Impact of blood pressure levels on different types of stroke: The Hisayama study

Hisatomi Arima, Yumihiro Tanizaki, Koji Yonemoto, Yasufumi Doi, Toshiharu Ninomiya, Jun Hata, Masayo Fukuhara, Kiyoshi Matsumura, Mitsuo Iida, Yutaka Kiyohara

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Abstract

OBJECTIVE: Clinical uncertainty remains whether the blood pressure classification and risk stratifications recommended by the Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2009) are useful in predicting the risks of stroke and its subtypes in the general Japanese population. METHODS: A total of 1621 stroke-free residents of a Japanese community aged at least 40 years were followed up for 32 years. Outcomes were total and cause-specific stroke (lacunar infarction, atherothrombotic infarction, cardioembolic infarction, cerebral haemorrhage and subarachnoid haemorrhage). Incidence was calculated by the pooling of repeated observations method. RESULTS: The age-adjusted incidence of total stroke rose progressively with higher blood pressure levels in both sexes (both P for trend <0.0001). A similar pattern was observed for lacunar infarction in both sexes and for cerebral haemorrhage in men: the differences were significant between optimal blood pressure and grades 1ĝ€"3 hypertension (all P < 0.05). The age-adjusted incidence of atherothrombotic infarction in either sex and that of cardioembolic infarction and subarachnoid haemorrhage in women significantly increased in grade 3 hypertension (all P < 0.05). These associations remained substantially unchanged even after adjustment for other risk factors. In regard to risk stratification, the age-adjusted incidence of stroke significantly increased with the level of risk in both sexes. CONCLUSION: Our findings suggest that the blood pressure classification and risk stratifications recommended by the JSH 2009 guidelines are useful in predicting the risk of stroke in a general Japanese population, but the magnitude and patterns of the impact of blood pressure categories are different among stroke subtypes.

Original languageEnglish
Pages (from-to)2437-2443
Number of pages7
JournalJournal of hypertension
Volume27
Issue number12
DOIs
Publication statusPublished - Dec 2009

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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    Arima, H., Tanizaki, Y., Yonemoto, K., Doi, Y., Ninomiya, T., Hata, J., Fukuhara, M., Matsumura, K., Iida, M., & Kiyohara, Y. (2009). Impact of blood pressure levels on different types of stroke: The Hisayama study. Journal of hypertension, 27(12), 2437-2443. https://doi.org/10.1097/HJH.0b013e328330e882