Home blood pressure level, blood pressure variability, smoking, and stroke risk in Japanese men: the Ohasama study.
BACKGROUND
Hypertension and smoking independently contribute to the risk of stroke. Our objective was to investigate home blood pressure (HBP) levels, day-by-day BP variability, and smoking in the prediction of stroke in Japanese men.


METHODS
In this study, 902 men (mean age, 58.6 years) without a past history of stroke were evaluated. HBP was measured once every morning for 4 weeks. Day-by-day BP variability was defined as within-subject standard deviations (SD) of HBP. Smoking history was obtained from a standardized questionnaire. Hazard ratios (HRs) for stroke were examined by Cox regression model, with adjustment for possible confounders.


RESULTS
During 13.1 years (median) of follow-up, 89 cerebral infarctions, 28 intracranial hemorrhages, and six other strokes occurred. Systolic HBP levels (HR = 1.59 per 14.6 mm Hg increase, P < 0.0001) and variability (HR = 1.26 per 3.1 mm Hg increase, P = 0.03) of +1 between-subject SD were significantly associated with cerebral infarction. The relationship between HBP and cerebral infarction differed with smoking status (interaction P = 0.021 and 0.017 for systolic level and variability, respectively). In analyses stratified according to smoking, systolic level (HR = 1.78, P < 0.0001) and variability (HR = 1.38, P = 0.006) were significantly associated with cerebral infarction in ever smokers (N = 511), but not in never smokers (N = 391; P ≥ 0.6 for both). No significant association was found between smoking and the risk of intracranial hemorrhage.


CONCLUSIONS
In ever smokers, both HBP levels and variability are significantly associated with the risk of cerebral infarction. Our findings further validate the benefit of smoking cessation in preventing cardiovascular disease (CVD), especially cerebral infarction.
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
Takanao
T
Hashimoto
Masahiro
M
Kikuya
Takayoshi
T
Ohkubo
Michihiro
M
Satoh
Hirohito
H
Metoki
Ryusuke
R
Inoue
Kei
K
Asayama
Atsuhiro
A
Kanno
Taku
T
Obara
Takuo
T
Hirose
Azusa
A
Hara
Haruhisa
H
Hoshi
Kazuhito
K
Totsune
Hiroshi
H
Satoh
Hiroshi
H
Sato
Yutaka
Y
Imai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology; D002544:Cerebral Infarction / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012907:Smoking / Q000503:physiopathology*; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*