PubMed Health⌕ Search

Biomedical subjects

T Ishimitsu

Publications and source records attributed to T Ishimitsu.

At least 55 records · Page 3Linked to original sources
PubMed1998

Comparison between cilnidipine and nisoldipine with respect to effects on blood pressure and heart rate in hypertensive patients.

Cilnidipine is a new and unique 1,4-dihydropyridine calcium antagonist that has both L-type and N-type voltage-dependent calcium channel blocking actions. We compared the effects of cilnidipine and another once-daily dihydropyridine calcium antagonist, nisoldipine, on 24-h blood pressure and heart rate in patients with essential hypertension. We enrolled 10 hypertensive outpatients [9 men and 1 woman; age, 55+/-3 yr (means+/-SEM)] in this study. Their ambulatory blood pressure and heart rate were monitored for 24 h at intervals of 30 min with a portable recorder (TM-2425) after 8 wk of treatment with cilnidipine (5 to 20 mg once daily) and after 8 wk of treatment with nisoldipine (5 to 20 mg once daily). The order of the two treatments was randomized. Blood pressure and heart rate measurements for a 24-h period were analyzed for four segments of the day: morning (06:00 to 11:30), afternoon (12:00 to 17:30), nighttime (18:00 to 23:30), and sleeping time (0:00 to 5:30). Blood pressure levels were similar during the two treatment periods for each 6-h segment of the day. Heart rate was significantly higher during treatment with nisoldipine than during treatment with cilnidipine in the morning segment [by 4.1+/-1.3 beats/min (p < 0.05)] and the afternoon segment [by 6.4+/-3.6 beats/min (p< 0.05)]. These results suggest that cilnidipine is effective as a once-daily antihypertensive agent and causes reflex tachycardia less than does nisoldipine.

Antihypertensive Agents↗
PubMed1998

Seasonal variations in office and home blood pressures in hypertensive patients treated with antihypertensive drugs.

OBJECTIVE: To analyze various factors influencing season variations in blood pressure under ordinary circumstances. METHODS: We examined home and office blood pressures in 315 outpatients with essential hypertension. The majority (88%) were being administered antihypertensived drugs. Their office and home blood pressures were recorded in 1993. The patients were 156 men and 159 women, aged 60.8 +/- 0.6 years (mean +/- SEM). The office blood pressure was measured monthly by the same physicians. The home blood pressure was measured every day by the patients, in the morning and evening. RESULTS: The home blood pressures both in men and in women exhibited significant seasonal variations, to a similar extent. The winter-summer difference in home blood pressure was 3.9 +/- 0.5 mmHg systolic and 1.7 +/- 0.3 mmHg diastolic for the men and 4.6 +/-0.5 mmHg systolic and 2.4 +/- 0.3 mmHg diastolic for the women. The office blood pressure of the men also exhibited significant seasonal variation. There was no seasonal variation in office systolic blood pressure in the women. The levels of home blood pressure in the men and women were similar during each season, whereas the office systolic blood pressure of the women was significantly higher than that of men throughout the year. For the total group of patients, the winter-summer differences in home systolic blood pressure was positively correlated to age. The seasonal variations in blood pressure were not affected by body mass index, smoking status, and administration of antihypertensive medication.CONCLUSIONS: Seasonal variations in blood pressure existed both for male and for female hypertensive patients and occurred even for subjects being treated with antihypertensive drugs. However, there was no seasonal variation in the office systolic blood pressure of women, suggesting that the differences between the office and home blood pressures and between thermoregulatory mechanisms for the sexes may have obscured it.

Journal Article↗
PubMed1997

Immunotactoid glomerulopathy: report of a case.

We report a 51-year-old man diagnosed as having immunotactoid glomerulopathy (IT) who achieved partial remission after approximately 1 year of a low-dose prednisolone regimen. On admission, he was noted to show proteinuria, hypoproteinemia, and hypocomplementemia. On electron microscopy of the renal biopsy specimen, the mesangial and subendothelial areas were expanded because of the electron-dense deposits, which were represented by mostly straight and nonbranching hollow microtubule structures. The microtubular width was on average 22.0 nm. Clinical and histological findings did not support the diagnosis of amyloidosis, cryoglobulinemic glomerulonephritis, systemic lupus erythematosus, or paraproteinemias. Under treatment with oral prednisolone, 4 months later, the patient's serum albumin level increased from its lowest level of 2.3 to 3.6 g/dL, and CH50 from the lowest level of less than 6.3 to 32.4 U/mL. A 24-hour collection of urine showed that the protein had decreased from its highest level of 3.9 g to 2.0 g. This case suggests the effectiveness of long-term, low-dose prednisolone therapy for IT.

Biopsy, Needle↗
PubMed1997

Effect of the Hanshin-Awaji earthquake on home blood pressure in patients with essential hypertension.

At 5:46 AM on January 17, 1995, the Hanshin-Awaji district of Japan was struck by a major earthquake. We investigated changes in home blood pressure (BP) of 36 hypertensive patients before and after the earthquake. In the 16 patients who lived within 50 km from the epicenter, the home Bp on the day of the earthquake was significantly higher than that just before the earthquake (+11/+6 mm Hg; P < .01 for systolic BP and P < .05 for diastolic BP). It remained higher throughout the first week after the earthquake, then gradually returned to the baseline level within 4 weeks. The home BP did not change significantly in the 20 patients who lived farther than 50 km from the epicenter. The earthquake-induced stress increased the BP in these hypertensive patients; however, its pressor effect was not persistent.

Aged↗
PubMed1997

Effects of alcohol intake on organ injuries in normotensive and hypertensive human subjects.

1. This cross-sectional study examined the influence of alcohol intake on organ injuries in normotensive and hypertensive subjects. 2. A total of 514 normotensive subjects and 302 never-treated hypertensive subjects were screened from 4557 men who entered the health check programme of our institute during the period 1990 to 1994. According to the daily alcohol consumption data reported by a self-administered questionnaire, the normotensive and hypertensive subjects were both classified into four categories; very light and non- (0-10 ml of ethanol), light (11-29 ml), moderate (30-58 ml) and heavy (> or = 59 ml) drinker groups. In these four pairs of groups, organ injuries in the heart, kidney and optic fundus were evaluated and serum lipids were measured. 3. Although the blood pressure levels were similar among the four groups of hypertensive subjects, the electrocardiographic findings of left ventricular hypertrophy were significantly more common among the moderate and heavy drinkers but not in the light drinkers compared with the very light and non-drinkers (very light and non-drinkers 25%, light drinkers 23%, moderate drinkers 38%, heavy drinkers 40%; P = 0.026). The alcohol intake increased the serum level of high-density lipoprotein cholesterol in a dose-dependent manner without changing the total cholesterol level; however, the serum gamma-glutamyl transpeptidase and triacylglycerol levels were increased in the moderate and heavy drinkers. Urinary albumin excretion and fundoscopic lesions were not associated with the drinking habit in either the normotensive or hypertensive subjects. 4. These data suggest that habitual alcohol consumption exceeding 29 ml per day facilitates the development of left ventricular hypertrophy in hypertensive patients. Among the hypertensive subjects, light drinkers consuming 11 to 29 ml of ethanol daily showed preferable profiles in terms of organ injuries and risks of cardiovascular diseases.

Alcohol Drinking↗
PubMed1997

Blunted parasympathetic modulation in salt-sensitive patients with essential hypertension: evaluation by power-spectral analysis of heart-rate variability.

OBJECTIVE: To evaluate autonomic nervous function by power-spectral analysis of heart-rate variability in salt-sensitive and non-salt-sensitive patients with essential hypertension under the conditions of low and high salt intakes. DESIGN AND METHODS: The blood pressures, heart rates, and electrocardiogram R-R intervals of 20 hypertensive patients were measured at intervals of 30 min during a 24 h period using a portable recorder (TM-2425) on the last day of the high- (250 mmol NaCl/day) and low-salt (25 mmol NaCl/day) diet periods. The patients whose 24 h average mean blood pressures were increased by more than 10% by the high salt intake were defined as salt-sensitive (n = 10); the other patients were considered non-salt-sensitive (n = 10). Power-spectral analysis of R-R intervals was performed to obtain the low-frequency component (0.05-0.15 Hz) and the high-frequency component (0.15-0.40 Hz). RESULTS: The average 24 h blood pressure in the salt-sensitive patients was increased by the high salt intake [by 19.1 +/- 2.0/9.1 +/- 0.8 mmHg (mean +/- SEM)], whereas the heart rate did not change. In contrast, the increase in 24 h blood pressure in the non-salt-sensitive patients caused by the high salt intake was not significant and the heart rate was decreased significantly by the high salt intake (by 5.9 +/- 1.4 beats/min). The high-salt diet increased significantly the high-frequency component and decreased the low-frequency:high-frequency component ratio both during the daytime and during the night-time for the non-salt-sensitive patients. In contrast, the high-frequency component and the night-time low-frequency: high-frequency component ratio of the salt-sensitive patients did not respond to dietary salt manoeuvres. CONCLUSIONS: Responses of the parasympathetic and sympathetic nervous systems to dietary salt manoeuvres were blunted in salt-sensitive patients. These altered modulations of the autonomic nervous system may contribute to the salt sensitivity of the blood pressure in patients with essential hypertension.

Blood Pressure↗
PubMed1997

Angiotensin-converting enzyme gene polymorphism and cardiovascular endocrine system in coronary angiography patients.

There is continuing interest in the link between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and cardiovascular diseases. Studies on various ethnic populations have shown conflicting evidence as to the association of the DD genotype with an increased risk of myocardial infarction. We examined the relationship between various cardiovascular hormones and ACE gene polymorphism in 149 subjects who underwent cardiac catheterization and had normal cardiac function. The distribution of the II, ID, and DD genotypes was 68, 67, and 14, respectively. Although serum ACE activity was higher in DD and ID than in II (II 9.7+/-0.5 IU/l, ID 12.2+/-0.5, DD 12.8+/-1.2; p < 0.005), other factors of the renin-angiotensin system such as plasma renin activity and plasma concentrations of angiotensin II and aldosterone were not different among the three genotypes. Plasma catecholamines did not differ among the ACE genotypes either, however, plasma atrial natriuretic peptide (ANP) was significantly lower in the subjects carrying the D allele (II 38+/-5 pg/ml, ID 26+/-2, DD 21+/-3; p < 0.05). In particular, the DD genotype showed a low plasma ANP level although the left ventricular mass index was greater than the other genotypes (II 133+/-5 g/m2, ID 137+/-6, DD 165+/-7; p < 0.05). The low plasma ANP in the DD genotype may contribute to the increased risk of cardiovascular diseases.

Atrial Natriuretic Factor↗
PubMed1997

Long-term evaluation of combined antihypertensive therapy with lisinopril and a thiazide diuretic in patients with essential hypertension.

For the treatment of hypertension, the combination of an angiotensin-converting enzyme (ACE) inhibitor and a thiazide diuretic is supported by multiple lines of evidence, because these drugs have synergistic action and are expected to cancel out each other's adverse side effects. However, the long-term outcome of this combination antihypertensive therapy is not entirely clear. In the present multicenter open trial, we investigated the long-term efficacy and safety of combined antihypertensive therapy with an ACE inhibitor, lisinopril, and a thiazide diuretic, trichlormethiazide. A total of 466 patients with essential hypertension were treated with lisinopril alone (monotherapy group, n = 360) or with a combination of lisinopril with trichlormethiazide (combination therapy group, n = 106) for 1 year. The average blood pressure was effectively lowered to below 150/90 mmHg in both the monotherapy and the combination therapy groups throughout the study period. The average maintenance dose of lisinopril was lower when combined with thiazide than when given alone (9.8 vs. 11.5 mg/day, p < 0.001). Dry cough was the major side effect of lisinopril; no severe adverse effects were observed. The incidence of cough was not significantly different between the monotherapy group (13.1%) and the combination therapy group (11.3%). The increase in serum potassium observed in the monotherapy group was reversed by the concurrent use of the thiazide diuretic in the combination therapy group. Fasting blood glucose was significantly reduced in the monotherapy group; the reduction observed in the combination therapy group was not significant. Thus, the present results provide useful information as to the effectiveness and safety of combined antihypertensive therapy with lisinopril and a thiazide in comparison with monotherapy with lisinopril.

Adult↗
PubMed1997

[Implications of obesity for target organ injuries and cardiovascular risk factors in hypertensive subjects].

The effects of obesity on target organ injuries and cardiovascular risk factors were examined in hypertensive subjects. The subjects were 22 obese (OB-HT) and 54 nonobese (NO-HT) men with never-treated essential hypertension, and 37 obese (OB-NT) and 50 nonobese (NO-NT) normotensive men. In these 4 groups with the average age of about 50 years, we evaluated serum lipids, glucose tolerance, and hypertensive organ injuries in the heart, kidney, and optic fundus. Although the fasting blood glucose levels were similar in the 4 groups, the area under the blood glucose curve after 75 g glucose ingestion (NO-NT 15.6, OB-NT 17.5, NO-HT 15.8, OB-HT 17.6 x 10(3) mg/dl.min; p < 0.02) and the fast serum insulin level (NO-NT 7.3, OB-NT 10.1, NO-HT 7.7, OB-HT 12.2 mU/l; p < 0.001) were increased in obese men. In OB-HT, serum HDL-cholesterol was decreased (-11%, p < 0.05) and triglycerides were increased (+ 58%, p < 0.01) comparing with NO-NT. The incidence of electrocardiographic left ventricular hypertrophy was not significantly different among the 4 groups, however, urinary albumin excretion was increased in OB-HT (NO-NT 3.0, OB-NT 3.4, NO-HT 3.6, OB-HT 4.3 mg/g creatinine; p < 0.05) and sclerotic lesions of the retinal arteries were observed even in normotensive OB-NT. These data suggest that obesity unfavorably alters lipid and glucose metabolism, and facilitates organ injuries such as arteriosclerosis and renal dysfunction in hypertensive subjects.

Albuminuria↗
PubMed1996

Behaviour of adrenomedullin during acute and chronic salt loading in normotensive and hypertensive subjects.

1. Responses of adrenomedullin to acute and chronic salt loading were examined in normotensive and hypertensive subjects. 2. In the acute salt load study, isotonic saline (50 ml/kg for 1 h) was intravenously infused into nine normotensive subjects and 11 patients with essential hypertension. Plasma adrenomedullin was higher in hypertensive than in normotensive subjects but was unchanged by saline infusion in either the normotensive (before infusion, 2.4 +/- 0.2 fmol/ml; after infusion, 2.4 +/- 0.1 fmol/ml) or hypertensive (before infusion, 3.0 +/- 0.1 fmol/ml; after infusion, 2.9 +/- 0.2 fmol/ml) group, while renin was suppressed and atrial natriuretic peptide was markedly increased. Plasma endothelin was not affected either. 3. In the chronic salt load study, seven normotensive subjects and 23 patients with essential hypertension underwent two 7-day periods of 30 and 260 mmol/day sodium intake. Depending on the blood pressure change, 13 hypertensive subjects were classified as salt-resistant and 10 as salt-sensitive. Salt-sensitive hypertensive subjects had suppressed plasma renin activity even during low salt intake. Plasma adrenomedullin or endothelin were not affected by the salt intake changes in any group; however, the high salt intake increased atrial natriuretic peptide in all groups. 4. These data indicate that the circulating level of adrenomedullin is not changed by either acute or chronic salt loading in normotensive subjects and patients with essential hypertension.

Adrenomedullin↗
PubMed1996

Seasonal variations in office, home and 24 h ambulatory blood pressure in patients with essential hypertension.

OBJECTIVE: To study the influence of seasons on blood pressure in ordinary circumstances. DESIGN AND METHODS: We examined seasonal variations of home and 24 h ambulatory and office blood pressures in outpatients with essential hypertension. Office, home and ambulatory blood pressures of 50 outpatients with essential hypertension were recorded in 1993. The subjects were 26 women and 24 men, aged 59.3 +/- 1.1 years (mean +/- SEM). Office blood pressure was measured monthly by physicians. Home blood pressure was measured every day by the patients in the morning and evening. Ambulatory blood pressure was recorded every 30 min in summer and in winter. The order of ambulatory blood pressure monitoring was randomized. The daytime and night-time blood pressures were calculated according to the true waking and sleeping times of the individual patients. RESULTS: Both office and home blood pressures showed significant seasonal variations. The winter-summer differences in office and home blood pressures were 4.7 +/- 1.3/ 3.3 +/- 0.9 and 5.9 +/- 1.1/2.7 +/- 0.6 mmHg, respectively. They were not influenced by the presence of antihypertensive agents. The winter-summer difference was also significant for daytime ambulatory blood pressure (3.5 +/- 1.4/ 2.5 +/- 0.8 mmHg), but not for night-time ambulatory blood pressure (-2.9 +/- 1.7/-1.2 +/- 1.0 mmHg) or average 24 h blood pressure (1.5 +/- 1.3/1.2 +/- 0.7 mmHg). There were no significant differences in the waking and sleeping times between the two seasons. CONCLUSIONS: Office, home and daytime ambulatory blood pressure levels were higher in winter than they were in summer in patients with essential hypertension. However, the seasonal variations in average 24 h blood pressure may be small because of the lack of changes in night-time blood pressure.

Adult↗
PubMed1996

High potassium diets reduce endothelial permeability in stroke-prone spontaneously hypertensive rats.

1. High potassium (K) diets are known to prevent hypertensive arterial lesions and reduce stroke incidence without affecting blood pressure. 2. To elucidate the mechanism of this beneficial effect, we studied the effect of K supplementation on the extravasation of plasma albumin in high NaCl-fed stroke-prone spontaneously hypertensive rats (SHRSP). Increased permeability of the endothelium to macromolecules is assumed to be an early manifestation of vascular injury. 3. The disappearance of intravenously injected [125I]-albumin was examined in SHRSP rats fed high NaCl diets containing either 0.5% normal K or 2.1% high K for 5 weeks. 4. The bodyweight, blood pressure, plasma volume and urinary protein excretion were not significantly different between the two SHRSP groups. 5. The high K SHRSP showed a slower plasma albumin disappearance rate than the normal K SHRSP (10.3 vs 14.7%/h, P < 0.004). The albumin radioactivity remaining in the aortic wall and in the brain after removing blood after perfusion was lower in the high K SHRSP than in the normal K SHRSP (aorta, -20%, P < 0.02; brain, -26%, P < 0.04). 6. These results suggest that the high K diet reduced the endothelial permeability to albumin in high NaCl-fed SHRSP rats. High K diets may have a protective effect against endothelial dysfunction and thereby contribute to the reduction of vascular lesion formation and stroke incidence.

Animals↗
PubMed1996

Successful erythropoietin treatment for severe anemia in nephrotic syndrome without renal dysfunction.

A 62-year-old woman presented with nephrotic syndrome and severe anemia although the renal function was not impaired. Renal biopsy revealed the histology of membranoproliferative glomerulonephritis, and the proteinuria was resistant to steroid therapy. Iron deficiency, bleeding and other causes of anemia were ruled out, however, her serum erythropoietin level was inappropriately low. The anemia was rapidly corrected by administration of recombinant human erythropoietin. It is suggested that inappropriately low erythropoietin level, in part at least, accounts for the anemia in nephrotic syndrome. It is proposed that erythropoietin therapy should be taken into consideration for severe anemia in nephrotic syndrome even when the renal function is not impaired.

Anemia↗
PubMed1996

Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension.

Previous studies have shown that plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are increased in essential hypertension. However, whether left ventricular geometry affects plasma ANP and BNP levels remains unknown. To investigate the effect of left ventricular geometry on plasma ANP and BNP levels in essential hypertension, we measured plasma ANP and BNP levels in 90 patients with essential hypertension. All patients were hospitalized, and fasting blood samples were obtained in the early morning after 30 minutes of bed rest. Plasma ANP and BNP levels were measured by immunoradiometric assay. Hypertensive patients were classified into four groups according to echocardiographic findings that showed normal geometry, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy. Mean plasma ANP and BNP levels in all essential hypertensive patients were higher than those in age-matched normotensive control subjects. Plasma ANP levels in hypertensive patients with concentric remodeling, eccentric hypertrophy, and concentric hypertrophy were higher than in normotensive control subjects, although there were no differences between normotensive subjects and hypertensive patients with normal geometry. Plasma BNP levels tended to be higher in hypertensive patients with normal geometry, concentric remodeling, and eccentric hypertrophy than in normotensive control subjects; however, the differences were not significant. Plasma BNP levels and BNP/ANP ratio were specifically higher in concentric hypertrophy. There were significant correlations between ANP and left ventricular mass index, relative wall thickness, interventricular septal thickness, posterior wall thickness, and mean arterial pressure. Plasma BNP levels significantly correlated with relative wall thickness, interventricular septal thickness, posterior wall thickness, and left ventricular mass index but not with mean arterial pressure. In addition, plasma BNP levels were well correlated with ANP levels, and the slope for the linear regression model was steeper in concentric hypertrophy than in the other four groups. These results show that plasma ANP and BNP levels are increased in essential hypertensive patients with left ventricular hypertrophy. Furthermore, BNP secretion is augmented to a greater extent in concentric hypertrophy. Thus, measurement of plasma ANP and BNP levels may be useful for the detection of concentric left ventricular hypertrophy in patients with essential hypertension.

Adult↗
PubMed1996

Long-term effects of doxazosin, an alpha 1-blocker, on serum lipids in hypertensive patients.

Nowadays practical antihypertensive therapy involves not only simple normalization of blood pressure but also a reduction of the risks of cardiovascular disease. In this multicenter open-label study, the long-term effects of doxazosin, an alpha 1-adrenergic receptor blocker, on serum lipids were prospectively investigated in 253 patients with essential hypertension. They were treated with doxazosin for 1 year. The averaged the blood pressure was maintained at levels lower than 150/90 mmHg throughout 1 year, but heart rate did not increase. After 3 months of doxazosin therapy, total and low density lipoprotein-cholesterol levels in serum were significantly reduced by 3.3% and 3.4%, respectively, and these levels were maintained throughout the study period. This effect of doxazosin on serum lipids was especially prominent in patients with hypercholesterolemia. In addition, the lipid profile of these patients was favorably altered even when other antihypertensive drugs or lipid-lowering drugs had already been used or were used concurrently. These results constitute useful information for physicians who treat hypertension with alpha 1-blockers to reduce the overall risk of cardiovascular disease.

Adrenergic alpha-2 Receptor Antagonists↗
PubMed1996

High potassium diets reduce vascular and plasma lipid peroxides in stroke-prone spontaneously hypertensive rats.

We examined the effect of high potassium (K) diet on oxidative stress to endothelium in hypertensive rats. Five-week-old stroke-prone spontaneously hypertensive rats (SHRsp) were fed a 5% high NaCl diet containing either 0.5% normal K (n = 28) or 2.1% high K (n = 19) for 6 weeks, and lipid peroxides in the aortic intima and plasma were measured. Lipid peroxides were extracted into an organic solvent to avoid the interference of carbohydrates or glycoproteins, and malondialdehyde (MDA) produced from lipid peroxides by acid-heating was measured by its reaction to thiobarbituric acid. The antioxidant butylated hydroxytoluene prevented spurious lipid peroxide formation during the whole procedure, and optimum Fe3+ allowed a maximum MDA production from lipid peroxides. The high K SHRsp showed lower lipid peroxide levels than the normal K SHRsp both in the intima (5.6 +/- 0.3 vs. 7.2 +/- 0.4 nmol MDA/mg fatty acids, p < 0.003) and plasma (0.91 +/- 0.08 vs. 1.46 +/- 0.10 nmol MDA/ml, p < 0.001). Mean arterial pressure was slightly lower by 13 mmHg in the high K SHRsp, but these differences were still obvious even when we compared groups of rats with precisely matching blood pressures. These results indicate that high K diets reduce oxidative stress on the endothelium of high NaCl-fed SHRsp independently of blood pressure changes. This effect may be involved in the mechanism by which high K diets protect endothelium and reduce stroke incidence in hypertensive animals. Thus, we improved the method of lipid peroxide measurement and propose the protective effects of high K diet against oxidative stress to endothelium in hypertension animals.

Animals↗
PubMed1996

[Guidelines on treatment of hypertension in the elderly, 1995--a tentative plan for comprehensive research projects on aging and health-- Members of the Research Group for "Guidelines on Treatment of Hypertension in the Elderly", Comprehensive Research Projects on Aging and Health, the Ministry of Health and Welfare of Japan].

We propose the following guidelines for treatment of hypertension in the elderly. 1. Indications for Treatment. 1) Age: Lifestyle modification is recommended for patients aged 85 years and older. Antihypertensive therapy should be limited to patients in whom the merit of the treatment is obvious. 2) Blood pressure: Systolic BP > 160 mmHg, diastolic BP > 90 approximately 10 mmHg. Systolic BP < age + 100 mmHg for those aged 70 years and older. Patients with mild hypertension (140-160/ 90-95 mmHg) associated with cardiovascular disease should be considered for antihypertensive drug therapy. 2. Goal of Therapy for BP: The goal BP in elderly patients is higher than that in younger patients (BP reduction of 10-20 mmHg for systolic BP and 5-10 mmHg for diastolic BP). In general, 140-160/< 90 mmHg is recommended as the goal. However, lowering the BP below 150/85 should be done with caution. 3. Rate of Lowering BP: Start with half the usual dose, observe at the same dose for at least four weeks, and reach the target BP over two months. Increasing the dose of antihypertensive drugs should be done very slowly. 4. Lifestyle Modification: 1) Dietary modification: (1) Reduction of sodium intake is highly effective in elderly patients due to their high salt-sensitivity. NaCl intake of less than 10 g/day is recommended. Serum Na+ should be occasionally measured. (2) Potassium supplementation is recommended, but with caution in patients with renal insufficiency. (3) Sufficient intake of calcium and magnesium is recommended. (4) Reduce saturated fatty acids. Intake of fish is recommended. (2) Regular physical activity: Recommended exercise for patients aged 60 years and older: peak heart rate 110/minute, for 30-40 minutes a day, 3-5 days a week. (3) Weight reduction. (4) Moderation of alcohol intake, smoking cessation. 5. Pharmacologic Treatment: 1) Initial drug therapy. First choice: Long-acting (once or twice a day) Ca antagonists or ACE inhibitors. Second choice: Thiazide diuretics (combined with potassium-sparing diuretic). 2) Combination therapy. (1) For patients without complications, either of the following is recommended. i) Ca antagoinst + ACE inhibitor, ii) ACE inhibitor + Ca antagonist (or low-dose diuretics), iii) diuretic + Ca antagonist (or ACE inhibitor), iv) beta-blockers, alpha 1-blockers, alpha + beta blockers can be used according to the patho-physiological state of the patient. (2) For patients with complications. Drug(s) should be selected according to each complication. 3) Relatively contraindicated drugs. beta-Blockers and alpha 1-blockers are relatively contraindicated in elderly patients with hypertension in Japan. Centrally acting agents such as reserpine, methyldopa and clonidine are also relatively contraindicated beta-Blockers are contraindicated in patients with congestive heart failure, arteriosclerosis obliterans, chronic obstructive pulmonary disease, diabetes mellitus (or glucose intolerance), or bradycardia. These conditions are often present in elderly subjects. Elderly subjects are susceptible to alpha 1-blocker-induced orthostatic hypotension, since their baroreceptor reflex is diminished. Orthostatic hypotension may cause falls and bone fractures in the elderly.

Aged↗