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3. Author Correction: Elephant shark genome provides unique insights into gnathostome evolution.

Author

Venkatesh, Byrappa, Lee, Alison, Ravi, Vydianathan, Maurya, Ashish, Lian, Michelle, Swann, Jeremy, Ohta, Yuko, Flajnik, Martin, Sutoh, Yoichi, Kasahara, Masanori, Hoon, Shawn, Gangu, Vamshidhar, Roy, Scott, Irimia, Manuel, Korzh, Vladimir, Kondrychyn, Igor, Lim, Zhi, Tay, Boon-Hui, Tohari, Sumanty, Kong, Kiat, Ho, Shufen, Lorente-Galdos, Belen, Quilez, Javier, Marques-Bonet, Tomas, Raney, Brian, Ingham, Philip, Tay, Alice, Hillier, LaDeana, Minx, Patrick, Boehm, Thomas, Wilson, Richard, Brenner, Sydney, and Warren, Wesley

Abstract

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Published
2020

5. Association between oral frailty and nutritional status among hemodialysis patients aged ≥50 years.

Author

Iwasaki, Masanori, Ohta, Yuko, Furusho, Natsuka, Kakuta, Satoko, Muraoka, Kosuke, Ansai, Toshihiro, Awano, Shuji, Fukuhara, Masayo, and Nakamura, Hidetoshi

Abstract

Aim: Malnutrition is a prevalent health issue among hemodialysis patients. Oral frailty, a condition characterized by impairments in multiple oral health aspects and functions, has been associated with nutritional status in the general population. We aimed to determine whether oral frailty was associated with nutritional status in hemodialysis patients aged ≥50 years. Our secondary aim was to determine the prevalence of oral frailty in this population. Methods: This cross‐sectional study included hemodialysis patients who were admitted to a single medical center. According to the Oral Frailty 5‐item Checklist, oral frailty is characterized by the presence of two or more of the following criteria: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. Patients' nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI). Multivariable ordinal logistic regression analysis was performed to assess the association between oral frailty and nutritional status (classified into three categories according to the GNRI: >98, 92–98, and <92). Results: In total, 152 hemodialysis patients (55 women and 97 men) with a mean age of 70.4 years were included. The prevalence of oral frailty was 61.2%. After adjusting for health characteristics and sociodemographic background, oral frailty was associated with poor nutritional status according to the GNRI (odds ratio = 2.04, 95% confidence interval = 1.02–4.09). Conclusions: In this study, approximately 60% of hemodialysis patients aged ≥50 years exhibited oral frailty, and hemodialysis patients with oral frailty had poor nutritional status according to the GNRI. Geriatr Gerontol Int 2024; 24: 891–897. [ABSTRACT FROM AUTHOR]

Published
2024
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8. CountASAP: A Lightweight, Easy to Use Python Package for Processing ASAPseq Data

Author

Boughter, Christopher T., primary, Chatterjee, Budhaditya, additional, Ohta, Yuko, additional, Gorga, Katrina, additional, Blair, Carly, additional, Hill, Elizabeth M., additional, Fasana, Zachary, additional, Adebamowo, Adedola, additional, Ammar, Farah, additional, Kosik, Ivan, additional, Murugan, Vel, additional, Chen, Wilbur H., additional, Singh, Nevil J., additional, and Meier-Schellersheim, Martin, additional

Published
2024
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13. Genome evolution in the allotetraploid frog Xenopus laevis

Author

Session, Adam M, Uno, Yoshinobu, Kwon, Taejoon, Chapman, Jarrod A, Toyoda, Atsushi, Takahashi, Shuji, Fukui, Akimasa, Hikosaka, Akira, Suzuki, Atsushi, Kondo, Mariko, van Heeringen, Simon J, Quigley, Ian, Heinz, Sven, Ogino, Hajime, Ochi, Haruki, Hellsten, Uffe, Lyons, Jessica B, Simakov, Oleg, Putnam, Nicholas, Stites, Jonathan, Kuroki, Yoko, Tanaka, Toshiaki, Michiue, Tatsuo, Watanabe, Minoru, Bogdanovic, Ozren, Lister, Ryan, Georgiou, Georgios, Paranjpe, Sarita S, van Kruijsbergen, Ila, Shu, Shengquiang, Carlson, Joseph, Kinoshita, Tsutomu, Ohta, Yuko, Mawaribuchi, Shuuji, Jenkins, Jerry, Grimwood, Jane, Schmutz, Jeremy, Mitros, Therese, Mozaffari, Sahar V, Suzuki, Yutaka, Haramoto, Yoshikazu, Yamamoto, Takamasa S, Takagi, Chiyo, Heald, Rebecca, Miller, Kelly, Haudenschild, Christian, Kitzman, Jacob, Nakayama, Takuya, Izutsu, Yumi, Robert, Jacques, Fortriede, Joshua, Burns, Kevin, Lotay, Vaneet, Karimi, Kamran, Yasuoka, Yuuri, Dichmann, Darwin S, Flajnik, Martin F, Houston, Douglas W, Shendure, Jay, DuPasquier, Louis, Vize, Peter D, Zorn, Aaron M, Ito, Michihiko, Marcotte, Edward M, Wallingford, John B, Ito, Yuzuru, Asashima, Makoto, Ueno, Naoto, Matsuda, Yoichi, Veenstra, Gert Jan C, Fujiyama, Asao, Harland, Richard M, Taira, Masanori, and Rokhsar, Daniel S

Subjects
Biological Sciences, Bioinformatics and Computational Biology, Genetics, Biotechnology, Human Genome, Animals, Chromosomes, Conserved Sequence, DNA Transposable Elements, Diploidy, Evolution, Molecular, Female, Gene Deletion, Gene Expression Profiling, Genome, Karyotype, Molecular Sequence Annotation, Mutagenesis, Phylogeny, Pseudogenes, Tetraploidy, Xenopus, Xenopus laevis, General Science & Technology
Abstract

To explore the origins and consequences of tetraploidy in the African clawed frog, we sequenced the Xenopus laevis genome and compared it to the related diploid X. tropicalis genome. We characterize the allotetraploid origin of X. laevis by partitioning its genome into two homoeologous subgenomes, marked by distinct families of 'fossil' transposable elements. On the basis of the activity of these elements and the age of hundreds of unitary pseudogenes, we estimate that the two diploid progenitor species diverged around 34 million years ago (Ma) and combined to form an allotetraploid around 17-18 Ma. More than 56% of all genes were retained in two homoeologous copies. Protein function, gene expression, and the amount of conserved flanking sequence all correlate with retention rates. The subgenomes have evolved asymmetrically, with one chromosome set more often preserving the ancestral state and the other experiencing more gene loss, deletion, rearrangement, and reduced gene expression.

Published
2016

17. Genetic factors associated with elevation of uric acid after treatment with thiazide-like diuretic in patients with essential hypertension

Author

Ohta, Yuko, Kamide, Kei, Hanada, Hironori, Morimoto, Shigeto, Nakahashi, Takeshi, Takiuchi, Shin, Ishimitsu, Toshihiko, Tsuchihashi, Takuya, Soma, Masayoshi, Tomohiro Katsuya, T., Sugimoto, Ken, Rakugi, Hiromi, Oukura, Takafumi, Higaki, Jitsuo, Matsuura, Hideo, Shinagawa, Tatsuo, Miwa, Yosikazu, Sasaguri, Toshiyuki, Igase, Michiya, Miki, Tetsuro, Takeda, Kazuo, Higashiura, Katsuhiro, Shimamoto, Kazuaki, Katabuchi, Ritsuko, Ueno, Michio, Hosomi, Naonaga, Kato, Johji, Komai, Norio, Kojima, Shunichi, Sase, Kazuhiro, Iwashima, Yoshio, Yoshihara, Fumiki, Horio, Takeshi, Nakamura, Satoko, Nakahama, Hajime, Miyata, Toshiyuki, and Kawano, Yuhei

Published
2020
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20. Decreased serum creatinine to cystatin C ratio is associated with low tongue pressure.

Author

Komorita, Yuji, Ide, Hitoshi, Yoshinari, Masahito, Ohta, Yuko, Nakamichi, Ikuo, Fujisawa, Ritsuko, Fujii, Wataru, and Fukuhara, Masayo

Subjects
TONGUE physiology, BIOMARKERS, CONFIDENCE intervals, CROSS-sectional method, MULTIPLE regression analysis, AGE distribution, ORAL health, SERUM albumin, MUSCLE strength, DESCRIPTIVE statistics, RESEARCH funding, LOGISTIC regression analysis, BODY mass index, CREATININE, CYSTATIN C
Abstract

Aim: Tongue strength plays an important role in the process of food intake, and low tongue pressure has been associated with aspiration pneumonia, cognitive decline, and mortality. However, special equipment for tongue pressure measurement is uncommon in general practice. Recently, the serum creatinine‐to‐cystatin C (Cr/CysC) ratio has been validated as a marker of muscle volume mass. Thus, we aimed to investigate the association of the serum Cr/CysC ratio with tongue pressure in a cross‐sectional study. Methods: This single‐center, cross‐sectional study enrolled 73 participants (mean age, 71.7 years; men, 49.3%) who regularly attended the hospital for treatment of chronic disease. A tongue pressure of <30 kPa was defined as low tongue pressure. We evaluated the relationships between the serum Cr/CysC ratio and tongue pressure using multiple regression analysis. Results: The serum Cr/CysC ratio was correlated with tongue pressure (R2 = 0.25, P < 0.0001). In multiple regression analyses adjusted for confounders including age, sex, body mass index, and serum albumin, the association remained significant (P = 0.0001). In logistic analyses, the multivariable‐adjusted odds ratios of the Cr/CysC ratio for tertiles 1 and 2 compared with tertile 3 for low tongue pressure were 7.81 (95% confidence interval, 1.45–51.73) and 2.71 (95% confidence interval, 0.60–13.19), respectively. Conclusions: We demonstrated that a decreased serum Cr/CysC ratio was associated with a higher risk of low tongue pressure. Our findings suggest that this simple serum surrogate marker may be a first step toward an intervention for oral function by general practitioners. Geriatr Gerontol Int 2024; 24: 102–108. [ABSTRACT FROM AUTHOR]

Published
2024
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21. An Ancestral Major Histocompatibility Complex Organization in Cartilaginous Fish: Reconstructing MHC Origin and Evolution.

Author

Veríssimo, Ana, Castro, L Filipe C, Muñoz-Mérida, Antonio, Almeida, Tereza, Gaigher, Arnaud, Neves, Fabiana, Flajnik, Martin F, and Ohta, Yuko

Subjects
CHONDRICHTHYES, MAJOR histocompatibility complex, T cell receptors, COMPLEX organizations, COMPLEMENT (Immunology), HUMAN chromosomes, ANTIGEN processing
Abstract

Cartilaginous fish (sharks, rays, and chimeras) comprise the oldest living jawed vertebrates with a mammalian-like adaptive immune system based on immunoglobulins (Ig), T-cell receptors (TCRs), and the major histocompatibility complex (MHC). Here, we show that the cartilaginous fish "adaptive MHC" is highly regimented and compact, containing (i) a classical MHC class Ia (MHC-Ia) region containing antigen processing (antigen peptide transporters and immunoproteasome) and presenting (MHC-Ia) genes, (ii) an MHC class II (MHC-II) region (with alpha and beta genes) with linkage to beta-2-microglobulin (β2m) and bromodomain-containing 2 , (iii) nonclassical MHC class Ib (MHC-Ib) regions with 450 million-year-old lineages, and (iv) a complement C4 associated with the MHC-Ia region. No MHC-Ib genes were found outside of the elasmobranch MHC. Our data suggest that both MHC-I and MHC-II genes arose after the second round of whole-genome duplication (2R) on a human chromosome (huchr) 6 precursor. Further analysis of MHC paralogous regions across early branching taxa from all jawed vertebrate lineages revealed that Ig/TCR genes likely arose on a precursor of the huchr9/12/14 MHC paralog. The β2m gene is linked to the Ig/TCR genes in some vertebrates suggesting that it was present at 1R, perhaps as the donor of C1 domain to the primordial MHC gene. In sum, extant cartilaginous fish exhibit a conserved and prototypical MHC genomic organization with features found in various vertebrates, reflecting the ancestral arrangement for the jawed vertebrates. [ABSTRACT FROM AUTHOR]

Published
2023
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23. High central blood pressure is associated with incident cardiovascular events in treated hypertensives: the ABC-J II Study

Author

Eguchi, Kazuo, Miyashita, Hiroshi, Takenaka, Tsuneo, Tabara, Yasuharu, Tomiyama, Hirofumi, Dohi, Yasuaki, Hashimoto, Junichiro, Ohkubo, Takayoshi, Ohta, Yuko, Hirooka, Yoshitaka, Kohara, Katsuhiko, Ito, Sadayoshi, Kawano, Yuhei, Sunagawa, Kenji, Suzuki, Hiromichi, Imai, Yutaka, Kario, Kazuomi, Takazawa, Kenji, Yamashina, Akira, Shimada, Kazuyuki, and the ABC-J II Investigator Group

Published
2018
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33. The Genome of the Western Clawed Frog Xenopus tropicalis

Author

Hellsten, Uffe, Harland, Richard M., Gilchrist, Michael J., Hendrix, David, Jurka, Jerzy, Kapitonov, Vladimir, Ovcharenko, Ivan, Putnam, Nicholas H., Shu, Shengqiang, Taher, Leila, Blitz, Ira L., Blumberg, Bruce, Dichmann, Darwin S., Dubchak, Inna, Amaya, Enrique, Detter, John C., Fletcher, Russell, Gerhard, Daniela S., Goodstein, David, Graves, Tina, Grigoriev, Igor V., Grimwood, Jane, Kawashima, Takeshi, Lindquist, Erika, Lucas, Susan M., Mead, Paul E., Mitras, Therese, Ogino, Hajime, Ohta, Yuko, Poliakov, Alexander V., Pollet, Nicolas, Robert, Jacques, Salamov, Asaf, Sater, Amy K., Schmutz, Jeremy, Terry, Astrid, Vize, Peter D., Warren, Wesley C., Wells, Dan, Wills, Andrea, Wilson, Richard K., Zimmerman, Lyle B., Zorn, Aaron M., Grainger, Robert, Grammer, Timothy, Khokha, Mustafa K., Richardson, Paul M., and Rokhsar, Daniel S.

Published
2010

35. Elephant shark genome provides unique insights into gnathostome evolution

Author

Venkatesh, Byrappa, Lee, Alison P., Ravi, Vydianathan, Maurya, Ashish K., Lian, Michelle M., Swann, Jeremy B., Ohta, Yuko, Flajnik, Martin F., Sutoh, Yoichi, Kasahara, Masanori, Hoon, Shawn, Gangu, Vamshidhar, Roy, Scott W., Irimia, Manuel, Korzh, Vladimir, Kondrychyn, Igor, Lim, Zhi Wei, Tay, Boon-Hui, Tohari, Sumanty, Kong, Kiat Whye, Ho, Shufen, Lorente-Galdos, Belen, Quilez, Javier, Marques-Bonet, Tomas, Raney, Brian J., Ingham, Philip W., Tay, Alice, Hillier, LaDeana W., Minx, Patrick, Boehm, Thomas, Wilson, Richard K., Brenner, Sydney, and Warren, Wesley C.

Subjects
Nucleotide sequencing -- Methods, Immune system -- Genetic aspects, DNA sequencing -- Methods, Genomes -- Identification and classification, Sharks -- Genetic aspects, Environmental issues, Science and technology, Zoology and wildlife conservation
Abstract

The emergence of jawed vertebrates (gnathostomes) from jawless vertebrates was accompanied by major morphological and physiological innovations, such as hinged jaws, paired fins and immunoglobulin-based adaptive immunity. Gnathostomes subsequently diverged [...]

Published
2014
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40. Effect of Standard vs Intensive Blood Pressure Control on the Risk of Recurrent Stroke A Randomized Clinical Trial and Meta-analysis

Author

Kitagawa Kazuo, Yamamoto Yasumasa, Arima Hisatomi, Maeda Toshiki, Sunami Norio, Kanzawa Takao, Eguchi Kazuo, Kamiyama Kenji, Minematsu Kazuo, Ueda Shinichiro, Rakugi Hiromi, Ohya Yusuke, Kohro Takahide, Yonemoto Koji, Okada Yasushi, Higaki Jitsuo, Tanahashi Norio, Kimura Genjiro, Umemura Satoshi, Matsumoto Masayasu, Shimamoto Kazuaki, Ito Sadayoshi, Saruta Takao, Shimada Kazuyuki, Kario Kazuomi, Saito Yoshihiko, Terayama Yasuo, Toyoda Kazunori, Okura Takafumi, Hoshino Haruhiko, Makino Hirofumi, Uchida Haruhito, Uchiyama Shinichiro, Etani Hideki, Kohriyama Tatsuo, Tomimoto Hidekazu, Yoshio Taku, Kobayashi , Shotai, Usami Hiroko, Iihoshi Satoshi, Mikami Takeshi, Mikuni Nobuhiro, Miyata Kei, Murakami Tomohiro, Endo Hideki, Fukui Takahito, Fumoto Kentaro, Hara Keiji, Honjo Kaori, Kinoshita Yusuke, Maeda Masana, Mikamoto Masaaki, Mori Daisuke, Murahashi Takeo, Nomura Ryota, Noro Shusaku, Ogino Tatsuya, Okuma Masahiro, Otake Yasuhumi, Shindo Koichiro, Sugio Hironori, Takada Hidekazu, Takahira Kazuki, Takeuchi Akiko, Watanabe Toshiichi, Yamaguchi Yohei, Abumiya Takeo, Houkin Kiyohiro, Matsumura Shigeki, Shinohe Rikiya, Kuroshima Kiyomi, Takizawa Katsumi, Yoshida Kazuto, Morimoto Hideo, Hasebe Naoyuki, Koyama Satoshi, Maruyama Junichi, Irie Shinsuke, Nakano Takahiro, Ogasawara Yukari, Ohkuma Hiroki, Shibanai Kazuo, Hikichi Kentaro, Kobayashi Shinya, Moroi Junta, Nakase Taizen, Okada Takeshi, Takano Daiki, Takenaka Shunsuke, Yoshioka Shotaro, Yanagisawa Toshiharu, Hirata Yutaka, Konno Shu, Sato Tomohiko, Ito Miiko, Kondo Rei, Mori Wataru, Saito Shinjiro, Kokubo Yasuaki, Kato Hideaki, Oyama Hideki, Matsuo Kaneyuki, Matsumoto Masahiro, Nakamura Mari, Koizumi Takayuki, Sato Hiroyuki, Shibata Yasushi, Hashimoto Masaaki, Kurita Hideharu, Matsumoto Eiji, Ishiguro Koji, Asakura Ken, Fujimaki Hiroya, Wakabayashi Kazuki, Akaji Kazunori, Horikoshi Tomo, Kano Tadashige, Katano Takehiro, Kimura Hiroaki, Mihara Ban, Suzuki Kentaro, Takayama Yohei, Ishii Akira, Momomura Sin-ichi, Sugawara Hitoshi, Yamashita Takeshi, Kaneko Uichi, Takahashi Toshie, Arai Toshinari, Tanaka Yoshihiro, Inokuma Shigehisa, Kato Yuji, Ishige Naoki, Muramatsu Kazuhiro, Nogawa Shigeru, Yoshizaki Takahito, Ohashi Takashi, Suda Sumio, Iguchi Yasuyuki, Mitsumura Hidetaka, Adachi Tomohide, Konoeda Fumie, Oki Koichi, Tanaka Ryota, Urabe Takao, Yamashiro Kazuo, Ito Akihiro, Nakatomi Hirofumi, Shojima Masaaki, Otsuka Kuniaki, Shibata Koichi, Abe Takato, Itoh Yoshiaki, Suzuki Norihiro, Toi Sono, Teramoto Tamio, Fukunaga Atsushi, Kujuro Yuki, Ohta Kouichi, Osada Takashi, Shimizu Katuyoshi, Kitagawa Yasuhisa, Tokuoka Kentaro, Omura Masao, Kikyo Hideyuki, Kamide Tomoya, Kitamura Yoshihisa, Miyashita Katsuyoshi, Mori Kentaro, Shima Hiroshi, Tamase Akira, Akutsu Tsugio, Nishiyama Kazutoshi, Takizawa Shunya, Uesugi Tsuyoshi, Ikeda Uichi, Koshikawa Megumi, Yamasaki Saeko, Inoue Atsushi, Matsumoto Yasuko, Yamaguchi Kazuyoshi, Hirose Genjirou, Kontani Satoshi, Takasawa Kazuya, Hirahara Katsumi, Kodama Makoto, Yagihara Nobue, Hata Takashi, Hori Makoto, Oda Rokuhei, Kubo Ayuka, Okuda Satoshi, Yamada Kentaro, Takeuchi Hiroki, Araki Yoshio, Ito Mizuki, Senda Joe, Wakabayashi Toshihiko, Ito Shinji, Mutoh Tatsuro, Kawase Yukinori, Ando Fumio, Okamoto Shinya, Shimada Takuya, Shindo Akihiro, Nishikawa Masakatsu, Niwa Atsushi, Sasaki Ryogen, Murata Hiroto, Yata Kenichiro, Matsuo Koushun, Yagi Hideo, Shiogai Toshiyuki, Nagakane Yoshinari, Fujinami Jun, Nakagawa Masanori, Ohara Ryo, Tomii Yasuhiro, Arakawa Yoshiki, Funaki Takeshi, Ihara Masafumi, Kitamura Akihiro, Maki Takakuni, Miyamoto Susumu, Nakaya Yoshifumi, Takahashi Ryosuke, Takenobu Yohei, Yoshida Kazumichi, Ino Tadashi, Murase Nagako, Ohotani Ryo, Kawashima Atsushi, Watanabe Akiko, Hayashi Yuko, Ohmichi Takuma, Yasuda Rei, Yoshioka Akira, Yuki Natsuko, Makino Masahiro, Yamaguchi Tatsuyuki, Matsuzaki Jyo, Niki Hitoshi, Shiraishi Shoichi, Yanagihara Takehiko, Yamada Keiichi, Hatate Jun, Miwa Kaori, Okazaki Shuhei, Arihiro Shoji, Doijiri Ryosuke, Higashida Kyoko, Kajimoto Katsufumi, Miyashita Kotaro, Nagatsuka Kazuyuki, Saito Kozue, Sugiura Yuri, Takizawa Hotake, Torii Takako, Yokota Chiaki, Kajimoto Yoshinaga, Kuroiwa Toshihiko, Fukunaga Ryuzo, Takahashi Tsutomu, Nakao Kazutami, Kajiyama Yuta, Kimura Yasuyoshi, Naka Takashi, Otomune Hironori, Tanahashi Takao, Uehara Takuya, Hashimoto Hiroyuki, Uematsu Toshihiko, Kataoka Kazuo, Okayama Satoshi, Somekawa Satoshi, Yamada Shuichi, Sasaki Rie, Yamano Shigeru, Nakao Naoyuki, Obayashi Shinji, Hamaguchi Hirotoshi, Toda Tatsushi, Washida Kazuo, Hoshi Taku, Kono Tomoyuki, Sekiya Hiroaki, Sugo Norifumi, Todo Kenichi, Togo Masaya, Yamagami Hiroshi, Yamamoto Shiro, Shiro Yoshihiko, Takaoka Toshio, Abe Satoshi, Hamada Chizuko, Ishihara Masaki, Kadota Katuhiko, Nakagawa Tomonori, Oguro Hiroaki, Takayoshi Hiroyuki, Yamaguchi Takuya, Yamaguchi , Shuuhei, Mizuhara Ryo, Okada Kazunori, Yamagata Shingo, Sasaki Akira, Abe Koji, Deguchi Kentaro, Deguchi Shoko, Nakano Yumiko, Hirai Satoshi, Uno Masaaki, Yokosuka Kimihiko, Manabe Yasuhiro, Ito Hijiri, Aoki Shiro, Hosomi Naohisa, Kihara Yasuki, Kisaka Tomohiko, Maruyama Hirofumi, Araki Hayato, Ogami Ryo, Torii Tsuyoshi, Yokoyama Noboru, Yokoyama Takakazu, Kataoka Satoshi, Kitamura Takeshi, Kanda Takashi, Maeda Toshihiko, Shimizu Fumitaka, Seki Kozaburo, Bando Yuko, Ohara Masaki, Yamasaki Masahiro, Masahira Noritaka, Ueba Tetsuya, Ueba Yusuke, Fujimoto Yuichi, Haro Keiko, Ogata Hidenori, Shida Norihiko, Matsumoto Takeshi, Okamoto Kensho, Kawamoto Ryuichi, Arakawa Shuji, Shii Hirofumi, Kanai Hidetoshi, Fujimoto Shigeru, Jinnouchi Juro, Matsuki Takayuki, Osaki Masato, Arakawa Kimika, Ibaraki Ai, Kiyohara Kanako, Ohta Yuko, Oniki Hideyuki, Sakaki Minako, Tominaga Mitsuhiro, Tsuchihashi Takuya, Higashi Saho, Ishikawa Hiromi, Ishitsuka Koji, Kitayama Jiro, Nakane Hiroshi, Yoshimura Takeo, Kakino Shunsuke, Kaneko Yoshirou, Inoue Junnosuke, Maruyama Yoshikazu, Isa Katsunori, Sakima Hirokuni, and Nakada Seigo

Subjects
medicine.medical_specialty, education.field_of_study, business.industry, Standard treatment, Population, medicine.disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Blood pressure, Randomized controlled trial, law, Relative risk, Internal medicine, Multicenter trial, Number needed to treat, Medicine, 030212 general & internal medicine, Neurology (clinical), business, education, Stroke, 030217 neurology & neurosurgery, Original Investigation
Abstract

Importance The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that a systolic blood pressure (BP) target less than 120 mm Hg was superior to less than 140 mm Hg for preventing vascular events. This trial excluded patients with prior stroke; therefore, the ideal BP target for secondary stroke prevention remains unknown. Objective To assess whether intensive BP control would achieve fewer recurrent strokes vs standard BP control. Design, Setting, and Participants Randomized clinical trial (RCT) of standard vs intensive BP control in an intent-to-treat population of patients who had a history of stroke. Patients were enrolled between October 20, 2010, and December 7, 2016. For an updated meta-analysis, PubMed and the Cochrane Central Library database were searched through September 30, 2018, using the Medical Subject Headings and relevant search terms forcerebrovascular diseaseand forintensive BP lowering. This was a multicenter trial that included 140 hospitals in Japan; 1514 patients who had a history of stroke within the previous 3 years were approached, but 234 refused to give informed consent. Interventions In total, 1280 patients were randomized 1:1 to BP control to less than 140/90 mm Hg (standard treatment) (n = 640) or to less than 120/80 mm Hg (intensive treatment) (n = 640). However, 17 patients never received intervention; therefore, 1263 patients assigned to standard treatment (n = 630) or intensive treatment (n = 633) were analyzed. Main Outcomes and Measures The primary outcome was stroke recurrence. Results The trial was stopped early. Among 1263 analyzed patients (mean [SD] age, 67.2 [8.8] years; 69.4% male), 1257 of 1263 (99.5%) completed a mean (SD) of 3.9 (1.5) years of follow-up. The mean BP at baseline was 145.4/83.6 mm Hg. Throughout the overall follow-up period, the mean BP was 133.2/77.7 (95% CI, 132.5-133.8/77.1-78.4) mm Hg in the standard group and 126.7/77.4 (95% CI, 125.9-127.2/73.8-75.0) mm Hg in the intensive group. Ninety-one first recurrent strokes occurred. Nonsignificant rate reductions were seen for recurrent stroke in the intensive group compared with the standard group (hazard ratio [HR], 0.73; 95% CI, 0.49-1.11;P = .15). When this finding was pooled in 3 previous relevant RCTs in a meta-analysis, the risk ratio favored intensive BP control (relative risk, 0.78; 95% CI, 0.64-0.96;P = .02; absolute risk difference, −1.5%; 95% CI, −2.6% to −0.4%; number needed to treat, 67; 95% CI, 39-250). Conclusions and Relevance Intensive BP lowering tended to reduce stroke recurrence. The updated meta-analysis supports a target BP less than 130/80 mm Hg in secondary stroke prevention. Trial Registration ClinicalTrials.gov identifier:NCT01198496

Published
2019

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