title: Cardiovascular risk with and without antihypertensive drug treatment in the Japanese general population: participant-level meta-analysis.
abstract: To evaluate the cardiovascular mortality risk in association with blood pressure level among people with and without antihypertensive treatment, we performed the participant-level meta-analysis that included 39,705 Japanese from 6 cohorts (58.4% women; mean age, 60.1 years; 20.4% treated). Multivariable-adjusted Cox models were used to analyze the risk of cardiovascular mortality and its subtypes among 6 blood pressure levels according to recent guidelines, optimal to Grade 3 hypertension, and the usage of antihypertensive medication at baseline. During median 10.0 years of follow-up, there were 2032 cardiovascular deaths (5.1 per 1000 person-years), of which 410 deaths were coronary heart disease, 371 were heart failure, and 903 deaths were stroke. Treated participants had significantly higher risk for cardiovascular mortality (hazard ratios, 1.50; 95% confidence intervals, 1.36-1.66), coronary heart disease (hazard ratios, 1.53; confidence intervals, 1.23-1.90), heart failure (hazard ratios, 1.39; confidence intervals, 1.09-1.76), and stroke (hazard ratios, 1.48; confidence intervals, 1.28-1.72) compared with untreated people. Among untreated participants, the risks increased linearly with an increment of blood pressure category (P≤0.011). The risk increments per blood pressure category were higher in young participants (<60 years; 22% to 79%) than those in old people (≥60 years; 7% to 15%) with significant interaction for total cardiovascular, heart failure, and stroke mortality (P≤0.026). Among treated participants, the significant linear association was also observed for cardiovascular mortality (P=0.0003), whereas no stepwise increase in stroke death was observed (P=0.19). The risks of cardiovascular mortality were ≈1.5-fold high in participants under antihypertensive medication. More attention should be paid to the residual cardiovascular risks in treated patients.
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium. kei@asayama.org.
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Sin-Ya
authors.initials: SY
authors.lastname: Nagasawa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People / Q000706:statistics & numerical data; D001794:Blood Pressure / Q000187:drug effects*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D003327:Coronary Disease / Q000150:complications / Q000208:ethnology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000208:ethnology / Q000401:mortality; D015996:Survival Rate
chemical_list: D000959:Antihypertensive Agents
keywords: cardiovascular diseases; hypertension; meta-analysis