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Nocturnal hypoxia and the difference in morning and evening blood pressure measured at home

Azahar NM, Ganbaatar G, Kitaoka K, Sawayama Y, Yano Y

Hypertens Res, 2023 Mar;46(3):781-783.
PMID: 36642752 DOI: 10.1038/s41440-022-01164-z
African Control of Hypertension through Innovative Epidemiology and a Vibrant Ecosystem (ACHIEVE): a holistic approach for hypertension control in Africa

Bayaraa N, Azahar NM, Kitaoka K, Kobayashi Y, Yano Y

J Hum Hypertens, 2025 Feb;39(2):83-85.
PMID: 37386123 DOI: 10.1038/s41371-023-00845-7
Fulltext Space Prescription: Initiative to Improve Health and Well-being in Tokyo

Ganbaatar G, Ohashi M, Zaman MK, Azahar NM, Yamawaki K, Matsuo H, et al.

J Atheroscler Thromb, 2025 Jan 01;32(1):1-10.
PMID: 39443132 DOI: 10.5551/jat.RV22028

This review introduces "space prescribing," an innovative healthcare approach that incorporates the physical environment's role in promoting health beyond traditional clinical settings. Recognizing that individuals spend a significant amount of time outside clinical environments, this approach explores the therapeutic potential of natural and built environments in improving well-being and managing diseases, particularly cardiovascular and mental health conditions.Traditional healthcare models focus on treatments in hospital and clinic settings. However, evidence suggests that environmental factors profoundly influence health outcomes. Space prescribing recommends specific environments that encourage healthier lifestyles and enhance wellbeing. This concept includes social prescribing, in which healthcare professionals direct patients to community-based, non-medical activities such as art classes and sports, acknowledging that well-being transcends biological factors.This review also highlights "Cultural Ecosystem Services" (CES) in health through stress reduction, social connections, and physical activity. For cardiovascular health, elements such as green spaces and urban design are vital for managing conditions, such as hypertension and heart disease. Similarly, the configuration of indoor and outdoor spaces plays a crucial role in mental health. Therapeutic landscapes, including community gardens and culturally enriched urban areas, support mental health recovery, foster community engagement and reduce isolation.In conclusion, space prescribing advocates an integrated approach that considers the physical and social environments as fundamental components of health promotion. This strategy aims to mitigate health disparities and enhance the quality of life, while making health-enhancing activities accessible in urban and rural settings. Through this holistic approach, space prescribing has the potential to transform public health by strategically utilizing environmental designs to support health outcomes.
Oral microbiome alpha diversity and all-cause, cardiovascular, and non-cardiovascular mortality in US adults: Evidence from the NHANES 2009-2019

Mondal R, Ritu RB, Kitaoka K, Azahar NM, Moniruzzaman M, Ogata S, et al.

Atherosclerosis, 2025 Feb;401:119074.
PMID: 39644613 DOI: 10.1016/j.atherosclerosis.2024.119074

BACKGROUND AND AIMS: Knowledge about the association between oral microbiome diversity within individuals and cardiovascular disease (CVD) and non-CVD mortality is scarce. Besides, variation by sex and racial and ethnic groups, and the potential mediators of these associations remain unclear. We aimed to investigate the associations of oral microbiome alpha diversity with all-cause, CVD, and non-CVD mortality, and the interaction effects of sex and racial and ethnic groups and potential mediators in the associations.
METHODS: The National Health and Nutrition Examination Survey (NHANES) is a population-based observational study, conducted periodically in Mexican American, Other Hispanic, Non-Hispanic (NH) White, NH Black, and other racial/ethnic participants. We linked 2009-12 survey data of 8199 adults to the mortality data until 2019. By analyzing RNA gene sequences from oral rinse samples, microbiome alpha diversity within individuals was assessed using operational taxonomic unit (OTU) richness. Potential mediators included obesity, diabetes mellitus, dyslipidemia, hypertension, and periodontitis. Multivariable Cox proportional hazards regression and causal mediation analysis were used.
RESULTS: Baseline mean ± standard deviation (SD) age was 42.1 ± 15.1 years. Over a median follow-up of 9.1 years, 405 all-cause mortality occurred (CVD, 105; non-CVD, 300). Each 1-SD increment in OTU richness was inversely associated with all-cause mortality (hazard ratio [HR] 0.92, 95 % confidence interval [CI] 0.90-0.95), CVD mortality (HR, 0.92; 95 % CI, 0.90-0.95), and non-CVD mortality (HR, 0.92; 95 % CI, 0.90-0.95). With evidence of significant racial and ethnic groups-interaction (p <0.05), these associations were evident in Mexican American, NH White, and others racial/ethnic participants. None of the potential mediators significantly mediated the associations of OTU richness with all-cause, CVD, and non-CVD mortality.
CONCLUSIONS: Lower oral microbiome alpha diversity is associated with higher risk for all-cause, CVD, and non-CVD mortality, and the associations are varied by racial and ethnic groups.
Fulltext Association of Arterial Stiffness and Atherosclerotic Burden With Brain Structural Changes Among Japanese Men

Azahar NM, Yano Y, Kadota A, Shiino A, Syaifullah AH, Miyagawa N, et al.

J Am Heart Assoc, 2023 Jun 06;12(11):e028586.
PMID: 37232267 DOI: 10.1161/JAHA.122.028586

Background Little is known regarding whether arterial stiffness and atherosclerotic burden are each independently associated with brain structural changes. Simultaneous assessments of both arterial stiffness and atherosclerotic burden in associations with brain could provide insights into the mechanisms of brain structural changes. Methods and Results Using data from the SESSA (Shiga Epidemiological Study of Subclinical Atherosclerosis), we analyzed data among 686 Japanese men (mean [SD] age, 67.9 [8.4] years; range, 46-83 years) free from history of stroke and myocardial infarction. Brachial-ankle pulse wave velocity and coronary artery calcification on computed tomography scans were measured between March 2010 and August 2014. Brain volumes (total brain volume, gray matter, Alzheimer disease signature and prefrontal) and brain vascular damage (white matter hyperintensities) were quantified using brain magnetic resonance imaging from January 2012 through February 2015. In multivariable adjustment models including mean arterial pressure, when brachial-ankle pulse wave velocity and coronary artery calcification were entered into the same models, the β (95% CI) for Alzheimer disease signature volume for each 1-SD increase in brachial-ankle pulse wave velocity was -0.33 (-0.64 to -0.02), and the unstandardized β (95% CI) for white matter hyperintensities for each 1-unit increase in coronary artery calcification was 0.68 (0.05-1.32). Brachial-ankle pulse wave velocity and coronary artery calcification were not statistically significantly associated with total brain and gray matter volumes. Conclusions Among Japanese men, higher arterial stiffness was associated with lower Alzheimer disease signature volumes, whereas higher atherosclerotic burden was associated with brain vascular damage. Arterial stiffness and atherosclerotic burden may be independently associated with brain structural changes via different pathways.