Disaster Hypertension: Experience from the Great East Japan Earthquake of 2011

After a major disaster, such as the East Japan Earthquake with ensuing tsunami and nuclear accident in March 2011, there is typically a spike in cardiovascular disease onset due to increased blood pressure and hypercoagulability. The risk of cardiovascular disease after an earthquake can be reduced by understanding the characteristics of these risks and taking appropriate preventive and remedial measures. During the East Japan Earthquake disaster, Disaster Cardiovascular Prevention (DCAP) Risk Scores (0-6 points; goal≤4 points)/Prevention Scores (0-8 points; goal ≥ 6 points) were used to identify patients at risk at shelters and then safeguard their living conditions, chiefly by monitoring blood pressure and offering appropriate lifestyle guidance as well as treatment. By quickly reducing elevated blood pressures and then assuring stable control we could prevent the mortality and morbidity associated with disaster hypertension. This paper reviews the disaster-related mechanisms that induce cardiovascular disease and introduces the DCAP system and four typical cases in which it intervened.     

Disaster hypertension and cardiovascular events in disaster and COVID‐19 pandemic

The incidence of large disasters has been increasing worldwide. This has led to a growing interest in disaster medicine. In this review, we report current evidence related to disasters and coronavirus disease‐2019 (COVID‐19) pandemic, such as cardiovascular diseases during disasters, management of disaster hypertension, and cardiovascular diseases associated with COVID‐19. This review summarizes the time course and mechanisms of disaster‐related diseases. It also discusses the use of information and communication technology (ICT) as a cardiovascular risk management strategy to prevent cardiovascular events. During the 2011 Great East Japan Earthquake, we used the “Disaster Cardiovascular Prevention” system that was employed for blood pressure (BP) monitoring and risk management using ICT. We introduced an ICT‐based BP monitoring device at evacuation centers and shared patients’ BP values in the database to support BP management by remote monitoring, which led to improved BP control. Effective use of telemedicine using ICT is important for risk management of cardiovascular diseases during disasters and pandemics in the future.     

Diabetes Care Providers’ Manual for Disaster Diabetes Care

To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the “Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake” under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata‐Chuetsu Earthquakes, the current “Manual for Disaster Diabetes Care” has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief.     

Strict Blood Pressure Control Achieved Using an ICT‐Based Home Blood Pressure Monitoring System in a Catastrophically Damaged Area After a Disaster

At the time of the Great East Japan earthquake and tsunami (March 2011), the authors developed a web‐based information and communications technology (ICT)–based blood pressure (BP) monitoring system (the Disaster CArdiovascular Prevention [DCAP] Network) and introduced it in an area that was catastrophically damaged (Minamisanriku town) to help control the survivors' BP. Using this system, home BP (HBP) was monitored and the data were automatically transmitted to a central computer database and to the survivors' attending physicians. The study participants, 341 hypertensive patients, continued to use this system for 4 years after the disaster and all of the obtained HBP readings were analyzed. This DCAP HBP‐guided approach helped achieve a decrease in the participants' HBPs (initial average: 151.3±20.0/86.9±10.2 mm Hg to 120.2±12.1/70.8±10.2 mm Hg) over the 4 years. In addition, the amplitude of seasonal BP variation was suppressed and the duration from the summer lowest HBP values to the winter peak HBP values was gradually prolonged. This ICT‐based approach was useful to achieve strict HBP control and minimize the seasonal BP variation even in a catastrophically damaged area during a 4‐year period after the disaster, suggesting that this approach could be a routine way to monitor BP in the community.     

Japan: super-aging society preparing for the future

Japan has the highest proportion of older adults in the world. Aging is not only an immediate personal issue but also a salient factor in crucial public policies, such as pensions, health, and long-term care. The Great East Japan Earthquake, tsunami, and nuclear power plant disaster of March 2011 has highlighted current and emerging issues of a "super-aging" society, especially the need for community-based support systems.     

Vanin-1 T26I polymorphism,hypertension and cardiovascular events in two large urban-based prospective studies in Swedes

Background and aimsVanin-1 (gene name VNN1) is an enzyme with pantetheinase activity generating the amino-thiol cysteamine which is implicated in the regulation of red-ox status through its effect on glutathione. We tested the hypothesis that the rs2294757 VNN1 T26I polymorphism could affect blood pressure (BP) levels, hypertension prevalence, and risk of incident cardiovascular events.Methods and resultsThe VNN1 T26I polymorphism was genotyped in 5664 participants of the cardiovascular cohort of the "Malmö Diet and Cancer" (MDC-CVA) study and successively in 17874 participants of the “Malmö Preventive project”(MPP). The incidence of cardiovascular events was monitored for an average of nearly 12 years of follow-up in the MDC-CVA and for 25 years in the MPP. Both before and after adjustment for sex, age and BMI in the MDC-CVA the polymorphism had a mild lowering effect on diastolic BP and hypertension, especially in females. However in MPP no effect on BP phenotypes was detectable. Before and after adjustment for major cardiovascular risk factors, the hazard ratio for incident ischemic stroke and coronary events in the MDC-CVA was not significantly different in carriers of different genotypes.ConclusionsOur data do not support a major role for the VNN1 T26I variant in determining BP level and incident ischemic events.     

The role of glycosaminoglycans in blood pressure regulation

Essential hypertension (HT) is the global health problem and is a major risk factor for the development of cardiovascular and kidney disease. High salt intake has been associated with HT and impaired kidney sodium excretion is considered to be a major mechanism for the development of HT. Although kidney has a very important role in regulation of BP, this traditional view of BP regulation was challenged by recent findings suggesting that nonosmotic tissue sodium deposition is very important for BP regulation. This new paradigm indicates that sodium can be stored and deposited nonosmotically in the interstitium without water retention and without increased BP. One of the major determinants of this deposition is glycosaminoglycans (GAGs). By binding to GAGs found in the endothelial surface layer (ESL) which contains glycocalyx, sodium is osmotically inactivated and not induce concurrent water retention. Thus, GAGs has important function for homeostatic BP and sodium regulation. In the current review, we summarized the role of GAGs in ESL and BP regulation.     

中年人群高血压患病率及控制状况的演变趋势

背景高血压是心血管病的主要危险因素,了解和掌握高血压的流行及控制状况对心血管病防治意义重大。目的了解中年人群高血压患病率及控制状况的演变趋势。方法利用国家八五(1992—1994年)、九五(1998年)和十五(2004—2005年)期间年龄在35～59岁的12组可比人群资料进行分析。结果 2004—2005期间高血压标化患病率、知晓率、治疗率和控制率分别达到24.4%、48.4%、38.5%和9.5%,与其他两个时期比较均有明显增加(P<0.05)。在接受治疗的高血压患者中,不同时期的控制率分别为12.2%、19.2%、24.0%。无论患病率、知晓率、治疗率和控制率,性别之间、不同体质量指数之间、城乡之间都存在差异。乡村控制率的增长高于城市(14.6%对11.7%)。结论高血压的患病率仍在不断攀升,尽管控制率有所增加,但仍处于低水平。进一步提高人群的控制率仍是当务之急。     

Accommodation in a refugee shelter as a risk factor for peptic ulcer bleeding after the Great East Japan Earthquake: a case–control study of 329 patients

Background

We have reported that the total number of peptic ulcers (PUs) had increased 1.5-fold after the Great East Japan Earthquake compared with those of the previous year, and that hemorrhagic ulcers were more prominently increased by 2.2-fold. The aim of this study is to determine the risk factors for bleeding ulcers after the Great East Japan Earthquake.

Methods

Clinical data of all peptic ulcer subjects endoscopically detected at the 7 major hospitals in the middle of the stricken area during the 3 months after the earthquake were retrospectively collected. Based on endoscopic and laboratory findings, peptic ulcer cases were divided into 227 bleeding ulcer cases and 102 non-bleeding controls. Other than ordinary risk factors for bleeding ulcers, the refugee shelter was included in the analysis as a unique confounder after the earthquake. Multiple logistic regression analyses were used to adjust for potential confounders.

Results

Eighty-seven (27 %) of 329 PUs emerged from refuge shelters, and the majority (76 of 87) of PUs occurring in such shelters was the bleeding type. Multivariate regression showed that residence in a shelter was a strong risk factor for ulcer bleeding with OR (95 % CI): 4.4 (2.1–9.6, p < 0.0001), independent of the progressiveness of ulcer diseases.

Conclusions

Accommodation in a refugee shelter can be a strong risk factor for ulcer bleeding after a large-scale disaster. Since acid-suppressive drugs are supposed to decrease the risk for stress-induced ulcer bleeding, our results will encourage effective use of a limited medical resource in such catastrophic events.

     

Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a tsunami in Japan

Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.     

Diuretics for cardiovascular prevention in the elderly

High blood pressure (BP) is a major risk factor for cardiovascular and cerebrovascular diseases in elderly subjects. Antihypertensive drugs have shown clinical benefit both in primary and secondary prevention of cardiovascular events. If BP lowering represents the major determinant of the effects conferred by the antihypertensive treatment for prevention, recent studies have suggested some differences between classes of antihypertensive drugs according to age. Based on the available clinical data, the recent medical guidelines have recommended thiazide-type diuretics as the preferred drug for the treatment of elderly hypertensive patients, followed by long-acting calcium antagonists. Indeed, diuretics constitute one of the most valuable classes of antihypertensive drugs, and in the elderly, diuretic-based treatment studies have been clearly shown to prevent major cardiovascular events, including stroke, heart failure and coronary heart disease.     

Arterial hypertension management in general practice in France according to global risk factors

OBJECTIVE: The absolute benefit of antihypertensive medications increases with the level of cardiovascular risk. Moreover in high risk groups, it has been demonstrated that tight blood pressure (BP) control conferred a substantial reduction in the risk of cardiovascular events compared to less tight BP control. Taking into accounts these data, the WHO guidelines recommend to achieve normal BP in high risk subjects. The aim of the study was to assess BP control in a large population of hypertensives (HT) after stratification by cardiovascular risk. METHODS: 15,514 HT defined as office BP > or = 140/90 or the presence of antihypertensive treatment were recruited in France by 3,152 general practitioners. Cardiovascular risk factors and office BP were recorded. Controlled hypertension was defined as a BP < 140/90 mmHg. In patients free of cardiovascular disease, 10-year cardiovascular risks were calculated on the basis of the equations derived from the Framingham Study. RESULTS: 10-year risks were available in 13,560 HT. Those in the highest quartile had greater body mass index (BMI) and the highest concentration of diabetics and current smokers (upper quartile versus lower quartile: BMI: 28.15 vs 26.51 kg/m2; diabetics: 45% vs 3%; current smoking 32% vs 12%; p < .001). [table: see text] Increasing quartiles of risk were associated with the prevalence of uncontrolled hypertension and at a lesser extent with the use of combination therapy. Subjects in the upper quartile had more frequent calcium-blockers, ACE inhibitors and diuretics use and a less frequent betablocker use. CONCLUSION: In general practice, 85% of hypertensives at highest risk are uncontrolled whereas half of them are under monotherapy. An antihypertensive strategy based on global risk may improve BP control in high risk patients.     

Pressure ulcer occurrence following the great East Japan Earthquake: observations from a disaster medical assistance team

Persons with limited mobility are at risk for pressure ulcers. The development of pressure ulcers following earthquakes has been reported secondary to disaster-related spinal cord injury. In the aftermath of the Great East Japan Earthquake, members of a disaster medical assistance team (DMAT), which included plastic surgeons and wound, ostomy, and continence (WOC) nurses working in acute care hospitals, temporary clinics, evacuation centers, and the community noticed an increase in the number of requests for pressure ulcer care. A review of hospital records and verbal reports from the community suggested that the incidence of Stage III and Stage IV pressure ulcers was 7.7% in an acute care hospital and 26.4% in home care patients - almost 10 times higher than the normal reported incidence in Japan. Patients were mostly elderly and did not have spinal cord injuries. Alternating-pressure air mattresses stopped working, alternative pressure-redistribution devices could not be delivered, caregivers could not reach the homebound, and evacuation centers did not have enough mattresses. It is believed that the high percentage of elderly living in the affected areas of Japan, combined with limited resources, manpower, and the absence of utilities, increased the number of persons with deep pressure ulcers. Following natural disasters, DMAT wound care specialists can make important contributions to the prevention of these wounds while providing much-needed care to prevent pressure ulcer-related complications. Clinician observations suggest that the risk of pressure-related injuries following a natural disaster is high, especially among the elderly.     

The impact of a large-scale natural disaster on patients with chronic obstructive pulmonary disease: The aftermath of the 2011 Great East Japan Earthquake

BackgroundA large-scale natural disaster may exacerbate chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD). The aftermath of a natural disaster can include poor access to medication, medical equipment, and medical supplies. Little is known about the impact on patients with COPD.MethodsA retrospective cohort study was conducted at a regional medical center in Ishinomaki, the area affected most severely by the Great East Japan Earthquake in 2011. The study was performed 6 months after the disaster. The characteristics, clinical courses, and outcomes of COPD patients hospitalized after emergency visits during the study period were investigated and compared.ResultsOne hundred patients (112 episodes) were identified. Within a few days after the disaster, patients undergoing oxygen therapy at home came to the hospital to receive oxygen. In the subacute phase (from the third to the fifth week), the number of hospitalizations due to COPD exacerbations was significantly increased compared to the numbers observed before the earthquake (p<0.05). On admission, COPD patients reported significantly reduced participation in the activities of daily living (ADLs) after as compared to before the disaster. The incidence of cases of exacerbated COPD normalized 6 weeks after the earthquake.ConclusionsThe large-scale natural disaster that hit Japan in 2011 had a serious negative impact on the clinical outcomes of COPD patients in the disaster-affected area.     

Funduscopic examination has limited benefit for management of hypertension

Hypertension (HT) increases the risks of major cardiovascular events and affects a majority of elderly populations. Thus, blood pressure control is the mainstay for prevention of cardiovascular diseases. However, there is only a limited number of parameters for management of HT. This study was performed on consecutive patients between the ages of 35 and 70 years with normotension (NT) and HT in order to determine the possible consequences of HT on retinal vasculature and to avoid debility-induced weight loss. We studied 120 patients (64 females, 54.3 +/- 9.3 years) with NT and 147 (81 females, 57.3 +/- 11.0 years) with HT. No case of grade III or IV hypertensive retinopathy (HR) was detected in the groups. Although the prevalences of grades I and II HR were higher and grade 0 HR was lower in the hypertensive group, respectively (P < 0.001 for all), differences according to obesity, diabetes mellitus, hypertriglyceridemia (P < 0.001 for all), and dyslipidemia (P < 0.01) were also significant between the 2 groups. Therefore, only 18.3% (27 cases) of the hypertensives, even in whom the effect of aging could not be excluded, had HT only in the absence of any other risk factor of atherosclerosis. Despite the relatively higher specificities of grades III and IV HR for HT, particularly for hypertensive crisis, funduscopic examination has limited benefit in the management of HT due to the very low prevalences of grades III and IV HR, the multifactorial backgrounds of grades I and II HR, and the association of the multiple risk factors of atherosclerosis in a majority of the hypertensive cases.     

Asian management of hypertension: Current status,home blood pressure,and specific concerns in Japan

Hypertension is highly prevalent in Japan, affecting up to 60% of males and 45% of females. Stroke is the main adverse cardiovascular event, occurring at a higher rate than acute myocardial infarction. Reducing blood pressure (BP) therefore has an important role to play in decreasing morbidity and mortality. The high use of home BP monitoring (HBPM) in Japan is a positive, and home BP is a better predictor of cardiovascular event occurrence than office BP. New 2019 Japanese Society of Hypertension Guidelines strongly recommend the use of HBPM to facilitate control of hypertension to new lower target BP levels (office BP < 130/80 mm Hg and home BP < 125/75 mm Hg). Lifestyle modifications, especially reducing salt intake, are also an important part of hypertension management strategies in Japan. The most commonly used antihypertensive agents are calcium channel blockers followed by angiotensin receptor blockers, and the combination of agents from these two classes is the most popular combination therapy. These agents are appropriate choices in South East Asian countries given that they have been shown to reduce stroke more effectively than other antihypertensives. Morning hypertension, nocturnal hypertension, and BP variability are important targets for antihypertensive therapy based on their association with target organ damage and cardiovascular events. Use of home and ambulatory BP monitoring techniques is needed to monitor these important hypertension phenotypes. Information and communication technology‐based monitoring platforms and wearable devices are expected to facilitate better management of hypertension in Japan in the future.     

Comprehensive effects of lifestyle reform,adherence, and related factors on hypertension control: A review

Despite the effectiveness of currently available antihypertensive medications, there is still a need for new treatment strategies that are more effective in certain groups of hypertensive and for additional resources to combat hypertension. However, medication non-adherence was previously recognized as a major problem in the treatment of hypertension. The mechanisms behind the positive impacts of lifestyle changes might occur in different ways. In comparison with other studies, the efficacy and effectiveness of lifestyle modifications and antihypertensive pharmaceutical treatment for the prevention and control of hypertension and concomitant cardiovascular disease have been demonstrated in randomized controlled trials. However, in this review, the attitudinal lifestyle modifications and barriers to blood pressure control were elaborated on. An effective method for reducing blood pressure (BP) and preventing cardiovascular events with antihypertensive medications has been outlined. Maintaining healthy lifestyle factors (body mass index, diet, smoking, alcohol consumption, sodium excretion, and sedentary behavior) could lower systolic blood pressure BP by 3.5 mm Hg and reduce the risk of cardiovascular disease (CVD) by about 30%, regardless of genetic susceptibility to hypertension. Conducting a lifestyle intervention using health education could improve lifestyle factors, such as reducing salt, sodium, and fat intake, changing eating habits to include more fruits and vegetables, not smoking, consuming less alcohol, exercising regularly, maintaining healthy body weight, and minimizing stressful conditions. Each behavior could affect BP by modulating visceral fat accumulation, insulin resistance, the renin-angiotensin-aldosterone system, vascular endothelial function, oxidative stress, inflammation, and autonomic function. Evidence of the joint effect of antihypertensive medications and lifestyle reforms suggests a pathway to reduce hypertension.     

Cardiovascular risk factors in normotensive and hypertensive Egyptians.

OBJECTIVES : To define the prevalence of cardiovascular risk factors and their relation to the level of blood pressure, in Egyptians. METHODS : Data were collected during the Egyptian National Hypertension project, a national hypertension survey in Egypt. During phase I of the survey, hypertensive (HT) patients were identified. In phase II, clinical and laboratory evaluations were made on HT and gender-matched normotensives (NT). A total of 2313 individuals were examined, 311 NT males, 443 NT females, 670 HT males and 889 HT females. RESULTS : The prevalence of obesity was 33 and 47% in hypertensive men and women, respectively. After adjusting for age, HT men had significantly higher heart rate, total cholesterol (TC), triglycerides (TG), fasting blood sugar (FBS), post-prandial blood sugar (PBS), body mass index and waist/hip (W/H) ratio than their NT counterparts. In addition, HT women had higher low-density lipoprotein cholesterol (LDL-C). The prevalence of elevated LDL-C and FBS increased with age. The prevalence of hypertriglyceridemia, elevated FBS and obesity rose with increasing level of blood pressure (BP). From the 25-34 to the 55-64 age group, the percentage of hypertensives with > or = 2 risk factors rose from 42.9 to 60.6% in men, and from 9.4 to 46.2% in women. All risk factors were more prevalent in urban populations. CONCLUSION : This is one of the few reports on the prevalence of cardiovascular risk factors in a developing country. Risk factors cluster with rising level of BP and with ageing. Obesity is very prevalent, particularly in hypertensive Egyptian women. Health efforts directed at the prevention and treatment of obesity should be a high priority.     

Evidence-based usefulness of Ca antagonists and ACEIs and ARBs for the primary and secondary prevention of major cardiovascular and renal events in patients with hypertension

The benefits of reducing blood pressure (BP) on the risks of major cardiovascular event and preservation of renal function are well established in patients with hypertension. We estimated effects of strategies based on angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor antagonist (ARB) and calcium channel antagonist (CCB), which is predominantly prevalent in Japan in patients with hypertenstion than ACEI/ARB, on the risks of these events, overviewed with data from clinical trials and meta-analysis of these trials including underwent in Japan. ACEI and ARB-based regimens reduced the risks of heart failure and progression of renal dysfunction complicated with and without diabetes mellitus (DM) in patients with hypertension compared with control and CCB-based regimens. CCB-based regimens reduced the primary risks of cerebella event and dementia and primary and secondary risks of coronary events in patients with hypertension having many coronary risk factors compared with control and ARB/ACEI-based regimens. Greater risk reductions, however, were produced by regimens that targeted lower (BP) goals, by combined regimens based on ACEI/ARB and CCB and diuretics, demonstrated in mega-trial of ALLHAT and proposed in guideline of JSH 2004.     

Controversies regarding hormone therapy: Insights from inflammation and hemostasis

Many observational studies and experimental and animal studies have demonstrated that estrogen therapy (ET) or hormone therapy (HT) significantly reduces the risk of coronary heart disease. Nonetheless, recent randomized controlled trials and the Nurses' Health Study in secondary prevention demonstrate trends toward an increased risk of cardiovascular events rather than a reduction of risk from HT. HT has both anti-inflammatory and pro-inflammatory effects, and it activates coagulation and improves fibrinolysis. These effects depend on the route of administration, doses of estrogen, age of women, and the presence of coronary artery disease or the coexistence of other risk factors for hypercoagulability. In this review, we discuss effects of HT on markers of inflammation, hemostasis, and fibrinolysis that may link endothelial dysfunction in cardiovascular diseases. We also briefly discuss effects of lower doses of HT and tibolone in postmenopausal women.