title: Stroke risk in systolic and combined systolic and diastolic hypertension determined using ambulatory blood pressure. The Ohasama study.
abstract: BACKGROUND
  To investigate the risk of stroke in subjects with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH) in a Japanese general population, we used 24-h ambulatory blood pressure (ABP) and casual-screening blood-pressure (CBP) readings.
  
  
  METHODS
  Subtypes of hypertension were defined based on systolic blood pressure (SBP) >135 mm Hg or diastolic blood pressure (DBP) >80 mm Hg for 24-h ABP, and SBP >140 mm Hg or DBP >90 mm Hg for CBP. We obtained 24-h ABP and CBP data for 1271 (40% male) subjects aged > or =40 years (mean age, 61 years) without a history of symptomatic stroke; their stroke-free survival was then determined. The prognostic significance of each subtype of hypertension was determined by Cox proportional hazard analysis.
  
  
  RESULTS
  There were 113 symptomatic strokes during follow-up (mean time, 11 years). Compared with normotension, among the hypertension subtypes determined by 24-h ABP, the adjusted relative hazards (RHs) of stroke were 2.24 for ISH (P = .002) and 2.39 for SDH (P = .0004). The association was less marked among subtypes determined by CBP (RH = 1.40 and P = .13 for ISH; RH = 2.07 and P = .017 for SDH). The IDH group was excluded from the Cox analysis because both the prevalence and the number of events were low in this group.
  
  
  CONCLUSIONS
  Isolated systolic hypertension, as determined by 24-h ABP measurements, was associated with a high risk of stroke, similar to that found in SDH subjects; this suggests that the prognosis of hypertensive patients would be improved by focusing treatment on 24-h systolic ABP.
authors: 21st Century COE Program Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation, Tohoku University, Sendai, Japan.
authors: Ryusuke
authors: R
authors: Inoue
authors: Takayoshi
authors: T
authors: Ohkubo
authors: Masahiro
authors: M
authors: Kikuya
authors: Hirohito
authors: H
authors: Metoki
authors: Kei
authors: K
authors: Asayama
authors: Taku
authors: T
authors: Obara
authors: Takuo
authors: T
authors: Hirose
authors: Azusa
authors: A
authors: Hara
authors: Haruhisa
authors: H
authors: Hoshi
authors: Junichiro
authors: J
authors: Hashimoto
authors: Kazuhito
authors: K
authors: Totsune
authors: Hiroshi
authors: H
authors: Satoh
authors: Yoshiaki
authors: Y
authors: Kondo
authors: Yutaka
authors: Y
authors: Imai
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D007564:Japan; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013599:Systole / Q000502:physiology*