title: Cardiovascular events increased at normal and high-normal blood pressure in young and middle-aged Japanese male smokers but not in nonsmokers.
abstract: OBJECTIVE
  To clarify whether the impact of normal and high-normal BP (BP) per se on cardiovascular disease (CVD) and all-cause death differs depending on smoking status.
  
  
  RESULTS
  A prospective observational cohort study (median follow-up period: 7.5 years) was performed among 25,077 healthy nondiabetic Japanese men aged 20-61 years (mean age 37.3 years), whose BP was less than 150/95 mmHg and who were not on medication. Hazard ratios (HRs), adjusted by known risk factors and a change in annual BP during the follow-up, were calculated by the Cox proportional model with less than 119/75 mmHg as a reference. Among smokers, CVD events increased significantly from a SBP of 120 mmHg, with HRs of 2.68 (120-129 mmHg), 4.28 (130-139 mmHg), and 11.7 (140-149 mmHg). The CVD events also increased from a DBP of 75 mmHg (P for trend less than 0.0001), with 75-79 mmHg and 90-94 mmHg considered statistically significant. Among noncurrent smokers, 110-149 mmHg (SBP) and 75-89 mmHg (DBP) were not associated with elevated HRs for CVD. The relation between BP and all-cause mortality was similar among both current and noncurrent smokers: 140-149 mmHg (SBP) and 90-94 mmHg (DBP) were significantly associated with elevated risk, and 130-139 mmHg (SBP) among noncurrent smokers associated with elevated risk.
  
  
  CONCLUSIONS
  Young and middle-aged healthy Japanese individuals with normal and high-normal BP (120-139/75-89 mmHg) were at risk for CVD among smokers, even after adjusting for an annual change in BP.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. takahisa@med.nagoya-u.ac.jp
authors.forename: Takahisa
authors.initials: T
authors.lastname: Kondo
authors.forename: Shigeki
authors.initials: S
authors.lastname: Osugi
authors.forename: Keiko
authors.initials: K
authors.lastname: Shimokata
authors.forename: Haruo
authors.initials: H
authors.lastname: Honjo
authors.forename: Naoki
authors.initials: N
authors.lastname: Okumura
authors.forename: Kyoko
authors.initials: K
authors.lastname: Matsudaira
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamashita
authors.forename: Kengo
authors.initials: K
authors.lastname: Maeda
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shintani
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000328:Adult; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007564:Japan; D008297:Male; D011446:Prospective Studies; D012907:Smoking / Q000503:physiopathology*