Significant Neurological Study for Lifestyle Related Diseases Worldwide From Now
1Medical Research/Tokushima University, Tokushima, Japan
2Japan Low Carbohydrate Diet Promotion Association (JLCDPA), Kyoto, Japan
Corresponding Author: Hiroshi BANDO, MD. PhD, FACP
Address: Medical Research/Tokushima University, Nakashowa 1-61, Tokushima 770-0943, Japan; Tel: +81-90-3187-2485; Fax: +81-88-603-1030; E-mail: email@example.com
Received date: 14 March 2020; Accepted date: 20 April 2020; Published date: 06 May 2020
Citation: Bando H. Significant Neurological Study for Lifestyle Related Diseases Worldwide From Now. J Health Care and Research. 2020 May 6;1(2):50-54.
Copyright © 2020 Bando H. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: European Society of Cardiology (ESC), European Society of Hypertension (ESH), ESC/ESH Guidelines for Hypertension, American Diabetes Association (ADA), Action to Control Cardiovascular Risk in Diabetes (ACCORD), Orthostatic Hypotension (OH)
An overview of modern medical society shows that various diseases of metabolic syndrome are increasing in both developed and developing countries . Among them, hypertension and diabetes are the most frequent diseases which require continuous treatment for years. They are lifestyle-related diseases and need the usual adequate habitual style for each person.
We can consider medical matters from the neurological point of view. A variety of nerve control and mental stress are involved in our daily lives. For example, blood pressure may increase in hypertension, and blood glucose value may increase in diabetes. In contrast, blood pressure may rapidly decrease in the diabetic patient with orthostatic hypotension (OH) due to diabetic neuropathy, when he changes his postures from lying to sitting, and from sitting to standing .
In other words, various factors of the nervous, psychological, and psychiatric systems can affect hypertension and diabetes. Furthermore, they can also affect the diet from the stress, probably leading to obesity, dyslipidemia, hyperuricemia, gout, cerebrovascular accident (CVA), and coronary artery disease (CAD). Recent research shows that neural cell adhesion molecule-1 (NCAM-1) was significantly associated with an increased risk of CAD .
As for hypertension, remarkable progress has found in understanding the pathophysiology, epidemiology, and treatment. There is a wealth of evidence that lower control of blood pressure can substantially decrease morbidity, mortality, and other complications [4,5]. To achieve this goal, various effective and proven strategies of medication and a well-tolerated lifestyle have been necessary. However, the control of blood pressure has not been satisfactory in the world. By controlling blood pressure in an adequate range for patients with hypertension, CVA, and CAD can be preventable to some extent [6,7].
Recently, the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) have both published guidelines for hypertension in Europe [8,9]. Furthermore, practice guidelines for them were also published [10,11]. 2018 ESC/ESH guideline for the management of arterial hypertension has 89 pages and 629 references [8,9], which seems to be satisfactory quality. From the neurological aspect, it includes white-coat hypertension, the brain in hypertension, cerebrovascular disease/cognition, and cognitive dysfunction/dementia.
Regarding the therapy for hypertension, antihypertensive agents should not be given from the beginning. Before medicine, non-drug therapy has been important, which is correcting or adjusting lifestyle. In addition to hypertensive patients, many people are in the preclinical stage for hypertensive tendencies. Such subjects are recommended to prevent hypertension by adjusting lifestyle in an appropriate way .
There are several methods of non-drug therapy for adjusting lifestyle . They include i) dietary sodium restriction , ii) moderation of alcohol consumption , iii) other dietary changes , iv) weight reduction , v) regular physical activity  and vi) smoking cessation .
As for clinical research for hypertension, authors and colleagues have reported the efficacy of adjusting the lifestyle . Among thousands of hypertensive patients, the percentage of subjects who can discontinued antihypertensive agents was approximately 4.6% – 6.1% for several years. We have picked up 50 cases including 25 males and 25 females and examined the detail of them. The results were that i) family history of hypertension was positive for 66% in women, ii) smoking ratio was 76% in men, iii) alcohol consumption was 76% in men, iv) dyslipidemia was 42%, v) T2DM was 12%. It seems that 12% would be lower than the usual ratio because there is a higher prevalence of diabetes associated with hypertension.
One of the reasons would be the presence of macroangiopathy and microangiopathy from diabetic complications. Then, the existence of the impaired function of the blood vessel in the whole body may be involved. The improvement of blood pressure control would not be easy, because of already impaired vascular function. Six diabetic cases out of 50 subjects (12%) showed a weight reduction of 2.8 kg on average due to lifestyle adjustment . Consequently, diabetic improvement seemed to be also beneficial to the hypertensive situation.
Diabetic patients have been at higher risk for kidney and cardiovascular diseases. They can lower the complication with lower blood pressure maintenance by adequate treatment . American Diabetes Association (ADA) had proposed the guideline for high blood pressure in its standards of medical care in diabetes . For patients with both diabetes and hypertension, a more detailed response has been required and recommended methods have been reported .
Concerning the blood pressure control in diabetic patients, both the blood flow in the cardiovascular system and regulation by the instantaneous nervous system has been involved in the various pathophysiological condition. For diabetic neuropathy, orthostatic hypotension (OH) is widely known as one of the autonomic nervous disorders.
Let me introduce the actual diabetic case with OH, from many patients that the author treated for long years. A case is a 59-year-old man associated with severe diabetic complications including microangiopathy and macroangiopathy. In the supine position on the bed, the blood pressure is 164/96. After changing the posture to the sitting position on the bed, it dropped to 126/78 at once. Successively, just after he changed standing up, blood pressure has fallen rapidly to 98/50. Furthermore, immediately after walking 2 or 3 steps, he felt blackout and fell on the floor. This episode can be involved in arteriosclerosis, hypertension, diabetes, neuropathy, OH, impaired blood pressure control system, and so on. These multiple factors may influence each other in the aggravating cycle.
Formerly, Action to Control Cardiovascular Risk in Diabetes (ACCORD) group studied intensive blood pressure (BP) control in type 2 diabetes mellitus (T2DM) . BP changes were checked after standing for 3 times in 3 minutes in more than 4000 T2DM patients. As a result, 20% of them showed OH. The definition of OH showed that orthostatic decline in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg, occurred at least 1 time . Consecutively, further study was conducted in 4268 subjects. As a result, the relationships of OH showed positive for dizziness, fractures, later mortality, and negative for falls or CVD events .
In summary, this article described the topics concerning the neural regulation for hypertension and diabetes. For the treatment of metabolic syndrome and lifestyle related diseases for long, psychological and psychiatric control would be also necessary. As a new trial, there is computer research on the Internet of things (IoT) concerning stress, diabetes, and hypertension . It is expected that current content would become a useful reference and that this journal would develop providing significant rehabilitation information for body and soul in the future.
 Ranasinghe P, Mathangasinghe Y, Jayawardena R, Hills AP, Misra A. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC Public Health. 2017 Jan 21;17(1):101. [PMID: 28109251]
 Juraschek SP, Lipsitz LA, Beach JL, Mukamal KJ. Association of Orthostatic Hypotension Timing With Clinical Events in Adults With Diabetes and Hypertension: Results From the ACCORD Trial. Am J Hypertens. 2019 Jun 11;32(7):684-94. [PMID: 30715100]
 Yu P, Zhao J, Jiang H, Liu M, Yang X, Zhang B, Yu Y, Zhang L, Tong R, Liu G, Chen R, Zou Y, Ge J. Neural cell adhesion molecule-1 may be a new biomarker of coronary artery disease. Int J Cardiol. 2018 Apr 15;257:238-42. [PMID: 29506702]
 NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017 Jan 7;389(10064):37-55. [PMID: 27863813]
 Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL, Hsu SP, Ko MJ, Pai MF, Tu YK, Hung KY, Chien KL. Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017 Jun 1;177(6):792-99. [PMID: 28288249]
 Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, Bahonar A, Chifamba J, Dagenais G, Diaz R, Kazmi K, Lanas F, Wei L, Lopez-Jaramillo P, Fanghong L, Ismail NH, Puoane T, Rosengren A, Szuba A, Temizhan A, Wielgosz A, Yusuf R, Yusufali A, McKee M, Liu L, Mony P, Yusuf S; PURE (Prospective Urban Rural Epidemiology) Study investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA. 2013 Sep 4;310(9):959-68. [PMID: 24002282]
 Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; Authors/Task Force Members. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018 Oct;36(10):1953-41. [PMID: 30234752]
 Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement D, Coca A, De Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen S, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder R, Shlyakhto E, Tsioufis K, Aboyans V, Desormais I; List of authors/Task Force members. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2018 Dec;36(12):2284-309. [PMID: 30379783]
 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension: Erratum. J Hypertens. 2019 Feb;37(2):456. [PMID: 30640882]
 Binia A, Jaeger J, Hu Y, Singh A, Zimmermann D. Daily potassium intake and sodium-to-potassium ratio in the reduction of blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2015 Aug;33(8):1509-20. [PMID: 26039623]
 Holmes MV, Dale CE, Zuccolo L, Silverwood RJ, Guo Y, Ye Z, Prieto-Merino D, Dehghan A, Trompet S, Wong A, Cavadino A, Drogan D, Padmanabhan S, Li S, Yesupriya A, Leusink M, Sundstrom J, Hubacek JA, Pikhart H, Swerdlow DI, Panayiotou AG, Borinskaya SA, Finan C, Shah S, Kuchenbaecker KB, Shah T, Engmann J, Folkersen L, Eriksson P, Ricceri F, Melander O, Sacerdote C, Gamble DM, Rayaprolu S, Ross OA, McLachlan S, Vikhireva O, Sluijs I, Scott RA, Adamkova V, Flicker L, Bockxmeer FM, Power C, Marques-Vidal P, Meade T, Marmot MG, Ferro JM, Paulos-Pinheiro S, Humphries SE, Talmud PJ, Mateo Leach I, Verweij N, Linneberg A, Skaaby T, Doevendans PA, Cramer MJ, van der Harst P, Klungel OH, Dowling NF, Dominiczak AF, Kumari M, Nicolaides AN, Weikert C, Boeing H, Ebrahim S, Gaunt TR, Price JF, Lannfelt L, Peasey A, Kubinova R, Pajak A, Malyutina S, Voevoda MI, Tamosiunas A, Maitland-van der Zee AH, Norman PE, Hankey GJ, Bergmann MM, Hofman A, Franco OH, Cooper J, Palmen J, Spiering W, de Jong PA, Kuh D, Hardy R, Uitterlinden AG, Ikram MA, Ford I, Hyppönen E, Almeida OP, Wareham NJ, Khaw KT, Hamsten A, Husemoen LL, Tjønneland A, Tolstrup JS, Rimm E, Beulens JW, Verschuren WM, Onland-Moret NC, Hofker MH, Wannamethee SG, Whincup PH, Morris R, Vicente AM, Watkins H, Farrall M, Jukema JW, Meschia J, Cupples LA, Sharp SJ, Fornage M, Kooperberg C, LaCroix AZ, Dai JY, Lanktree MB, Siscovick DS, Jorgenson E, Spring B, Coresh J, Li YR, Buxbaum SG, Schreiner PJ, Ellison RC, Tsai MY, Patel SR, Redline S, Johnson AD, Hoogeveen RC, Hakonarson H, Rotter JI, Boerwinkle E, de Bakker PI, Kivimaki M, Asselbergs FW, Sattar N, Lawlor DA, Whittaker J, Davey Smith G, Mukamal K, Psaty BM, Wilson JG, Lange LA, Hamidovic A, Hingorani AD, Nordestgaard BG, Bobak M, Leon DA, Langenberg C, Palmer TM, Reiner AP, Keating BJ, Dudbridge F, Casas JP; InterAct Consortium. Association between alcohol and cardiovascular disease: Mendelian randomisation analysis based on individual participant data. BMJ. 2014 Jul 10;349:g4164. [PMID: 25011450]
 Li G, Zhang Y, Thabane L, Mbuagbaw L, Liu A, Levine MA, Holbrook A. Effect of green tea supplementation on blood pressure among overweight and obese adults: a systematic review and meta-analysis. J Hypertens. 2015 Feb;33(2):243-54. [PMID: 25479028]
 Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju ShN, Wormser D, Gao P, Kaptoge S, Berrington de Gonzalez A, Cairns BJ, Huxley R, Jackson ChL, Joshy G, Lewington S, Manson JE, Murphy N, Patel AV, Samet JM, Woodward M, Zheng W, Zhou M, Bansal N, Barricarte A, Carter B, Cerhan JR, Smith GD, Fang X, Franco OH, Green J, Halsey J, Hildebrand JS, Jung KJ, Korda RJ, McLerran DF, Moore SC, O’Keeffe LM, Paige E, Ramond A, Reeves GK, Rolland B, Sacerdote C, Sattar N, Sofianopoulou E, Stevens J, Thun M, Ueshima H, Yang L, Yun YD, Willeit P, Banks E, Beral V, Chen Zh, Gapstur SM, Gunter MJ, Hartge P, Jee SH, Lam TH, Peto R, Potter JD, Willett WC, Thompson SG, Danesh J, Hu FB. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016 Aug 20;388(10046):776-86. [PMID: 27423262]
 Bando M, Fujiwara I, Imamura Y, Takeuchi Y, Hayami E, Nagao N, Abe H, Okumura M, Little M, Tanaka N, Mori S. Lifestyle Habits Adjustment for Hypertension and Discontinuation of Antihypertensive Agents. Journal of Hypertension: Open Access. 2018 Mar 1;7(1):248.
 de Boer IH, Bangalore S, Benetos A, Davis AM, Michos ED, Muntner P, Rossing P, Zoungas S, Bakris G. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Sep;40(9):1273-84. [PMID: 28830958]
 ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, Cutler JA, Simons-Morton DG, Basile JN, Corson MA, Probstfield JL, Katz L, Peterson KA, Friedewald WT, Buse JB, Bigger JT, Gerstein HC, Ismail-Beigi F. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 Apr 29;362(17):1575-85. [PMID: 20228401]
 Fleg JL, Evans GW, Margolis KL, Barzilay J, Basile JN, Bigger JT, Cutler JA, Grimm R, Pedley C, Peterson K, Pop-Busui R, Sperl-Hillen J, Cushman WC. Orthostatic Hypotension in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance. Hypertension. 2016 Oct;68(4):888-95. [PMID: 27504006]
 Priyadarshini R, Barik RK, Dubey H. Deepfog: Fog computing-based deep neural architecture for prediction of stress types, diabetes and hypertension attacks. Computation. 2018 Dec;6(4):62.