Impact of blood pressure levels on different types of stroke: the Hisayama study.
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.


CONCLUSIONS
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.
Arima
Hisatomi
H
Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University Fukuoka, Japan. harima@envmed.med.kyushu-u.ac.jp
Tanizaki
Yumihiro
Y
Yonemoto
Koji
K
Doi
Yasufumi
Y
Ninomiya
Toshiharu
T
Hata
Jun
J
Fukuhara
Masayo
M
Matsumura
Kiyoshi
K
Iida
Mitsuo
M
Kiyohara
Yutaka
Y
D001794:Blood Pressure / Q000502:physiology*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D017700:Embolism, Cholesterol / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology