The results from the present 8-year follow-up study demonstrate that white-coat hypertension is a transitional condition to hypertension outside medical settings, suggesting that white-coat hypertension may carry a poor cardiovascular prognosis.

No abstract

Cigarette smoking is an established risk factor for all-cause mortality among Caucasians 1-8 as well as Japanese. [9][10][11] Since smoking habit often accompanies with unhealthy lifestyle, appropriate control for confounding factors is necessary to estimate the hazard of cigarette smoking.12-14 However, there have been only one Japanese study that analyzed the relative risk (RR) for all-cause mortality associated with cigarette smoking adjusted for possible confounders.9 Therefore, we conducted a prospective study among Japanese men and women to examine the association between cigarette smoking and all-cause mortality. The objective of this study was (1) to clarify the association between smoking habit and the other risk factors, (2) to investigate the association between smoking habit and all-cause mortality, (3) to examine the proportion of premature death from all causes attributable to cigarette smoking, and (4) to examine the effect of duration of smoking cessation on all-cause mortality. Study CohortWe have reported the design of this prospective cohort study in detail elsewhere. 15 Briefly, from June through August 1990, we delivered a self-administered questionnaire on various health habits to 51,921 subjects (25,279 men and 26,642 women) who were 40-64 years of age and lived in 14 municipalities of Miyagi Prefecture in northern Japan. The questionnaires were delivered to and collected from the subjects' residences by members of health promotion committees appointed by the municipal governments. Usable questionnaires were returned from 47,605 subjects (22,836 men and 24,769 women), yielding a response rate of Statistical AnalysisWe used Cox proportional-hazards regression to estimate RR and 95% confidence interval (CI) of all-cause mortality according to categories of smoking habit and to adjust for potentially confounding variables, using the PHREG procedure on SAS ® version 8.2 statistical software package (SAS Inc., Cary, NC, USA). We conducted all analyses separately for men and women.We considered the following variables as potential confounders: age in years; body mass index in kg/m 2 (less than 18.5, 18.5-24.9, or 25 or higher); education (up to 15 years of age, 16-18, or 19 years or older); marital status at baseline (whether or not living with spouse); past histories of hypertension, renal diseases, liver diseases, diabetes mellitus, peptic ulcers, or tuberculosis; alcohol drinking (never drinkers, ex-drinkers, current drinkers); walking time per day (less than 1 hour, or 1 hour or longer); and consumption frequencies of green vegetables and oranges (almost daily, 3-4 times per week, 1-2 times per week, or 1-2 times per month or less often).We repeated all analyses after excluding the subjects who died during the first three years of follow-up. P values for tests of linear trends were calculated by treating the categories for numbers of cigarette smoking per day or the categories of pack-years as ordinal variables, with the exclusion of ex-drinkers. All P values were two-tailed. Population att...

BACKGROUND: Although many studies in western populations demonstrated that time spent walking was associated with a reduced risk of all-cause mortality, data on Japanese has been sparse. METHODS: In 1990, 20,004 men and 21,159 women in Miyagi Prefecture in rural northern Japan (40-64 year of age) completed a self-administered questionnaire including a question on time spent walking. Cox regression was used to estimate relative risk (RR) of mortality according to three levels of walking (30 minutes or less, between 30 minutes and one hour, and one hour or more), with adjustment for age, education, marital status, past history of diseases, smoking, drinking, body mass index, and dietary variables. During 11 years of follow-up, 1,879 subjects had died. RESULTS: Time spent walking was inversely associated with risk of all-cause mortality: compared with men and women who walked one hour or more per day, multivariate RR (95% confidence intervals) was 1.06 (0.95-1.19) for subjects who walked between 30 minutes and one hour per day, and 1.16 (1.04-1.29) for subjects who walked 30 minutes or less per day (P for trend=0.007). Shorter duration of walking was associated with increased mortality among men who were never smokers (P for trend=0.081) and past smokers (P for trend=0.026), but not among currently smoking men (P for trend=0.751). We observed similar effect modification for women. CONCLUSIONS: Time spent walking was associated with a reduced risk for all-cause mortality, especially among nonsmoking men and women.

To examine the relationship between 8-isoprostane and blood pressure, we measured plasma 8-isoprostane concentration and home blood pressure levels in an elderly Japanese population. Our study population comprised 569 subjects aged 70 years and over who were not receiving antihypertensive medication. On the basis of their blood pressure values, the participants were classified into three groups: normotensive (home blood pressure <135/85 mmHg), hypertensive (home blood pressure 135/85-160/90 mmHg), and severely hypertensive (home blood pressure > or =160/90 mmHg). The mean plasma 8-isoprostane level in the severely hypertensive group (21.1+/-5.2 pg/ml) was significantly higher than that in the normotensive (20.2+/-4.9 pg/ml) or hypertensive (19.7+/-5.1 pg/ml) group, and this result was unchanged when we adjusted for possible confounding factors such as age, sex, use of vitamin A, C or E supplements, smoking status, drinking status, body mass index, use of non-steroidal anti-inflammatory drugs, history of diabetes, hypercholesterolemia, home heart rate and serum creatinine level. Thus, the level of plasma 8-isoprostane appears to be elevated in older subjects with severe hypertension.