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Relationship between blood pressure level and mortality rate: an 18-year study conducted in two rural communities in
1Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan. takagis@sapmed.ac.jp
Insights
Cardiovascular disease mortality risk increases with higher blood pressure in Japanese adults. Treatment for hypertension should ideally begin when blood pressure reaches 140/90 mmHg or less.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Limited research exists on cardiovascular disease prognosis based on blood pressure levels in the Japanese population.
- Hypertension management in Japan faces challenges regarding optimal timing for initiating treatment despite medication availability.
Purpose of the Study:
- To examine the long-term cardiovascular disease prognosis in the Japanese general population stratified by blood pressure.
- To identify the blood pressure thresholds associated with increased cardiovascular mortality risk.
Main Methods:
- A prospective community-based cohort study followed 1996 adults (40-64 years) for 18 years.
- Data on mortality and causes of death were collected via public health nurses, death certificates, and physician questionnaires.
- Analysis correlated baseline blood pressure categories with cardiovascular disease mortality.
Main Results:
- Cardiovascular disease mortality significantly increased with higher systolic blood pressure (≥140 mmHg) and diastolic blood pressure (≥90 mmHg).
- Adjusted analyses confirmed this association, considering age, sex, and other cardiovascular risk factors.
- No J-shaped relationship was observed between blood pressure levels and cardiovascular disease mortality risk.
Conclusions:
- The findings suggest that initiating hypertension treatment when blood pressure is 140/90 mmHg or lower is optimal for the Japanese population.
- This threshold aims to mitigate the increased risk of cardiovascular disease mortality associated with elevated blood pressure.
Background:
There have been very few studies on life prognosis of cardiovascular disease according to blood pressure stratification in the Japanese. Therefore, in Japan, although treatment of hypertension is possible, albeit at times difficult, due to the availability of various antihypertensive medications, the appropriate time at which treatment should be started remains a problem.
Objective:
To investigate the long-term prognosis of cardiovascular disease in the Japanese general population according to blood pressure stratification in the Japanese.
Design:
A community-based prospective cohort study of 1996 men and women between the ages of 40 and 64 years at the baseline examination was conducted over an 18-year period. Information on death was obtained from local public health nurses and death certificates. The causes of death were clarified by questionnaires sent to doctors in the hospital in which the deceased was hospitalized, and the causes of death were analysed in each blood pressure category at baseline examination.
Results:
Mortality from cardiovascular disease increased with increases in the level of blood pressure and was significantly higher in > or = 140 mmHg group in systolic blood pressure and > or = 90 mmHg group in diastolic blood pressure, adjusted for age, sex and other cardiovascular risk factors in the Japanese general population. However, mortality risk from cardiovascular disease did not have a J-shaped relationship with systolic and diastolic blood pressure.
Conclusion:
We conclude that the optimum time for starting treatment in Japanese people is when blood pressure is 140/90 mmHg or less.