Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population: Participant-level meta-analysis

Kei Asayama, Michihiro Satoh, Yoshitaka Murakami, Takayoshi Ohkubo, Sin Ya Nagasawa, Ichiro Tsuji, Takeo Nakayama, Akira Okayama, Katsuyuki Miura, Yutaka Imai, Hirotsugu Ueshima, Tomonori Okamura

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

To evaluate the cardiovascular mortality risk in association with blood pressure level among people with and without antihypertensive treatment, we performed the participant-level meta-analysis that included 39 705 Japanese from 6 cohorts (58.4% women; mean age, 60.1 years; 20.4% treated). Multivariable-adjusted Cox models were used to analyze the risk of cardiovascular mortality and its subtypes among 6 blood pressure levels according to recent guidelines, optimal to Grade 3 hypertension, and the usage of antihypertensive medication at baseline. During median 10.0 years of follow-up, there were 2032 cardiovascular deaths (5.1 per 1000 person-years), of which 410 deaths were coronary heart disease, 371 were heart failure, and 903 deaths were stroke. Treated participants had significantly higher risk for cardiovascular mortality (hazard ratios, 1.50; 95% confidence intervals, 1.36-1.66), coronary heart disease (hazard ratios, 1.53; confidence intervals, 1.23-1.90), heart failure (hazard ratios, 1.39; confidence intervals, 1.09-1.76), and stroke (hazard ratios, 1.48; confidence intervals, 1.28-1.72) compared with untreated people. Among untreated participants, the risks increased linearly with an increment of blood pressure category (P≤0.011). The risk increments per blood pressure category were higher in young participants (<60 years; 22% to 79%) than those in old people (≥60 years; 7% to 15%) with significant interaction for total cardiovascular, heart failure, and stroke mortality (P≤0.026). Among treated participants, the significant linear association was also observed for cardiovascular mortality (P=0.0003), whereas no stepwise increase in stroke death was observed (P=0.19). The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication. More attention should be paid to the residual cardiovascular risks in treated patients.

Original languageEnglish
Pages (from-to)1189-1197
Number of pages9
JournalHypertension
Volume63
Issue number6
DOIs
Publication statusPublished - 2014

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Antihypertensive Agents
Meta-Analysis
Mortality
Population
Stroke
Confidence Intervals
Blood Pressure
Heart Failure
Therapeutics
Coronary Disease
Proportional Hazards Models
Guidelines
Hypertension

Keywords

  • Cardiovascular diseases
  • Hypertension
  • Meta-analysis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population : Participant-level meta-analysis. / Asayama, Kei; Satoh, Michihiro; Murakami, Yoshitaka; Ohkubo, Takayoshi; Nagasawa, Sin Ya; Tsuji, Ichiro; Nakayama, Takeo; Okayama, Akira; Miura, Katsuyuki; Imai, Yutaka; Ueshima, Hirotsugu; Okamura, Tomonori.

In: Hypertension, Vol. 63, No. 6, 2014, p. 1189-1197.

Research output: Contribution to journalArticle

Asayama, K, Satoh, M, Murakami, Y, Ohkubo, T, Nagasawa, SY, Tsuji, I, Nakayama, T, Okayama, A, Miura, K, Imai, Y, Ueshima, H & Okamura, T 2014, 'Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population: Participant-level meta-analysis', Hypertension, vol. 63, no. 6, pp. 1189-1197. https://doi.org/10.1161/HYPERTENSIONAHA.113.03206
Asayama, Kei ; Satoh, Michihiro ; Murakami, Yoshitaka ; Ohkubo, Takayoshi ; Nagasawa, Sin Ya ; Tsuji, Ichiro ; Nakayama, Takeo ; Okayama, Akira ; Miura, Katsuyuki ; Imai, Yutaka ; Ueshima, Hirotsugu ; Okamura, Tomonori. / Cardiovascular risk with and without antihypertensive drug treatment in the japanese general population : Participant-level meta-analysis. In: Hypertension. 2014 ; Vol. 63, No. 6. pp. 1189-1197.
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