Long-term risk of BP values above normal for cardiovascular mortality

A 24-year observation of Japanese aged 30 to 92 years

Naoyuki Takashima, Takayoshi Ohkubo, Katsuyuki Miura, Tomonori Okamura, Yoshitaka Murakami, Akira Fujiyoshi, Shin Ya Nagasawa, Aya Kadota, Yoshikuni Kita, Naoko Miyagawa, Takashi Hisamatsu, Takehito Hayakawa, Akira Okayama, Hirotsugu Ueshima

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Objective: In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population. Methods: We followed up a nationwide sample of 8592 Japanese, aged 30 years or above without a history of CVD and antihypertensive medication at baseline, for 24 years. Hazard ratios for CVD mortality in BP categories defined according to JCN7 criteria were estimated using Cox model adjusted for potential confounding factors with normal BP treated as the reference category. Results: We observed 689 CVD deaths. Hazard ratios for CVD mortality were progressively and significantly increased from the category of prehypertension. Population-attributable fraction (PAF) demonstrated that 43 and 48% of CVD and stroke deaths were explained by non-normal BP at baseline. Hazard ratios and PAF were remarkably higher in younger participants (aged 30-59 years) than those in the elderly (aged 60 years or above). Particularly, in younger men, 81% of CVD deaths were explained by non-normal BP. In sensitivity analysis, participants with antihypertensive medication showed the highest hazard ratio for CVD morality compared with the other categories. Conclusions: BP levels above normal at baseline retained significant relative and absolute risks of CVD and stroke mortality during 24 years. Long-lasting burden of non-normal BP particularly in younger individuals suggests the importance of primary prevention of high BP from younger generation.

Original languageEnglish
Pages (from-to)2299-2306
Number of pages8
JournalJournal of Hypertension
Volume30
Issue number12
DOIs
Publication statusPublished - 2012 Dec

Fingerprint

Reference Values
Cardiovascular Diseases
Observation
Blood Pressure
Mortality
Antihypertensive Agents
Myocardial Infarction
Prehypertension
Population
Population Dynamics
Primary Prevention
Proportional Hazards Models
Stroke
Hypertension

Keywords

  • blood pressure
  • cardiovascular disease
  • cerebral hemorrhage
  • cerebral infarction
  • long-term follow up
  • population-attributable fraction
  • stroke

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Long-term risk of BP values above normal for cardiovascular mortality : A 24-year observation of Japanese aged 30 to 92 years. / Takashima, Naoyuki; Ohkubo, Takayoshi; Miura, Katsuyuki; Okamura, Tomonori; Murakami, Yoshitaka; Fujiyoshi, Akira; Nagasawa, Shin Ya; Kadota, Aya; Kita, Yoshikuni; Miyagawa, Naoko; Hisamatsu, Takashi; Hayakawa, Takehito; Okayama, Akira; Ueshima, Hirotsugu.

In: Journal of Hypertension, Vol. 30, No. 12, 12.2012, p. 2299-2306.

Research output: Contribution to journalArticle

Takashima, N, Ohkubo, T, Miura, K, Okamura, T, Murakami, Y, Fujiyoshi, A, Nagasawa, SY, Kadota, A, Kita, Y, Miyagawa, N, Hisamatsu, T, Hayakawa, T, Okayama, A & Ueshima, H 2012, 'Long-term risk of BP values above normal for cardiovascular mortality: A 24-year observation of Japanese aged 30 to 92 years', Journal of Hypertension, vol. 30, no. 12, pp. 2299-2306. https://doi.org/10.1097/HJH.0b013e328359a9f7
Takashima, Naoyuki ; Ohkubo, Takayoshi ; Miura, Katsuyuki ; Okamura, Tomonori ; Murakami, Yoshitaka ; Fujiyoshi, Akira ; Nagasawa, Shin Ya ; Kadota, Aya ; Kita, Yoshikuni ; Miyagawa, Naoko ; Hisamatsu, Takashi ; Hayakawa, Takehito ; Okayama, Akira ; Ueshima, Hirotsugu. / Long-term risk of BP values above normal for cardiovascular mortality : A 24-year observation of Japanese aged 30 to 92 years. In: Journal of Hypertension. 2012 ; Vol. 30, No. 12. pp. 2299-2306.
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abstract = "Objective: In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population. Methods: We followed up a nationwide sample of 8592 Japanese, aged 30 years or above without a history of CVD and antihypertensive medication at baseline, for 24 years. Hazard ratios for CVD mortality in BP categories defined according to JCN7 criteria were estimated using Cox model adjusted for potential confounding factors with normal BP treated as the reference category. Results: We observed 689 CVD deaths. Hazard ratios for CVD mortality were progressively and significantly increased from the category of prehypertension. Population-attributable fraction (PAF) demonstrated that 43 and 48{\%} of CVD and stroke deaths were explained by non-normal BP at baseline. Hazard ratios and PAF were remarkably higher in younger participants (aged 30-59 years) than those in the elderly (aged 60 years or above). Particularly, in younger men, 81{\%} of CVD deaths were explained by non-normal BP. In sensitivity analysis, participants with antihypertensive medication showed the highest hazard ratio for CVD morality compared with the other categories. Conclusions: BP levels above normal at baseline retained significant relative and absolute risks of CVD and stroke mortality during 24 years. Long-lasting burden of non-normal BP particularly in younger individuals suggests the importance of primary prevention of high BP from younger generation.",
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T2 - A 24-year observation of Japanese aged 30 to 92 years

AU - Takashima, Naoyuki

AU - Ohkubo, Takayoshi

AU - Miura, Katsuyuki

AU - Okamura, Tomonori

AU - Murakami, Yoshitaka

AU - Fujiyoshi, Akira

AU - Nagasawa, Shin Ya

AU - Kadota, Aya

AU - Kita, Yoshikuni

AU - Miyagawa, Naoko

AU - Hisamatsu, Takashi

AU - Hayakawa, Takehito

AU - Okayama, Akira

AU - Ueshima, Hirotsugu

PY - 2012/12

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N2 - Objective: In Western populations, blood pressure (BP) measured at baseline has been reported to predict long-term (over 20 years) risk of mortality from cardiovascular diseases (CVDs). However, corresponding evidence is scarce in Asia where stroke is dominant. We investigated the association between baseline BP and 24-year mortality risk due to CVD, in a representative Japanese general population. Methods: We followed up a nationwide sample of 8592 Japanese, aged 30 years or above without a history of CVD and antihypertensive medication at baseline, for 24 years. Hazard ratios for CVD mortality in BP categories defined according to JCN7 criteria were estimated using Cox model adjusted for potential confounding factors with normal BP treated as the reference category. Results: We observed 689 CVD deaths. Hazard ratios for CVD mortality were progressively and significantly increased from the category of prehypertension. Population-attributable fraction (PAF) demonstrated that 43 and 48% of CVD and stroke deaths were explained by non-normal BP at baseline. Hazard ratios and PAF were remarkably higher in younger participants (aged 30-59 years) than those in the elderly (aged 60 years or above). Particularly, in younger men, 81% of CVD deaths were explained by non-normal BP. In sensitivity analysis, participants with antihypertensive medication showed the highest hazard ratio for CVD morality compared with the other categories. Conclusions: BP levels above normal at baseline retained significant relative and absolute risks of CVD and stroke mortality during 24 years. Long-lasting burden of non-normal BP particularly in younger individuals suggests the importance of primary prevention of high BP from younger generation.

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KW - long-term follow up

KW - population-attributable fraction

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