Stroke risk and antihypertensive drug treatment in the general population: the Japan arteriosclerosis longitudinal study

Asayama, Kei; Ohkubo, Takayoshi; Yoshida, Seitaro; Suzuki, Kazuhiro; Metoki, Hirohito; Harada, Akira; Murakami, Yoshitaka; Ohashi, Yasuo; Ueshima, Hirotsugu; Imai, Yutaka

doi:10.1097/hjh.0b013e32831967ca

Cited by 61 publications

(44 citation statements)

References 37 publications

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“…Furthermore, we estimated the absolute disease risks for incident CVD associated with different levels of BP in the community and demonstrated that treated hypertensives had a greater risk of incident CVD compared with untreated participants with similar BP. These observations are in line with the results from population‐based analyses from Japan and Sweden reporting greater risks of cardiovascular mortality and stroke in treated versus untreated persons 9, 10, 11. Finally, we report that the increased hazard for CVD is attenuated by ≈3% to 20% on adjustment for the greater subclinical disease burden in treated hypertensives, consistent with the concept that part of the increased CVD risk is related to the greater subclinical disease burden.…”

Section: Discussionsupporting

confidence: 90%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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BackgroundHypertensive individuals on blood pressure (BP)–lowering treatment with BP in the normal or high‐normal range have higher cardiovascular risk than untreated persons with usual BP in the same range. This residual risk (relative and absolute) is not well quantified and may be attributable in part to the higher burden of subclinical disease in treated individuals.Methods and ResultsWe assigned 3024 Framingham Offspring Cohort participants to 5 categories based on systolic BP (SBP) and diastolic BP (DBP) and use of BP‐lowering treatment: (1) untreated SBP/DBP <120/80 mm Hg; (2) untreated SBP/DB ≥120/80 to <140/90 mm Hg; (3) treated SBP/DBP <140/90 mm Hg; (4) untreated SBP/DBP ≥140/90 mm Hg; and (5) treated SBP/DBP ≥140/90 mm Hg. A composite subclinical disease score was constructed, including information on left ventricular hypertrophy, systolic dysfunction, carotid ultrasound abnormality, peripheral artery disease, and microalbuminuria. The prevalence of subclinical disease rose across BP groups, as did the event rates for incident cardiovascular disease (449 events, median follow‐up of 11 years; group 1, 0.65 event per 100 person‐years; group 5, 3.20 events per 100 person‐years; P<0.0001 for trend). On multivariable adjustment, treated hypertensives in groups 3 and 5 had 50% (95% CI 13% to 99%) and 28% (95% CI −6% to 73%) higher hazards, respectively, of developing cardiovascular disease compared with their untreated counterparts with similar levels of BP (groups 1 and 2 and group 4, respectively). The increased risk of cardiovascular disease in treated hypertensives was attributable in part to greater subclinical disease burden.ConclusionsTreated hypertensives have higher subclinical cardiovascular disease burden, which partly explains their higher cardiovascular disease risk compared with untreated persons with similar BP levels.

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Section: Discussionsupporting

confidence: 90%

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Lieb

Enserro

Sullivan

et al. 2015

JAHA

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“…Previous observational studies, unlike clinical trials, have also found residual cardiovascular risk in treated hypertensive subjects. [32][33][34] Antihypertensive medication use in observational studies probably indicates more severe hypertension, not just the effect of treatment. In addition, the period during which antihypertensive medication has been used as well as the age at which the treatment was initiated could also contribute to the apparent risk.…”

Section: Discussionmentioning

confidence: 99%

Development of a Point-based Prediction Model for the Incidence of Total Stroke

Yatsuya

Iso

Yamagishi

et al. 2013

Stroke

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Background and Purpose-An individualized risk score for the development of stroke may be a useful tool to motivate patients to modify their risk behaviors. We developed and validated a point-based prediction model (risk score) for stroke incidence using a Japanese cohort of general men and women. Methods-The Japan Public Health Center-based prospective study cohort II (age range, 40-69 years at baseline in 1993-1994; n=15 672) was used to derive the point-based model according to Cox regression results. The model was externally validated using the Japan Public Health Center study cohort I and also by bootstrap methods within cohort II. The model discrimination was evaluated by the area under the receiver operating characteristic curve, model calibration, by the Grønnesby-Borgan χ 2 statistic. Vascular age was also calculated. Results-During 14 years of follow-up, 790 incident stroke cases occurred. Variables selected for the model were age, sex, current smoking, body mass index, blood pressure, antihypertensive medication use, and diabetes mellitus. Interactions of sex with current smoking and of antihypertensive medication use with systolic blood pressure were statistically significant. The point-based model discriminated reasonably well (area under the receiver operating characteristic curve, 0.73). The area under the receiver operating characteristic curve of the point-based model applied externally to cohort I was reasonably good: 0.69. A 50-year-old man with diabetes mellitus and hypertension has an estimated vascular age of 69 years. High normal blood pressure and grade 1 hypertension accounted for one third of the stroke incidence. Conclusions-We developed score to predict 10-year stroke risk using variables that are easily available in the community setting. See list of all JPHC study participants is given in the online-only Data Supplement. The online-only Data Supplement is available with this article at http://stroke.ahajournals.org/lookup/suppl

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“…13,[27][28][29][30][31][32][33] Likewise, a number of large-scale cohort studies have reported significant effects of prehypertension separately on the risks of stroke 13,29,30,32 and coronary heart disease. 13,29 The present analysis from the APCSC confirmed the results from the previous observational studies and provided more detailed information about the separately significant associations of prehypertension with all of the major types of CVD, including ischemic and hemorrhagic stroke in the Asia-Pacific region.…”

Section: Discussionmentioning

confidence: 99%

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

et al. 2012

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Abstract-The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure defined blood pressure (BP) levels of 120 to 139/80 to 89 mm Hg as prehypertension and those of Ն140/90 mm Hg as hypertension. Hypertension can be divided into 3 categories, isolated diastolic (IDH; systolic BP Ͻ140 mm Hg and diastolic BP Ն90 mmHg), isolated systolic (systolic BP Ն140 mm Hg and diastolic BP Ͻ90 mmHg), and systolic-diastolic hypertension (systolic BP Ն140 mm Hg and diastolic BP Ն90 mmHg). Although there is clear evidence that isolated systolic hypertension and systolic-diastolic hypertension increase the risks of future vascular events, there remains uncertainty about the effects of IDH. The objective was to determine the effects of prehypertension and hypertension subtypes (IDH, isolated systolic hypertension, and systolic-diastolic hypertension) on the risks of cardiovascular disease (CVD) in the Asia-Pacific Region. The Asia Pacific Cohort Studies Collaboration is an individual participant data overview of cohort studies in the region. This analysis included a total of 346570 participants from 36 cohort studies. Outcomes were fatal and nonfatal CVD. The relationship between BP categories and CVD was explored using a Cox proportional hazards model adjusted for age, cholesterol, and smoking and stratified by sex and study. Compared with normal BP (Ͻ120/80 mmHg), hazard ratios (95% CIs) for CVD were 1.41 (1.31-1.53) for prehypertension, 1.81 (1.61-2.04) for IDH, 2.18 (2.00 -2.37) for isolated systolic hypertension, and 3.42 (3.17-3.70) for systolic-diastolic hypertension. Separately significant effects of prehypertension and hypertension subtypes were also observed for coronary heart disease, ischemic stroke, and hemorrhagic stroke. In the Asia-Pacific region, prehypertension and all hypertension subtypes, including IDH, thus clearly predicted increased risks of CVD. Key Words: prehypertension Ⅲ hypertension Ⅲ hypertension subtype Ⅲ isolated diastolic hypertension Ⅲ cardiovascular disease Ⅲ coronary heart disease Ⅲ stroke C ardiovascular disease (CVD) is a leading cause of premature death and disability globally.

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Stroke risk and antihypertensive drug treatment in the general population: the Japan arteriosclerosis longitudinal study

Abstract: Treated individuals with optimal BP had a higher stroke risk than untreated ones with optimal BP. Healthcare providers need to be vigilant for residual cardiovascular risks in treated hypertensive patients.

Cited by 61 publications

References 37 publications

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Residual Cardiovascular Risk in Individuals on Blood Pressure–Lowering Treatment

Development of a Point-based Prediction Model for the Incidence of Total Stroke

Effects of Prehypertension and Hypertension Subtype on Cardiovascular Disease in the Asia-Pacific Region

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