Endpoints The primary endpoint was the change in clinic systolic and diastolic BP after 6 months of treatment. Secondary endpoints included change in home BP, urinary albumin creatinine excretion ratio (ACR), B-type natriuretic peptide (BNP) and serum UA concentration. BP measurements and laboratory tests The clinic BP was measured in a sitting position during a morning visit (9–11 am) every 4 weeks. We followed all American

Heart Association Recommendations published in 1988 [8, 10] including using a 47 × 13 cm cuff and 24 × 13 cm bladder to avoid cuff hypertension. The cuff was strictly positioned 2 cm above the antecubital crease to obtain a similarly leveled complete compression of the brachial artery. All BP values were expressed as the average of two measurements obtained at the same time-point. Patients were required to measure home BP in the morning in a sitting Akt inhibitor position within 30 min after awakening before taking Sirtuin activator medications in a fasting state. Night time home BP measurement was also required to measure at any given

time between supper and bedtime with having patient’s habitual drinking unrestricted. BP measuring devices equipped with upper arm cuff were encouraged to use. The averages of several measured values check details were used for analysis. Laboratory tests carried out after 6 months of treatment were BNP, serum Cr concentration, ACR, estimated-GFR (eGFR), serum UA concentration, and others including lipid profiles. The urinary albumin level was

determined from a spot urine sample using a turbidimetric immunoassay (SRL, Tokyo, Japan). Plasma BNP was measured using high-sensitivity, noncompetitive radioimmunoassays (Shiono-RIA BNP, Shionogi Inc, Osaka, Japan) Statistical analyses The paired student’s t test, Wilcoxon’s signed rank test, and one-way analysis of variance (ANOVA) and Bonferroni’s post hoc test were carried out with JMP 9.0 software. The computer used for the analysis was a Dynabook Satellite 2590X (Toshiba, Tokyo, Japan). Data are presented as the mean ± standard deviation much (SD) for continuous variables with normal distribution. Continuous variables without normal distribution are presented as median and interquartile range (IQR) with 25 and 75 percentiles. Because of their skewed distribution, logarithmic transformation of BNP and ACR values were performed as the geometric means with 95% confidence intervals. A P value of less than 0.05 was considered statistically significant. Results Prescription of antihypertensive agents A total of 277 patients were registered in the JOINT study, of whom 49 were excluded (33 were lost during follow-up, 7 had protocol violations, and 9 had inadequate data for analyses). Consequently a total of 228 patients with clinical index data were included in the analysis.