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Proposal of a risk-stratification system for the Japanese population based on blood pressure levels: the Ohasama

Kei Asayama1, Takayoshi Ohkubo, Atsushi Sato

  • 1Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University 21st Century COE Program, Japan.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|October 30, 2008
PubMed

Insights

Home blood pressure (HBP) monitoring, unlike casual screening BP (CBP), significantly identifies elevated stroke and transient ischemic attack (TIA) risk, even in high-normal ranges. This highlights the importance of HBP for accurate risk stratification.

Area of Science:

  • Cardiovascular Epidemiology
  • Hypertension Management
  • Preventive Medicine

Background:

  • Current hypertension guidelines rely on casual screening blood pressure (CBP), which may underestimate cardiovascular risk.
  • Accurate risk stratification is crucial for preventing stroke and transient ischemic attack (TIA).
  • Home blood pressure (HBP) measurement offers a potential alternative for more precise BP assessment.

Purpose of the Study:

  • To develop a risk-stratification system using both home blood pressure (HBP) and casual screening blood pressure (CBP).
  • To evaluate the predictive value of HBP and CBP for stroke and TIA incidence.
  • To compare the risk stratification capabilities of HBP versus CBP based on Japanese Society of Hypertension Guidelines (JSH 2004).

Main Methods:

  • A prospective cohort study involving 2,368 Ohasama residents aged ≥35 years without a history of stroke.
  • Home blood pressure (HBP) was self-measured daily for 4 weeks; casual screening blood pressure (CBP) was measured twice at baseline.
  • Follow-up for stroke or TIA incidence over a median of 9.4 years.

Main Results:

  • Statistically significant linear increases in stroke/TIA risk were observed with both CBP-based and HBP-based classifications.
  • High-normal blood pressure (BP) showed significantly elevated stroke/TIA risk with HBP (RH 1.91) but not with CBP (RH 1.52).
  • Stroke/TIA risk increased linearly with increasing risk strata, irrespective of BP measurement type (trend p < 0.0001).

Conclusions:

  • Home blood pressure (HBP) measurement is superior to casual screening blood pressure (CBP) in identifying individuals at high risk for stroke/TIA.
  • The study proposes a novel risk-stratification system emphasizing the importance of HBP for accurate cardiovascular risk evaluation.
  • Future Japanese BP guidelines should incorporate HBP assessment and consider risks for non-hypertensive individuals.

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