endothelial function in elderly hypertensive patients with arteriosclerosis obliterans has not been evaluated. We examined whether antihypertensive drugs improve vasodilatory response to reactive hyperemia of the limbs in elderly hypertensive patients ( ... ...

Abstract	Endothelial function in elderly hypertensive patients with arteriosclerosis obliterans has not been evaluated. We examined whether antihypertensive drugs improve vasodilatory response to reactive hyperemia of the limbs in elderly hypertensive patients (83 +/- 8 [SD] years) without (n=46, 0.9 < or = ankle-brachial pressure index < or = 1.4) and with (n=24) arteriosclerosis obliterans (ankle-brachial pressure index < 0.2). Patients were randomized for treatment with monotherapy of either temocapril (14 with and 26 without arteriosclerosis obliterans) or amlodipine (10 with and 20 without arteriosclerosis obliterans) for 6 months. Blood flows of the forearms and legs were measured by strain-gauge plethysmography. The vasodilatory response to the release of compression of the forearms and thighs at 200 mmHg or 20 mmHg more than systolic blood pressure for 5 min and to sublingual administration of nitroglycerin (0.3 mg) was assessed. The maximum reactive hyperemic flow in 35 legs with arteriosclerosis obliterans was significantly (p < 0.001) decreased compared to the value in legs in the control hypertensive subjects. Moreover, maximum reactive hyperemic flow in the forearms of patients with arteriosclerosis obliterans was significantly (p = 0.002) decreased compared to that in the control subjects. Blood pressure was similarly decreased by treatment with temocapril or amlodipine. Response to nitroglycerin (0.3 mg) was not changed by either drug. Treatment with temocapril significantly improved maximum reactive hyperemic flow of not only the legs and forearms in control hypertensives but also the legs and forearms in patients with arteriosclerosis obliterans, and attenuated the worsening of activity of daily living in these patients, although treatment with amlodipine did not. These results suggest that the angiotensin-converting enzyme inhibitor temocapril has a beneficial effect on endothelial function in elderly patients with arteriosclerosis obliterans.
MeSH term(s)	Aged ; Aged, 80 and over ; Amlodipine/pharmacology ; Amlodipine/therapeutic use ; Angiotensin-Converting Enzyme Inhibitors/pharmacology ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Arteriosclerosis Obliterans/drug therapy ; Calcium Channel Blockers/pharmacology ; Calcium Channel Blockers/therapeutic use ; Female ; Forearm/blood supply ; Humans ; Hyperemia/drug therapy ; Hypertension/drug therapy ; Leg/blood supply ; Male ; Thiazepines/pharmacology ; Thiazepines/therapeutic use ; Vasodilation/drug effects
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Calcium Channel Blockers ; Thiazepines ; Amlodipine (1J444QC288) ; temocapril hydrochloride (8G820I95VP)
Language	English
Publishing date	2006-09
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1175297-x
ISSN	0916-9636
ISSN	0916-9636
DOI	10.1291/hypres.29.655
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Article: Reduction of pneumonia risk by an angiotensin I-converting enzyme inhibitor in elderly Japanese inpatients according to insertion/deletion polymorphism of the angiotensin I-converting enzyme gene.

Takahashi, Takashi / Morimoto, Shigeto / Okaishi, Kohya / Kanda, Tsugiyasu / Nakahashi, Takeshi / Okuro, Masashi / Murai, Hiroshi / Nishimura, Yukiharu / Iwai, Kunimitsu / Matsumoto, Masayuki

American journal of hypertension

2005 Volume 18, Issue 10, Page(s) 1353–1359

Abstract: Background: We have reported that use of angiotensin I-converting enzyme (ACE) inhibitor, which is a class of antihypertensive agent that induces cough, is an independent factor in reducing risk of pneumonia among elderly inpatients. Insertion/deletion ( ...

Abstract	Background: We have reported that use of angiotensin I-converting enzyme (ACE) inhibitor, which is a class of antihypertensive agent that induces cough, is an independent factor in reducing risk of pneumonia among elderly inpatients. Insertion/deletion (I/D) polymorphism of the ACE gene (ACE) has been associated with the risk of pneumonia in elderly individuals. However, the ability of ACE inhibitors to reduce pneumonia-related morbidity in individuals with the ACE polymorphism is unclear. Therefore we determined the association of ACE inhibitor use and ACE genotypes with reduction of pneumonia risk in the Japanese elderly population. Methods: We conducted a hospital-based, retrospective, case-control study to evaluate the effect of an ACE inhibitor and ACE polymorphism on incidence of pneumonia. Case subjects were pneumonia patients (N = 105) >or=65 years of age, during an 8-month period of a nonwinter season. Control subjects (n = 420) were elderly patients who were frequency matched to the case subjects by age (within +/- 2 years) and gender. Data were collected on medication with the ACE inhibitor temocapril and on known risk factors for pneumonia. The significances of differences for the risk factors were analyzed using univariate and multivariate comparisons of the case and control subjects. Results: After adjustment for potential confounders by multiple logistic regression analysis, the odds ratio (OR) estimates for pneumonia were 0.458 (95% confidential interval [CI]: 0.230 to 0.909, P = .026) for ACE inhibitor use. Conditional logistic regression analysis according to ACE genotypes revealed significant reduction of pneumonia risk by use of temocapril compared with that in nonhypertensive individuals (ie, the reference group) in those with ACE ID + II (OR: 0. 416, 95% CI: 0.177 to 0.976, P = .044), but not in those with ACE DD (OR: 0.706, 95% CI: 0.198 to 2.518, P = .592). Conclusion: These results suggest that use of an ACE inhibitor is beneficial for reducing risk of pneumonia, particularly in individuals with the ACE genotypes ID + II.
MeSH term(s)	Aged ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Antihypertensive Agents/therapeutic use ; Case-Control Studies ; Female ; Gene Deletion ; Genetic Predisposition to Disease/genetics ; Genotype ; Humans ; Incidence ; Japan/epidemiology ; Male ; Multivariate Analysis ; Mutagenesis, Insertional ; Peptidyl-Dipeptidase A/genetics ; Pneumonia/drug therapy ; Pneumonia/epidemiology ; Pneumonia/genetics ; Polymorphism, Genetic/genetics ; Retrospective Studies ; Risk Factors ; Thiazepines/therapeutic use ; Treatment Outcome
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Thiazepines ; temocapril hydrochloride (8G820I95VP) ; Peptidyl-Dipeptidase A (EC 3.4.15.1)
Language	English
Publishing date	2005-10
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639383-4
ISSN	1879-1905 ; 0895-7061
ISSN (online)	1879-1905
ISSN	0895-7061
DOI	10.1016/j.amjhyper.2005.04.020
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Zs.A 2329: Show issues

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Article: Deletion allele of the angiotensin-converting enzyme gene as a risk factor for pneumonia in elderly patients.

Morimoto, Shigeto / Okaishi, Kohya / Onishi, Miyuki / Katsuya, Tomohiro / Yang, Jin / Okuro, Masashi / Sakurai, Shoroku / Onishi, Toshio / Ogihara, Toshio

The American journal of medicine

2002 Volume 112, Issue 2, Page(s) 89–94

Abstract: Purpose: Aspiration due to an age-related reduction in cough is a major cause of pneumonia in elderly persons. Because the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene (ACE) has been associated with the cough ... ...

Abstract	Purpose: Aspiration due to an age-related reduction in cough is a major cause of pneumonia in elderly persons. Because the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene (ACE) has been associated with the cough reflex, we studied whether this genetic polymorphism was also associated with the risk of pneumonia. Subjects and methods: We studied 1011 elderly inpatients (221 men and 790 women, mean [+/- SD] age of 82 +/- 7 years) in a long-term care hospital. The association between the ACE I/D polymorphism and the incidence of pneumonia (defined using specific criteria that included radiographic abnormalities) was assessed during an 8-month period that excluded the winter. Data were analyzed using proportional hazards models, with adjustment for age, sex, and other potential confounders. Results: During follow-up, 87 cases (9%) of pneumonia occurred, 38 of which were fatal. The ACE DD allele (vs. ID + II) was associated with an increased risk of pneumonia (relative risk [RR] = 2.9; 95% confidence interval [CI]: 1.7 to 4.8, P < 0.001) and fatal pneumonia [RR = 4.4; 95% CI: 2.1 to 9.0; P < 0.0001). Conclusions: The ACE D allele is an independent risk factor for pneumonia in elderly persons.
MeSH term(s)	Aged ; Aged, 80 and over ; Alleles ; Female ; Follow-Up Studies ; Gene Deletion ; Gene Frequency ; Genotype ; Humans ; Incidence ; Japan/epidemiology ; Male ; Peptidyl-Dipeptidase A/genetics ; Pneumonia/enzymology ; Pneumonia/epidemiology ; Pneumonia/genetics ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Proportional Hazards Models ; Risk Factors
Chemical Substances	Peptidyl-Dipeptidase A (EC 3.4.15.1)
Language	English
Publishing date	2002-02-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/s0002-9343(01)01071-3
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Article: [A ninety-eight-year-old woman with ruptured pancreatic anaplastic mucinous cystadenocarcinoma].

Murai, Hiroshi / Morimoto, Shigeto / Ohashi, Isao / Okaishi, Kohya / Tsuchiy, Hiroshi / Iwai, Kunimitsu / Nakahashi, Takeshi / Nishimura, Yukiharu / Okuro, Masashi / Miyauchi, Eiji / Nojima, Takayuki / Matsumoto, Masayuki

Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics

2006 Volume 43, Issue 2, Page(s) 246–251

Abstract: A 98-year-old woman was admitted to our hospital complaining of anorexia, epigastralgia, and vomiting. An elastic hard tumor was palpable in her epigastric region. CT and US examination revealed a huge cystic lesion adjacent to the left lobe of the liver ...

Abstract	A 98-year-old woman was admitted to our hospital complaining of anorexia, epigastralgia, and vomiting. An elastic hard tumor was palpable in her epigastric region. CT and US examination revealed a huge cystic lesion adjacent to the left lobe of the liver and the stomach. Her serum levels of CEA (13.6 ng/ml), CA19-9 (95 U/ml) and CA125 (99 U/ml) were high. She suffered from aspiration pneumonia on the 10th day of admission, which progressed to acute respiratory distress syndrome. On the 20th day of admission, the epigastric tumor suddenly disappeared. She passed away on the 31st day due to respiratory failure. Autopsy revealed that she had a ruptured pancreatic anaplastic mucinous cystadenocarcinoma. To the best of our knowledge, this is the oldest reported case of ruptured pancreatic cystadenocarcinoma in the world.
MeSH term(s)	Aged, 80 and over ; Cystadenocarcinoma, Mucinous/diagnosis ; Cystadenocarcinoma, Mucinous/pathology ; Female ; Humans ; Pancreatic Cyst/diagnosis ; Pancreatic Cyst/pathology ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/pathology ; Rupture, Spontaneous
Language	Japanese
Publishing date	2006-05-01
Publishing country	Japan
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	604107-3
ISSN	0300-9173
ISSN	0300-9173
DOI	10.3143/geriatrics.43.246
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Zs.A 1039: Show issues

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Article: Questionnaire survey on the Japanese guidelines for treatment of hypertension in the elderly: 1999 revised version.

Ogihara, Toshio / Morimoto, Shigeto / Okaishi, Kohya / Hiwada, Kunio / Matsuoka, Hiroaki / Matsumoto, Masayuki / Takishita, Shuichi / Shimamoto, Kazuaki / Shimada, Kazuyuki / Abe, Isao / Kohara, Katsuhiko / Ouchi, Yasuyoshi

Hypertension research : official journal of the Japanese Society of Hypertension

2003 Volume 25, Issue 1, Page(s) 69–75

Abstract: A questionnaire survey was administered to Japanese clinical specialists in hypertension in order to gauge their opinions on the 1999 revised version of the Guidelines for Hypertension in the Elderly prepared by the Comprehensive Research Project on ... ...

Abstract	A questionnaire survey was administered to Japanese clinical specialists in hypertension in order to gauge their opinions on the 1999 revised version of the Guidelines for Hypertension in the Elderly prepared by the Comprehensive Research Project on Aging and Health of the Ministry of Health and Welfare. Out of 162 council members of the Japanese Society of Hypertension, 122 (75%) replied. The majority (93%) of respondents approved of the guidelines in general, and 72% of them approved of the age-related setting of a therapeutic goal for blood pressure. Sixty-five percent of respondents selected long-acting Ca antagonists, ACE inhibitors and low-dose diuretics as first-line agents for hypertension without complications in the elderly. The results of the questionnaire survey should be reflected in the next version of the guidelines.
MeSH term(s)	Aged ; Aging/physiology ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Calcium Channel Blockers/therapeutic use ; Cardiology ; Data Collection ; Diuretics/administration & dosage ; Diuretics/therapeutic use ; Dose-Response Relationship, Drug ; Humans ; Hypertension/drug therapy ; Japan ; Practice Guidelines as Topic/standards ; Societies, Medical ; Surveys and Questionnaires
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Calcium Channel Blockers ; Diuretics
Language	English
Publishing date	2003-02-21
Publishing country	England
Document type	Evaluation Studies ; Journal Article
ZDB-ID	1175297-x
ISSN	0916-9636
ISSN	0916-9636
DOI	10.1291/hypres.25.69
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Article: Guidelines for treatment of hypertension in the elderly--2002 revised version.

Ogihara, Toshio / Hiwada, Kunio / Morimoto, Shigeto / Matsuoka, Hiroaki / Matsumoto, Masayuki / Takishita, Shuichi / Shimamoto, Kazuaki / Shimada, Kazuyuki / Abe, Isao / Ouchi, Yasuyoshi / Tsukiyama, Hisaichiro / Katayama, Shigehiro / Imai, Yutaka / Suzuki, Hiromichi / Kohara, Katsuhiko / Okaishi, Kohya / Mikami, Hiroshi

Hypertension research : official journal of the Japanese Society of Hypertension

2003 Volume 26, Issue 1, Page(s) 1–36

MeSH term(s)	Aged ; Antihypertensive Agents/therapeutic use ; Geriatrics/standards ; Humans ; Hypertension/diagnosis ; Hypertension/drug therapy ; Practice Guidelines as Topic
Chemical Substances	Antihypertensive Agents
Language	English
Publishing date	2003-11-03
Publishing country	England
Document type	Consensus Development Conference ; Journal Article ; Review
ZDB-ID	1175297-x
ISSN	0916-9636
ISSN	0916-9636
DOI	10.1291/hypres.26.1
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