Stroke Risk in Systolic and Combined Systolic and Diastolic Hypertension Determined Using Ambulatory Blood Pressure. The Ohasama Study

Ryusuke Inoue, Takayoshi Ohkubo, Masahiro Kikuya, Hirohito Metoki, Kei Asayama, Taku Obara, Takuo Hirose, Azusa Hara, Haruhisa Hoshi, Junichiro Hashimoto, Kazuhito Totsune, Hiroshi Satoh, Yoshiaki Kondo, Yutaka Imai

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: To investigate the risk of stroke in subjects with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH) in a Japanese general population, we used 24-h ambulatory blood pressure (ABP) and casual-screening blood-pressure (CBP) readings. Methods: Subtypes of hypertension were defined based on systolic blood pressure (SBP) >135 mm Hg or diastolic blood pressure (DBP) >80 mm Hg for 24-h ABP, and SBP >140 mm Hg or DBP >90 mm Hg for CBP. We obtained 24-h ABP and CBP data for 1271 (40% male) subjects aged ≥40 years (mean age, 61 years) without a history of symptomatic stroke; their stroke-free survival was then determined. The prognostic significance of each subtype of hypertension was determined by Cox proportional hazard analysis. Results: There were 113 symptomatic strokes during follow-up (mean time, 11 years). Compared with normotension, among the hypertension subtypes determined by 24-h ABP, the adjusted relative hazards (RHs) of stroke were 2.24 for ISH (P = .002) and 2.39 for SDH (P = .0004). The association was less marked among subtypes determined by CBP (RH = 1.40 and P = .13 for ISH; RH = 2.07 and P = .017 for SDH). The IDH group was excluded from the Cox analysis because both the prevalence and the number of events were low in this group. Conclusions: Isolated systolic hypertension, as determined by 24-h ABP measurements, was associated with a high risk of stroke, similar to that found in SDH subjects; this suggests that the prognosis of hypertensive patients would be improved by focusing treatment on 24-h systolic ABP.

Original languageEnglish
Pages (from-to)1125-1131
Number of pages7
JournalAmerican journal of hypertension
Volume20
Issue number10
DOIs
Publication statusPublished - 2007 Oct 1
Externally publishedYes

    Fingerprint

Keywords

  • ambulatory blood pressure
  • stroke
  • Systolic hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Inoue, R., Ohkubo, T., Kikuya, M., Metoki, H., Asayama, K., Obara, T., Hirose, T., Hara, A., Hoshi, H., Hashimoto, J., Totsune, K., Satoh, H., Kondo, Y., & Imai, Y. (2007). Stroke Risk in Systolic and Combined Systolic and Diastolic Hypertension Determined Using Ambulatory Blood Pressure. The Ohasama Study. American journal of hypertension, 20(10), 1125-1131. https://doi.org/10.1016/j.amjhyper.2007.04.017