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Impact of blood pressure levels on different types of stroke: the Hisayama study
Hisatomi Arima1, Yumihiro Tanizaki, Koji Yonemoto
1Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan. harima@envmed.med.kyushu-u.ac.jp
Insights
The Japanese Society of Hypertension (JSH) 2009 guidelines effectively predict stroke risk in the Japanese population. Blood pressure categories show varying impacts across different stroke subtypes.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Public Health
Background:
- Clinical uncertainty exists regarding the predictive value of the Japanese Society of Hypertension (JSH) 2009 guidelines for stroke risk in Japan.
- The guidelines' blood pressure classification and risk stratification utility for predicting stroke and its subtypes in the general Japanese population requires further investigation.
Purpose of the Study:
- To evaluate the effectiveness of the JSH 2009 guidelines in predicting the risk of total stroke and its subtypes.
- To assess the utility of blood pressure classification and risk stratification recommended by JSH 2009 in a general Japanese population.
Main Methods:
- A prospective cohort study followed 1621 stroke-free Japanese residents (aged ≥40 years) for 32 years.
- Outcomes included total stroke and cause-specific strokes: lacunar infarction, atherothrombotic infarction, cardioembolic infarction, cerebral hemorrhage, and subarachnoid hemorrhage.
- Incidence was calculated using the pooling of repeated observations method.
Main Results:
- Age-adjusted total stroke incidence increased with higher blood pressure levels in both sexes (P < 0.0001).
- Lacunar infarction and cerebral hemorrhage (men) showed significant increases with hypertension grades.
- Atherothrombotic, cardioembolic (women), and subarachnoid hemorrhage (women) incidences significantly rose in grade 3 hypertension, independent of other risk factors.
Conclusions:
- The JSH 2009 blood pressure classification and risk stratification are useful for predicting stroke risk in the Japanese population.
- The impact of blood pressure categories on stroke risk varies among different stroke subtypes.
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 1-3 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.
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