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Kazuhiro Shimizu, Takuo Iiduka, Shuji Sato, Hajime Kiyokawa, Takahiro Nakagami, Hiroshi Mikamo, Masayo Kawazoe, Mao Takahashi, Mahito Noro Department of Internal Medicine, Toho University Sakura Medical Center, Sakura City, Chiba, Japan Background: For the management of venous thromboembolism (VTE), providing anticoagulant therapy within the therapeutic range has been a major challenge, as conventional therapy with unfractionated heparin (UFH) and vitamin K antagonist (VKA) requires frequent laboratory monitoring and dose adjustment. Recently, fondaparinux and edoxaban are being used as beneficial alternatives to UFH and VKA.Methods: We evaluated the clinical course of symptomatic deep vein thrombosis (DVT) in patients who received the 3-month anticoagulation therapy with fondaparinux/edoxaban (Group A; n=40) in comparison with the findings from our previous experience of patients who received the fondaparinux/VKA combination (Group B; n=33).Results: In both Groups A and B, serum D-dimer was significantly improved after treatment (p

It has been suggested that non-fasting triglyceride (TG) concentrations may be useful in predicting various diseases. However, current epidemiological evidence focuses mainly on the effects of fasting TG concentrations. The aim of this study was to investigate the effect of fasting and non-fasting TG levels on new-onset hyperuricemia (HUA) in the general Japanese population. This is a population-based retrospective cohort study (ISSA-CKD study); it included 5,576 participants without HUA at baseline between 2008 and 2019. Participants were categorized into gender-specific tertile groups of serum TG levels: group 1 (< 83 mg/dL [0.94 mmol/l] in male and < 77 mg/dL [0.87mmol/l] in female), group 2 (83-129mg/dL [0.94-1.46mmol/l] in male and 77-114 mg/dL [0.87-1.29mmol/l in female), and group 3 (≥ 130mg/dL [1.47 mmol/l] in male and ≥ 115 mg/dL [1.30mmol/l] in female). Outcome of this study was new-onset HUA (serum uric acid > 7 mg/dL [0.42 mmol/l]). During the 5.4-year follow-up period, 552 male and 146 female participants developed new-onset HUA. Incidence rates (per 1,000 person-years) of HUA were 18.2 in group 1, 21.9 in group 2 and 31.0 in group 3 among male, and 2.1 in group 1, 4.0 in group 2 and 7.4 group 3 among female. These associations remained significant after adjustment for confounders (p trend < 0.0001 among male and 0.0004 for female). There was no clear difference in effect of non-fasting and fasting TG levels on the development of new HUA (P interaction = 0.546 for male and 0.886 for female). Non-fasting and fasting TG concentrations were significantly associated with new-onset HUA among general Japanese men and women., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The effect of self-measurement of blood pressure (BP) at home (home BP measurement, HBPM) has been evaluated over the past decade. This meta-analysis included the latest studies to determine whether HBPM reduced BP (PROSPERO ID: CRD42023442225). PubMed, Cochrane Library Database, and IchuShi-Web were searched for randomized controlled trials after the year 2000 which demonstrated the effect of HBPM on BP change compared with usual care (UC). Overall, 65 articles (n = 21,053; 63 based on patients with hypertension) were included. The systolic/diastolic BP reduction was significantly greater in the HBPM than in the UC group by 3.27/1.61 mmHg (95% confidence intervals: 2.40-4.15/1.14-2.07) at the end of the intervention, and I 2 values ≥ 46.7% suggested moderate-to-high heterogeneity. The funnel plots exhibited no notable publication bias (Egger's test p ≥ 0.16). HBPM with co-interventions (such as telemonitoring) showed a stronger BP-lowering effect than without co-interventions while the effect of HBPM on BP change remained significant in the absence of co-interventions. HBPM was not associated with systolic BP changes when we combined the four studies that used a wrist cuff device for HBPM. The number of antihypertensive medications increased by 0.17 medications in the HBPM group compared with that in the UC group. There were no significant differences in body mass index changes or risk of severe adverse outcomes between the groups. Our results demonstrated a beneficial effect of HBPM in reducing BP, particularly when used in conjunction with telemonitoring or additional medical support and when employing upper-arm cuff devices., Competing Interests: Compliance with ethical standards. Conflict of interest: TO received honoraria (lecture fee) and a joint research grant from Omron Healthcare Co., Ltd., (© 2024. The Author(s).)

Japanese guidelines recommend angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) as first-line therapy in hypertensive patients with chronic kidney disease (CKD) and proteinuria, but calcium channel blockers in patients with stage G4-5 CKD aged ≥75 years; however, the implementation of these guidelines in clinical practice is unclear. We investigated the actual use of these agents in this patient population. We conducted a cross-sectional study using the DeSC database, which includes anonymous information from various health insurance systems in Japan. A total of 34,362 hypertensive patients aged <75 years with CKD stage G1-G5 with urinary protein ≥1+ or aged ≥75 years with CKD stage G1-G3 with urinary protein ≥1+, for whom Japanese guidelines recommend first-line ARBs/ACEIs, were included in the analysis. Prescription rates of ARBs and ACEIs were calculated overall and separately for each age group and glomerular filtration rate category. The mean participant age was 65.8 ± 14.8 years, including 24,585 patients (72%) <75 years and 9777 (28%) ≥75 years. Of these, 9529 were prescribed ARBs/ACEIs (prescription rate 28%). The prescription rate was lower in patients aged <75 years with CKD stage G1-G5 (prescription rate 23%) compared with patients aged ≥75 years old with CKD stage G1-G3 (prescription rate 41%) (p < 0.001). Patients with CKD stage G1 had the lowest prescription rates for ARBs/ACEIs in both age categories. These results indicate that, despite guideline recommendations, ARBs/ACEIs are insufficiently prescribed for patients with hypertension associated with CKD with proteinuria. ARBs and ACEIs were only used in 28% of hypertensive patients aged<75 years (CKD stage G1-G5) or aged ⩾75 years (CKD stage G1-G3), with urinary protein ⩾1+, for whom Japanese guidelines recommend ARBs/ACEIs. The prescription rate was lower in the younger compared with the older patients., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)