Serial blood pressure measurements and cardiovascular disease in a Japanese cohort
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This study on Hiroshima and Nagasaki residents found diastolic blood pressure (DBP) strongly predicts cerebral hemorrhage, while systolic blood pressure (SBP) is key for cerebral infarction and coronary heart disease risk, with past readings offering predictive value.
Area of Science:
- Epidemiology
- Cardiovascular Disease Research
- Public Health
Background:
- Long-term health surveillance of atomic bomb survivors in Hiroshima and Nagasaki.
- Biennial clinical examinations and history taking initiated in 1958 for a cohort of 16,711 residents.
- Incident cases of cerebrovascular disease (621) and coronary heart disease (218) recorded between 1958-1974.
Purpose of the Study:
- To examine the relationship between serial blood pressure (BP) measurements and cardiovascular disease risk.
- To quantify the association between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and disease risk.
- To assess the predictive value of past BP levels in conjunction with recent measurements.
Main Methods:
- Analysis of biennial BP measurements from a large cohort study.
- Statistical modeling to determine the quantitative relationship between BP and disease incidence.
- Evaluation of predictive accuracy of recent versus past BP readings for cardiovascular events.
Main Results:
- Cerebral hemorrhage risk strongly depends on recent DBP, with past DBP providing additional predictive value; SBP has limited additional impact.
- SBP is the primary predictor for cerebral infarction, though high DBP adds risk at elevated SBP levels.
- Recent BP is more predictive for cerebral infarction, while past SBP is more strongly associated with coronary heart disease risk.
Conclusions:
- DBP is a critical predictor for cerebral hemorrhage, and historical DBP is valuable for risk assessment.
- SBP is a significant predictor for cerebral infarction and coronary heart disease, with past SBP levels being particularly relevant for coronary heart disease.
- BP predictive models should consider both recent and past measurements, with varying importance of SBP and DBP depending on the specific cardiovascular outcome and age/sex factors.
Abstract:
A cohort of 16,711 residents of Hiroshima and Nagasaki have participated in a program of biennial clinical examination and history taking that began in 1958. During 1958-1974, a total of 621 confirmed cases of cerebrovascular disease and 218 confirmed cases of coronary heart disease were incident. This study makes a detailed examination of the relationship between a series of biennial examination blood pressure (BP) measurements and cardiovascular disease risk. Two aspects are emphasized: the quantitative relationship between risk and both systolic blood pressure (SBP) and diastolic blood pressure (DBP), and the predictive value of BP levels some years in the past, given more recent BP determinations. Cerebral hemorrhage incidence is shown to depend markedly on recent DBP level, while earlier DBP levels make an additional important contribution to risk prediction. Corresponding SBP levels have little additional predictive value. With cerebral infarction, SBP is the more important predictor, though elevated DBP conveys some additional risk at high SBP levels. Recent BP levels are more strongly predictive for cerebral infarction than are BP levels some years earlier. Elevated SBP is also an important predictor of coronary heart disease risk in this population, while elevated DBP does not appear to be predictive at specified SBP. SBP levels several years in the past are more closely associated with coronary heart disease risk than are recent SBP readings. The dependence of BP relative risk functions on sex and age is examined and some departures from the results just listed are noted at younger ages. Implications for disease mechanism and hypertensive therapy are discussed.