Specialized medical services

We specialize in geriatric medicine and in all forms of hypertension. Please visit our department if you have symptoms such as dizziness or unsteadiness, forgetfulness, weight loss, or unexplained fever that cannot be addressed by organ-specific departments, if you do not know which department to consult, or if you simply feel vaguely unwell as you grow older. We not only treat diseases but also support our patients' quality of life.
Our Memory Clinic welcomes anyone concerned about forgetfulness or suspected of having dementia, and provides diagnosis of the underlying disease and a treatment plan. We place emphasis on early diagnosis and early treatment. For patients at the stage of mild cognitive impairment (MCI) or mild dementia, we offer a diagnostic admission that includes cerebrospinal fluid biomarker testing to confirm the diagnosis of Alzheimer's disease and to assess eligibility for disease-modifying therapy (anti-amyloid-beta antibodies). An eye-tracking-based cognitive assessment program developed by our department is also used in routine practice.
Our Resistant Hypertension Clinic provides differential diagnosis and treatment for resistant hypertension, in which blood pressure remains uncontrolled despite three or more antihypertensive drugs, and for secondary hypertension, including primary aldosteronism and other endocrine or renal causes. When adequate blood pressure control cannot be achieved with medication, we evaluate eligibility for renal denervation (percutaneous renal sympathetic nerve ablation) and offer it as a treatment option in cooperation with the relevant departments. Our Hypertension and Sleep Apnea Clinic investigates sleep apnea as a cause of hypertension and initiates CPAP therapy during a short hospital stay. We also specialize in the diagnosis and treatment of conditions associated with low blood pressure, such as orthostatic hypotension and neurally mediated syncope.

Features

In older adults, disease develops on a background of age-related changes such as frailty, sarcopenia, and cognitive decline. We therefore combine a geriatric perspective with the diagnostic approach of general internal medicine. Using the Geriatric 5Ms framework (Mobility, Mind, Medications, Multicomplexity, and Matters Most), we assess each patient comprehensively and provide individualized care that goes beyond treating disease to include medication review and maintenance of daily functioning. Our department has contributed to the hypertension management guidelines of the Japanese Society of Hypertension and has played a leading role in the section on hypertension in older adults. We make full use of home blood pressure and 24-hour ambulatory blood pressure monitoring (ABPM) to deliver antihypertensive treatment that takes frailty, cognitive function, and polypharmacy into account. We have extensive experience in the diagnosis and treatment of secondary hypertension, including primary aldosteronism, and in the management of resistant hypertension, and we participate in a nationwide registry study. In the Memory Clinic, we have established a system for biological diagnosis by cerebrospinal fluid testing in all eligible patients, supporting early diagnosis and early treatment, including assessment of eligibility for disease-modifying therapy.

Considerations in referring your patients to Geriatrics and Hypertension

We accept referrals of older patients in general, patients with geriatric syndromes including dementia, and patients with multiple coexisting conditions who are difficult to manage in organ-specific outpatient clinics. Please feel free to refer patients to the Memory Clinic as soon as forgetfulness becomes a concern; the earlier the referral, the wider the range of diagnostic and treatment options. For resistant hypertension and suspected secondary hypertension, we provide differential diagnosis and treatment planning. For patients with essential hypertension in general, we assess complications and propose a guideline-based management plan for your reference. We also evaluate patients with hypertension complicated by sleep apnea, and patients with hypotension or syncope. Please attach the patient's home blood pressure records and current medication list. Once the diagnosis and treatment plan have been established, the patient will be referred back to you.